Novel Use of Google Glass for Procedural Wireless Vital Sign Monitoring.

PubMed

Liebert, Cara A; Zayed, Mohamed A; Aalami, Oliver; Tran, Jennifer; Lau, James N

2016-08-01

Purpose This study investigates the feasibility and potential utility of head-mounted displays for real-time wireless vital sign monitoring during surgical procedures. Methods In this randomized controlled pilot study, surgery residents (n = 14) performed simulated bedside procedures with traditional vital sign monitors and were randomized to addition of vital sign streaming to Google Glass. Time to recognition of preprogrammed vital sign deterioration and frequency of traditional monitor use was recorded. User feedback was collected by electronic survey. Results The experimental group spent 90% less time looking away from the procedural field to view traditional monitors during bronchoscopy (P = .003), and recognized critical desaturation 8.8 seconds earlier; the experimental group spent 71% (P = .01) less time looking away from the procedural field during thoracostomy, and recognized hypotension 10.5 seconds earlier. Trends toward earlier recognition of deterioration did not reach statistical significance. The majority of participants agreed that Google Glass increases situational awareness (64%), is helpful in monitoring vitals (86%), is easy to use (93%), and has potential to improve patient safety (85%). Conclusion In this early feasibility study, use of streaming to Google Glass significantly decreased time looking away from procedural fields and resulted in a nonsignificant trend toward earlier recognition of vital sign deterioration. Vital sign streaming with Google Glass or similar platforms is feasible and may enhance procedural situational awareness. © The Author(s) 2016.

Physical Activity as a Vital Sign: A Systematic Review

PubMed Central

Allen, Kelli D.; Ambrose, Kirsten R.; Stiller, Jamie L.; Evenson, Kelly R.; Voisin, Christiane; Hootman, Jennifer M.; Callahan, Leigh F.

2017-01-01

Introduction Physical activity (PA) is strongly endorsed for managing chronic conditions, and a vital sign tool (indicator of general physical condition) could alert providers of inadequate PA to prompt counseling or referral. This systematic review examined the use, definitions, psychometric properties, and outcomes of brief PA instruments as vital sign measures, with attention primarily to studies focused on arthritis. Methods Electronic databases were searched for English-language literature from 1985 through 2016 using the terms PA, exercise, vital sign, exercise referral scheme, and exercise counseling. Of the 838 articles identified for title and abstract review, 9 articles qualified for full text review and data extraction. Results Five brief PA measures were identified: Exercise Vital Sign (EVS), Physical Activity Vital Sign (PAVS), Speedy Nutrition and Physical Activity Assessment (SNAP), General Practice Physical Activity Questionnaire (GPPAQ), and Stanford Brief Activity Survey (SBAS). Studies focusing on arthritis were not found. Over 1.5 years of using EVS in a large hospital system, improvements occurred in relative weight loss among overweight patients and reduction in glycosylated hemoglobin among diabetic patients. On PAVS, moderate physical activity of 5 or more days per week versus fewer than 5 days per week was associated with a lower body mass index (−2.90 kg/m2). Compared with accelerometer-defined physical activity, EVS was weakly correlated (r = 0.27), had low sensitivity (27%–59%), and high specificity (74%–89%); SNAP showed weak agreement (κ = 0.12); GPPAQ had moderate sensitivity (46%) and specificity (50%), and SBAS was weakly correlated (r = 0.10–0.28), had poor to moderate sensitivity (18%–67%), and had moderate specificity (58%–79%). Conclusion Few studies have examined a brief physical activity tool as a vital sign measure. Initial investigations suggest the promise of these simple and quick assessment tools, and

Vital signs and other observations used to detect deterioration in pregnant women: an analysis of vital sign charts in consultant-led UK maternity units.

PubMed

Smith, G B; Isaacs, R; Andrews, L; Wee, M Y K; van Teijlingen, E; Bick, D E; Hundley, V

2017-05-01

Obstetric early warning systems are recommended for monitoring hospitalised pregnant and postnatal women. We decided to compare: (i) vital sign values used to define physiological normality; (ii) symptoms and signs used to escalate care; (iii) type of chart used; and (iv) presence of explicit instructions for escalating care. One-hundred-and-twenty obstetric early warning charts and escalation protocols were obtained from consultant-led maternity units in the UK and Channel Islands. These data were extracted: values used to determine normality for each maternal vital sign; chart colour-coding; instructions following early warning system triggering; other criteria used as triggers. There was considerable variation in the charts, warning systems and escalation protocols. Of 120 charts, 89.2% used colour; 69.2% used colour-coded escalation systems. Forty-one (34.2%) systems required the calculation of weighted scores. Seventy-five discrete combinations of 'normal' vital sign ranges were found, the most common being: heart rate=50-99beats/min; respiratory rate=11-20breaths/min; blood pressure, systolic=100-149mmHg, diastolic ≤89mmHg; SpO 2 =95-100%; temperature=36.0-37.9°C; and Alert-Voice-Pain-Unresponsive assessment=Alert. Most charts (90.8%) provided instructions about who to contact following triggering, but only 41.7% gave instructions about subsequent observation frequency. The wide range of 'normal' vital sign values in different systems suggests a lack of equity in the processes for detecting deterioration and escalating care in hospitalised pregnant and postnatal women. Agreement regarding 'normal' vital sign ranges is urgently required and would assist the development of a standardised obstetric early warning system and chart. Copyright © 2017 Elsevier Ltd. All rights reserved.

Validating emergency department vital signs using a data quality engine for data warehouse.

PubMed

Genes, N; Chandra, D; Ellis, S; Baumlin, K

2013-01-01

Vital signs in our emergency department information system were entered into free-text fields for heart rate, respiratory rate, blood pressure, temperature and oxygen saturation. We sought to convert these text entries into a more useful form, for research and QA purposes, upon entry into a data warehouse. We derived a series of rules and assigned quality scores to the transformed values, conforming to physiologic parameters for vital signs across the age range and spectrum of illness seen in the emergency department. Validating these entries revealed that 98% of free-text data had perfect quality scores, conforming to established vital sign parameters. Average vital signs varied as expected by age. Degradations in quality scores were most commonly attributed logging temperature in Fahrenheit instead of Celsius; vital signs with this error could still be transformed for use. Errors occurred more frequently during periods of high triage, though error rates did not correlate with triage volume. In developing a method for importing free-text vital sign data from our emergency department information system, we now have a data warehouse with a broad array of quality-checked vital signs, permitting analysis and correlation with demographics and outcomes.

Longitudinal analysis of one million vital signs in patients in an academic medical center.

PubMed

Bleyer, Anthony J; Vidya, Sri; Russell, Gregory B; Jones, Catherine M; Sujata, Leon; Daeihagh, Pirouz; Hire, Donald

2011-11-01

Recognition of critically abnormal vital signs has been used to identify critically ill patients for activation of rapid response teams. Most studies have only analyzed vital signs obtained at the time of admission. The intent of this study was to examine the association of critical vital signs occurring at any time during the hospitalization with mortality. All vital sign measurements were obtained for hospitalizations from January 1, 2008 to June 30, 2009 at a large academic medical center. There were 1.15 million individual vital sign determinations obtained in 42,430 admissions on 27,722 patients. Critical vital signs were defined as a systolic blood pressure <85 mmHg, heart rate >120 bpm, temperature <35°C or >38.9°C, oxygen saturation <91%, respiratory rate ≤ 12 or ≥ 24, and level of consciousness recorded as anything but "alert". The presence of a solitary critically abnormal vital sign was associated with a mortality of 0.92% vs. a mortality of 23.6% for three simultaneous critical vital signs. Of those experiencing three simultaneous critical vital signs, only 25% did so within 24h of admission. The Modified Early Warning Score (MEWS) and VitalPAC Early Warning Score (VIEWS) were validated as good predictors of mortality at any time point during the hospitalization. The simultaneous presence of three critically abnormal vital signs can occur at any time during the hospital admission and is associated with very high mortality. Early recognition of these events presents an opportunity for decreasing mortality. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

CDC Vital Signs: Preventing Repeat Teen Births

MedlinePlus

... Healthcare-associated Infections Healthy Living HIV / AIDS Injury, Violence & Safety Motor Vehicle Safety Obesity Prescription Drug Overdoses Teen Pregnancy Tobacco Digital Media Tools About Vital Signs Subscribe to RSS Feed ...

The factors that affect the frequency of vital sign monitoring in the emergency department.

PubMed

Johnson, Kimberly D; Winkelman, Chris; Burant, Christopher J; Dolansky, Mary; Totten, Vicken

2014-01-01

Vital signs are an important component of the nursing assessment and are used as early warning signs of changes in a patient's condition; however, little research has been conducted to determine how often vital signs are monitored in the emergency department. Additionally, it has not been determined what personal, social, and environmental factors affect the frequency of vital sign monitoring. The purpose of this study was to examine what factors may influence the time between recording vital signs in the emergency department. We performed a descriptive, retrospective chart review of 202 randomly selected adult ED patients' charts from representative times to capture a variety of ED levels of occupancy in an urban, Midwestern, teaching hospital. Descriptive and hierarchical regression analyses were used. The strongest predictor of the increased time between vital signs from the personal health factors was lower patient acuity (Emergency Severity Index). This relationship remained strong even when social factors and environmental factors were included. Increased length of stay and fewer routes of medications also had significant relationships to the increased time between vital sign monitoring. These findings are clinically important because greater time between vital sign recordings can lead to errors of omission by not detecting changes in vital signs that could reveal changes in the patient's condition. The findings of this study provide direction for future research focusing on determining whether higher frequency of vital signs surveillance contributes to higher quality care and linking quality of care to missing vital signs/inadequate monitoring. Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Relationship between nighttime vital sign assessments and acute care transfers in the rehabilitation inpatient.

PubMed

Pellicane, Anthony J

2014-01-01

To investigate the role of nighttime vital sign assessment in predicting acute care transfers (ACT) from inpatient rehabilitation. Retrospective chart review. Fifty patients unexpectedly discharged to acute care underwent chart review to determine details of each ACT. Seven of 50 ACT possessed new vital sign abnormalities at the 11 pm vital sign assessment the night before ACT. None of these seven underwent ACT during the night shift the abnormalities were detected. Two of 50 ACT were transferred between 11 pm and 6:59 am; both demonstrating normal vital sign at the 11 pm assessment. During study period, an estimated 5,607 11 pm vital sign assessments were performed. Nighttime vital sign assessments do not seem to be a good screening tool for clinical instability in the rehabilitation hospital. Eliminating sleep disturbance is important to the rehabilitation inpatient as inadequate sleep hinders physical performance. Tailoring vital sign monitoring to fit patents' clinical presentation may benefit this population. © 2014 Association of Rehabilitation Nurses.

Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest.

PubMed

Stevenson, Jean E; Israelsson, Johan; Nilsson, Gunilla C; Petersson, Göran I; Bath, Peter A

2016-03-01

Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPAC™ Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety. © The Author(s) 2014.

The Prevalence and Significance of Abnormal Vital Signs Prior to In-Hospital Cardiac Arrest

PubMed Central

Andersen, Lars W.; Kim, Won Young; Chase, Maureen; Berg, Katherine; Mortensen, Sharri J.; Moskowitz, Ari; Novack, Victor; Cocchi, Michael N.; Donnino, Michael W.

2015-01-01

Background Patients suffering in-hospital cardiac arrest often show signs of physiological deterioration before the event. The purpose of this study was to determine the prevalence of abnormal vital signs 1–4 hours before cardiac arrest, and to evaluate the association between these vital sign abnormalities and inhospital mortality. Methods We included adults from the Get With the Guidelines® - Resuscitation registry with an in-hospital cardiac arrest. We used two a priori definitions for vital signs: abnormal (heart rate (HR) ≤ 60 or ≥ 100 min−1, respiratory rate (RR) ≤ 10 or > 20 min−1 and systolic blood pressure (SBP) ≤ 90 mm Hg) and severely abnormal (HR ≤ 50 or ≥ 130 min−1, RR ≤ 8 or ≥ 30 min−1 and SBP ≤80 mm Hg). We evaluated the association between the number of abnormal vital signs and in-hospital mortality using a multivariable logistic regression model. Results 7,851 patients were included. Individual vital signs were associated with in-hospital mortality. The majority of patients (59.4%) had at least one abnormal vital sign 1–4 hours before the arrest and 13.4% had at least one severely abnormal sign. We found a step-wise increase in mortality with increasing number of abnormal vital signs within the abnormal (odds ratio (OR) 1.53 (CI: 1.42 – 1.64) and severely abnormal groups (OR 1.62 [CI: 1.38 – 1.90]). This remained in multivariable analysis (abnormal: OR 1.38 [CI: 1.28 – 1.48], and severely abnormal: OR 1.40 [CI: 1.18 – 1.65]). Conclusion Abnormal vital signs are prevalent 1–4 hours before in-hospital cardiac arrest on hospital wards. Inhospital mortality increases with increasing number of pre-arrest abnormal vital signs as well as increased severity of vital sign derangements. PMID:26362486

Validating Emergency Department Vital Signs Using a Data Quality Engine for Data Warehouse

PubMed Central

Genes, N; Chandra, D; Ellis, S; Baumlin, K

2013-01-01

Background : Vital signs in our emergency department information system were entered into free-text fields for heart rate, respiratory rate, blood pressure, temperature and oxygen saturation. Objective : We sought to convert these text entries into a more useful form, for research and QA purposes, upon entry into a data warehouse. Methods : We derived a series of rules and assigned quality scores to the transformed values, conforming to physiologic parameters for vital signs across the age range and spectrum of illness seen in the emergency department. Results : Validating these entries revealed that 98% of free-text data had perfect quality scores, conforming to established vital sign parameters. Average vital signs varied as expected by age. Degradations in quality scores were most commonly attributed logging temperature in Fahrenheit instead of Celsius; vital signs with this error could still be transformed for use. Errors occurred more frequently during periods of high triage, though error rates did not correlate with triage volume. Conclusions : In developing a method for importing free-text vital sign data from our emergency department information system, we now have a data warehouse with a broad array of quality-checked vital signs, permitting analysis and correlation with demographics and outcomes. PMID:24403981

Modelling physiological deterioration in post-operative patient vital-sign data.

PubMed

Pimentel, Marco A F; Clifton, David A; Clifton, Lei; Watkinson, Peter J; Tarassenko, Lionel

2013-08-01

Patients who undergo upper-gastrointestinal surgery have a high incidence of post-operative complications, often requiring admission to the intensive care unit several days after surgery. A dataset comprising observational vital-sign data from 171 post-operative patients taking part in a two-phase clinical trial at the Oxford Cancer Centre, was used to explore the trajectory of patients' vital-sign changes during their stay in the post-operative ward using both univariate and multivariate analyses. A model of normality based vital-sign data from patients who had a "normal" recovery was constructed using a kernel density estimate, and tested with "abnormal" data from patients who deteriorated sufficiently to be re-admitted to the intensive care unit. The vital-sign distributions from "normal" patients were found to vary over time from admission to the post-operative ward to their discharge home, but no significant changes in their distributions were observed from halfway through their stay on the ward to the time of discharge. The model of normality identified patient deterioration when tested with unseen "abnormal" data, suggesting that such techniques may be used to provide early warning of adverse physiological events.

ED Triage Process Improvement: Timely Vital Signs for Less Acute Patients.

PubMed

Falconer, Stella S; Karuppan, Corinne M; Kiehne, Emily; Rama, Shravan

2018-06-13

Vital signs can result in an upgrade of patients' Emergency Severity Index (ESI) levels. It is therefore preferable to obtain vital signs early in the triage process, particularly for ESI level 3 patients. Emergency departments have an opportunity to redesign triage processes to meet required protocols while enhancing the quality and experience of care. We performed process analyses to redesign the door-to-vital signs process. We also developed spaghetti diagrams to reconfigure the patient arrival area. The door-to-vital signs time was reduced from 43.1 minutes to 6.44 minutes. Both patients and triage staff seemed more satisfied with the new process. The patient arrival area was less congested and more welcoming. Performing activities in parallel reduces flow time with no additional resources. Staff involvement in process planning, redesign, and control ensures engagement and early buy-in. One should anticipate how changes to one process might affect other processes. Copyright © 2018. Published by Elsevier Inc.

Vital signs monitoring and nurse-patient interaction: A qualitative observational study of hospital practice.

PubMed

Cardona-Morrell, M; Prgomet, M; Lake, R; Nicholson, M; Harrison, R; Long, J; Westbrook, J; Braithwaite, J; Hillman, K

2016-04-01

High profile safety failures have demonstrated that recognising early warning signs of clinical and physiological deterioration can prevent or reduce harm resulting from serious adverse events. Early warning scoring systems are now routinely used in many places to detect and escalate deteriorating patients. Timely and accurate vital signs monitoring are critical for ensuring patient safety through providing data for early warning scoring systems, but little is known about current monitoring practices. To establish a profile of nurses' vital signs monitoring practices, related dialogue, and adherence to health service protocol in New South Wales, Australia. Direct observations of nurses' working practices were conducted in two wards. The observations focused on times of the day when vital signs were generally measured. Patient interactions were recorded if occurring any time during the observation periods. Participants (n=42) included nursing staff on one chronic disease medical and one acute surgical ward in a large urban teaching hospital in New South Wales. We observed 441 patient interactions. Measurement of vital signs occurred in 52% of interactions. The minimum five vital signs measures required by New South Wales Health policy were taken in only 6-21% of instances of vital signs monitoring. Vital signs were documented immediately on 93% of vitals-taking occasions and documented according to the policy in the patient's chart on 89% of these occasions. Nurse-patient interactions were initiated for the purpose of taking vital signs in 49% of interactions, with nurse-patient discourse observed during 88% of all interactions. Nurse-patient dialogue led to additional care being provided to patients in 12% of interactions. The selection of appropriate vital signs measured and responses to these appears to rely on nurses' clinical judgement or time availability rather than on policy-mandated frequency. The prevalence of incomplete sets of vital signs may limit

CDC Vital Signs: Prescription Painkiller Overdoses (Methadone)

MedlinePlus

... or www.samhsa.gov/treatment/ ). Top of Page Science Behind the Issue MMWR Science Clips Related Pages Vital Signs Issue details: Morbidity ... factsheet [PDF – 1.34 MB] Read the MMWR Science Clips File Formats Help: How do I view ...

The detection of 4 vital signs of in-patients Using fuzzy database

NASA Astrophysics Data System (ADS)

Haris Rangkuti, A.; Erlisa Rasjid, Zulfany

2014-03-01

Actually in order to improve in the performance of the Hospital's administrator, by serve patients effectively and efficiently, the role of information technology become the dominant support. Especially when it comes to patient's conditions, such that it will be reported to a physician as soon as possible, including monitoring the patient's conditions regularly. For this reason it is necessary to have a Hospital Monitoring Information System, that is able to provide information about the patient's condition which is based on the four vital signs, temperature, blood pressure, pulse, and respiration. To monitor the 4 vital signs, the concept of fuzzy logic is used, where the vital signs number approaches 1 then the patient is close to recovery, and on the contrary, when the vital signs number approaches 0 then the patient still has problems. This system also helps nurses to provide answers to the relatives of patients, who wants to know the development of the patient's condition, including the recovery percentage based on the average of Fuzzy max from the 4 vital signs. Using Fuzzy-based monitoring system, the monitoring of the patient's condition becomes simpler and easier.

[Research and Implementation of Vital Signs Monitoring System Based on Cloud Platform].

PubMed

Yu, Man; Tan, Anzu; Huang, Jianqi

2018-05-30

Through analyzing the existing problems in the current mode, the vital signs monitoring information system based on cloud platform is designed and developed. The system's aim is to assist nurse carry out vital signs nursing work effectively and accurately. The system collects, uploads and analyzes patient's vital signs data by PDA which connecting medical inspection equipments. Clinical application proved that the system can effectively improve the quality and efficiency of medical care and may reduce medical expenses. It is alse an important practice result to build a medical cloud platform.

Frequency of vital sign assessment and clinical deterioration in an Australian emergency department.

PubMed

Lambe, Katherine; Currey, Judy; Considine, Julie

2016-11-01

Understanding of clinical deterioration of emergency department patients is rapidly evolving. The aim of this study was to investigate the frequency and nature of vital sign collection and clinical deterioration in emergency care. A descriptive exploratory approach was used. Data were collected from the records of 200 randomly selected adults with presenting complaints of abdominal pain, shortness of breath, chest pain and febrile illness from 1 January to 31 December 2014 at a 22 bed emergency department in Melbourne, Australia. When controlled for length of stay, heart rate was the most frequently assessed vital sign per hour (median=0.9) whilst Glasgow Coma Score was the least frequently assessed vital sign per hour (median=0.5). Clinical deterioration (one or more vital signs fulfilling hospital medical emergency team activation criteria during emergency department care) occurred in 14.5% of patients. Of the 5466 vital sign measures, 19.6% were abnormal, 1.9% indicated clinical deterioration. Clinical deterioration occurred in one in seven patients, and one in five vital signs documented were outside of accepted normal ranges. Thus, emergency department physiological status has implications for patient safety and nursing practice, in particular clinical handover for patients requiring hospital admission. Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

CDC Vital Signs: New Hope for Stopping HIV

MedlinePlus

... Healthcare-associated Infections Healthy Living HIV / AIDS Injury, Violence & Safety Motor Vehicle Safety Obesity Prescription Drug Overdoses Teen Pregnancy Tobacco Digital Media Tools About Vital Signs Subscribe to RSS Feed ...

Vital sign documentation in electronic records: The development of workarounds.

PubMed

Stevenson, Jean E; Israelsson, Johan; Nilsson, Gunilla; Petersson, Goran; Bath, Peter A

2018-06-01

Workarounds are commonplace in healthcare settings. An increase in the use of electronic health records has led to an escalation of workarounds as healthcare professionals cope with systems which are inadequate for their needs. Closely related to this, the documentation of vital signs in electronic health records has been problematic. The accuracy and completeness of vital sign documentation has a direct impact on the recognition of deterioration in a patient's condition. We examined workflow processes to identify workarounds related to vital signs in a 372-bed hospital in Sweden. In three clinical areas, a qualitative study was performed with data collected during observations and interviews and analysed through thematic content analysis. We identified paper workarounds in the form of handwritten notes and a total of eight pre-printed paper observation charts. Our results suggested that nurses created workarounds to allow a smooth workflow and ensure patients safety.

Importance of vital signs to the early diagnosis and severity of sepsis: association between vital signs and sequential organ failure assessment score in patients with sepsis.

PubMed

Kenzaka, Tsuneaki; Okayama, Masanobu; Kuroki, Shigehiro; Fukui, Miho; Yahata, Shinsuke; Hayashi, Hiroki; Kitao, Akihito; Sugiyama, Daisuke; Kajii, Eiji; Hashimoto, Masayoshi

2012-01-01

While much attention is given to the fifth vital sign, the utility of the 4 classic vital signs (blood pressure, respiratory rate, body temperature, and heart rate) has been neglected. The aim of this study was to assess a possible association between vital signs and the Sequential Organ Failure Assessment (SOFA) score in patients with sepsis. We performed a prospective, observational study of 206 patients with sepsis. Blood pressure, respiratory rate, body temperature, and heart rate were measured on arrival at the hospital. The SOFA score was also determined on the day of admission. Bivariate correlation analysis showed that all of the vital signs were correlated with the SOFA score. Multiple regression analysis indicated that decreased values of systolic blood pressure (multivariate regression coefficient [Coef] = -0.030, 95% confidence interval [CI] = -0.046 to -0.013) and diastolic blood pressure (Coef = -0.045, 95% CI = -0.070 to -0.019), increased respiratory rate (Coef = 0.176, 95% CI = 0.112 to 0.240), and increased shock index (Coef = 4.232, 95% CI = 2.401 to 6.062) significantly influenced the SOFA score. Increased respiratory rate and shock index were significantly correlated with disease severity in patients with sepsis. Evaluation of these signs may therefore improve early identification of severely ill patients at triage, allowing more aggressive and timely interventions to improve the prognosis of these patients.

Statewide real-time in-flight trauma patient vital signs collection system.

PubMed

Hu, Peter F; Mackenzie, Colin; Dutton, Richard; Sen, Ayan; Xiao, Yan; Handley, Christopher; Ho, Danny; Scalea, Thomas

2008-11-06

Continuous recorded in-flight vital signs monitoring and life-saving interventions linked to outcomes may provide better understanding of pre-hospital triage, care management and patient responses during the 'golden hour' of trauma care. Evaluation of 157 patients' vital signs data collected from our statewide network has identified episodes of physiological decompensation which holds promise for creation of new triage algorithms and enhanced trauma center preparedness.

CDC Vital Signs: E-cigarette Ads and Youth

MedlinePlus

... students were current (past 30-day) users of electronic cigarettes, or e-cigarettes, in 2014. Most e- ... the Issue Vital Signs Issue details: Exposure to Electronic Cigarette Advertising Among Middle School and High School ...

Centile-based early warning scores derived from statistical distributions of vital signs.

PubMed

Tarassenko, Lionel; Clifton, David A; Pinsky, Michael R; Hravnak, Marilyn T; Woods, John R; Watkinson, Peter J

2011-08-01

To develop an early warning score (EWS) system based on the statistical properties of the vital signs in at-risk hospitalised patients. A large dataset comprising 64,622 h of vital-sign data, acquired from 863 acutely ill in-hospital patients using bedside monitors, was used to investigate the statistical properties of the four main vital signs. Normalised histograms and cumulative distribution functions were plotted for each of the four variables. A centile-based alerting system was modelled using the aggregated database. The means and standard deviations of our population's vital signs are very similar to those published in previous studies. When compared with EWS systems based on a future outcome, the cut-off values in our system are most different for respiratory rate and systolic blood pressure. With four-hourly observations in a 12-h shift, about 1 in 8 at-risk patients would trigger our alerting system during the shift. A centile-based EWS system will identify patients with abnormal vital signs regardless of their eventual outcome and might therefore be more likely to generate an alert when presented with patients with redeemable morbidity or avoidable mortality. We are about to start a stepped-wedge clinical trial gradually introducing an electronic version of our EWS system on the trauma wards in a teaching hospital. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

[Modifications of vital signs during hygiene care in intensive care patients: an explorative study].

PubMed

Lucchini, Alberto; Giacovelli, Matteo; Elli, Stefano; Gariboldi, Roberto; Pelucchi, Giulia; Bondi, Herman; Brambilla, Daniela

2009-01-01

Hygiene care in critical patients may alter vital signs. Aim of this paper is to measure vital signs and their modifications in critical patients during hygiene care and measure differences with pre and post hygiene values. Vital signs of 6 patients two hours before, during and 90 minutes after hygienic care were measured. During and 2 hours after the end of hygiene a modification of vital signs was observed compared to basic values (mean values during/90 min after, compared to baseline): heart rate +11.20%/ +1.48; systolic blood pressure +22.68%/+1.56; arterial capillary saturimetry -4.31/+0.27, Respiratory frequency +8.10/+2.66, tidal volume +4,04/-7,51, CO2 min/vol +5,34/- 22.33, bladder temperature -0.85/-0.60. Hygiene care in critical care patients may significantly alter vital signs. Therefore a strict haemodinamic and respiratory monitoring is warranted as well as protocols for the management of sedation and of vasoactive support.

Pyruvate dose response studies targeting the vital signs following hemorrhagic shock

PubMed Central

Sharma, Pushpa; Vyacheslav, Makler; Carissa, Chalut; Vanessa, Rodriguez; Bodo, Mike

2015-01-01

Objectives: To determine the optimal effective dose of sodium pyruvate in maintaining the vital signs following hemorrhagic shock (HS) in rats. Materials and Methods: Anesthetized, male Sprague-Dawley rats underwent computer-controlled HS for 30 minute followed by fluid resuscitation with either hypertonic saline, or sodium pyruvate solutions of 0.5 M, 1.0 M, 2.0 M, and 4.0 M at a rate of 5ml/kg/h (60 minute) and subsequent blood infusion (60 minute). The results were compared with sham and non- resuscitated groups. The animals were continuously monitored for mean arterial pressure, systolic and diastolic pressure, heart rate, pulse pressure, temperature, shock index and Kerdo index (KI). Results: The Sham group remained stable throughout the experiment. Non-resuscitated HS animals did not survive for the entire experiment due to non-viable vital signs and poor shock and KI. All fluids were effective in normalizing the vital signs when shed blood was used adjunctively. Sodium pyruvate 2.0 M was most effective, and 4.0 M solution was least effective in improving the vital signs after HS. Conclusions: Future studies should be directed to use 2.0 M sodium pyruvate adjuvant for resuscitation on multiorgan failure and survival rate in HS. PMID:26229300

Evaluating the frequency of vital sign monitoring during blood transfusion: an evidence-based practice initiative.

PubMed

DeYoung Sullivan, Karen; Vu, Truc; Richardson, Goley; Castillo, Estella; Martinez, Fernando

2015-10-01

Patients with cancer are often dependent on blood transfusions during treatment. Frequent vital sign monitoring during transfusions may interrupt sleep and the patient's ability to ambulate or participate in unit activities. Relying heavily on vital sign findings may also overshadow unmeasurable symptoms of transfusion reaction. The aim of this evidence-based practice initiative was to examine the evidence regarding the optimum frequency of vital sign monitoring for patients undergoing stem cell transplantation receiving blood products and to amend policy and practice to be consistent with the literature. 
AT A GLANCE
: Patients with cancer frequently require transfusion support during treatment.Inconsistencies exist in recommendations for the frequency of vital sign monitoring during transfusion.Examining best practice guidelines suggests that less frequent vital sign monitoring may be appropriate if coupled with thoughtful physiologic assessment.

When and how do GPs record vital signs in children with acute infections? A cross-sectional study

PubMed Central

Blacklock, Claire; Haj-Hassan, Tanya Ali; Thompson, Matthew J

2012-01-01

Background NICE recommendations and evidence from ambulatory settings promotes the use of vital signs in identifying serious infections in children. This appears to differ from usual clinical practice where GPs report measuring vital signs infrequently. Aim To identify frequency of vital sign documentation by GPs, in the assessment of children with acute infections in primary care. Design and setting Observational study in 15 general practice surgeries in Oxfordshire and Somerset, UK. Method A standardised proforma was used to extract consultation details including documentation of numerical vital signs, and words or phrases used by the GP in assessing vital signs, for 850 children aged 1 month to 16 years presenting with acute infection. Results Of the children presenting with acute infections 31.6% had one or more numerical vital signs recorded (269, 31.6%), however GP recording rate improved if free text proxies were also considered: at least one vital sign was then recorded in over half (54.1%) of children. In those with recorded numerical values for vital signs, the most frequent was temperature (210, 24.7%), followed by heart rate (62, 7.3%), respiratory rate (58, 6.8%), and capillary refill time (36, 4.2%). Words or phrases for vital signs were documented infrequently (temperature 17.6%, respiratory rate 14.6%, capillary refill time 12.5%, and heart rate 0.5%), Text relating to global assessment was documented in 313/850 (36.8%) of consultations. Conclusion GPs record vital signs using words and phrases as well as numerical methods, although overall documentation of vital signs is infrequent in children presenting with acute infections. PMID:23265227

Using vital signs to assess children with acute infections: a survey of current practice.

PubMed

Thompson, Matthew; Mayon-White, Richard; Harnden, Anthony; Perera, Rafael; McLeod, Diane; Mant, David

2008-04-01

GPs are advised to measure vital signs in children presenting with acute infections. Current evidence supports the value of GPs' overall assessment in determining how unwell a child is, but the additional benefit of measuring vital signs is not known. To describe the vital signs and clinical features that GPs use to assess children (aged <5 years) with acute infections. Questionnaire survey. All 210 GP principals working within a 10 mile radius of Oxford, UK. Data were collected on reported frequency, methods, and utility of measuring vital signs. Description of clinical features was used to assess the overall severity of illness. One hundred and sixty-two (77%) GPs responded. Half (54%, 95% confidence interval [CI] = 47 to 62) measured temperature at least weekly, compared to pulse (21%, 95% CI = 15 to 27), and respiratory rates (17%, 95% CI = 11 to 23). Almost half of GPs (77, 48%) never measured capillary refill time. Temperature was measured most frequently using electronic aural thermometers (131/152; 86%); auscultation or counting were used for pulse and respiratory rates. A minority used pulse oximeters to assess respiratory status (30/151, 20%). GPs' thresholds for tachypnoea were similar to published values, but there was no consensus on the threshold of tachycardia. Observations of behaviour and activity were considered more useful than vital signs in assessing severity of illness. Vital signs are uncommonly measured in children in general practice and are considered less useful than observation in assessing the severity of illness. If measurement of vital signs is to become part of standard practice, the issues of inaccurate measurement and diagnostic value need to be addressed urgently.

CDC Vital Signs: More People Walk to Better Health

MedlinePlus

... Healthcare-associated Infections Healthy Living HIV / AIDS Injury, Violence & Safety Motor Vehicle Safety Obesity Prescription Drug Overdoses Teen Pregnancy Tobacco Digital Media Tools About Vital Signs Subscribe to RSS Feed ...

The value of vital sign trends for detecting clinical deterioration on the wards

PubMed Central

Churpek, Matthew M; Adhikari, Richa; Edelson, Dana P

2016-01-01

Aim Early detection of clinical deterioration on the wards may improve outcomes, and most early warning scores only utilize a patient’s current vital signs. The added value of vital sign trends over time is poorly characterized. We investigated whether adding trends improves accuracy and which methods are optimal for modelling trends. Methods Patients admitted to five hospitals over a five-year period were included in this observational cohort study, with 60% of the data used for model derivation and 40% for validation. Vital signs were utilized to predict the combined outcome of cardiac arrest, intensive care unit transfer, and death. The accuracy of models utilizing both the current value and different trend methods were compared using the area under the receiver operating characteristic curve (AUC). Results A total of 269,999 patient admissions were included, which resulted in 16,452 outcomes. Overall, trends increased accuracy compared to a model containing only current vital signs (AUC 0.78 vs. 0.74; p<0.001). The methods that resulted in the greatest average increase in accuracy were the vital sign slope (AUC improvement 0.013) and minimum value (AUC improvement 0.012), while the change from the previous value resulted in an average worsening of the AUC (change in AUC −0.002). The AUC increased most for systolic blood pressure when trends were added (AUC improvement 0.05). Conclusion Vital sign trends increased the accuracy of models designed to detect critical illness on the wards. Our findings have important implications for clinicians at the bedside and for the development of early warning scores. PMID:26898412

The value of vital sign trends for detecting clinical deterioration on the wards.

PubMed

Churpek, Matthew M; Adhikari, Richa; Edelson, Dana P

2016-05-01

Early detection of clinical deterioration on the wards may improve outcomes, and most early warning scores only utilize a patient's current vital signs. The added value of vital sign trends over time is poorly characterized. We investigated whether adding trends improves accuracy and which methods are optimal for modelling trends. Patients admitted to five hospitals over a five-year period were included in this observational cohort study, with 60% of the data used for model derivation and 40% for validation. Vital signs were utilized to predict the combined outcome of cardiac arrest, intensive care unit transfer, and death. The accuracy of models utilizing both the current value and different trend methods were compared using the area under the receiver operating characteristic curve (AUC). A total of 269,999 patient admissions were included, which resulted in 16,452 outcomes. Overall, trends increased accuracy compared to a model containing only current vital signs (AUC 0.78 vs. 0.74; p<0.001). The methods that resulted in the greatest average increase in accuracy were the vital sign slope (AUC improvement 0.013) and minimum value (AUC improvement 0.012), while the change from the previous value resulted in an average worsening of the AUC (change in AUC -0.002). The AUC increased most for systolic blood pressure when trends were added (AUC improvement 0.05). Vital sign trends increased the accuracy of models designed to detect critical illness on the wards. Our findings have important implications for clinicians at the bedside and for the development of early warning scores. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The prevalence and diagnostic utility of systemic inflammatory response syndrome vital signs in a pediatric emergency department.

PubMed

Scott, Halden F; Deakyne, Sara J; Woods, Jason M; Bajaj, Lalit

2015-04-01

This study sought to determine the prevalence, test characteristics, and severity of illness of pediatric patients with systemic inflammatory response syndrome (SIRS) vital signs among pediatric emergency department (ED) visits. This was a retrospective descriptive cohort study of all visits to the ED of a tertiary academic free-standing pediatric hospital over 1 year. Visits were included if the patient was <18 years of age and did not leave before full evaluation or against medical advice. Exclusion criteria were trauma diagnoses or missing documentation of vital signs. Data were electronically extracted from the medical record. The primary predictor was presence of vital signs meeting pediatric SIRS definitions. Specific vital sign pairs comprising SIRS were evaluated as predictors (temperature-heart rate, temperature-respiratory rate, and temperature-corrected heart rate, in which a formula was used to correct heart rate for degree of temperature elevation). The primary outcome measure was requirement for critical care (receipt of a vasoactive agent or intubation) within 24 hours of ED arrival. There were 56,210 visits during the study period; 40,356 met inclusion criteria. Of these, 6,596 (16.3%) visits had fever >38.5°C, and 6,122 (15.2% of included visits) met SIRS vital sign criteria. Among included visits, those with SIRS vital signs accounted for 92.8% of all visits with fever >38.5°C. Among patients with SIRS vital signs, 4993 (81.6%) were discharged from the ED without intravenous (IV) therapy and without 72-hour readmission. Critical care within the first 24 hours was present in 99 (0.25%) patients: 23 patients with and 76 without SIRS vital signs. Intensive care unit (ICU) admission was present in 126 (2.06%) with SIRS vital signs and 487 (1.42%) without SIRS vital signs. SIRS vital signs were associated with increased risk of critical care within 24 hours (relative risk [RR] = 1.69, 95% confidence interval [CI] = 1.06 to 2.70), ICU admission (RR

Using vital signs to assess children with acute infections: a survey of current practice

PubMed Central

Thompson, Matthew; Mayon-White, Richard; Harnden, Anthony; Perera, Rafael; McLeod, Diane; Mant, David

2008-01-01

Background GPs are advised to measure vital signs in children presenting with acute infections. Current evidence supports the value of GPs' overall assessment in determining how unwell a child is, but the additional benefit of measuring vital signs is not known. Aim To describe the vital signs and clinical features that GPs use to assess children (aged <5 years) with acute infections. Design of study Questionnaire survey. Setting All 210 GP principals working within a 10 mile radius of Oxford, UK. Method Data were collected on reported frequency, methods, and utility of measuring vital signs. Description of clinical features was used to assess the overall severity of illness. Results One hundred and sixty-two (77%) GPs responded. Half (54%, 95% confidence interval [CI] = 47 to 62) measured temperature at least weekly, compared to pulse (21%, 95% CI = 15 to 27), and respiratory rates (17%, 95% CI = 11 to 23). Almost half of GPs (77, 48%) never measured capillary refill time. Temperature was measured most frequently using electronic aural thermometers (131/152; 86%); auscultation or counting were used for pulse and respiratory rates. A minority used pulse oximeters to assess respiratory status (30/151, 20%). GPs' thresholds for tachypnoea were similar to published values, but there was no consensus on the threshold of tachycardia. Observations of behaviour and activity were considered more useful than vital signs in assessing severity of illness. Conclusion Vital signs are uncommonly measured in children in general practice and are considered less useful than observation in assessing the severity of illness. If measurement of vital signs is to become part of standard practice, the issues of inaccurate measurement and diagnostic value need to be addressed urgently. PMID:18494174

Home telemonitoring of vital signs--technical challenges and future directions.

PubMed

Celler, Branko G; Sparks, Ross S

2015-01-01

The telemonitoring of vital signs from the home is an essential element of telehealth services for the management of patients with chronic conditions, such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, or poorly controlled hypertension. Telehealth is now being deployed widely in both rural and urban settings, and in this paper, we discuss the contribution made by biomedical instrumentation, user interfaces, and automated risk stratification algorithms in developing a clinical diagnostic quality longitudinal health record at home. We identify technical challenges in the acquisition of high-quality biometric signals from unsupervised patients at home, identify new technical solutions and user interfaces, and propose new measurement modalities and signal processing techniques for increasing the quality and value of vital signs monitoring at home. We also discuss use of vital signs data for the automated risk stratification of patients, so that clinical resources can be targeted to those most at risk of unscheduled admission to hospital. New research is also proposed to integrate primary care, hospital, personal genomic, and telehealth electronic health records, and apply predictive analytics and data mining for enhancing clinical decision support.

A smart all-in-one device to measure vital signs in admitted patients

PubMed Central

van Goor, Harry; van Acht, Maartje; van de Belt, Tom H.; Bredie, Sebastian J. H.

2018-01-01

Background Vital sign measurements in hospitalized patients by nurses are time consuming and prone to operational errors. The Checkme, a smart all-in-one device capable of measuring vital signs, could improve daily patient monitoring by reducing measurement time, inter-observer variability, and incorrect inputs in the Electronic Health Record (EHR). We evaluated the accuracy of self measurements by patient using the Checkme in comparison with gold standard and nurse measurements. Methods and findings This prospective comparative study was conducted at the Internal Medicine ward of an academic hospital in the Netherlands. Fifty non-critically ill patients were enrolled in the study. Time-related measurement sessions were conducted on consecutive patients in a randomized order: vital sign measurement in duplicate by a well-trained investigator (gold standard), a Checkme measurement by the patient, and a routine vital sign measurement by a nurse. In 41 patients (82%), initial calibration of the Checkme was successful and results were eligible for analysis. In total, 69 sessions were conducted for these 41 patients. The temperature results recorded by the patient with the Checkme differed significantly from the gold standard core temperature measurements (mean difference 0.1 ± 0.3). Obtained differences in vital signs and calculated Modified Early Warning Score (MEWS) were small and were in range with predefined accepted discrepancies. Conclusions Patient-calculated MEWS using the Checkme, nurse measurements, and gold standard measurements all correlated well, and the small differences observed between modalities would not have affected clinical decision making. Using the Checkme, patients in a general medical ward setting are able to measure their own vital signs easily and accurately by themselves. This could be time saving for nurses and prevent errors due to manually entering data in the EHR. PMID:29432461

A smart all-in-one device to measure vital signs in admitted patients.

PubMed

Weenk, Mariska; van Goor, Harry; van Acht, Maartje; Engelen, Lucien Jlpg; van de Belt, Tom H; Bredie, Sebastian J H

2018-01-01

Vital sign measurements in hospitalized patients by nurses are time consuming and prone to operational errors. The Checkme, a smart all-in-one device capable of measuring vital signs, could improve daily patient monitoring by reducing measurement time, inter-observer variability, and incorrect inputs in the Electronic Health Record (EHR). We evaluated the accuracy of self measurements by patient using the Checkme in comparison with gold standard and nurse measurements. This prospective comparative study was conducted at the Internal Medicine ward of an academic hospital in the Netherlands. Fifty non-critically ill patients were enrolled in the study. Time-related measurement sessions were conducted on consecutive patients in a randomized order: vital sign measurement in duplicate by a well-trained investigator (gold standard), a Checkme measurement by the patient, and a routine vital sign measurement by a nurse. In 41 patients (82%), initial calibration of the Checkme was successful and results were eligible for analysis. In total, 69 sessions were conducted for these 41 patients. The temperature results recorded by the patient with the Checkme differed significantly from the gold standard core temperature measurements (mean difference 0.1 ± 0.3). Obtained differences in vital signs and calculated Modified Early Warning Score (MEWS) were small and were in range with predefined accepted discrepancies. Patient-calculated MEWS using the Checkme, nurse measurements, and gold standard measurements all correlated well, and the small differences observed between modalities would not have affected clinical decision making. Using the Checkme, patients in a general medical ward setting are able to measure their own vital signs easily and accurately by themselves. This could be time saving for nurses and prevent errors due to manually entering data in the EHR.

Is heart rate variability better than routine vital signs for prehospital identification of major hemorrhage?

PubMed

Edla, Shwetha; Reisner, Andrew T; Liu, Jianbo; Convertino, Victor A; Carter, Robert; Reifman, Jaques

2015-02-01

During initial assessment of trauma patients, metrics of heart rate variability (HRV) have been associated with high-risk clinical conditions. Yet, despite numerous studies, the potential of HRV to improve clinical outcomes remains unclear. Our objective was to evaluate whether HRV metrics provide additional diagnostic information, beyond routine vital signs, for making a specific clinical assessment: identification of hemorrhaging patients who receive packed red blood cell (PRBC) transfusion. Adult prehospital trauma patients were analyzed retrospectively, excluding those who lacked a complete set of reliable vital signs and a clean electrocardiogram for computation of HRV metrics. We also excluded patients who did not survive to admission. The primary outcome was hemorrhagic injury plus different PRBC transfusion volumes. We performed multivariate regression analysis using HRV metrics and routine vital signs to test the hypothesis that HRV metrics could improve the diagnosis of hemorrhagic injury plus PRBC transfusion vs routine vital signs alone. As univariate predictors, HRV metrics in a data set of 402 subjects had comparable areas under receiver operating characteristic curves compared with routine vital signs. In multivariate regression models containing routine vital signs, HRV parameters were significant (P<.05) but yielded areas under receiver operating characteristic curves with minimal, nonsignificant improvements (+0.00 to +0.05). A novel diagnostic test should improve diagnostic thinking and allow for better decision making in a significant fraction of cases. Our findings do not support that HRV metrics add value over routine vital signs in terms of prehospital identification of hemorrhaging patients who receive PRBC transfusion. Published by Elsevier Inc.

Wireless Vital Sign Monitoring in Pregnant Women: A Functionality and Acceptability Study.

PubMed

Boatin, Adeline Adwoa; Wylie, Blair Johnson; Goldfarb, Ilona; Azevedo, Robin; Pittel, Elena; Ng, Courtney; Haberer, Jessica Elizabeth

2016-07-01

To test the functionality and acceptability of a wireless vital sign monitor in an inpatient obstetric unit. Pregnant women at a U.S. tertiary-care hospital wore a wireless vital sign sensor that captures heart rate, respiratory rate, and temperature. Measurements were compared with vital signs obtained by standard devices. We defined continuous capture of vital signs for 30 min with wireless data transfer to a central monitor as functional success. Acceptability was assessed per the pregnant women and nurses observing the device. Bland-Altman plots were constructed to assess agreement between the wireless sensor and standard measurements. Thirty of 32 enrolled pregnant women had successful monitoring; 2 cases were stopped early for non-study-related reasons. Comparing wireless sensor and standard measurements, the mean difference (limits of agreement) values at the 25th and 75th percentiles were 1.6 (±13.2) and 4.2 (±18.6) heartbeats/min, 4.2 (±6.1) and 0.7 (±5.4) respirations/min, and 0.02°C (±1.5) and 0.5°C (±1.8), respectively. Most pregnant women found the device comfortable, likeable, and useful (78%, 81%, and 97%, respectively); 80% of nurses found the monitor easy to use, and 84% would recommend it to a patient. We successfully obtained maternal vital signs using a simple wireless monitor with high acceptability. Well-validated monitors of this nature could significantly alleviate the human resource burden of monitoring during labor and confer greatly desired mobility to laboring pregnant women, although incorporation of blood pressure monitoring will be critical.

Vital signs monitoring plan for the Klamath Network: Phase I report

USGS Publications Warehouse

Sarr, Daniel; Odion, Dennis; Truitt, Robert E.; Beever, Erik A.; Shafer, Sarah; Duff, Andrew; Smith, Sean B.; Bunn, Windy; Rocchio, Judy; Sarnat, Eli; Alexander, John; Jessup, Steve

2004-01-01

This report chronicles the Phase 1 stage of the vital signs monitoring program for the Klamath Network. It consists of two chapters and eleven appendixes. The purposes of Chapter One are to 1) describe the network administrative structure and approach to planning; 2) introduce the Klamath Network parks, their resources, and environmental settings; 3) explain the need for monitoring changes in resources and supporting environments; 4) identify key information gaps that limit understanding of how to best achieve these monitoring goals. The purpose of Chapter Two is to develop the descriptive information provided in Chapter One into a conceptual basis for vital signs monitoring and to present the Network’s initial suite of conceptual models. The Report Appendices provide in-depth information on a variety of topics researched in preparation of the report, including: detailed natural resource profiles for each park, supporting policies and guidelines, regional fire regimes, vegetation types of the parks, exotic species threats, interagency monitoring programs, air issues, water quality (Phase 1 Report), Network vital signs (Scoping Summary Report), rare species, and rare habitats of the parks.

Rapid response team patients triaged to remain on ward despite deranged vital signs: missed opportunities?

PubMed

Tirkkonen, J; Kontula, T; Hoppu, S

2017-11-01

Rapid response teams (RRTs) triage most patients to stay on ward, even though some of them have deranged vital signs according to RRTs themselves. We investigated the prevalence and outcome of this RRT patient cohort. A prospective observational study was conducted in a Finnish tertiary referral centre, Tampere University Hospital. Data on RRT activations were collected between 1 May 2012 and 30 April 2015. Vital signs of patients triaged to stay on ward without treatment limitations were classified according to objective RRT trigger criteria observed during the reviews. During the study period, 860 patients had their first RRT review and were triaged to stay on ward. Of these, 564 (66%) had deranged vital signs, while 296 (34%) did not. RRT patients with deranged vital signs were of comparable age and comorbidity index as stable patients. Even though the patients with deranged vital signs had received RRT interventions, such as fluids and medications, more often than the stable patients, they required new RRT reviews more often and had higher in-hospital and 30-day mortality. Moreover, the former group had substantially higher 1-year mortality than the latter (37% vs. 29%, P = 0.014). In a multivariate regression analysis, deranged vital signs during RRT review was found to be independently associated with 30-day mortality (OR 1.74; 95% CI 1.12-2.70). Patients triaged to stay on ward despite deranged vital signs are high-risk patients who could benefit from routine follow-up by RRT nurses before they deteriorate beyond salvation. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

A Web-based vital sign telemonitor and recorder for telemedicine applications.

PubMed

Mendoza, Patricia; Gonzalez, Perla; Villanueva, Brenda; Haltiwanger, Emily; Nazeran, Homer

2004-01-01

We describe a vital sign telemonitor (VST) that acquires, records, displays, and provides readings such as: electrocardiograms (ECGs), temperature (T), and oxygen saturation (SaO2) over the Internet to any site. The design of this system consisted of three parts: sensors, analog signal processing circuits, and a user-friendly graphical user interface (GUI). The first part involved selection of appropriate sensors. For ECG, disposable Ag/AgCl electrodes; for temperature, LM35 precision temperature sensor; and for SaO2 the Nonin Oximetry Development Kit equipped with a finger clip were selected. The second part consisted of processing the analog signals obtained from these sensors. This was achieved by implementing suitable amplifiers and filters for the vital signs. The final part focused on development of a GUI to display the vital signs in the LabVIEW environment. From these measurements, important values such as heart rate (HR), beat-to-beat (RR) intervals, SaO2 percentages, and T in both degrees Celsius and Fahrenheit were calculated The GUI could be accessed through the Internet in a Web-page facilitating the possibility of real-time patient telemonitoring. The final system was completed and tested on volunteers with satisfactory results.

Exploring Vital Sign Data Quality in Electronic Health Records with Focus on Emergency Care Warning Scores.

PubMed

Skyttberg, Niclas; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2017-08-30

Computerized clinical decision support and automation of warnings have been advocated to assist clinicians in detecting patients at risk of physiological instability. To provide reliable support such systems are dependent on high-quality vital sign data. Data quality depends on how, when and why the data is captured and/or documented. This study aims to describe the effects on data quality of vital signs by three different types of documentation practices in five Swedish emergency hospitals, and to assess data fitness for calculating warning and triage scores. The study also provides reference data on triage vital signs in Swedish emergency care. We extracted a dataset including vital signs, demographic and administrative data from emergency care visits (n=335027) at five Swedish emergency hospitals during 2013 using either completely paper-based, completely electronic or mixed documentation practices. Descriptive statistics were used to assess fitness for use in emergency care decision support systems aiming to calculate warning and triage scores, and data quality was described in three categories: currency, completeness and correctness. To estimate correctness, two further categories - plausibility and concordance - were used. The study showed an acceptable correctness of the registered vital signs irrespectively of the type of documentation practice. Completeness was high in sites where registrations were routinely entered into the Electronic Health Record (EHR). The currency was only acceptable in sites with a completely electronic documentation practice. Although vital signs that were recorded in completely electronic documentation practices showed plausible results regarding correctness, completeness and currency, the study concludes that vital signs documented in Swedish emergency care EHRs cannot generally be considered fit for use for calculation of triage and warning scores. Low completeness and currency were found if the documentation was not completely

Algorithmic tools for interpreting vital signs.

PubMed

Rathbun, Melina C; Ruth-Sahd, Lisa A

2009-07-01

Today's complex world of nursing practice challenges nurse educators to develop teaching methods that promote critical thinking skills and foster quick problem solving in the novice nurse. Traditional pedagogies previously used in the classroom and clinical setting are no longer adequate to prepare nursing students for entry into practice. In addition, educators have expressed frustration when encouraging students to apply newly learned theoretical content to direct the care of assigned patients in the clinical setting. This article presents algorithms as an innovative teaching strategy to guide novice student nurses in the interpretation and decision making related to vital sign assessment in an acute care setting.

Variations in vital signs in the last days of life in patients with advanced cancer.

PubMed

Bruera, Sebastian; Chisholm, Gary; Dos Santos, Renata; Crovador, Camila; Bruera, Eduardo; Hui, David

2014-10-01

Few studies have examined variation in vital signs in the last days of life. We determined the variation of vital signs in the final two weeks of life in patients with advanced cancer and examined their association with impending death in three days. In this prospective, longitudinal, observational study, we enrolled consecutive patients admitted to two acute palliative care units and documented their vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation, and temperature) twice a day serially from admission to death or discharge. Of 357 patients, 203 (57%) died in hospital. Systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), and oxygen saturation (P < 0.001) decreased significantly in the final three days of life, and temperature increased slightly (P < 0.04). Heart rate (P = 0.22) and respiratory rate (P = 0.24) remained similar in the last three days. Impending death in three days was significantly associated with increased heart rate (odds ratio [OR] = 2; P = 0.01), decreased systolic blood pressure (OR = 2.5; P = 0.004), decreased diastolic blood pressure (OR = 2.3; P = 0.002), and decreased oxygen saturation (OR = 3.7; P = 0.003) from baseline readings on admission. These changes had high specificity (≥ 80%), low sensitivity (≤ 35%), and modest positive likelihood ratios (≤ 5) for impending death within three days. A large proportion of patients had normal vital signs in the last days of life. Blood pressure and oxygen saturation decreased in the last days of life. Clinicians and families cannot rely on vital sign changes alone to rule in or rule out impending death. Our findings do not support routine vital signs monitoring of patients who are imminently dying. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Variations in Vital Signs in the Last Days of Life in Patients With Advanced Cancer

PubMed Central

Bruera, Sebastian; Chisholm, Gary; Dos Santos, Renata; Crovador, Camila; Bruera, Eduardo; Hui, David

2014-01-01

Context Few studies have examined variation in vital signs in the last days of life. Objectives We determined the variation of vital signs in the final two weeks of life in patients with advanced cancer and examined their association with impending death in three days. Methods In this prospective, longitudinal, observational study, we enrolled consecutive patients admitted to two acute palliative care units and documented their vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation, and temperature) twice a day serially from admission to death or discharge. Results Of 357 patients, 203 (55%) died in hospital. Systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), and oxygen saturation (P < 0.001) decreased significantly in the final three days of life, and temperature increased slightly (P < 0.04). Heart rate (P = 0.22) and respiratory rate (P = 0.24) remained similar in the last three days. Impending death in three days was significantly associated with increased heart rate (odds ratio [OR] = 2; P = 0.01), decreased systolic blood pressure (OR = 2.5; P = 0.004), decreased diastolic blood pressure (OR = 2.3; P = 0.002), and decreased oxygen saturation (OR = 3.7; P = 0.003) from baseline readings on admission. These changes had high specificity (≥80%), low sensitivity (≤35%), and modest positive likelihood ratios (≤5) for impending death within three days. A large proportion of patients had normal vital signs in the last days of life. Conclusion Blood pressure and oxygen saturation decreased in the last days of life. Clinicians and families cannot rely on vital sign changes alone to rule in or rule out impending death. Our findings do not support routine vital signs monitoring of patients who are imminently dying. PMID:24731412

Vital signs monitoring and patient tracking over a wireless network.

PubMed

Gao, Tia; Greenspan, Dan; Welsh, Matt; Juang, Radford; Alm, Alex

2005-01-01

Patients at a disaster scene can greatly benefit from technologies that continuously monitor their vital status and track their locations until they are admitted to the hospital. We have designed and developed a real-time patient monitoring system that integrates vital signs sensors, location sensors, ad-hoc networking, electronic patient records, and web portal technology to allow remote monitoring of patient status. This system shall facilitate communication between providers at the disaster scene, medical professionals at local hospitals, and specialists available for consultation from distant facilities.

A simple intervention improves the recording of vital signs in children presenting to the emergency department.

PubMed

Bird, C; Shea, A; Michie, C A; George, G

2009-10-01

Vital signs are often not documented in paediatric patients at triage. This study was conducted to find out whether the use of a small, laminated aide memoire and a short teaching session might improve this situation. A preliminary audit of the measurement of vital signs in 106 children aged less than 6 years was carried out in a district general hospital emergency department (ED). A small card illustrating normal values for these was then distributed-this could be attached to staff identity cards. At the same time doctors and nursing staff were given a teaching session on the importance of these measures. The audit was then repeated in a further 106 children. There was significant improvement in recording of all vital signs with the exception of blood pressure and temperature. A low-cost card together with a short period of training offers a useful strategy to improve the rate of documentation of vital signs in children presenting to the ED.

How to improve vital sign data quality for use in clinical decision support systems? A qualitative study in nine Swedish emergency departments.

PubMed

Skyttberg, Niclas; Vicente, Joana; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2016-06-04

Vital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood. This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments. Semi-structured interviews were conducted with sixteen physicians and nurses from nine hospitals and vital sign documentation templates were collected and analysed. Follow-up interviews and process observations were done at three of the hospitals to verify the results. Content analysis with constant comparison of the data was used to analyse and categorize the collected data. Factors related to care process and information technology were perceived to affect vital sign data quality. Despite electronic health records (EHRs) being available in all hospitals, these were not always used for vital sign documentation. Only four out of nine sites had a completely digitalized vital sign documentation flow and paper-based triage records were perceived to provide a better mobile workflow support than EHRs. Observed documentation practices resulted in low currency, completeness, and interoperability of the vital signs. To improve vital sign data quality, we propose to standardize the care process, improve the digital documentation support, provide workflow support, ensure interoperability and perform quality control. Vital sign data quality in Swedish emergency departments is currently not fit for use by CDSS. To address both technical and organisational challenges, we propose

Sample entropy predicts lifesaving interventions in trauma patients with normal vital signs.

PubMed

Naraghi, L; Mejaddam, A Y; Birkhan, O A; Chang, Y; Cropano, C M; Mesar, T; Larentzakis, A; Peev, M; Sideris, A C; Van der Wilden, G M; Imam, A M; Hwabejire, J O; Velmahos, G C; Fagenholz, P J; Yeh, D; de Moya, M A; King, D R

2015-08-01

Heart rate complexity, commonly described as a "new vital sign," has shown promise in predicting injury severity, but its use in clinical practice is not yet widely adopted. We previously demonstrated the ability of this noninvasive technology to predict lifesaving interventions (LSIs) in trauma patients. This study was conducted to prospectively evaluate the utility of real-time, automated, noninvasive, instantaneous sample entropy (SampEn) analysis to predict the need for an LSI in a trauma alert population presenting with normal vital signs. Prospective enrollment of patients who met criteria for trauma team activation and presented with normal vital signs was conducted at a level I trauma center. High-fidelity electrocardiogram recording was used to calculate SampEn and SD of the normal-to-normal R-R interval (SDNN) continuously in real time for 2 hours with a portable, handheld device. Patients who received an LSI were compared to patients without any intervention (non-LSI). Multivariable analysis was performed to control for differences between the groups. Treating clinicians were blinded to results. Of 129 patients enrolled, 38 (29%) received 136 LSIs within 24 hours of hospital arrival. Initial systolic blood pressure was similar in both groups. Lifesaving intervention patients had a lower Glasgow Coma Scale. The mean SampEn on presentation was 0.7 (0.4-1.2) in the LSI group compared to 1.5 (1.1-2.0) in the non-LSI group (P < .0001). The area under the curve with initial SampEn alone was 0.73 (95% confidence interval [CI], 0.64-0.81) and increased to 0.93 (95% CI, 0.89-0.98) after adding sedation to the model. Sample entropy of less than 0.8 yields sensitivity, specificity, negative predictive value, and positive predictive value of 58%, 86%, 82%, and 65%, respectively, with an overall accuracy of 76% for predicting an LSI. SD of the normal-to-normal R-R interval had no predictive value. In trauma patients with normal presenting vital signs, decreased Samp

Multi-parameter vital sign database to assist in alarm optimization for general care units.

PubMed

Welch, James; Kanter, Benjamin; Skora, Brooke; McCombie, Scott; Henry, Isaac; McCombie, Devin; Kennedy, Rosemary; Soller, Babs

2016-12-01

Continual vital sign assessment on the general care, medical-surgical floor is expected to provide early indication of patient deterioration and increase the effectiveness of rapid response teams. However, there is concern that continual, multi-parameter vital sign monitoring will produce alarm fatigue. The objective of this study was the development of a methodology to help care teams optimize alarm settings. An on-body wireless monitoring system was used to continually assess heart rate, respiratory rate, SpO 2 and noninvasive blood pressure in the general ward of ten hospitals between April 1, 2014 and January 19, 2015. These data, 94,575 h for 3430 patients are contained in a large database, accessible with cloud computing tools. Simulation scenarios assessed the total alarm rate as a function of threshold and annunciation delay (s). The total alarm rate of ten alarms/patient/day predicted from the cloud-hosted database was the same as the total alarm rate for a 10 day evaluation (1550 h for 36 patients) in an independent hospital. Plots of vital sign distributions in the cloud-hosted database were similar to other large databases published by different authors. The cloud-hosted database can be used to run simulations for various alarm thresholds and annunciation delays to predict the total alarm burden experienced by nursing staff. This methodology might, in the future, be used to help reduce alarm fatigue without sacrificing the ability to continually monitor all vital signs.

A fundamental conflict of care: Nurses' accounts of balancing patients' sleep with taking vital sign observations at night.

PubMed

Hope, Joanna; Recio-Saucedo, Alejandra; Fogg, Carole; Griffiths, Peter; Smith, Gary B; Westwood, Greta; Schmidt, Paul E

2017-12-21

To explore why adherence to vital sign observations scheduled by an early warning score protocol reduces at night. Regular vital sign observations can reduce avoidable deterioration in hospital. early warning score protocols set the frequency of these observations by the severity of a patient's condition. Vital sign observations are taken less frequently at night, even with an early warning score in place, but no literature has explored why. A qualitative interpretative design informed this study. Seventeen semi-structured interviews with nursing staff working on wards with varying levels of adherence to scheduled vital sign observations. A thematic analysis approach was used. At night, nursing teams found it difficult to balance the competing care goals of supporting sleep with taking vital sign observations. The night-time frequency of these observations was determined by clinical judgement, ward-level expectations of observation timing and the risk of disturbing other patients. Patients with COPD or dementia could be under-monitored, while patients nearing the end of life could be over-monitored. In this study, we found an early warning score algorithm focused on deterioration prevention did not account for long-term management or palliative care trajectories. Nurses were therefore less inclined to wake such patients to take vital sign observations at night. However, the perception of widespread exceptions and lack of evidence regarding optimum frequency risks delegitimising the early warning score approach. This may pose a risk to patient safety, particularly patients with dementia or chronic conditions. Nurses should document exceptions and discuss these with the wider team. Hospitals should monitor why vital sign observations are missed at night, identify which groups are under-monitored and provide guidance on prioritising competing expectations. early warning score protocols should take account of different care trajectories. © 2017 The Authors. Journal of

Doppler Radar Vital Signs Detection Method Based on Higher Order Cyclostationary.

PubMed

Yu, Zhibin; Zhao, Duo; Zhang, Zhiqiang

2017-12-26

Due to the non-contact nature, using Doppler radar sensors to detect vital signs such as heart and respiration rates of a human subject is getting more and more attention. However, the related detection-method research meets lots of challenges due to electromagnetic interferences, clutter and random motion interferences. In this paper, a novel third-order cyclic cummulant (TOCC) detection method, which is insensitive to Gaussian interference and non-cyclic signals, is proposed to investigate the heart and respiration rate based on continuous wave Doppler radars. The k -th order cyclostationary properties of the radar signal with hidden periodicities and random motions are analyzed. The third-order cyclostationary detection theory of the heart and respiration rate is studied. Experimental results show that the third-order cyclostationary approach has better estimation accuracy for detecting the vital signs from the received radar signal under low SNR, strong clutter noise and random motion interferences.

Vital Sign Monitoring and Mobile Phone Usage Detection Using IR-UWB Radar for Intended Use in Car Crash Prevention.

PubMed

Leem, Seong Kyu; Khan, Faheem; Cho, Sung Ho

2017-05-30

In order to avoid car crashes, active safety systems are becoming more and more important. Many crashes are caused due to driver drowsiness or mobile phone usage. Detecting the drowsiness of the driver is very important for the safety of a car. Monitoring of vital signs such as respiration rate and heart rate is important to determine the occurrence of driver drowsiness. In this paper, robust vital signs monitoring through impulse radio ultra-wideband (IR-UWB) radar is discussed. We propose a new algorithm that can estimate the vital signs even if there is motion caused by the driving activities. We analyzed the whole fast time vital detection region and found the signals at those fast time locations that have useful information related to the vital signals. We segmented those signals into sub-signals and then constructed the desired vital signal using the correlation method. In this way, the vital signs of the driver can be monitored noninvasively, which can be used by researchers to detect the drowsiness of the driver which is related to the vital signs i.e., respiration and heart rate. In addition, texting on a mobile phone during driving may cause visual, manual or cognitive distraction of the driver. In order to reduce accidents caused by a distracted driver, we proposed an algorithm that can detect perfectly a driver's mobile phone usage even if there are various motions of the driver in the car or changes in background objects. These novel techniques, which monitor vital signs associated with drowsiness and detect phone usage before a driver makes a mistake, may be very helpful in developing techniques for preventing a car crash.

Vital Sign Monitoring and Mobile Phone Usage Detection Using IR-UWB Radar for Intended Use in Car Crash Prevention

PubMed Central

Leem, Seong Kyu; Khan, Faheem; Cho, Sung Ho

2017-01-01

In order to avoid car crashes, active safety systems are becoming more and more important. Many crashes are caused due to driver drowsiness or mobile phone usage. Detecting the drowsiness of the driver is very important for the safety of a car. Monitoring of vital signs such as respiration rate and heart rate is important to determine the occurrence of driver drowsiness. In this paper, robust vital signs monitoring through impulse radio ultra-wideband (IR-UWB) radar is discussed. We propose a new algorithm that can estimate the vital signs even if there is motion caused by the driving activities. We analyzed the whole fast time vital detection region and found the signals at those fast time locations that have useful information related to the vital signals. We segmented those signals into sub-signals and then constructed the desired vital signal using the correlation method. In this way, the vital signs of the driver can be monitored noninvasively, which can be used by researchers to detect the drowsiness of the driver which is related to the vital signs i.e., respiration and heart rate. In addition, texting on a mobile phone during driving may cause visual, manual or cognitive distraction of the driver. In order to reduce accidents caused by a distracted driver, we proposed an algorithm that can detect perfectly a driver's mobile phone usage even if there are various motions of the driver in the car or changes in background objects. These novel techniques, which monitor vital signs associated with drowsiness and detect phone usage before a driver makes a mistake, may be very helpful in developing techniques for preventing a car crash. PMID:28556818

Severely deranged vital signs as triggers for acute treatment modifications on an intensive care unit in a low-income country.

PubMed

Schell, Carl Otto; Castegren, Markus; Lugazia, Edwin; Blixt, Jonas; Mulungu, Moses; Konrad, David; Baker, Tim

2015-07-25

Critical care saves lives of the young with reversible disease. Little is known about critical care services in low-income countries. In a setting with a shortage of doctors the actions of the nurse bedside are likely to have a major impact on the outcome of critically ill patients with rapidly changing physiology. Identification of severely deranged vital signs and subsequent treatment modifications are the basis of modern routines in critical care, for example goal directed therapy and rapid response teams. This study assesses how often severely deranged vital signs trigger an acute treatment modification on an Intensive Care Unit (ICU) in Tanzania. A medical records based, observational study. Vital signs (conscious level, respiratory rate, oxygen saturation, heart rate and systolic blood pressure) were collected as repeated point prevalences three times per day in a 1-month period for all adult patients on the ICU. Severely deranged vital signs were identified and treatment modifications within 1 h were noted. Of 615 vital signs studied, 126 (18%) were severely deranged. An acute treatment modification was in total indicated in 53 situations and was carried out three times (6%) (2/32 for hypotension, 0/8 for tachypnoea, 1/6 for tachycardia, 0/4 for unconsciousness and 0/3 for hypoxia). This study suggests that severely deranged vital signs are common and infrequently lead to acute treatment modifications on an ICU in a low-income country. There may be potential to improve outcome if nurses are guided to administer acute treatment modifications by using a vital sign directed approach. A prospective study of a vital sign directed therapy protocol is underway.

Effect of simulation on the ability of first year nursing students to learn vital signs.

PubMed

Eyikara, Evrim; Baykara, Zehra Göçmen

2018-01-01

The acquisition of cognitive, affective and psychomotor knowledge and skills are required in nursing, made possible via an interactive teaching method, such as simulation. This study conducted to identify the impact of simulation on first-year nursing students' ability to learn vital signs. A convenience sample of 90 first-year nursing students enrolled at a University, Ankara, in 2014-2015. Ninety students enrolled for lessons on the "Fundamentals of Nursing" were identified using a simple random sampling method. The students were taught vital signs theory via traditional methods. They were grouped into experimental 1, experimental 2 and control group, of 30 students each. Students in the experimental 1 group attended sessions on simulation and those in the experimental 2 group sessions on laboratory work, followed by simulation. The control group were taught via traditional methods and only attended the laboratory work sessions. The students' cognitive knowledge acquisition was evaluated using a knowledge test before and after the lessons. The ability to measure vital signs in adults (healthy ones and patients) was evaluated using a skill control list. A statistically significant difference was not observed between the groups in terms of the average pre-test scores on knowledge (p>0.050). Groups exposed to simulation obtained statistically significantly higher scores than the control group in post-test knowledge (p<0.050). The ability of the groups exposed to simulation to measure vital signs in healthy adults and patients was more successful than that the control group (p<0.050). This was statistically significant. Simulation had a positive effect on the ability of nursing students to measure vital signs. Thus, simulation should be included in the mainstream curriculum in order to effectively impart nursing knowledge and skills. Copyright © 2017 Elsevier Ltd. All rights reserved.

Defining a reference range for vital signs in healthy term pregnant women undergoing caesarean section.

PubMed

Dennis, A; Hardy, L

2016-11-01

Early warning systems (EWS), used to identify deteriorating hospitalised patients, are based on measurement of vital signs. When the patients are pregnant, most EWS still use non-pregnant reference ranges of vital signs to determine trigger thresholds. There are no published reference ranges for all vital signs in pregnancy. We aimed to define vital signs reference ranges for term pregnancy in the preoperative period, and to determine the appropriateness of EWS trigger criteria in pregnancy. We conducted a one-year retrospective study in a tertiary referral obstetric hospital. The study sample was healthy term women undergoing planned caesarean section (CS). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), oxygen saturation (SpO 2 ) and temperature were all measured automatically and data was extracted from the medical record. Two hundred and fifty-eight women met inclusion criteria. Results were (mean ± SD [standard deviation]) SBP 118 ± 11.2 mmHg, DBP 75 ± 10.3 mmHg, HR 84 ± 10.2 /minute, respiratory rate 18 ± 1.5 /minute, SpO 2 99%  ± 1.0% and temperature 36.4°C ± 0.43°C. The reference ranges (mean ± 2SD) determined were SBP 96-140 mmHg, DBP 54-96 mmHg, HR 64-104/minute, RR 15-21 /minute, SpO 2 97%-100% and temperature 35.5°C-37.3°C. This study defined a reference range for vital signs in healthy term pregnant women undergoing CS. Study findings suggest that currently used criteria for EWS triggers, based on non-pregnant values, may be too extreme for timely detection of deteriorating pregnant patients. Further research examining the modified HR triggers of ≤50 and ≥110 /minute in pregnant women and their relationship to clinical outcomes is required.

Innovations in vital signs measurement for the detection of hypertension and shock in pregnancy.

PubMed

Vousden, Nicola; Nathan, Hannah L; Shennan, Andrew H

2018-06-22

Approximately 820 women die in pregnancy and childbirth every day worldwide, with 99% of these occurring in low-resource settings. The most common causes of maternal mortality are haemorrhage, sepsis and hypertensive disorders. There are established, effective solutions to these complications, however challenges remain in identifying who is at greatest risk and ensuring that interventions are delivered early when they have the greatest potential to benefit. Measuring vital signs is the first step in identifying women at risk. Overstretched or poorly trained staff and inadequate access to accurate, reliable equipment to measure vital signs can potentially result in delayed treatment initiation. Early warning systems may help alert users to identify patients at risk, especially where novel technologies can improve usability by automating calculations and alerting users to abnormalities. This may be of greatest benefit in under-resourced settings where task-sharing is common and early identification of complications can allow for prioritisation of life-saving interventions. This paper highlights the challenges of accurate vital sign measurement in pregnancy and identifies innovations which may improve detection of pregnancy complications.

Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country.

PubMed

Baker, Tim; Schell, Carl Otto; Lugazia, Edwin; Blixt, Jonas; Mulungu, Moses; Castegren, Markus; Eriksen, Jaran; Konrad, David

2015-01-01

Global Critical Care is attracting increasing attention. At several million deaths per year, the worldwide burden of critical illness is greater than generally appreciated. Low income countries (LICs) have a disproportionally greater share of critical illness, and yet critical care facilities are scarce in such settings. Routines utilizing abnormal vital signs to identify critical illness and trigger medical interventions have become common in high-income countries but have not been investigated in LICs. The aim of the study was to assess whether the introduction of a vital signs directed therapy protocol improved acute care and reduced mortality in an Intensive Care Unit (ICU) in Tanzania. Prospective, before-and-after interventional study in the ICU of a university hospital in Tanzania. A context-appropriate protocol that defined danger levels of severely abnormal vital signs and stipulated acute treatment responses was implemented in a four week period using sensitisation, training, job aids, supervision and feedback. Acute treatment of danger signs at admission and during care in the ICU and in-hospital mortality were compared pre and post-implementation using regression models. Danger signs from 447 patients were included: 269 pre-implementation and 178 post-implementation. Acute treatment of danger signs was higher post-implementation (at admission: 72.9% vs 23.1%, p<0.001; in ICU: 16.6% vs 2.9%, p<0.001). A danger sign was five times more likely to be treated post-implementation (Prevalence Ratio (PR) 4.9 (2.9-8.3)). Intravenous fluids were given in response to 35.0% of hypotensive episodes post-implementation, as compared to 4.1% pre-implementation (PR 6.4 (2.5-16.2)). In patients admitted with hypotension, mortality was lower post-implementation (69.2% vs 92.3% p = 0.02) giving a numbers-needed-to-treat of 4.3. Overall in-hospital mortality rates were unchanged (49.4% vs 49.8%, p = 0.94). The introduction of a vital signs directed therapy protocol improved

Monitoring of Vital Signs with Flexible and Wearable Medical Devices.

PubMed

Khan, Yasser; Ostfeld, Aminy E; Lochner, Claire M; Pierre, Adrien; Arias, Ana C

2016-06-01

Advances in wireless technologies, low-power electronics, the internet of things, and in the domain of connected health are driving innovations in wearable medical devices at a tremendous pace. Wearable sensor systems composed of flexible and stretchable materials have the potential to better interface to the human skin, whereas silicon-based electronics are extremely efficient in sensor data processing and transmission. Therefore, flexible and stretchable sensors combined with low-power silicon-based electronics are a viable and efficient approach for medical monitoring. Flexible medical devices designed for monitoring human vital signs, such as body temperature, heart rate, respiration rate, blood pressure, pulse oxygenation, and blood glucose have applications in both fitness monitoring and medical diagnostics. As a review of the latest development in flexible and wearable human vitals sensors, the essential components required for vitals sensors are outlined and discussed here, including the reported sensor systems, sensing mechanisms, sensor fabrication, power, and data processing requirements. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

CDC Vital Signs: Prescription Painkiller Overdoses (Opioids): A Growing Epidemic, Especially Among Women

MedlinePlus

... Healthcare-associated Infections Healthy Living HIV / AIDS Injury, Violence & Safety Motor Vehicle Safety Obesity Prescription Drug Overdoses Teen Pregnancy Tobacco Digital Media Tools About Vital Signs Subscribe to RSS Feed ...

Impact of peer pressure on accuracy of reporting vital signs: An interprofessional comparison between nursing and medical students.

PubMed

Kaba, Alyshah; Beran, Tanya N

2016-01-01

The hierarchical relationship between nursing and medicine has long been known, yet its direct influence on procedural tasks has yet to be considered. Drawing on the theory of conformity from social psychology, we suggest that nursing students are likely to report incorrect information in response to subtle social pressures imposed by medical students. Second-year medical and third-year nursing students took vital signs readings from a patient simulator. In a simulation exercise, three actors, posing as medical students, and one nursing student participant all took a total of three rounds of vital signs on a high-fidelity patient simulator. In the first two rounds the three actors individually stated the same correct vital signs values, and on the third round the three actors individually stated the same incorrect vital sign values. This same procedure was repeated with actors posing as nursing students, and one medical student. A two-way analysis of variance (ANOVA) revealed that nursing student participants (M = 2.84; SD = 1.24) reported a higher number of incorrect vital signs than did medical student participants (M = 2.13; SD = 1.07), F (1,100) = 5.51, p = 0.021 (Cohen's d = 0.61). The study indicated that social pressure may prevent nursing students from questioning incorrect information within interprofessional environments, potentially affecting quality of care.

Detecting Vital Signs with Wearable Wireless Sensors

PubMed Central

Yilmaz, Tuba; Foster, Robert; Hao, Yang

2010-01-01

The emergence of wireless technologies and advancements in on-body sensor design can enable change in the conventional health-care system, replacing it with wearable health-care systems, centred on the individual. Wearable monitoring systems can provide continuous physiological data, as well as better information regarding the general health of individuals. Thus, such vital-sign monitoring systems will reduce health-care costs by disease prevention and enhance the quality of life with disease management. In this paper, recent progress in non-invasive monitoring technologies for chronic disease management is reviewed. In particular, devices and techniques for monitoring blood pressure, blood glucose levels, cardiac activity and respiratory activity are discussed; in addition, on-body propagation issues for multiple sensors are presented. PMID:22163501

Task Shifting: The Use of Laypersons for Acquisition of Vital Signs Data for Clinical Decision Making in the Emergency Room Following Traumatic Injury.

PubMed

Haac, Bryce E; Gallaher, Jared R; Mabedi, Charles; Geyer, Andrew J; Charles, Anthony G

2017-12-01

In resource-limited settings, identification of successful and sustainable task-shifting interventions is important for improving care. To determine whether the training of lay people to take vital signs as trauma clerks is an effective and sustainable method to increase availability of vital signs in the initial evaluation of trauma patients. We conducted a quasi-experimental study of patients presenting with traumatic injury pre- and post-intervention. The study was conducted at Kamuzu Central Hospital, a tertiary care referral hospital, in Lilongwe, Malawi. All adult (age ≥ 18 years) trauma patients presenting to emergency department over a six-month period from January to June prior to intervention (2011), immediately post-intervention (2012), 1 year post-intervention (2013) and 2 years post-intervention (2014). Lay people were trained to take and record vital signs. The number of patients with recorded vital signs pre- and post-intervention and sustainability of the intervention as determined by time-series analysis. Availability of vital signs on initial evaluation of trauma patients increased significantly post-intervention. The percentage of patients with at least one vital sign recorded increased from 23.5 to 92.1%, and the percentage of patients with all vital signs recorded increased from 4.1 to 91.4%. Availability of Glasgow Coma Scale also increased from 40.3 to 88.6%. Increased documentation of vital signs continued at 1 year and 2 years post-intervention. However, the percentage of documented vital signs did decrease slightly after the US-trained medical student and surgeon who trained the trauma clerks were no longer available in country, except for Glasgow Coma Scale. Patients who died during emergency department evaluation were significantly less likely to have vital signs recorded. The training of lay people to collect vital signs and Glasgow Coma Scale is an effective and sustainable method of task shifting in a resource-limited setting.

Muscle Oxygen Saturation Improves Diagnostic Association Between Initial Vital Signs and Major Hemorrhage: A Prospective Observational Study.

PubMed

Reisner, Andrew T; Edla, Shwetha; Liu, Jianbo; Rubin, John T; Thorsen, Jill E; Kittell, Erin; Smith, Jason B; Yeh, Daniel D; Reifman, Jaques

2016-03-01

During initial assessment of trauma patients, vital signs do not identify all patients with life-threatening hemorrhage. We hypothesized that a novel vital sign, muscle oxygen saturation (SmO2 ), could provide independent diagnostic information beyond routine vital signs for identification of hemorrhaging patients who require packed red blood cell (RBC) transfusion. This was an observational study of adult trauma patients treated at a Level I trauma center. Study staff placed the CareGuide 1100 tissue oximeter (Reflectance Medical Inc., Westborough, MA), and we analyzed average values of SmO2 , systolic blood pressure (sBP), pulse pressure (PP), and heart rate (HR) during 10 minutes of early emergency department evaluation. We excluded subjects without a full set of vital signs during the observation interval. The study outcome was hemorrhagic injury and RBC transfusion ≥ 3 units in 24 hours (24-hr RBC ≥ 3). To test the hypothesis that SmO2 added independent information beyond routine vital signs, we developed one logistic regression model with HR, sBP, and PP and one with SmO2 in addition to HR, sBP, and PP and compared their areas under receiver operating characteristic curves (ROC AUCs) using DeLong's test. We enrolled 487 subjects; 23 received 24-hr RBC ≥ 3. Compared to the model without SmO2 , the regression model with SmO2 had a significantly increased ROC AUC for the prediction of ≥ 3 units of 24-hr RBC volume, 0.85 (95% confidence interval [CI], 0.75-0.91) versus 0.77 (95% CI, 0.66-0.86; p < 0.05 per DeLong's test). Results were similar for ROC AUCs predicting patients (n = 11) receiving 24-hr RBC ≥ 9. SmO2 significantly improved the diagnostic association between initial vital signs and hemorrhagic injury with blood transfusion. This parameter may enhance the early identification of patients who require blood products for life-threatening hemorrhage. © 2016 The Authors. Academic Emergency Medicine published by Wiley Periodicals, Inc. on behalf

A Non-Invasive Multichannel Hybrid Fiber-Optic Sensor System for Vital Sign Monitoring

PubMed Central

Fajkus, Marcel; Nedoma, Jan; Martinek, Radek; Vasinek, Vladimir; Nazeran, Homer; Siska, Petr

2017-01-01

In this article, we briefly describe the design, construction, and functional verification of a hybrid multichannel fiber-optic sensor system for basic vital sign monitoring. This sensor uses a novel non-invasive measurement probe based on the fiber Bragg grating (FBG). The probe is composed of two FBGs encapsulated inside a polydimethylsiloxane polymer (PDMS). The PDMS is non-reactive to human skin and resistant to electromagnetic waves, UV absorption, and radiation. We emphasize the construction of the probe to be specifically used for basic vital sign monitoring such as body temperature, respiratory rate and heart rate. The proposed sensor system can continuously process incoming signals from up to 128 individuals. We first present the overall design of this novel multichannel sensor and then elaborate on how it has the potential to simplify vital sign monitoring and consequently improve the comfort level of patients in long-term health care facilities, hospitals and clinics. The reference ECG signal was acquired with the use of standard gel electrodes fixed to the monitored person’s chest using a real-time monitoring system for ECG signals with virtual instrumentation. The outcomes of these experiments have unambiguously proved the functionality of the sensor system and will be used to inform our future research in this fast developing and emerging field. PMID:28075341

Continuous non-contact vital sign monitoring in neonatal intensive care unit

PubMed Central

Guazzi, Alessandro; Jorge, João; Davis, Sara; Watkinson, Peter; Green, Gabrielle; Shenvi, Asha; McCormick, Kenny; Tarassenko, Lionel

2014-01-01

Current technologies to allow continuous monitoring of vital signs in pre-term infants in the hospital require adhesive electrodes or sensors to be in direct contact with the patient. These can cause stress, pain, and also damage the fragile skin of the infants. It has been established previously that the colour and volume changes in superficial blood vessels during the cardiac cycle can be measured using a digital video camera and ambient light, making it possible to obtain estimates of heart rate or breathing rate. Most of the papers in the literature on non-contact vital sign monitoring report results on adult healthy human volunteers in controlled environments for short periods of time. The authors' current clinical study involves the continuous monitoring of pre-term infants, for at least four consecutive days each, in the high-dependency care area of the Neonatal Intensive Care Unit (NICU) at the John Radcliffe Hospital in Oxford. The authors have further developed their video-based, non-contact monitoring methods to obtain continuous estimates of heart rate, respiratory rate and oxygen saturation for infants nursed in incubators. In this Letter, it is shown that continuous estimates of these three parameters can be computed with an accuracy which is clinically useful. During stable sections with minimal infant motion, the mean absolute error between the camera-derived estimates of heart rate and the reference value derived from the ECG is similar to the mean absolute error between the ECG-derived value and the heart rate value from a pulse oximeter. Continuous non-contact vital sign monitoring in the NICU using ambient light is feasible, and the authors have shown that clinically important events such as a bradycardia accompanied by a major desaturation can be identified with their algorithms for processing the video signal. PMID:26609384

Continuous non-contact vital sign monitoring in neonatal intensive care unit.

PubMed

Villarroel, Mauricio; Guazzi, Alessandro; Jorge, João; Davis, Sara; Watkinson, Peter; Green, Gabrielle; Shenvi, Asha; McCormick, Kenny; Tarassenko, Lionel

2014-09-01

Current technologies to allow continuous monitoring of vital signs in pre-term infants in the hospital require adhesive electrodes or sensors to be in direct contact with the patient. These can cause stress, pain, and also damage the fragile skin of the infants. It has been established previously that the colour and volume changes in superficial blood vessels during the cardiac cycle can be measured using a digital video camera and ambient light, making it possible to obtain estimates of heart rate or breathing rate. Most of the papers in the literature on non-contact vital sign monitoring report results on adult healthy human volunteers in controlled environments for short periods of time. The authors' current clinical study involves the continuous monitoring of pre-term infants, for at least four consecutive days each, in the high-dependency care area of the Neonatal Intensive Care Unit (NICU) at the John Radcliffe Hospital in Oxford. The authors have further developed their video-based, non-contact monitoring methods to obtain continuous estimates of heart rate, respiratory rate and oxygen saturation for infants nursed in incubators. In this Letter, it is shown that continuous estimates of these three parameters can be computed with an accuracy which is clinically useful. During stable sections with minimal infant motion, the mean absolute error between the camera-derived estimates of heart rate and the reference value derived from the ECG is similar to the mean absolute error between the ECG-derived value and the heart rate value from a pulse oximeter. Continuous non-contact vital sign monitoring in the NICU using ambient light is feasible, and the authors have shown that clinically important events such as a bradycardia accompanied by a major desaturation can be identified with their algorithms for processing the video signal.

A flexible system for vital signs monitoring in hospital general care wards based on the integration of UNIX-based workstations, standard networks and portable vital signs monitors.

PubMed Central

Welch, J. P.; Sims, N.; Ford-Carlton, P.; Moon, J. B.; West, K.; Honore, G.; Colquitt, N.

1991-01-01

The article describes a study conducted on general surgical and thoracic surgical floors of a 1000-bed hospital to assess the impact of a new network for portable patient care devices. This network was developed to address the needs of hospital patients who need constant, multi-parameter, vital signs surveillance, but do not require intensive nursing care. Bedside wall jacks were linked to UNIX-based workstations using standard digital network hardware, creating a flexible system (for general care floors of the hospital) that allowed the number of monitored locations to increase and decrease as patient census and acuity levels varied. It also allowed the general care floors to provide immediate, centralized vital signs monitoring for patients who unexpectedly became unstable, and permitted portable monitors to travel with patients as they were transferred between hospital departments. A disk-based log within the workstation automatically collected performance data, including patient demographics, monitor alarms, and network status for analysis. The log has allowed the developers to evaluate the use and performance of the system. PMID:1807720

A flexible system for vital signs monitoring in hospital general care wards based on the integration of UNIX-based workstations, standard networks and portable vital signs monitors.

PubMed

Welch, J P; Sims, N; Ford-Carlton, P; Moon, J B; West, K; Honore, G; Colquitt, N

1991-01-01

The article describes a study conducted on general surgical and thoracic surgical floors of a 1000-bed hospital to assess the impact of a new network for portable patient care devices. This network was developed to address the needs of hospital patients who need constant, multi-parameter, vital signs surveillance, but do not require intensive nursing care. Bedside wall jacks were linked to UNIX-based workstations using standard digital network hardware, creating a flexible system (for general care floors of the hospital) that allowed the number of monitored locations to increase and decrease as patient census and acuity levels varied. It also allowed the general care floors to provide immediate, centralized vital signs monitoring for patients who unexpectedly became unstable, and permitted portable monitors to travel with patients as they were transferred between hospital departments. A disk-based log within the workstation automatically collected performance data, including patient demographics, monitor alarms, and network status for analysis. The log has allowed the developers to evaluate the use and performance of the system.

How well do vital signs identify children with serious infections in paediatric emergency care?

PubMed

Thompson, M; Coad, N; Harnden, A; Mayon-White, R; Perera, R; Mant, D

2009-11-01

To determine whether vital signs identify children with serious infections, and to compare their diagnostic value with that of the Manchester triage score (MTS) and National Institute for Health and Clinical Excellence (NICE) traffic light system of clinical risk factors. Prospective cohort of children presenting with suspected acute infection. We recorded vital signs, level of consciousness, activity level, respiratory distress, hydration and MTS category. Paediatric assessment unit at a teaching hospital in England. 700 children (median age 3 years), of whom 357 (51.0%) were referred from primary care, 198 (28.3%) self-referrals and 116 (16.6%) emergency ambulance transfers. Just over half (383 or 54.7%) were admitted. Severity of infection categorised as serious, intermediate, minor or not infection. Children with serious or intermediate infections (n = 313) were significantly more likely than those with minor or no infection (n = 387) to have a temperature >or=39 degrees C, tachycardia, saturations 2 seconds. Having one or more of temperature >or=39 degrees C, saturations vital signs can be used to differentiate children with serious infections from those with less serious infections in a paediatric assessment unit and has comparable sensitivity to more complicated triage systems. The diagnostic value of combined vital signs and the NICE traffic light system remains to be determined in populations where the prevalence of severe illness is much lower.

Non-Contact Sensor for Long-Term Continuous Vital Signs Monitoring: A Review on Intelligent Phased-Array Doppler Sensor Design

PubMed Central

Hall, Travis; Nguyen, Tam Q.; Mayeda, Jill C.; Lie, Paul E.; Lopez, Jerry; Banister, Ron E.

2017-01-01

It has been the dream of many scientists and engineers to realize a non-contact remote sensing system that can perform continuous, accurate and long-term monitoring of human vital signs as we have seen in many Sci-Fi movies. Having an intelligible sensor system that can measure and record key vital signs (such as heart rates and respiration rates) remotely and continuously without touching the patients, for example, can be an invaluable tool for physicians who need to make rapid life-and-death decisions. Such a sensor system can also effectively help physicians and patients making better informed decisions when patients’ long-term vital signs data is available. Therefore, there has been a lot of research activities on developing a non-contact sensor system that can monitor a patient’s vital signs and quickly transmit the information to healthcare professionals. Doppler-based radio-frequency (RF) non-contact vital signs (NCVS) monitoring system are particularly attractive for long term vital signs monitoring because there are no wires, electrodes, wearable devices, nor any contact-based sensors involved so the subjects may not be even aware of the ubiquitous monitoring. In this paper, we will provide a brief review on some latest development on NCVS sensors and compare them against a few novel and intelligent phased-array Doppler-based RF NCVS biosensors we have built in our labs. Some of our NCVS sensor tests were performed within a clutter-free anechoic chamber to mitigate the environmental clutters, while most tests were conducted within the typical Herman-Miller type office cubicle setting to mimic a more practical monitoring environment. Additionally, we will show the measurement data to demonstrate the feasibility of long-term NCVS monitoring. The measured data strongly suggests that our latest phased array NCVS system should be able to perform long-term vital signs monitoring intelligently and robustly, especially for situations where the subject is

Non-Contact Sensor for Long-Term Continuous Vital Signs Monitoring: A Review on Intelligent Phased-Array Doppler Sensor Design.

PubMed

Hall, Travis; Lie, Donald Y C; Nguyen, Tam Q; Mayeda, Jill C; Lie, Paul E; Lopez, Jerry; Banister, Ron E

2017-11-15

It has been the dream of many scientists and engineers to realize a non-contact remote sensing system that can perform continuous, accurate and long-term monitoring of human vital signs as we have seen in many Sci-Fi movies. Having an intelligible sensor system that can measure and record key vital signs (such as heart rates and respiration rates) remotely and continuously without touching the patients, for example, can be an invaluable tool for physicians who need to make rapid life-and-death decisions. Such a sensor system can also effectively help physicians and patients making better informed decisions when patients' long-term vital signs data is available. Therefore, there has been a lot of research activities on developing a non-contact sensor system that can monitor a patient's vital signs and quickly transmit the information to healthcare professionals. Doppler-based radio-frequency (RF) non-contact vital signs (NCVS) monitoring system are particularly attractive for long term vital signs monitoring because there are no wires, electrodes, wearable devices, nor any contact-based sensors involved so the subjects may not be even aware of the ubiquitous monitoring. In this paper, we will provide a brief review on some latest development on NCVS sensors and compare them against a few novel and intelligent phased-array Doppler-based RF NCVS biosensors we have built in our labs. Some of our NCVS sensor tests were performed within a clutter-free anechoic chamber to mitigate the environmental clutters, while most tests were conducted within the typical Herman-Miller type office cubicle setting to mimic a more practical monitoring environment. Additionally, we will show the measurement data to demonstrate the feasibility of long-term NCVS monitoring. The measured data strongly suggests that our latest phased array NCVS system should be able to perform long-term vital signs monitoring intelligently and robustly, especially for situations where the subject is sleeping

Psychosocial vital signs: using simulation to introduce a new concept.

PubMed

Spade, Charlotte M

2008-01-01

Psychosocial vital signs (PVS) is a tool used for defining and measuring essential psychosocial variables of health. Because nurse-patient interaction is basic to PVS, simulation is the methodology used for introducing this new concept to students. When learning PVS as a fundamental nursing skill, students' thinking is informed and guided toward a holistic view of their patients. The author discusses components of PVS and the curriculum used for teaching students how to use PVS.

Medical Device Integrated Vital Signs Monitoring Application with Real-Time Clinical Decision Support.

PubMed

Moqeem, Aasia; Baig, Mirza; Gholamhosseini, Hamid; Mirza, Farhaan; Lindén, Maria

2018-01-01

This research involves the design and development of a novel Android smartphone application for real-time vital signs monitoring and decision support. The proposed application integrates market available, wireless and Bluetooth connected medical devices for collecting vital signs. The medical device data collected by the app includes heart rate, oxygen saturation and electrocardiograph (ECG). The collated data is streamed/displayed on the smartphone in real-time. This application was designed by adopting six screens approach (6S) mobile development framework and focused on user-centered approach and considered clinicians-as-a-user. The clinical engagement, consultations, feedback and usability of the application in the everyday practices were considered critical from the initial phase of the design and development. Furthermore, the proposed application is capable to deliver rich clinical decision support in real-time using the integrated medical device data.

Effect of Inhalation of Lavender Essential Oil on Vital Signs in Open Heart Surgery ICU.

PubMed

Salamati, Armaiti; Mashouf, Soheyla; Mojab, Faraz

2017-01-01

This study evaluated the effects of inhalation of Lavender essential oil on vital signs in open heart surgery ICU. The main complaint of patients after open-heart surgery is dysrhythmia, tachycardia, and hypertension due to stress and pain. Due to the side effects of chemical drugs, such as opioids, use of non-invasive methods such as aromatherapy for relieving stress and pain parallel to chemical agents could be an important way to decrease the dose and side effects of analgesics. In a multicenter, single-blind trial, 40 patients who had open-heart surgery were recruited. Inclusion criteria were full consciousness, lack of hemorrhage, heart rate >60 beats/min, systolic blood pressure > 100 mmHg, and diastolic blood pressure > 60 mmHg, not using beta blockers in the operating room or ICU, no history of addiction to opioids or use of analgesics in regular, spontaneous breathing ability and not receiving synthetic opioids within 2 h before extubation. Ten minutes after extubation, the patients› vital signs [including BP, HR, Central Venous Pressure (CVP), SPO2, and RR] were measured. Then, a cotton swab, which was impregnated with 2 drops of Lavender essential oil 2%, was placed in patients' oxygen mask and patients breathed for 10 min. Thirty minutes after aromatherapy, the vital signs were measured again. Main objective of this study was the change in vital sign before and after aromatherapy. Statistical significance was accepted for P < 0.05. There was a significant difference in systolic blood pressure (p > 0.001), diastolic blood pressure (p = 0.001), and heart rate (p = 0.03) before and after the intervention using paired t-test. Although, the results did not show any significant difference in respiratory rate (p = 0.1), SpO2 (p = 0.5) and CVP (p = 0.2) before and after inhaling Lavender essential oil. Therefore, the aromatherapy could effectively reduce blood pressure and heart rate in patients admitted to the open heart surgery ICU and can be used as an

Effect of Inhalation of Lavender Essential Oil on Vital Signs in Open Heart Surgery ICU

PubMed Central

Salamati, Armaiti; Mashouf, Soheyla; Mojab, Faraz

2017-01-01

This study evaluated the effects of inhalation of Lavender essential oil on vital signs in open heart surgery ICU. The main complaint of patients after open-heart surgery is dysrhythmia, tachycardia, and hypertension due to stress and pain. Due to the side effects of chemical drugs, such as opioids, use of non-invasive methods such as aromatherapy for relieving stress and pain parallel to chemical agents could be an important way to decrease the dose and side effects of analgesics. In a multicenter, single-blind trial, 40 patients who had open-heart surgery were recruited. Inclusion criteria were full consciousness, lack of hemorrhage, heart rate >60 beats/min, systolic blood pressure > 100 mmHg, and diastolic blood pressure > 60 mmHg, not using beta blockers in the operating room or ICU, no history of addiction to opioids or use of analgesics in regular, spontaneous breathing ability and not receiving synthetic opioids within 2 h before extubation. Ten minutes after extubation, the patients› vital signs [including BP, HR, Central Venous Pressure (CVP), SPO2, and RR] were measured. Then, a cotton swab, which was impregnated with 2 drops of Lavender essential oil 2%, was placed in patients’ oxygen mask and patients breathed for 10 min. Thirty minutes after aromatherapy, the vital signs were measured again. Main objective of this study was the change in vital sign before and after aromatherapy. Statistical significance was accepted for P < 0.05. There was a significant difference in systolic blood pressure (p > 0.001), diastolic blood pressure (p = 0.001), and heart rate (p = 0.03) before and after the intervention using paired t-test. Although, the results did not show any significant difference in respiratory rate (p = 0.1), SpO2 (p = 0.5) and CVP (p = 0.2) before and after inhaling Lavender essential oil. Therefore, the aromatherapy could effectively reduce blood pressure and heart rate in patients admitted to the open heart surgery ICU and can be used as an

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department.

PubMed

Daoust, Raoul; Paquet, Jean; Bailey, Benoit; Lavigne, Gilles; Piette, Éric; Sanogo, Karine; Chauny, Jean-Marc

2016-01-01

This study aimed to ascertain the association between self-reported pain intensity and vital signs in both emergency department (ED) patients and a subgroup of patients with diagnosed conditions known to produce significant pain. We performed a retrospective analysis of real-time, archived data from an electronic medical record system at an urban teaching hospital and regional community hospital. We included consecutive ED patients ≥16 years old who had a self-reported pain intensity ≥1 as measured during triage, from March 2005 to December 2012. The primary outcome was vital signs for self-reported pain intensity levels (mild, moderate, severe) on an 11-point verbal numerical scale. Changes in pain intensity levels were also compared to variations in vital signs. Both analyses were repeated on a subgroup of patients with diagnosed conditions recognized to produce significant pain: fracture, dislocation, or renal colic. We included 153,567 patients (mean age of 48.4±19.3 years; 55.5% women) triaged with pain (median intensity of 7/10±3). Of these, 8.9% of patients had diagnosed conditions recognized to produce significant pain. From the total sample, the difference between mild and severe pain categories was 2.7 beats/minutes (95% CI: 2.4-3.0) for heart rate and 0.13 mm Hg (95% CI: -0.26-0.52) for systolic blood pressure. These differences generated small effect sizes and were not clinically significant. Results were similar for patients who experienced changes in pain categories and for those conditions recognized to produce significant pain. Health care professionals cannot use vital signs to estimate or substantiate self-reported pain intensity levels or changes over time.

Abnormal ranges of vital signs in children in Japanese prehospital settings.

PubMed

Nosaka, Nobuyuki; Muguruma, Takashi; Knaup, Emily; Tsukahara, Kohei; Enomoto, Yuki; Kaku, Noriyuki

2015-10-01

The revised Fire Service Law obliges each prefectural government in Japan to establish a prehospital acuity scale. The Foundation for Ambulance Service Development (FASD) created an acuity scale for use as a reference. Our preliminary survey revealed that 32 of 47 prefectures directly applied the FASD scale for children. This scale shows abnormal ranges of heart rate and respiratory rate in young children. This study aimed to evaluate the validity of the abnormal ranges on the FASD scale to assess its overall performance for triage purposes in paediatric patients. We evaluated the validity of the ranges by comparing published centile charts for these vital signs with records of 1,296 ambulance patients. A large portion of the abnormal ranges on the scale substantially overlapped with the normal centile charts. Triage decisions using the FASD scale of vital signs properly classified 22% ( n  = 287) of children. The sensitivity and specificity for high urgency were as high as 91% (95% confidence interval, 82-96%) and as low as 18% (95% confidence interval, 16-20%). We found there is room for improvement of the abnormal ranges on the FASD scale.

Measuring Adult Literacy in Health Care: Performance of the Newest Vital Sign

ERIC Educational Resources Information Center

Osborn, Chandra Y.; Weiss, Barry D.; Davis, Terry C.; Skripkauskas, Silvia; Rodrigue, Christopher; Bass, Pat F., III; Wolf, Michael S.

2007-01-01

Objective: To compare performance of the newest vital sign (NVS) with existing literacy measures. Methods: We administered the NVS and REALM to 129 patients, and NVS and S-TOFHLA to 119 patients all in public clinics. Results: The NVS demonstrated high sensitivity for detecting limited literacy and moderate specificity (area under the receiver…

Speckle POF sensor for detecting vital signs of patients

NASA Astrophysics Data System (ADS)

Lomer, M.; Rodriguez-Cobo, L.; Revilla, P.; Herrero, G.; Madruga, F.; Lopez-Higuera, J. M.

2014-05-01

In this work, both arterial pulse and respiratory rate have been successfully measured based on changes in speckle patterns of multimode fibers. Using two fiber-based transducers, one located on the wrist and another in the chest, both disturbances were transmitted to the fiber, varying the speckle pattern. These variations of the speckle pattern were captured using a commercial webcam and further processed using different methods. The achieved results have been presented and the simultaneous monitoring of both vital signs has been also discussed. The feasibility to use the proposed sensor system for this application is demonstrated.

Whole body massage for reducing anxiety and stabilizing vital signs of patients in cardiac care unit

PubMed Central

Adib-Hajbaghery, Mohsen; Abasi, Ali; Rajabi-Beheshtabad, Rahman

2014-01-01

Background: Patients admitted in coronary care units face various stressors. Ambiguity of future life conditions and unawareness of caring methods intensifies the patients’ anxiety and stress. This study was conducted to assess the effects of whole body massage on anxiety and vital signs of patients with acute coronary disorders. Methods: A randomized controlled trial was conducted on 120 patients. Patients were randomly allocated into two groups. The intervention group received a session of whole body massage and the control group received routine care. The levels of State, Trait and overall anxiety and vital signs were assessed in both groups before and after intervention. Independent sample t-test, paired t-test, Chi-square and Fischer exact tests were used for data analysis. Results: The baseline overall mean score of anxiety was 79.43±29.34 in the intervention group and was decreased to 50.38±20.35 after massage therapy (p=0.001). However, no significant changes were occurred in the overall mean anxiety in the control group during the study. The baseline diastolic blood pressure was 77.05±8.12 mmHg and was decreased to 72.18±9.19 mmHg after the intervention (p=0.004). Also, significant decreases were occurred in heart rate and respiration rate of intervention group after massage therapy (p=0.001). However, no significant changes were occurred in vital signs of the control group during the study. Conclusion: The results suggest that whole body massage was effective in reducing anxiety and stabilizing vital signs of patients with acute coronary disorders. PMID:25405113

A data protection scheme for a remote vital signs monitoring healthcare service.

PubMed

Gritzalis, D; Lambrinoudakis, C

2000-01-01

Personal and medical data processed by Healthcare Information Systems must be protected against unauthorized access, modification and withholding. Security measures should be selected to provide the required level of protection in a cost-efficient manner. This is only feasible if specific characteristics of the information system are examined on a basis of a risk analysis methodology. This paper presents the results of a risk analysis, based on the CRAMM methodology, for a healthcare organization offering a patient home-monitoring service through the transmission of vital signs, focusing on the identified security needs and the proposed countermeasures. The architectural and functional models of this service were utilized for identifying and valuating the system assets, the associated threats and vulnerabilities, as well as for assessing the impact on the patients and on the service provider, should the security of any of these assets is affected. A set of adequate organizational, administrative and technical countermeasures is described for the remote vital signs monitoring service, thus providing the healthcare organization with a data protection framework that can be utilized for the development of its own security plan.

Availability and performance of image/video-based vital signs monitoring methods: a systematic review protocol.

PubMed

Harford, Mirae; Catherall, Jacqueline; Gerry, Stephen; Young, Duncan; Watkinson, Peter

2017-10-25

For many vital signs, monitoring methods require contact with the patient and/or are invasive in nature. There is increasing interest in developing still and video image-guided monitoring methods that are non-contact and non-invasive. We will undertake a systematic review of still and video image-based monitoring methods. We will perform searches in multiple databases which include MEDLINE, Embase, CINAHL, Cochrane library, IEEE Xplore and ACM Digital Library. We will use OpenGrey and Google searches to access unpublished or commercial data. We will not use language or publication date restrictions. The primary goal is to summarise current image-based vital signs monitoring methods, limited to heart rate, respiratory rate, oxygen saturations and blood pressure. Of particular interest will be the effectiveness of image-based methods compared to reference devices. Other outcomes of interest include the quality of the method comparison studies with respect to published reporting guidelines, any limitations of non-contact non-invasive technology and application in different populations. To the best of our knowledge, this is the first systematic review of image-based non-contact methods of vital signs monitoring. Synthesis of currently available technology will facilitate future research in this highly topical area. PROSPERO CRD42016029167.

Millimeter-wave radar for vital signs sensing

NASA Astrophysics Data System (ADS)

Petkie, Douglas T.; Benton, Carla; Bryan, Erik

2009-05-01

In this paper, we will describe the development of a 228 GHz heterodyne radar system as a vital signs sensing monitor that can remotely measure respiration and heart rates from distances of 1 to 50 meters. We will discuss the design of the radar system along with several studies of its performance. The system includes the 228 GHz transmitter and heterodyne receiver that are optically coupled to the same 6 inch optical mirror that is used to illuminate the subject under study. Intermediate Frequency (IF) signal processing allows the system to track the phase of the reflected signal through I and Q detection and phase unwrapping. The system monitors the displacement in real time, allowing various studies of its performance to be made. We will review its successes by comparing the measured rates with a wireless health monitor and also describe the challenges of the system.

Social Media as a New Vital Sign: Commentary

PubMed Central

2018-01-01

Mobile technologies, such as wireless glucometers and mobile health apps, are increasingly being integrated into health and medical care. Because patients openly share real-time information about their health behaviors and outcomes on social media, social media data may also be used as a tool for monitoring patient care. This commentary describes how recent advances in computer science, psychology, and medicine enable social media data to become a new health “vital sign,” as well as actionable steps that public health officials, health systems, and clinics can take to integrate social data into both public and population health as well as into individual patient care. Barriers that first need to be addressed, including privacy concerns, legal and ethical responsibilities, and infrastructure support, are discussed. PMID:29712631

The effect of the quality of vital sign recording on clinical decision making in a regional acute care trauma ward.

PubMed

Keene, Claire M; Kong, Victor Y; Clarke, Damian L; Brysiewicz, Petra

2017-10-01

Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score (MEWS) uses vital signs to categorise the severity of a patient's physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making. Vital signs recorded by the nursing staff of all trauma patients in the acute care trauma wards at a regional hospital in South Africa were collected from January 2013 to February 2013. Investigator-measured values taken within 2 hours of the routine observations and baseline patient information were also recorded. A MEWS for each patient was calculated from the routine and investigator-measured observations. Basic descriptive statistics were performed using EXCEL. The details of 181 newly admitted patients were collected. Completion of recordings was 81% for heart rate, 88% for respiratory rate, 98% for blood pressure, 92% for temperature and 41% for GCS. The recorded heart rate was positively correlated with the investigator's measurement (Pearson's correlation coefficient of 0.76); while the respiratory rate did not correlate (Pearson's correlation coefficient of 0.02). In 59% of patients the recorded respiratory rate (RR) was exactly 20 breaths per minute and 27% had a recorded RR of exactly 15. Seven percent of patients had aberrant Glasgow Coma Scale readings above the maximum value of 15. The average MEWS was 2 for both the recorded (MEWS(R)) and investigator (MEWS(I)) vitals, with the range of MEWS(R) 0-7 and MEWS(I) 0-9. Analysis showed 59% of the MEWS(R) underestimated the physiological derangement (scores were lower than the MEWS

[Development and evaluation of a vital signs e-book for undergraduate student nurses].

PubMed

Ko, Il-Sun; Kang, Kyu-Sook; Shim, Joung-Ohn; Park, Jin-Hee; Yook, Shin-Young; Yun, So-Young

2005-10-01

The purpose of this study was to develop a vital signs e-book for undergraduate student nurses and evaluate the content, system and student satisfaction. This study was done in three stages, the development of a vital signs e-book, implementation and evaluation. The subjects were 73 undergraduate student nurses in Y university. Thirty one learning objectives were used to create the contents. A set of 5 chapters and 18 subsections were defined after validation from nurse educators. The e-book is available at http://123.134.207.23/ebook/vitalsigns. Analysis of the questionnaires showed a mean score for content, system and students satisfaction of 3.17 +/- .73, 3.11 +/-.79, and 2.96 +/-.74 respectively out of a possible 4 points. Nurse educators should provide quality and effective web-based courses that meet undergraduate student nurses' learning needs and they should incorporate web-based learning into traditional teaching to meet the demands of nursing education.

Monitoring Ecological Resources within U.S. National Parks: Developing "Vital Signs" of Ecological Integrity for the Northeast Temperate Network

Treesearch

Don Faber-Langendoen; Geraldine Tierney; James Gibbs; Greg Shriver; Fred Dieffenbach; Pam Lombard

2006-01-01

The National Park Service (NPS) initiated a new “Vital Signs” program in 1998 to develop comprehensive, long-term monitoring of ecological resources within U.S. national parks. Vital signs (VS) are indicators, and are defined as key elements, processes or features of the environment that can be measured or estimated and that indicate the ecological integrity of an...

Safety Profile and Effects of Pulsed Methylprednisolone on Vital Signs in Thyroid Eye Disease.

PubMed

Yong, Kai-Ling; Chng, Chiaw Ling; Htoon, Hla Myint; Lim, Lee Hooi; Seah, Lay Leng

2015-01-01

Objective. To analyze changes in vital signs (heart rate (HR), systolic (SBP), and diastolic blood pressure (DBP)) during and after intravenous methylprednisolone (IVMP) and any other adverse effects. Methods. Retrospective review of charts of patients who received IVMP as treatment regime for thyroid eye disease. All subjects had vital signs charted during and after infusions. Results. This study included 38 subjects and a total of 242 infusions administered. IVMP resulted in a small but significant percentage drop in mean SBP at 30 min (p < 0.001) and 60 min (p = 0.03) but no difference at 90 min. There was also small but significant percentage drop in mean DBP and HR (DBP: p < 0.001 for 30 min, p = 0.001 for 60 min, and p = 0.02 for 90 min and HR: p < 0.001 for 30 min, 60 min, and 90 min). There were no cumulative effects on change of blood pressure or HR. There were 6 episodes of bradycardia (2.5%) and 12 episodes of moderate to severe hypertension (5%). No significant cardiovascular or hepatic toxicity was found. Conclusion. IVMP is relatively safe and efficacious. IVMP demonstrated mild and noncumulative effects on vital signs. Severe hypertension may occur in susceptible individuals such as those with underlying hypertension and uncontrolled thyroid dysfunction, whereas bradycardia may be more likely in those on beta-blockers.

Effect of therapeutic Swedish massage on anxiety level and vital signs of Intensive Care Unit patients.

PubMed

Alves da Silva, Tatiana; Stripari Schujmann, Debora; Yamada da Silveira, Leda Tomiko; Caromano, Fátima Aparecida; Fu, Carolina

2017-07-01

To evaluate how Swedish massage affects the level of anxiety and vital signs of Intensive Care Unit (ICU) patients. Quasi-experimental study. ICU patients, 18-50 years old, cooperative, respiratory and hemodynamic stable, not under invasive mechanical ventilation. allergic to massage oil, vascular or orthopedic post-operative, skin lesions, thrombosis, fractures. A 30-min Swedish massage was applied once. arterial pressure, heart rate, respiratory rate, S-STAI questionnaire. Timing of evaluation: pre-massage, immediately post-massage, 30 min post-massage. Comparison: T-test, corrected by Bonferroni method, level of significance of 5%, confidence interval of 95%. 48 patients included, 30 (62.5%) female, mean age 55.46 (15.70) years old. Mean S-STAI pre-massage: 42.51 (9.48); immediately post-massage: 29.34 (6.37); 30 min post-massage: 32.62 (8.56), p < 0.001 for all comparison. Mean vital signs achieved statistical significance between pre-massage and immediately post-massage. Swedish massage reduced anxiety of ICU patients immediately and 30 min post-massage. Vital signs were reduced immediately post-massage. Copyright © 2016 Elsevier Ltd. All rights reserved.

Vital Signs building work-up: The Museum of Anthropology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Millet, M.S.; Erwine, B.

The paper will present the structure and the results of an in depth study of the Museum of Anthropology, designed by Arthur Erickson Architects for the University of British Columbia in Vancouver and completed in 1976. Part of the Vital Signs Curriculum Project created by Cris Benton and administered through the University of California at Berkeley, this analytic project was designed and carried out by a faculty/student team in the Department of Architecture at the University of Washington. The significance of this study is the simultaneous presentation of qualitative and quantitative information about the thermal and luminous environment of thismore » building.« less

Development of a remote vital signs sensor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ladd, M.D.; Pacheco, M.S.; Rivas, R.R.

1997-06-01

This paper describes the work at Sandia National Laboratories to develop sensors that remotely detect unique life-form characteristics, such as breathing patterns or heartbeat patterns. This paper will address the Technical Support Working Group`s (TSWG) objective: to develop a remote vital signs detector which can be used to assess someone`s malevolent intent. The basic concept of operations for the projects, system development issues, and the preliminary results for a radar device currently in-house and the implications for implementation are described. A survey that identified the in-house technology currently being evaluated is reviewed, as well as ideas for other potential technologiesmore » to explore. A radar unit for breathing and heartbeat detection is being tested, and the applicability of infrared technology is being explored. The desire for rapid prototyping is driving the need for off-the-shelf technology. As a conclusion, current status and future directions of the effort are reviewed.« less

[Delirium: The 7th Vital Sign?

PubMed

Prayce, Rita; Quaresma, Filipa; Neto, Isabel Galriça

2018-01-31

Delirium is an acute, transient and fluctuating neuropsychiatric syndrome that is common in medical wards, particularly in the geriatric and palliative care population. We present a brief literature review of the definition, pathophysiology, aetiology, diagnosis, prevention and treatment of delirium and its social and economic impact. Delirium is under-recognized, especially by health professionals, and is associated with higher morbidity, mortality and economic burden. Moreover, the presence of delirium interferes with the evaluation and approach to other symptoms. Furthermore, it causes significant distress in patient's families and health professionals. The best treatment for delirium is prevention which is based on multidisciplinary interventions that addresses the main risk factors. The scientific evidence for the treatment of delirium is scarce. Non-pharmacological approaches are usually the first choice, and includes environmental, behavioural and social strategies. Pharmacological options, mainly antipsychotics, are a second-line treatment used essentially to prevent self harm. The recognition and prevention of delirium are crucial. Health professional education and training, patient clinical monitoring and families support are mandatory. Considering the impact of delirium on patients, relatives, health services and professionals we must be more aware of delirium and, why not, make it the 7th vital sign.

[The Present Implementation Status and Problems of Vital-signs Measurement by Community Pharmacists in Home Medical Care in Osaka].

PubMed

Niki, Kazuyuki; Takemura, Miho; Kitagawa, Kyosuke; Shimizu, Ruka; Takahashi, Yuri; Hatabu, Asuka; Uejima, Etsuko

2018-01-01

　While the community-based integrated care systems are in the process of being structured currently, more and more community pharmacists want to learn physical assessment skills. However, no large-scale survey focusing on present implementation status and problems of physical assessment by community pharmacists has been conducted yet. Osaka has the 2nd highest number of community pharmacies in Japan now, and the population aged ≥65 years will be expected to become the 3rd highest in 2025. Thus, Osaka can become a national leading model case for community pharmacists' activity in future home medical care. Therefore, this study aimed to reveal the present implementation status and problems of physical assessment by community pharmacists in Osaka, especially focusing on vital-signs. The questionnaires were sent to all the 3571 insurance pharmacies belonging to the Osaka Pharmaceutical Association and 871 pharmacies responded. Many pharmacists recognized the necessity for vital-signs measurement by pharmacists in home medical care (81.5% of pharmacies that offered home medical care and 75.4% of pharmacies that did not offer one). However, the proportion of pharmacies that conduct vital-signs measurement in home medical care was 18.7%, therefore, it was suggested that the present problem is "many pharmacists cannot conduct vital-signs measurement, although they think it should be conducted". Moreover, the most common reason for not measuring vital-signs was the lack of instruments, such as stethoscopes and sphygmomanometer (43.2%). This is the latest report with a large-scale sample, thus, it can serve as valuable knowledge in considering what pharmacists do for the future.

A clinical decision-making mechanism for context-aware and patient-specific remote monitoring systems using the correlations of multiple vital signs.

PubMed

Forkan, Abdur Rahim Mohammad; Khalil, Ibrahim

2017-02-01

In home-based context-aware monitoring patient's real-time data of multiple vital signs (e.g. heart rate, blood pressure) are continuously generated from wearable sensors. The changes in such vital parameters are highly correlated. They are also patient-centric and can be either recurrent or can fluctuate. The objective of this study is to develop an intelligent method for personalized monitoring and clinical decision support through early estimation of patient-specific vital sign values, and prediction of anomalies using the interrelation among multiple vital signs. In this paper, multi-label classification algorithms are applied in classifier design to forecast these values and related abnormalities. We proposed a completely new approach of patient-specific vital sign prediction system using their correlations. The developed technique can guide healthcare professionals to make accurate clinical decisions. Moreover, our model can support many patients with various clinical conditions concurrently by utilizing the power of cloud computing technology. The developed method also reduces the rate of false predictions in remote monitoring centres. In the experimental settings, the statistical features and correlations of six vital signs are formulated as multi-label classification problem. Eight multi-label classification algorithms along with three fundamental machine learning algorithms are used and tested on a public dataset of 85 patients. Different multi-label classification evaluation measures such as Hamming score, F1-micro average, and accuracy are used for interpreting the prediction performance of patient-specific situation classifications. We achieved 90-95% Hamming score values across 24 classifier combinations for 85 different patients used in our experiment. The results are compared with single-label classifiers and without considering the correlations among the vitals. The comparisons show that multi-label method is the best technique for this problem

Developing Brain Vital Signs: Initial Framework for Monitoring Brain Function Changes Over Time

PubMed Central

Ghosh Hajra, Sujoy; Liu, Careesa C.; Song, Xiaowei; Fickling, Shaun; Liu, Luke E.; Pawlowski, Gabriela; Jorgensen, Janelle K.; Smith, Aynsley M.; Schnaider-Beeri, Michal; Van Den Broek, Rudi; Rizzotti, Rowena; Fisher, Kirk; D'Arcy, Ryan C. N.

2016-01-01

Clinical assessment of brain function relies heavily on indirect behavior-based tests. Unfortunately, behavior-based assessments are subjective and therefore susceptible to several confounding factors. Event-related brain potentials (ERPs), derived from electroencephalography (EEG), are often used to provide objective, physiological measures of brain function. Historically, ERPs have been characterized extensively within research settings, with limited but growing clinical applications. Over the past 20 years, we have developed clinical ERP applications for the evaluation of functional status following serious injury and/or disease. This work has identified an important gap: the need for a clinically accessible framework to evaluate ERP measures. Crucially, this enables baseline measures before brain dysfunction occurs, and might enable the routine collection of brain function metrics in the future much like blood pressure measures today. Here, we propose such a framework for extracting specific ERPs as potential “brain vital signs.” This framework enabled the translation/transformation of complex ERP data into accessible metrics of brain function for wider clinical utilization. To formalize the framework, three essential ERPs were selected as initial indicators: (1) the auditory N100 (Auditory sensation); (2) the auditory oddball P300 (Basic attention); and (3) the auditory speech processing N400 (Cognitive processing). First step validation was conducted on healthy younger and older adults (age range: 22–82 years). Results confirmed specific ERPs at the individual level (86.81–98.96%), verified predictable age-related differences (P300 latency delays in older adults, p < 0.05), and demonstrated successful linear transformation into the proposed brain vital sign (BVS) framework (basic attention latency sub-component of BVS framework reflects delays in older adults, p < 0.05). The findings represent an initial critical step in developing, extracting, and

The effectiveness of Google GLASS as a vital signs monitor in surgery: A simulation study.

PubMed

Iqbal, Mohammed Husnain; Aydin, Abdullatif; Lowdon, Alexandra; Ahmed, Hamza Ibn; Muir, Gordon H; Khan, M Shamim; Dasgupta, Prokar; Ahmed, Kamran

2016-12-01

To assess the effectiveness of the Google GLASS as a vital signs monitor in a surgical setting and identify potential uses. This prospective, observational and comparative study recruited novice (n = 24), intermediate (n = 8) and expert urologists (n = 5). All candidates performed a procedure on the GreenLight Simulator within a simulated setting using a standard vital signs monitor and then the Google GLASS. The time taken to respond to abnormal vital signs during both sessions was recorded. A quantitative survey was used to assess the usability and acceptability of the Google GLASS surgery. The majority (84%) of participants responded quicker to abnormal signs with the Google GLASS compared to a standard monitor (p = 0.0267). The average simulation score during a standard-monitor and GLASS-session scored to be statistically insignificant (p = 0.253). All parameters of simulation were also similar in both sessions including average sweep speed (p = 0.594), average blood loss (p = 0.761) and average grams vaporised (p = 0.102). Surgical performance between both sessions was similar and not hampered by the use of Google GLASS. Furthermore, 81% of candidates stated the GLASS was comfortable to wear during the procedure. This study has demonstrated that head-mounted displays such as the Google GLASS are potentially useful in surgery to aid patient care without hampering the surgeons view. It is hoped that the innovation and evolution of these devices triggers the potential future application of such devices within the medical field. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Lead-Time Bias and Interhospital Transfer after Injury: Trauma Center Admission Vital Signs Underpredict Mortality in Transferred Trauma Patients.

PubMed

Holena, Daniel N; Wiebe, Douglas J; Carr, Brendan G; Hsu, Jesse Y; Sperry, Jason L; Peitzman, Andrew B; Reilly, Patrick M

2017-03-01

Admission physiology predicts mortality after injury, but may be improved by resuscitation before transfer. This phenomenon, which has been termed lead-time bias, may lead to underprediction of mortality in transferred patients and inaccurate benchmarking in centers receiving large numbers of transfer patients. We sought to determine the impact of using vital signs on arrival at the referring center vs on arrival at the trauma center in mortality prediction models for transferred trauma patients. We performed a retrospective cohort study using a state-wide trauma registry including all patients age 16 years or older, with Abbreviated Injury Scale scores ≥ 3, admitted to level I and II trauma centers in Pennsylvania, from 2011 to 2014. The primary outcomes measure was the risk-adjusted association between mortality and interhospital transfer (IHT) when adjusting for physiology (as measured by Revised Trauma Score [RTS]) using the referring hospital arrival vital signs (model 1) compared with trauma center arrival vital signs (model 2). After adjusting for patient and injury factors, IHT was associated with reduced mortality (odds ratio [OR] 0.85; 95% CI 0.77 to 0.93) using the RTS from trauma center admission, but with increased mortality (OR 1.15; 95% CI 1.05 to 1.27) using RTS from the referring hospital. The greater the number of transfer patients seen by a center, the greater the difference in center-level mortality predicted by the 2 models (β -0.044; 95% CI -0.044 to -0.0043; p ≤ 0.001). Trauma center vital signs underestimate mortality in transfer patients and may lead to incorrect estimates of expected mortality. Where possible, benchmarking efforts should use referring hospital vital signs to risk-adjust IHT patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Social Media as a New Vital Sign: Commentary.

PubMed

Young, Sean D

2018-04-30

Mobile technologies, such as wireless glucometers and mobile health apps, are increasingly being integrated into health and medical care. Because patients openly share real-time information about their health behaviors and outcomes on social media, social media data may also be used as a tool for monitoring patient care. This commentary describes how recent advances in computer science, psychology, and medicine enable social media data to become a new health "vital sign," as well as actionable steps that public health officials, health systems, and clinics can take to integrate social data into both public and population health as well as into individual patient care. Barriers that first need to be addressed, including privacy concerns, legal and ethical responsibilities, and infrastructure support, are discussed. ©Sean D Young. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.04.2018.

The use of spectral skin reflectivity and laser doppler vibrometry data to determine the optimal site and wavelength to collect human vital sign signatures

NASA Astrophysics Data System (ADS)

Byrd, Kenneth A.; Kaur, Balvinder; Hodgkin, Van A.

2012-06-01

The carotid artery has been used extensively by researchers to demonstrate that Laser Doppler Vibrometry (LDV) is capable of exploiting vital sign signatures from cooperative human subjects at stando. Research indicates that, the carotid, although good for cooperative and non-traumatic scenarios, is one of the first vital signs to become absent or irregular when a casualty is hemorrhaging and in progress to circulatory (hypovolemic) shock. In an effort to determine the optimal site and wavelength to measure vital signs off human skin, a human subject data collection was executed whereby 14 subjects had their spectral skin reflectivity and vital signs measured at five collection sites (carotid artery, chest, back, right wrist and left wrist). In this paper, we present our findings on using LDV and re ectivity data to determine the optimal collection site and wavelength that should be used to sense pulse signals from quiet and relatively motionless human subjects at stando. In particular, we correlate maximum levels of re ectivity across the ensemble of 14 subjects with vital sign measurements made with an LDV at two ranges, for two scenarios.

An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care?

PubMed

Ogero, Morris; Ayieko, Philip; Makone, Boniface; Julius, Thomas; Malla, Lucas; Oliwa, Jacquie; Irimu, Grace; English, Mike

2018-06-01

Measurement and correct interpretation of vital signs is part of routine clinical care. Repeated measurement enhances early recognition of deterioration, may help prevent morbidity and mortality and is a standard of care in most countries. To examine documentation of vital signs by clinicians for admissions to paediatric wards in Kenyan hospitals, to describe monitoring frequency by nurses and explore factors influencing frequency. Vital signs information (temperature, respiratory and pulse rate) for the first 48 hours of admission was collected from case records of children admitted with non-surgical conditions to 13 Kenyan county hospitals between September 2013 and April 2016. A mixed effect negative binomial regression model was used to explore whether the severity of illness (indicated by danger signs or severe diagnostic episodes) is associated with increased vital signs observation frequency. We examined 54 800 admission episodes with an overall mortality 6.1%. Nurse to bed ratios were very low (1:10 to 1:41 across hospitals). Admitting clinicians documented all or no vital signs in 57.0% and 8.4% cases respectively. For respiratory and pulse rates there was pronounced even end-digit preference (an indicator of incorrect information) and high frequency recording of specific values ( P  < 0.001) suggesting approximation. Monitoring frequency was explored in 41 738 children. Those with inpatient stays ≥48 hours were expected to have a vital signs count of 18, hospitals varied but most did not achieve this benchmark (median 9, range 2-30). There were clinically small but significant associations between vital signs count and presence of multiple severe illnesses or presence of severe pallor (adjusted relative risk ratio = 1.04, P  < 0.01, 95% confidence interval CI = 1.02-1.06 and 1.05, P  = 0.02, 95% CI = 1.01-1.09, respectively). Data suggest accurate admission measures are sometimes missing especially for pulse and respiratory

An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care?

PubMed Central

Ogero, Morris; Ayieko, Philip; Makone, Boniface; Julius, Thomas; Malla, Lucas; Oliwa, Jacquie; Irimu, Grace; English, Mike

2018-01-01

Background Measurement and correct interpretation of vital signs is part of routine clinical care. Repeated measurement enhances early recognition of deterioration, may help prevent morbidity and mortality and is a standard of care in most countries. Objective To examine documentation of vital signs by clinicians for admissions to paediatric wards in Kenyan hospitals, to describe monitoring frequency by nurses and explore factors influencing frequency. Methods Vital signs information (temperature, respiratory and pulse rate) for the first 48 hours of admission was collected from case records of children admitted with non-surgical conditions to 13 Kenyan county hospitals between September 2013 and April 2016. A mixed effect negative binomial regression model was used to explore whether the severity of illness (indicated by danger signs or severe diagnostic episodes) is associated with increased vital signs observation frequency. Results We examined 54 800 admission episodes with an overall mortality 6.1%. Nurse to bed ratios were very low (1:10 to 1:41 across hospitals). Admitting clinicians documented all or no vital signs in 57.0% and 8.4% cases respectively. For respiratory and pulse rates there was pronounced even end-digit preference (an indicator of incorrect information) and high frequency recording of specific values (P < 0.001) suggesting approximation. Monitoring frequency was explored in 41 738 children. Those with inpatient stays ≥48 hours were expected to have a vital signs count of 18, hospitals varied but most did not achieve this benchmark (median 9, range 2-30). There were clinically small but significant associations between vital signs count and presence of multiple severe illnesses or presence of severe pallor (adjusted relative risk ratio = 1.04, P < 0.01, 95% confidence interval CI = 1.02-1.06 and 1.05, P = 0.02, 95% CI = 1.01-1.09, respectively). Conclusions Data suggest accurate admission measures are sometimes

Internet of Health Things: Toward intelligent vital signs monitoring in hospital wards.

PubMed

da Costa, Cristiano André; Pasluosta, Cristian F; Eskofier, Björn; da Silva, Denise Bandeira; da Rosa Righi, Rodrigo

2018-06-02

Large amounts of patient data are routinely manually collected in hospitals by using standalone medical devices, including vital signs. Such data is sometimes stored in spreadsheets, not forming part of patients' electronic health records, and is therefore difficult for caregivers to combine and analyze. One possible solution to overcome these limitations is the interconnection of medical devices via the Internet using a distributed platform, namely the Internet of Things. This approach allows data from different sources to be combined in order to better diagnose patient health status and identify possible anticipatory actions. This work introduces the concept of the Internet of Health Things (IoHT), focusing on surveying the different approaches that could be applied to gather and combine data on vital signs in hospitals. Common heuristic approaches are considered, such as weighted early warning scoring systems, and the possibility of employing intelligent algorithms is analyzed. As a result, this article proposes possible directions for combining patient data in hospital wards to improve efficiency, allow the optimization of resources, and minimize patient health deterioration. It is concluded that a patient-centered approach is critical, and that the IoHT paradigm will continue to provide more optimal solutions for patient management in hospital wards. Copyright © 2018 Elsevier B.V. All rights reserved.

From a Vital Sign to Vitality: Selling Exercise So Patients Want to Buy It.

PubMed

Segar, Michelle L; Guérin, Eva; Phillips, Edward; Fortier, Michelle

2016-01-01

Exercise is Medicine (EIM) and physical activity as a vital sign are based on health-focused research and reflect ideal frames and messages for clinicians. However, they are nonoptimal for patients because they do not address what drives patients' decision-making and motivation. With the growing national emphasis on patient-centered and value-based care, it is the perfect time for EIM to evolve and advance a second-level consumer-oriented exercise prescription and communication strategy. Through research on decision-making, motivation, consumer behavior, and meaningful goal pursuit, this article features six evidence-based issues to help clinicians make physical activity more relevant and compelling for patients to sustain in ways that concurrently support patient-centered care. Physical activity prescriptions and counseling can evolve to reflect affective and behavioral science and sell exercise so patients want to buy it.

The effect of live classical piano music on the vital signs of patients undergoing ophthalmic surgery.

PubMed

Camara, Jorge G; Ruszkowski, Joseph M; Worak, Sandra R

2008-06-25

Music and surgery. To determine the effect of live classical piano music on vital signs of patients undergoing ophthalmic surgery. Retrospective case series. 203 patients who underwent various ophthalmologic procedures in a period during which a piano was present in the operating room of St. Francis Medical Center. [Note: St. Francis Medical Center has recently been renamed Hawaii Medical Center East.] Demographic data, surgical procedures, and the vital signs of 203 patients who underwent ophthalmic procedures were obtained from patient records. Blood pressure, heart rate, and respiratory rate measured in the preoperative holding area were compared with the same parameters taken in the operating room, with and without exposure to live piano music. A paired t-test was used for statistical analysis. Mean arterial pressure, heart rate, and respiratory rate. 115 patients who were exposed to live piano music showed a statistically significant decrease in mean arterial blood pressure, heart rate, and respiratory rate in the operating room compared with their vital signs measured in the preoperative holding area (P < .0001). The control group of 88 patients not exposed to live piano music showed a statistically significant increase in mean arterial blood pressure (P < .0002) and heart rate and respiratory rate (P < .0001). Live classical piano music lowered the blood pressure, heart rate, and respiratory rate in patients undergoing ophthalmic surgery.

Using Supervised Machine Learning to Classify Real Alerts and Artifact in Online Multisignal Vital Sign Monitoring Data.

PubMed

Chen, Lujie; Dubrawski, Artur; Wang, Donghan; Fiterau, Madalina; Guillame-Bert, Mathieu; Bose, Eliezer; Kaynar, Ata M; Wallace, David J; Guttendorf, Jane; Clermont, Gilles; Pinsky, Michael R; Hravnak, Marilyn

2016-07-01

The use of machine-learning algorithms to classify alerts as real or artifacts in online noninvasive vital sign data streams to reduce alarm fatigue and missed true instability. Observational cohort study. Twenty-four-bed trauma step-down unit. Two thousand one hundred fifty-three patients. Noninvasive vital sign monitoring data (heart rate, respiratory rate, peripheral oximetry) recorded on all admissions at 1/20 Hz, and noninvasive blood pressure less frequently, and partitioned data into training/validation (294 admissions; 22,980 monitoring hours) and test sets (2,057 admissions; 156,177 monitoring hours). Alerts were vital sign deviations beyond stability thresholds. A four-member expert committee annotated a subset of alerts (576 in training/validation set, 397 in test set) as real or artifact selected by active learning, upon which we trained machine-learning algorithms. The best model was evaluated on test set alerts to enact online alert classification over time. The Random Forest model discriminated between real and artifact as the alerts evolved online in the test set with area under the curve performance of 0.79 (95% CI, 0.67-0.93) for peripheral oximetry at the instant the vital sign first crossed threshold and increased to 0.87 (95% CI, 0.71-0.95) at 3 minutes into the alerting period. Blood pressure area under the curve started at 0.77 (95% CI, 0.64-0.95) and increased to 0.87 (95% CI, 0.71-0.98), whereas respiratory rate area under the curve started at 0.85 (95% CI, 0.77-0.95) and increased to 0.97 (95% CI, 0.94-1.00). Heart rate alerts were too few for model development. Machine-learning models can discern clinically relevant peripheral oximetry, blood pressure, and respiratory rate alerts from artifacts in an online monitoring dataset (area under the curve > 0.87).

Community Vital Signs: Taking the Pulse of the Community While Caring for Patients.

PubMed

Hughes, Lauren S; Phillips, Robert L; DeVoe, Jennifer E; Bazemore, Andrew W

2016-01-01

In 2014 both the Institute of Medicine and the National Quality Forum recommended the inclusion of social determinants of health data in electronic health records (EHRs). Both entities primarily focus on collecting socioeconomic and health behavior data directly from individual patients. The burden of reliably, accurately, and consistently collecting such information is substantial, and it may take several years before a primary care team has actionable data available in its EHR. A more reliable and less burdensome approach to integrating clinical and social determinant data exists and is technologically feasible now. Community vital signs-aggregated community-level information about the neighborhoods in which our patients live, learn, work, and play-convey contextual social deprivation and associated chronic disease risks based on where patients live. Given widespread access to "big data" and geospatial technologies, community vital signs can be created by linking aggregated population health data with patient addresses in EHRs. These linked data, once imported into EHRs, are a readily available resource to help primary care practices understand the context in which their patients reside and achieve important health goals at the patient, population, and policy levels. © Copyright 2016 by the American Board of Family Medicine.

Detection of low-volume blood loss: compensatory reserve versus traditional vital signs.

PubMed

Stewart, Camille L; Mulligan, Jane; Grudic, Greg Z; Convertino, Victor A; Moulton, Steven L

2014-12-01

Humans are able to compensate for low-volume blood loss with minimal change in traditional vital signs. We hypothesized that a novel algorithm, which analyzes photoplethysmogram (PPG) wave forms to continuously estimate compensatory reserve would provide greater sensitivity and specificity to detect low-volume blood loss compared with traditional vital signs. The compensatory reserve index (CRI) is a measure of the reserve remaining to compensate for reduced central blood volume, where a CRI of 1 represents supine normovolemia and 0 represents the circulating blood volume at which hemodynamic decompensation occurs; values between 1 and 0 indicate the proportion of reserve remaining. Subjects underwent voluntary donation of 1 U (approximately 450 mL) of blood. Demographic and continuous noninvasive vital sign wave form data were collected, including PPG, heart rate, systolic blood pressure, cardiac output, and stroke volume. PPG wave forms were later processed by the algorithm to estimate CRI values. Data were collected from 244 healthy subjects (79 males and 165 females), with a mean (SD) age of 40.1 (14.2) years and mean (SD) body mass index of 25.6 (4.7). After blood donation, CRI significantly decreased in 92% (α = 0.05; 95% confidence interval [CI], 88-95%) of the subjects. With the use of a threshold decrease in CRI of 0.05 or greater for the detection of 1 U of blood loss, the receiver operating characteristic area under the curve was 0.90, with a sensitivity of 0.84 and specificity of 0.86. In comparison, systolic blood pressure (52%; 95% CI, 45-59%), heart rate (65%; 95% CI, 58-72%), cardiac output (47%; 95% CI, 40-54%), and stroke volume (74%; 95% CI, 67-80%) changed in fewer subjects, had significantly lower receiver operating characteristic area under the curve values, and significantly lower specificities for detecting the same volume of blood loss. Consistent with our hypothesis, CRI detected low-volume blood loss with significantly greater

Vital signs and their cross-correlation in sepsis and NEC: A study of 1065 very low birth weight infants in two NICUs

PubMed Central

Fairchild, Karen D.; Lake, Douglas E.; Kattwinkel, John; Moorman, J. Randall; Bateman, David A; Grieve, Philip G; Isler, Joseph R; Sahni, Rakesh

2016-01-01

Background Subtle changes in vital signs and their interactions occur in preterm infants prior to overt deterioration from late-onset septicemia (LOS) or necrotizing enterocolitis (NEC). Optimizing predictive algorithms may lead to earlier treatment. Methods For 1065 very low birth weight (VLBW) infants in two NICUs, mean, SD, and cross-correlation of respiratory rate, heart rate (HR), and oxygen saturation (SpO2) were analyzed hourly (131 infant-years’ data). Cross-correlation (co-trending) between two vital signs was measured allowing a lag of +/− 30 seconds. Cases of LOS and NEC were identified retrospectively (n=186) and vital sign models were evaluated for ability to predict illness diagnosed in the ensuing 24h. Results The best single illness predictor within and between institutions was cross-correlation of HR-SpO2. The best combined model (mean SpO2, SD HR, and cross correlation of HR-SpO2,) trained at one site with ROC area 0.695 had external ROC area of 0.754 at the other site, and provided additive value to an established HR characteristics index for illness prediction (Net Reclassification Improvement 0.25, 95% CI 0.113, 0.328). Conclusion Despite minor inter-institutional differences in vital sign patterns of VLBW infants, cross-correlation of HR-SpO2 and a 3-variable vital sign model performed well at both centers for preclinical detection of sepsis or NEC. PMID:28001143

Effect of advanced age and vital signs on admission from an ED observation unit.

PubMed

Caterino, Jeffrey M; Hoover, Emily M; Moseley, Mark G

2013-01-01

The primary objective was to determine the relationship between advanced age and need for admission from an emergency department (ED) observation unit. The secondary objective was to determine the relationship between initial ED vital signs and admission. We conducted a prospective, observational cohort study of ED patients placed in an ED-based observation unit. Multivariable penalized maximum likelihood logistic regression was used to identify independent predictors of need for hospital admission. Age was examined continuously and at a cutoff of 65 years or more. Vital signs were examined continuously and at commonly accepted cutoffs.We additionally controlled for demographics, comorbid conditions, laboratory values, and observation protocol. Three hundred patients were enrolled, 12% (n = 35) were 65 years or older, and 11% (n = 33) required admission. Admission rates were 2.9% (95% confidence interval [CI], 0.07%-14.9%) in older adults and 12.1% (95% CI, 8.4%-16.6%) in younger adults. In multivariable analysis, age was not associated with admission (odds ratio [OR], 0.30; 95% CI, 0.05-1.67). Predictors of admission included systolic pressure 180 mm Hg or greater (OR, 4.19; 95% CI, 1.08-16.30), log Charlson comorbidity score (OR, 2.93; 95% CI, 1.57-5.46), and white blood cell count 14,000/mm(3) or greater (OR, 11.35; 95% CI, 3.42-37.72). Among patients placed in an ED observation unit, age 65 years or more is not associated with need for admission. Older adults can successfully be discharged from these units. Systolic pressure 180 mm Hg or greater was the only predictive vital sign. In determining appropriateness of patients selected for an ED observation unit, advanced age should not be an automatic disqualifying criterion. Copyright © 2013 Elsevier Inc. All rights reserved.

The Effect of Live Classical Piano Music on the Vital Signs of Patients Undergoing Ophthalmic Surgery

PubMed Central

Camara, Jorge G.; Ruszkowski, Joseph M.; Worak, Sandra R.

2008-01-01

Context Music and surgery. Objective To determine the effect of live classical piano music on vital signs of patients undergoing ophthalmic surgery. Design Retrospective case series. Setting and Patients 203 patients who underwent various ophthalmologic procedures in a period during which a piano was present in the operating room of St. Francis Medical Center. [Note: St. Francis Medical Center has recently been renamed Hawaii Medical Center East.] Intervention Demographic data, surgical procedures, and the vital signs of 203 patients who underwent ophthalmic procedures were obtained from patient records. Blood pressure, heart rate, and respiratory rate measured in the preoperative holding area were compared with the same parameters taken in the operating room, with and without exposure to live piano music. A paired t-test was used for statistical analysis. Main outcome measure Mean arterial pressure, heart rate, and respiratory rate. Results 115 patients who were exposed to live piano music showed a statistically significant decrease in mean arterial blood pressure, heart rate, and respiratory rate in the operating room compared with their vital signs measured in the preoperative holding area (P < .0001). The control group of 88 patients not exposed to live piano music showed a statistically significant increase in mean arterial blood pressure (P < .0002) and heart rate and respiratory rate (P < .0001). Conclusion Live classical piano music lowered the blood pressure, heart rate, and respiratory rate in patients undergoing ophthalmic surgery. PMID:18679538

The impact of continuous versus intermittent vital signs monitoring in hospitals: A systematic review and narrative synthesis.

PubMed

Downey, C L; Chapman, S; Randell, R; Brown, J M; Jayne, D G

2018-08-01

Continuous vital signs monitoring on general hospital wards may allow earlier detection of patient deterioration and improve patient outcomes. This systematic review will assess if continuous monitoring is practical outside of the critical care setting, and whether it confers any clinical benefit to patients. MEDLINE ® , MEDLINE ® In-Process, EMBASE, CINAHL and The Cochrane Library were searched for articles that evaluated the clinical or non-clinical outcomes of continuous vital signs monitoring in adults outside of the critical care setting. The protocol was registered with PROSPERO (CRD42017058098). Twenty-four studies met the inclusion criteria and reported outcomes on a total of 40,274 patients and 59 ward staff in nine countries. The majority of studies showed benefits in terms of critical care use and length of hospital stay. Larger studies were more likely to demonstrate clinical benefit, particularly critical care use and length of hospital stay. Three studies showed cost-effectiveness. Barriers to implementation included nursing and patient satisfaction and the burden of false alerts. Continuous vital signs monitoring outside the critical care setting is feasible and may provide a benefit in terms of improved patient outcomes and cost efficiency. Large, well-controlled studies in high-risk populations are required to evaluate the clinical benefit of continuous monitoring systems. Copyright © 2018 Elsevier Ltd. All rights reserved.

Attitudes towards vital signs monitoring in the detection of clinical deterioration: scale development and survey of ward nurses.

PubMed

Mok, Wenqi; Wang, Wenru; Cooper, Simon; Ang, Emily Neo Kim; Liaw, Sok Ying

2015-06-01

To develop and determine the psychometrics properties of an instrument (V-scale) and to explore nurses' attitudes towards vital signs monitoring in the detection of clinical deterioration in general wards. Scale development with psychometric testing and a descriptive quantitative survey. Tertiary acute care hospital. A total of 614 general ward nurses. Principal component analysis revealed a 16-item instrument in a five-factor solution (key indicators, knowledge, communication, workload and technology) that explained 56.27% of the variance. The internal consistency was sufficient with Cronbach's alpha of 0.71 and strong item subscale correlations (0.56-0.89). The test-retest reliability was adequate with an Intraclass Correlation Coefficient (ICC) of 0.85. Many nurses (56.9%) erroneously perceived blood pressure changes as the first indicator of deterioration, and 46% agreed that an altered respiratory rate was the least important indicator. Most nurses (59.8%) also reported relying on oxygen saturation to evaluate respiratory dysfunction, and 27.4% indicated that they make quick estimates of the respiratory rate. Current practices for vital signs monitoring were considered to be time consuming (21.0%) and overwhelming (35.3%). Nurses' attitudes were most significantly influenced by whether they had a degree qualification followed by whether they worked in a general ward with a specialty and had >5 years of experience. This exploratory study provides evidence for the psychometric properties of the V-scale. It reveals a need for continuous professional development to improve ward nurses' attitudes towards vital signs monitoring. Vital signs monitoring needs to be prioritized in workload planning. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Vital signs and their cross-correlation in sepsis and NEC: a study of 1,065 very-low-birth-weight infants in two NICUs.

PubMed

Fairchild, Karen D; Lake, Douglas E; Kattwinkel, John; Moorman, J Randall; Bateman, David A; Grieve, Philip G; Isler, Joseph R; Sahni, Rakesh

2017-02-01

Subtle changes in vital signs and their interactions occur in preterm infants prior to overt deterioration from late-onset septicemia (LOS) or necrotizing enterocolitis (NEC). Optimizing predictive algorithms may lead to earlier treatment. For 1,065 very-low-birth-weight (VLBW) infants in two neonatal intensive care units (NICUs), mean, SD, and cross-correlation of respiratory rate, heart rate (HR), and oxygen saturation (SpO 2 ) were analyzed hourly (131 infant-years' data). Cross-correlation (cotrending) between two vital signs was measured allowing a lag of ± 30 s. Cases of LOS and NEC were identified retrospectively (n = 186) and vital sign models were evaluated for ability to predict illness diagnosed in the ensuing 24 h. The best single illness predictor within and between institutions was cross-correlation of HR-SpO 2 . The best combined model (mean SpO 2 , SDHR, and cross-correlation of HR-SpO 2 ,) trained at one site with ROC area 0.695 had external ROC area of 0.754 at the other site, and provided additive value to an established HR characteristics index for illness prediction (Net Reclassification Improvement: 0.205; 95% confidence interval (CI): 0.113, 0.328). Despite minor inter-institutional differences in vital sign patterns of VLBW infants, cross-correlation of HR-SpO 2 and a 3-variable vital sign model performed well at both centers for preclinical detection of sepsis or NEC.

Inpatient-Derived Vital Sign Parameters Implementation: An Initiative to Decrease Alarm Burden.

PubMed

Kipps, Alaina K; Poole, Sarah F; Slaney, Cheryl; Feehan, Shannon; Longhurst, Christopher A; Sharek, Paul J; Goel, Veena V

2017-08-01

To implement data-driven vital sign parameters to reduce bedside monitor alarm burden. Single-center, quality-improvement initiative with historical controls assessing the impact of age-based, inpatient-derived heart rate (HR) and respiratory rate (RR) parameters on a 20-bed acute care ward that serves primarily pediatric cardiology patients. The primary outcome was the number of alarms per monitored bed day (MBD) with the aim to decrease the alarms per MBD. Balancing measures included the frequency of missed rapid response team activations, acute respiratory code events, and cardiorespiratory arrest events in the unit with the new vital sign parameters. The median number of all cardiorespiratory monitor alarms per MBD decreased by 21% from 52 (baseline period) to 41 (postintervention period) ( P < .001). This included a 17% decrease in the median HR alarms (9-7.5 per MBD) and a 53% drop in RR alarms (16.8-8.0 per MBD). There were 57 rapid response team activations, 8 acute respiratory code events, and no cardiorespiratory arrest events after the implementation of the new parameters. An evaluation of HRs and RRs recorded at the time of the event revealed that all patients with HRs and/or RRs out of range per former default parameters would also be out of range with the new parameters. Implementation of data-driven HR and iteratively derived RR parameters safely decreased the total alarm frequency by 21% in a pediatric acute care unit. Copyright © 2017 by the American Academy of Pediatrics.

The effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation.

PubMed

Bousarri, Mitra Payami; Shirvani, Yadolah; Agha-Hassan-Kashani, Saeed; Nasab, Nouredin Mousavi

2014-05-01

In patients undergoing mechanical ventilation, mucus production and secretion is high as a result of the endotracheal tube. Because endotracheal suction in these patients is essential, chest physiotherapy techniques such as expiratory rib cage compression before endotracheal suctioning can be used as a means to facilitate mobilizing and removing airway secretion and improving alveolar ventilation. As one of the complications of mechanical ventilation and endotracheal suctioning is decrease of cardiac output, this study was carried out to determine the effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation. This study was a randomized clinical trial with a crossover design. The study subjects included 50 mechanically ventilated patients, hospitalized in intensive care wards of Valiasr and Mousavi hospitals in Zanjan, Iran. Subjects were selected by consecutive sampling and randomly allocated to groups 1 and 2. The patients received endotracheal suctioning with or without rib cage compression, with a minimum of 3 h interval between the two interventions. Expiratory rib cage compression was performed for 5 min before endotracheal suctioning. Vital signs were measured 5 min before and 15 and 25 min after endotracheal suctioning. Data were recorded on a data recording sheet. Data were analyzed using paired t-tests. There were statistically significant differences in the means of vital signs measured 5 min before with 15 and 25 min after endotracheal suctioning with rib cage compression (P < 0. 01). There was no significant difference in the means of diastolic pressure measured 25 min after with baseline in this stage). But on the reverse mode, there was a significant difference between the means of pulse and respiratory rate 15 min after endotracheal suctioning and the baseline values (P < 0.002). This effect continued up to 25 min after endotracheal suctioning just for respiratory rate (P = 0

Effect of advanced age and vital signs on admission from an emergency department observation unit

PubMed Central

Caterino, Jeffrey M.; Hoover, Emily; Moseley, Mark G.

2012-01-01

Objectives The primary objective was to determine the relationship between advanced age and need for admission from an emergency department (ED) observation unit. The secondary objective was to determine the relationship between initial ED vital signs and admission. Methods We conducted a prospective, observational cohort study of ED patients placed in an ED-based observation unit. Multivariable penalized maximum likelihood logistic regression was used to identify independent predictors of need for hospital admission. Age was examined continuously and at a cutoff of ≥65 years. Vital signs were examined continuously and at commonly accepted cutoffs. We additionally controlled for demographics, co-morbid conditions, laboratory values, and observation protocol. Results Three hundred patients were enrolled, 12% (n=35) ≥65 years old and 11% (n=33) requiring admission. Admission rates were 2.9% (95% confidence interval [CI], 0.07-14.9%) in older adults and 12.1% (95% CI, 8.4-16.6%) in younger adults. In multivariable analysis, age was not associated with admission (odds ratio [OR] 0.30, 95% CI 0.05-1.67). Predictors of admission included: systolic pressure ≥180 mmHg (OR 4.19, 95% CI 1.08-16.30), log Charlson co-morbidity score (OR 2.93, 95% CI 1.57-5.46), and white blood cell count ≥14,000/mm3 (OR11.35, 95% CI 3.42-37.72). Conclusions Among patients placed in an ED observation unit, age ≥65 years is not associated with need for admission. Older adults can successfully be discharged from these units. Systolic pressure≥180 mmHg was the only predictive vital sign. In determining appropriateness of patients selected for an ED observation unit, advanced age should not be an automatic disqualifying criterion. PMID:22386358

A ward-based time study of paper and electronic documentation for recording vital sign observations.

PubMed

Wong, David; Bonnici, Timothy; Knight, Julia; Gerry, Stephen; Turton, James; Watkinson, Peter

2017-07-01

To investigate time differences in recording observations and an early warning score using traditional paper charts and a novel e-Obs system in clinical practice. Researchers observed the process of recording observations and early warning scores across 3 wards in 2 university teaching hospitals immediately before and after introduction of the e-Obs system. The process of recording observations included both measurement and documentation of vital signs. Interruptions were timed and subtracted from the measured process duration. Multilevel modeling was used to compensate for potential confounding factors. In all, 577 nurse events were observed (281 paper, 296 e-Obs). The geometric mean time to take a complete set of vital signs was 215 s (95% confidence interval [CI], 177 s-262 s) on paper, and 150 s (95% CI, 130 s-172 s) electronically. The treatment effect ratio was 0.70 (95% CI, 0.57-0.85, P  < .001). The treatment effect ratio in ward 1 was 0.37 (95% CI, 0.26-0.53), in ward 2 was 0.98 (95% CI, 0.70-1.38), and in ward 3 was 0.93 (95% CI, 0.66-1.33). Introduction of an e-Obs system was associated with a statistically significant reduction in overall time to measure and document vital signs electronically compared to paper documentation. The reductions in time varied among wards and were of clinical significance on only 1 of 3 wards studied. Our results suggest that introduction of an e-Obs system could lower nursing workload as well as increase documentation quality. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

The CRADLE vital signs alert: qualitative evaluation of a novel device designed for use in pregnancy by healthcare workers in low-resource settings.

PubMed

Nathan, Hannah L; Boene, Helena; Munguambe, Khatia; Sevene, Esperança; Akeju, David; Adetoro, Olalekan O; Charanthimath, Umesh; Bellad, Mrutyunjaya B; de Greeff, Annemarie; Anthony, John; Hall, David R; Steyn, Wilhelm; Vidler, Marianne; von Dadelszen, Peter; Chappell, Lucy C; Sandall, Jane; Shennan, Andrew H

2018-01-05

Vital signs measurement can identify pregnant and postpartum women who require urgent treatment or referral. In low-resource settings, healthcare workers have limited access to accurate vital signs measuring devices suitable for their environment and training. The CRADLE Vital Signs Alert (VSA) is a novel device measuring blood pressure and pulse that is accurate in pregnancy and designed for low-resource settings. Its traffic light early warning system alerts healthcare workers to the need for escalation of care for women with hypertension, haemorrhage or sepsis. This study evaluated the usability and acceptability of the CRADLE VSA device. Evaluation was conducted in community and primary care settings in India, Mozambique and Nigeria and tertiary hospitals in South Africa. Purposeful sampling was used to convene 155 interviews and six focus groups with healthcare workers using the device (n = 205) and pregnant women and their family members (n = 41). Interviews and focus groups were conducted in the local language and audio-recorded, transcribed and translated into English for analysis. Thematic analysis was undertaken using an a priori thematic framework, as well as an inductive approach. Most healthcare workers perceived the CRADLE device to be easy to use and accurate. The traffic lights early warning system was unanimously reported positively, giving healthcare workers confidence with decision-making and a sense of professionalism. However, a minority in South Africa described manual inflation as tiring, particularly when measuring vital signs in obese and hypertensive women (n = 4) and a few South African healthcare workers distrusted the device's accuracy (n = 7). Unanimously, pregnant women liked the CRADLE device. The traffic light early warning system gave women and their families a better understanding of the importance of vital signs in pregnancy and during the postpartum period. The CRADLE device was well accepted by healthcare workers

Effects of hammock positioning in behavioral status, vital signs, and pain in preterms: a case series study.

PubMed

Jesus, Valdecira Rodrigues de; Oliveira, Pricila Mara Novais de; Azevedo, Vivian Mara Gonçalves de Oliveira

2018-03-15

The hammock positioning within the incubators simulates the intrauterine environment, however, there is little evidence of its benefits and possible risks. The aim of this study was to assess the effects of hammock positioning on behavioral status, vital signs, and pain in very low birth weight preterm newborns. This is a quasi-experimental/case series study in which premature infants (<1500g) were positioned in supine for one hour in a hammock. The preterm newborns were assessed 10min before, during (2, 20, 40, and 60min), and 10min after hammock positioning with the Brazelton Neonatal Behavioral Assessment Scale, vital signs and pain by the Neonatal Facial Coding System. 28 preterm infants between 28 and 36 weeks of gestational age were evaluated. Regarding the behavioral state, the preterm newborns progressively evolved to light or deep sleep during hammock positioning. There was a statistically significant reduction of the heart and respiratory rate from 2 to 60th minute in a hammock, which was maintained after the positioning. The oxygen saturation remained within normal values. No changes in pain scores were observed. The hammock positioning can be considered a safe method of positioning that can be used to reduce the stress levels in very low birth weight preterm newborns. We did not observe worsening in either pain or vital signs. Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Derivation and Validation of Predictive Factors for Clinical Deterioration after Admission in Emergency Department Patients Presenting with Abnormal Vital Signs Without Shock

PubMed Central

Henning, Daniel J.; Oedorf, Kimie; Day, Danielle E.; Redfield, Colby S.; Huguenel, Colin J.; Roberts, Jonathan C.; Sanchez, Leon D.; Wolfe, Richard E.; Shapiro, Nathan I.

2015-01-01

Introduction Strategies to identify high-risk emergency department (ED) patients often use markedly abnormal vital signs and serum lactate levels. Risk stratifying such patients without using the presence of shock is challenging. The objective of the study is to identify independent predictors of in-hospital adverse outcomes in ED patients with abnormal vital signs or lactate levels, but who are not in shock. Methods We performed a prospective observational study of patients with abnormal vital signs or lactate level defined as heart rate ≥130 beats/min, respiratory rate ≥24 breaths/min, shock index ≥1, systolic blood pressure <90mm/Hg, or lactate ≥4mmole/L. We excluded patients with isolated atrial tachycardia, seizure, intoxication, psychiatric agitation, or tachycardia due to pain (ie: extremity fracture). The primary outcome was deterioration, defined as development of acute renal failure (creatinine 2× baseline), non-elective intubation, vasopressor requirement, or mortality. Independent predictors of deterioration after hospitalization were determined using logistic regression. Results Of 1,152 consecutive patients identified with abnormal vital signs or lactate level, 620 were excluded, leaving 532 for analysis. Of these, 53/532 (9.9±2.5%) deteriorated after hospital admission. Independent predictors of in-hospital deterioration were: lactate >4.0mmol/L (OR 5.1, 95% CI [2.1–12.2]), age ≥80 yrs (OR 1.9, CI [1.0–3.7]), bicarbonate <21mEq/L (OR 2.5, CI [1.3–4.9]), and initial HR≥130 (OR 3.1, CI [1.5–6.1]). Conclusion Patients exhibiting abnormal vital signs or elevated lactate levels without shock had significant rates of deterioration after hospitalization. ED clinical data predicted patients who suffered adverse outcomes with reasonable reliability. PMID:26759655

Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in-hospital cardiac arrest.

PubMed

Oh, HyunSoo; Lee, KangIm; Seo, WhaSook

2016-05-01

To determine temporal patterns of vital sign and Cardiac Arrest Risk Triage score changes over the 48-hour period preceding cardiac arrest in an ICU setting. Vital sign instability usually occurs prior to cardiac arrest. However, few studies have been conducted on the temporal patterns of individual vital signs preceding cardiac arrest. A retrospective case-control study. The study subjects were 140 ICU patients (1 June 2011-31 December 2012): 46 died of cardiac arrest (case group), 45 died of other illnesses (control I group) and 49 were discharged after recovering (control II group). Initial detectable changes in blood pressure appeared 18-20 hours and became dramatic at 5-10 hours before cardiac arrest. Noticeable changes in heart rates began at 4 hours and became more prominent at 2 hours pre-arrest. No apparent patterns in respiratory rate changes were observed. Body temperatures usually indicated a hypothermic state pre-arrest. Cardiac Arrest Risk Triage scores were 16-18 at 48 hours pre-arrest and then continuously increased to 20. Only mean values of systolic blood pressures were significantly different between the three study groups. Mean diastolic blood pressures, heart rates, respiratory rates and Cardiac Arrest Risk Triage scores differed between the case and control II groups and between the control I and II groups. The study demonstrates vital sign instability preceded cardiac arrest and that the temporal patterns of changes in individual vital signs and Cardiac Arrest Risk Triage scores differed between groups. The findings of this study may aid the development of management strategies for cardiac arrest. © 2016 John Wiley & Sons Ltd.

Wireless chest wearable vital sign monitoring platform for hypertension.

PubMed

Janjua, G; Guldenring, D; Finlay, D; McLaughlin, J

2017-07-01

Hypertension, a silent killer, is the biggest challenge of the 21 st century in public health agencies worldwide [1]. World Health Organization (WHO) statistic shows that the mortality rate of hypertension is 9.4 million per year and causes 55.3% of total deaths in cardiovascular (CV) patients [2]. Early detection and prevention of hypertension can significantly reduce the CV mortality. We are presenting a wireless chest wearable vital sign monitoring platform. It measures Electrocardiogram (ECG), Photoplethsmogram (PPG) and Ballistocardiogram (BCG) signals and sends data over Bluetooth low energy (BLE) to mobile phone-acts as a gateway. A custom android application relays the data to thingspeak server where MATLAB based offline analysis estimates the blood pressure. A server reacts on the health of subject to friends & family on the social media - twitter. The chest provides a natural position for the sensor to capture legitimate signals for hypertension condition. We have done a clinical technical evaluation of prototypes on 11 normotensive subjects, 9 males 2 females.

From vital signs to clinical outcomes for patients with sepsis: a machine learning basis for a clinical decision support system

PubMed Central

Gultepe, Eren; Green, Jeffrey P; Nguyen, Hien; Adams, Jason; Albertson, Timothy; Tagkopoulos, Ilias

2014-01-01

Objective To develop a decision support system to identify patients at high risk for hyperlactatemia based upon routinely measured vital signs and laboratory studies. Materials and methods Electronic health records of 741 adult patients at the University of California Davis Health System who met at least two systemic inflammatory response syndrome criteria were used to associate patients’ vital signs, white blood cell count (WBC), with sepsis occurrence and mortality. Generative and discriminative classification (naïve Bayes, support vector machines, Gaussian mixture models, hidden Markov models) were used to integrate heterogeneous patient data and form a predictive tool for the inference of lactate level and mortality risk. Results An accuracy of 0.99 and discriminability of 1.00 area under the receiver operating characteristic curve (AUC) for lactate level prediction was obtained when the vital signs and WBC measurements were analysed in a 24 h time bin. An accuracy of 0.73 and discriminability of 0.73 AUC for mortality prediction in patients with sepsis was achieved with only three features: median of lactate levels, mean arterial pressure, and median absolute deviation of the respiratory rate. Discussion This study introduces a new scheme for the prediction of lactate levels and mortality risk from patient vital signs and WBC. Accurate prediction of both these variables can drive the appropriate response by clinical staff and thus may have important implications for patient health and treatment outcome. Conclusions Effective predictions of lactate levels and mortality risk can be provided with a few clinical variables when the temporal aspect and variability of patient data are considered. PMID:23959843

Vital Sign Monitoring Through the Back Using an UWB Impulse Radar With Body Coupled Antennas.

PubMed

Schires, Elliott; Georgiou, Pantelis; Lande, Tor Sverre

2018-04-01

Radar devices can be used in nonintrusive situations to monitor vital sign, through clothes or behind walls. By detecting and extracting body motion linked to physiological activity, accurate simultaneous estimations of both heart rate (HR) and respiration rate (RR) is possible. However, most research to date has focused on front monitoring of superficial motion of the chest. In this paper, body penetration of electromagnetic (EM) wave is investigated to perform back monitoring of human subjects. Using body-coupled antennas and an ultra-wideband (UWB) pulsed radar, in-body monitoring of lungs and heart motion was achieved. An optimised location of measurement in the back of a subject is presented, to enhance signal-to-noise ratio and limit attenuation of reflected radar signals. Phase-based detection techniques are then investigated for back measurements of vital sign, in conjunction with frequency estimation methods that reduce the impact of parasite signals. Finally, an algorithm combining these techniques is presented to allow robust and real-time estimation of both HR and RR. Static and dynamic tests were conducted, and demonstrated the possibility of using this sensor in future health monitoring systems, especially in the form of a smart car seat for driver monitoring.

Multimodal characterization of the semantic N400 response within a rapid evaluation brain vital sign framework.

PubMed

Ghosh Hajra, Sujoy; Liu, Careesa C; Song, Xiaowei; Fickling, Shaun D; Cheung, Teresa P L; D'Arcy, Ryan C N

2018-06-04

For nearly four decades, the N400 has been an important brainwave marker of semantic processing. It can be recorded non-invasively from the scalp using electrical and/or magnetic sensors, but largely within the restricted domain of research laboratories specialized to run specific N400 experiments. However, there is increasing evidence of significant clinical utility for the N400 in neurological evaluation, particularly at the individual level. To enable clinical applications, we recently reported a rapid evaluation framework known as "brain vital signs" that successfully incorporated the N400 response as one of the core components for cognitive function evaluation. The current study characterized the rapidly evoked N400 response to demonstrate that it shares consistent features with traditional N400 responses acquired in research laboratory settings-thereby enabling its translation into brain vital signs applications. Data were collected from 17 healthy individuals using magnetoencephalography (MEG) and electroencephalography (EEG), with analysis of sensor-level effects as well as evaluation of brain sources. Individual-level N400 responses were classified using machine learning to determine the percentage of participants in whom the response was successfully detected. The N400 response was observed in both M/EEG modalities showing significant differences to incongruent versus congruent condition in the expected time range (p < 0.05). Also as expected, N400-related brain activity was observed in the temporal and inferior frontal cortical regions, with typical left-hemispheric asymmetry. Classification robustly confirmed the N400 effect at the individual level with high accuracy (89%), sensitivity (0.88) and specificity (0.90). The brain vital sign N400 characteristics were highly consistent with features of the previously reported N400 responses acquired using traditional laboratory-based experiments. These results provide important evidence supporting

Is Heart Rate Variability Better Than Routine Vital Signs for Prehospital Identification of Major Hemorrhage

DTIC Science & Technology

2015-01-01

different PRBC transfusion volumes. We performed multivariate regression analysis using HRV metrics and routine vital signs to test the hypothesis that...study sponsors did not have any role in the study design, data collection, analysis and interpretation of data, report writing, or the decision to...primary outcome was hemorrhagic injury plus different PRBC transfusion volumes. We performed multivariate regression analysis using HRV metrics and

"Community vital signs": incorporating geocoded social determinants into electronic records to promote patient and population health.

PubMed

Bazemore, Andrew W; Cottrell, Erika K; Gold, Rachel; Hughes, Lauren S; Phillips, Robert L; Angier, Heather; Burdick, Timothy E; Carrozza, Mark A; DeVoe, Jennifer E

2016-03-01

Social determinants of health significantly impact morbidity and mortality; however, physicians lack ready access to this information in patient care and population management. Just as traditional vital signs give providers a biometric assessment of any patient, "community vital signs" (Community VS) can provide an aggregated overview of the social and environmental factors impacting patient health. Knowing Community VS could inform clinical recommendations for individual patients, facilitate referrals to community services, and expand understanding of factors impacting treatment adherence and health outcomes. This information could also help care teams target disease prevention initiatives and other health improvement efforts for clinic panels and populations. Given the proliferation of big data, geospatial technologies, and democratization of data, the time has come to integrate Community VS into the electronic health record (EHR). Here, the authors describe (i) historical precedent for this concept, (ii) opportunities to expand upon these historical foundations, and (iii) a novel approach to EHR integration. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[The Status, Change and Health Issues of Inpatients' Sixth Vital Sign in a Medical Center].

PubMed

Lin, Li-Ying; Huang, Ya-Hui; Hung, Chung-Lung; Chen, Ya-Mei; Kuo, Ching-Ju; Ku, Yan-Chiou

2017-04-01

Hospitalized patients generally have elevated levels of emotional distress. Gaining a better under-standing of the problem of emotional distress among hospitalized patients is conducive to providing appropriate emotional care and promoting their recovery. To analyze the scores for the "sixth vital sign" (i.e., emotional distress), diversification, and the health-related problems of hospitalized patients at a medical center in Taiwan. The results may offer an important reference for providing effective emotional care to hospitalized patients. A retrospective descriptive research design was used. Data were collected from all of the 27,885 inpatients that were registered at the target hospital in 2013. Further, a total of 245,814 attendance records were assessed to extract the data that were relevant to emotional distress. The findings revealed that 58.3% of hospitalized patients had earned a sixth vital sign score ≥ 1 and that 0.8% of these patients had earned a score ≥ 4. On the whole, the sixth vital sign scores of hospitalized patients were found to decrease progressively with the number of hospitalization days except for hematology and oncology, neurosurgery, and plastic surgery patients. The highest emotional distress scores were found among family medicine, dermatology, and plastic surgery patients. Moreover, emotional distress scores were significantly higher in patients who had health problems that involved pain, anxiety, or sleep disorder. The present study suggests that improving the emotional care of hematology, oncology, neurosurgery, family medicine, dermatology, and plastic surgery patients and of patients with health problems involving pain, anxiety, or sleep disorder may significantly improve the quality of inpatient holistic healthcare. Only 0.8% of the subjects in the present study had an emotional distress score ≥ 4, which is significantly lower than the level reported in other similar studies. Our findings suggest that related education and

Effects of therapeutic touch on anxiety, vital signs, and cardiac dysrhythmia in a sample of Iranian women undergoing cardiac catheterization: a quasi-experimental study.

PubMed

Zolfaghari, Mitra; Eybpoosh, Sana; Hazrati, Maryam

2012-12-01

To investigate the effects of Therapeutic Touch (TT) on anxiety, vital signs, and cardiac dysrhythmia in women undergoing cardiac catheterization. It was a quasi-experimental study. The participants had no history of hallucination, anxiety, or other psychological problems. Participants had to be conscious and have attained at least sixth-grade literacy level. Participants were randomly assigned into an intervention group (n = 23; received 10-15 minutes TT), a placebo group (n = 23; received 10-15 minutes simulated touch), and a control group (n = 23; did not receive any therapy). Data were collected using Spielberger's anxiety test, cardiac dysrhythmia checklist, and vital signs recording sheet. Statistical analyses were considered to be significant at α = .05 levels. Sixty-nine women ranging in age from 35 to 65 years participated. TT significantly decreased state anxiety p < 0.0001 but not trait anxiety (p = .88), decreased the incidence of all cardiac dysrhythmias p < 0.0001 except premature ventricular contraction (p = .01), and regulated vital signs p < 0.0001 in the intervention group versus placebo and control group. TT is an effective approach for managing state anxiety, regulating vital signs, and decreasing the incidence of cardiac dysrhythmia during stressful situations, such as cardiac catheterization, in Iranian cardiac patients.

Comparing the effects of two Swedish massage techniques on the vital signs and anxiety of healthy women

PubMed Central

Gholami-Motlagh, Farzaneh; Jouzi, Mina; Soleymani, Bahram

2016-01-01

Background: Anxiety is an inseparable part of our lives and a serious threat to health. Therefore, it is necessary to use certain strategies to prevent disorders caused by anxiety and adjust the vital signs of people. Swedish massage is one of the most recognized techniques for reducing anxiety. This study aims to compare the effects of two massage techniques on the vital signs and anxiety of healthy women. Materials and Methods: This quasi-experimental study with a two-group, crossover design was conducted on 20 healthy women who were selected by simple sampling method and were randomly assigned to BNC (Back, Neck, and Chest) or LAF (Leg, Arm, and Face) groups. Massage therapy was carried out for a 14-week period (two 4-week massage therapy sessions and 6 weeks washout stage). Gathered data were analyzed using paired t-test with a significance level of P < 0.05. Results: Both BNC and LAF methods caused a significant decrease in systolic BP in the first stage (P = 0.02, 0.00); however, diastolic BP showed significant decrease only in BNC group (P = 0.01). The mean average of body temperature of LAF group showed a significant decrease in the first stage (P = 0.0.3), and pulse and respiratory rate showed significant decrease in both groups during the second stage (P = 0.00). In addition, anxiety scores showed no significant difference before and after massage therapy (P < 0.05). Conclusions: Massage therapy caused a decrease in systolic BP, pulse, and respiratory rate. It can be concluded that massage therapy was useful for decreasing the vital signs associated with anxiety in healthy women. PMID:27563325

Overnight non-contact continuous vital signs monitoring using an intelligent automatic beam-steering Doppler sensor at 2.4 GHz.

PubMed

Batchu, S; Narasimhachar, H; Mayeda, J C; Hall, T; Lopez, J; Nguyen, T; Banister, R E; Lie, D Y C

2017-07-01

Doppler-based non-contact vital signs (NCVS) sensors can monitor heart rates, respiration rates, and motions of patients without physically touching them. We have developed a novel single-board Doppler-based phased-array antenna NCVS biosensor system that can perform robust overnight continuous NCVS monitoring with intelligent automatic subject tracking and optimal beam steering algorithms. Our NCVS sensor achieved overnight continuous vital signs monitoring with an impressive heart-rate monitoring accuracy of over 94% (i.e., within ±5 Beats-Per-Minute vs. a reference sensor), analyzed from over 400,000 data points collected during each overnight monitoring period of ~ 6 hours at a distance of 1.75 meters. The data suggests our intelligent phased-array NCVS sensor can be very attractive for continuous monitoring of low-acuity patients.

Automatic Pre-Hospital Vital Signs Waveform and Trend Data Capture Fills Quality Management, Triage and Outcome Prediction Gaps

PubMed Central

Mackenzie, Colin F; Hu, Peter; Sen, Ayan; Dutton, Rick; Seebode, Steve; Floccare, Doug; Scalea, Tom

2008-01-01

Trauma Triage errors are frequent and costly. What happens in pre-hospital care remains anecdotal because of the dual responsibility of treatment (resuscitation and stabilization) and documentation in a time-critical environment. Continuous pre-hospital vital signs waveforms and numerical trends were automatically collected in our study. Abnormalities of pulse oximeter oxygen saturation (< 95%) and validated heart rate (> 100/min) showed better prediction of injury severity, need for immediate blood transfusion, intra-abdominal surgery, tracheal intubation and chest tube insertion than Trauma Registry data or Pre-hospital provider estimations. Automated means of data collection introduced the potential for more accurate and objective reporting of patient vital signs helping in evaluating quality of care and establishing performance indicators and benchmarks. Addition of novel and existing non-invasive monitors and waveform analyses could make the pulse oximeter the decision aid of choice to improve trauma patient triage. PMID:18999022

Does Size and Location of the Vital Signs Monitor Matter? A Study of Two Trauma Centers

PubMed Central

Sarcevic, Aleksandra; Marsic, Ivan; Burd, Randall S.

2010-01-01

We report the results of an observational study in which we compared how the size and location of the vital signs monitor impact teamwork at two trauma centers. Our observations focused on three factors: information exchange, situational awareness, and ergonomic issues. We found that the smaller display was difficult to view and required more team communication and workarounds, such as periodic verbal reports. The larger and closer display, although accessible to more team members, did not uniformly improve team’s situational awareness because vital signals were not verbalized and the monitor was often ignored. We suggest introducing multiple larger and closer displays, while keeping the practice of periodic verbal reporting. PMID:21347070

Automated Analysis of Vital Signs Identified Patients with Substantial Bleeding Prior to Hospital Arrival

DTIC Science & Technology

2015-10-01

Flight (MHLF; Houston, TX) by Cooke et al. [4] and Holcomb et al. [5]. In both datasets, we analyzed all subjects with at least one recorded non-zero...4] W. H. Cooke , J. Salinas, V. A. Convertino, D. A. Ludwig, D. Hinds, J. H. Duke, F. A. Moore, and J. B. Holcomb, "Heart rate variability and its...McManus, C. C. Miller, W. H. Cooke , and V. A. Convertino, "Manual vital signs reliably predict need for life-saving interventions in trauma patients

Technology platforms for remote monitoring of vital signs in the new era of telemedicine.

PubMed

Zhao, Fang; Li, Meng; Tsien, Joe Z

2015-07-01

Driven by healthcare cost and home healthcare need, the development of remote monitoring technologies is poised to improve and revolutionize healthcare delivery and accessibility. This paper reviews the recent progress in the field of remote monitoring technologies that may have the potential to become the basic platforms for telemedicine. In particular, key techniques and devices for monitoring cardiorespiratory activity, blood pressure and blood glucose concentration are summarized and discussed. In addition, the US FDA approved remote vital signs monitoring devices currently available on the market are presented.

Fiber sensor for non-contact estimation of vital bio-signs

NASA Astrophysics Data System (ADS)

Sirkis, Talia; Beiderman, Yevgeny; Agdarov, Sergey; Beiderman, Yafim; Zalevsky, Zeev

2017-05-01

Continuous noninvasive measurement of vital bio-signs, such as cardiopulmonary parameters, is an important tool in evaluation of the patient's physiological condition and health monitoring. On the demand of new enabling technologies, some works have been done in arterial pulse monitoring using optical fiber sensors. In this paper, we introduce a novel device based on single mode in-fibers Mach-Zehnder interferometer (MZI) to detect heartbeat, respiration and pulse wave velocity (PWV). The introduced interferometer is based on a new implanted scheme. It replaces the conventional MZI realized by inserting of discontinuities in the fiber to break the total internal reflection and scatter/collect light. The proposed fiber sensor was successfully incorporated into shirt to produce smart clothing. The measurements obtained from the smart clothing could be obtained in comfortable manner and there is no need to have an initial calibration or a direct contact between the sensor and the skin of the tested individual.

Overcoming the problem of diagnostic heterogeneity in applying measurement-based care in clinical practice: the concept of psychiatric vital signs.

PubMed

Zimmerman, Mark; Young, Diane; Chelminski, Iwona; Dalrymple, Kristy; Galione, Janine N

2012-02-01

Measurement-based care refers to the use of standardized scales to measure the outcome of psychiatric treatment. Diagnostic heterogeneity poses a challenge toward the adoption of a measurement-based care approach toward outcome evaluation in clinical practice. In the present article, we propose adopting the concept of psychiatric vital signs to facilitate measurement-based care. Medical vital signs are measures of basic physiologic functions that are routinely determined in medical settings. Vital signs are often a primary outcome measure, and they are also often adjunctive measurements. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined the frequency of depression and anxiety in a diagnostically heterogeneous group of psychiatric outpatients to determine the appropriateness of considering their measurement as psychiatric vital signs. Three thousand psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV supplemented with items from the Schedule for Affective Disorders and Schizophrenia. We determined the frequency of depression and anxiety evaluated according to the Schedule for Affective Disorders and Schizophrenia items. In the entire sample of 3000 patients, 79.3% (n = 2378) reported clinically significant depression of at least mild severity, 64.4% (n = 1932) reported anxiety of at least mild severity, and 87.4% (n = 2621) reported either anxiety or depression. In all 10 diagnostic categories examined, most patients had clinically significant anxiety or depression of at least mild severity. These findings support the routine assessment of anxiety and depression in clinical practice because almost all patients will have these problems as part of their initial presentation. Even for those patients without depression or anxiety, the case could be made that the measurement of depression and anxiety is relevant and analogous to measuring certain physiologic

Quantifying risk of adverse clinical events with one set of vital signs among primary care patients with hypertension.

PubMed

Tierney, William M; Brunt, Margaret; Kesterson, Joseph; Zhou, Xiao-Hua; L'Italien, Gil; Lapuerta, Pablo

2004-01-01

Hypertension is often uncontrolled. One reason might be physicians' reticence to modify therapy in response to single office measurements of vital signs. Using electronic records from an inner-city primary care practice, we extracted information about vital signs, diagnoses, test results, and drug therapy available on the first primary care visit in 1993 for patients with hypertension. We then identified multivariable predictors of subsequent vascular complications in the ensuing 5 years. Of 5,825 patients (mean age 57 years) previously treated for hypertension for 5.6 years, 7% developed myocardial infarctions, 17% had strokes, 24% developed ischemic heart disease, 22% had heart failure, 12% developed renal insufficiency, and 13% died in 5 years. Controlling for other clinical data, a 10-mmHg increase in systolic blood pressure was associated with 13% increased risk (95% confidence interval [CI], 6%-21%) of renal insufficiency, 9% (95% CI, 3%-15%) increased risk of ischemic heart disease, 7% (95% CI, 3%-11%) increased risk of stroke, and 6% (95% CI, 2%-9%) increased risk of first stroke or myocardial infarction. A 10-mmHg elevation in mean blood pressure predicted a 12% (95% CI, 5%-20%) increased risk of heart failure. An increase in heart rate of 10 beats per minute predicted a 16% (95% CI, 2%-5%) increased risk of death. Diastolic blood pressure predicted only a 13% (95% CI, 4%-23%) increased risk of first stroke. Vital signs-especially systolic blood pressure-recorded routinely during a single primary care visit had significant prognostic value for multiple adverse clinical events among patients treated for hypertension and should not be ignored by clinicians.

Effect of interaction with clowns on vital signs and non-verbal communication of hospitalized children

PubMed Central

Alcântara, Pauline Lima; Wogel, Ariane Zonho; Rossi, Maria Isabela Lobo; Neves, Isabela Rodrigues; Sabates, Ana Llonch; Puggina, Ana Cláudia

2016-01-01

Abstract Objective: Compare the non-verbal communication of children before and during interaction with clowns and compare their vital signs before and after this interaction. Methods: Uncontrolled, intervention, cross-sectional, quantitative study with children admitted to a public university hospital. The intervention was performed by medical students dressed as clowns and included magic tricks, juggling, singing with the children, making soap bubbles and comedic performances. The intervention time was 20min. Vital signs were assessed in two measurements with an interval of 1min immediately before and after the interaction. Non-verbal communication was observed before and during the interaction using the Non-Verbal Communication Template Chart, a tool in which non-verbal behaviors are assessed as effective or ineffective in the interactions. Results: The sample consisted of 41 children with a mean age of 7.6±2.7 years; most were aged 7-11 years (n=23; 56%) and were males (n=26; 63.4%). There was a statistically significant difference in systolic and diastolic blood pressure, pain and non-verbal behavior of children with the intervention. Systolic and diastolic blood pressure increased and pain scales showed decreased scores. Conclusions: The playful interaction with clowns can be a therapeutic resource to minimize the effects of the stressing environment during the intervention, improve the children's emotional state and reduce the perception of pain. PMID:27080219

Vital Signs Evaluation of Human Behaviour via an Autonomous Body Area Network System

NASA Astrophysics Data System (ADS)

Hussin, S.; Takayama, S.

2016-11-01

Enhancing Quality of Life (QOL) has long been an explicit and implicit goal for individuals, nations, and the world. QOL involves diverse multidimensional factors spanning wealth, physical health, social well-being, and international relationships. This study presents a definition of QOL combining the measurement of health-related QOL with an autonomous Body Area Network System (BANs). A method of evaluating vital signs is performed and linked to physical intensity assistance in exercise. Specifically, BAN acts as a supportive system which can assist a user in monitoring his or her body's parameters, providing real-time feedbacks and dynamically sharing information from any location to one or more users.

Design Considerations for Aural Vital Signs Using PZT Piezoelectric Ceramics Sensor Based on the Computerization Method.

PubMed

Noimanee, Suranan; Tunkasiri, Tawee; Siriwitayakorn, Kingkeo; Tantrakoon, Jerapong

2007-11-11

The purpose was to illustrate how system developed for measurement of the aural vital signs such as patient's heart and lung sounds in the hospital. For heart sounds measurement must operate the frequency response between 20 - 800 Hz, and lung sounds measurement must operate the frequency response between 160 - 4,000 Hz. The method was designed PZT piezoelectric ceramics for both frequency response in the same PZT sensor. It converts a signal from aural vital sign form to voltage signal. The signal is suitably amplified and re-filtered in band pass frequency band. It is converted to digital signal by an analog to digital conversion circuitry developed for the purpose. The results were that all signals can fed to personal computer through the sound card port. With the supporting software for drawing of graphic on the screen, the signal for a specific duration is accessed and stored in the computer's memory in term of each patient's data. In conclusion, the data of each patient call dot pcg (.pcg) for drawing graph and dot wave (.wave) for sound listening or automatic sending via electronic mail to the physician for later analysis of interpreting the sounds on the basis of their time domain and frequency domain representation to diagnose heart disorders.

Effects of xylazine-ketamine anesthesia on plasma levels of cortisol and vital signs during laparotomy in dogs.

PubMed

Naddaf, H; Varzi, H Najafzade; Sabiza, S; Falah, H

2014-01-01

This study was designed to evaluate effects of xylazine-ketamine anesthesia on plasma levels of cortisol and vital signs during and after laparotomy in dogs. Eight clinically healthy, adult male dogs, weighing 20 kg were used. All dogs were initially sedated by acepromazine. Thirty minutes later, ketamine plus xylazine was used to induce anesthesia. Surgical incision of laparotomy was done. After a 5 min manipulation of the abdominal organs, the incision was sutured. Vital signs including heart rate, respiratory rate and rectal temperature (RT) were recorded at the times of -30: premedication, 0: induction and Surgical incision, 30: End of surgery, 60, 90 and 120 min. Blood was sampled at the above mentioned times and analyzed using a commercial ELISA kit for cortisol. A significant decreasing trend in RT was observed during the studied times. No significant changes were observed in heart rate and respiratory rate (p>0.05), except at the time of 60 respiratory rate significantly decreased when compared to the time of 90 (p=0.026) and 120 (p=0.041). A non-significant but increasing trend in plasma levels of cortisol was observed.

Effects of xylazine-ketamine anesthesia on plasma levels of cortisol and vital signs during laparotomy in dogs

PubMed Central

Naddaf, H.; Varzi, H. Najafzade; Sabiza, S.; Falah, H.

2014-01-01

This study was designed to evaluate effects of xylazine-ketamine anesthesia on plasma levels of cortisol and vital signs during and after laparotomy in dogs. Eight clinically healthy, adult male dogs, weighing 20 kg were used. All dogs were initially sedated by acepromazine. Thirty minutes later, ketamine plus xylazine was used to induce anesthesia. Surgical incision of laparotomy was done. After a 5 min manipulation of the abdominal organs, the incision was sutured. Vital signs including heart rate, respiratory rate and rectal temperature (RT) were recorded at the times of -30: premedication, 0: induction and Surgical incision, 30: End of surgery, 60, 90 and 120 min. Blood was sampled at the above mentioned times and analyzed using a commercial ELISA kit for cortisol. A significant decreasing trend in RT was observed during the studied times. No significant changes were observed in heart rate and respiratory rate (p>0.05), except at the time of 60 respiratory rate significantly decreased when compared to the time of 90 (p=0.026) and 120 (p=0.041). A non-significant but increasing trend in plasma levels of cortisol was observed. PMID:26623345

Effect of Massage Therapy on Vital Signs and GCS Scores of ICU Patients: A Randomized Controlled Clinical Trial.

PubMed

Vahedian-Azimi, Amir; Ebadi, Abbas; Asghari Jafarabadi, Mohammad; Saadat, Soheil; Ahmadi, Fazlollah

2014-08-01

Unalleviated complications related to hospitalization, including stress, anxiety, and pain, can easily influence different structures, like the neural system, by enhancing the stimulation of sympathetic nervous pathways and causing unstable vital signs and deterioration in the level of consciousness. The purpose of this study was to determine the effects of massage therapy by family members on vital signs and Glasgow Coma Scale Score (GCS) of patients hospitalized in the Intensive Care Unit (ICU). This randomized controlled clinical trial was conducted at the ICU of the Shariati Hospital during 2012; 45 ICU patients and 45 family members in the experimental group and the same number of patients and family members in the control group were consecutively selected . The data collection instrument consisted of two parts. The first part included demographic data (age, marital status and Body Mass Index) and the second part included a checklist to record the patient's vital signs (systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), pulse rate (PR)) and GCS. All measurements were done at the same time in both groups before the intervention (full body massage therapy), and 1 hour, 2 hours, 3 hours, and 4 hours after intervention. The patients were provided with a 60-minute full body massage The massage protocol included static, surface tension, stretching, superficial lymph unload, transverse friction, and myofacial releasing techniques. Significant differences were observed between experimental and control groups in the SBP at 1 hour, SBP 2 hours, and SBP 3 hours, and also in GCS at 1 hour to GCS at 4 hours (P < 0.05). Multivariate analysis revealed a significant difference between experimental and control groups in SBP at all time points (P < 0.05). Massage via family members had several positive effects on the patients' clinical conditions, and therefore, it should be recognized as one of the most important clinical considerations in

Adding navigation, artificial audition and vital sign monitoring capabilities to a telepresence mobile robot for remote home care applications.

PubMed

Laniel, Sebastien; Letourneau, Dominic; Labbe, Mathieu; Grondin, Francois; Polgar, Janice; Michaud, Francois

2017-07-01

A telepresence mobile robot is a remote-controlled, wheeled device with wireless internet connectivity for bidirectional audio, video and data transmission. In health care, a telepresence robot could be used to have a clinician or a caregiver assist seniors in their homes without having to travel to these locations. Many mobile telepresence robotic platforms have recently been introduced on the market, bringing mobility to telecommunication and vital sign monitoring at reasonable costs. What is missing for making them effective remote telepresence systems for home care assistance are capabilities specifically needed to assist the remote operator in controlling the robot and perceiving the environment through the robot's sensors or, in other words, minimizing cognitive load and maximizing situation awareness. This paper describes our approach adding navigation, artificial audition and vital sign monitoring capabilities to a commercially available telepresence mobile robot. This requires the use of a robot control architecture to integrate the autonomous and teleoperation capabilities of the platform.

Remote sensing of multiple vital signs using a CMOS camera-equipped infrared thermography system and its clinical application in rapidly screening patients with suspected infectious diseases.

PubMed

Sun, Guanghao; Nakayama, Yosuke; Dagdanpurev, Sumiyakhand; Abe, Shigeto; Nishimura, Hidekazu; Kirimoto, Tetsuo; Matsui, Takemi

2017-02-01

Infrared thermography (IRT) is used to screen febrile passengers at international airports, but it suffers from low sensitivity. This study explored the application of a combined visible and thermal image processing approach that uses a CMOS camera equipped with IRT to remotely sense multiple vital signs and screen patients with suspected infectious diseases. An IRT system that produced visible and thermal images was used for image acquisition. The subjects' respiration rates were measured by monitoring temperature changes around the nasal areas on thermal images; facial skin temperatures were measured simultaneously. Facial blood circulation causes tiny color changes in visible facial images that enable the determination of the heart rate. A logistic regression discriminant function predicted the likelihood of infection within 10s, based on the measured vital signs. Sixteen patients with an influenza-like illness and 22 control subjects participated in a clinical test at a clinic in Fukushima, Japan. The vital-sign-based IRT screening system had a sensitivity of 87.5% and a negative predictive value of 91.7%; these values are higher than those of conventional fever-based screening approaches. Multiple vital-sign-based screening efficiently detected patients with suspected infectious diseases. It offers a promising alternative to conventional fever-based screening. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Effect of interaction with clowns on vital signs and non-verbal communication of hospitalized children.

PubMed

Alcântara, Pauline Lima; Wogel, Ariane Zonho; Rossi, Maria Isabela Lobo; Neves, Isabela Rodrigues; Sabates, Ana Llonch; Puggina, Ana Cláudia

2016-12-01

Compare the non-verbal communication of children before and during interaction with clowns and compare their vital signs before and after this interaction. Uncontrolled, intervention, cross-sectional, quantitative study with children admitted to a public university hospital. The intervention was performed by medical students dressed as clowns and included magic tricks, juggling, singing with the children, making soap bubbles and comedic performances. The intervention time was 20minutes. Vital signs were assessed in two measurements with an interval of one minute immediately before and after the interaction. Non-verbal communication was observed before and during the interaction using the Non-Verbal Communication Template Chart, a tool in which nonverbal behaviors are assessed as effective or ineffective in the interactions. The sample consisted of 41 children with a mean age of 7.6±2.7 years; most were aged 7 to 11 years (n=23; 56%) and were males (n=26; 63.4%). There was a statistically significant difference in systolic and diastolic blood pressure, pain and non-verbal behavior of children with the intervention. Systolic and diastolic blood pressure increased and pain scales showed decreased scores. The playful interaction with clowns can be a therapeutic resource to minimize the effects of the stressing environment during the intervention, improve the children's emotional state and reduce the perception of pain. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Can we improve the clinical utility of respiratory rate as a monitored vital sign?

PubMed

Chen, Liangyou; Reisner, Andrew T; Gribok, Andrei; McKenna, Thomas M; Reifman, Jaques

2009-06-01

Respiratory rate (RR) is a basic vital sign, measured and monitored throughout a wide spectrum of health care settings, although RR is historically difficult to measure in a reliable fashion. We explore an automated method that computes RR only during intervals of clean, regular, and consistent respiration and investigate its diagnostic use in a retrospective analysis of prehospital trauma casualties. At least 5 s of basic vital signs, including heart rate, RR, and systolic, diastolic, and mean arterial blood pressures, were continuously collected from 326 spontaneously breathing trauma casualties during helicopter transport to a level I trauma center. "Reliable" RR data were identified retrospectively using automated algorithms. The diagnostic performances of reliable versus standard RR were evaluated by calculation of the receiver operating characteristic curves using the maximum-likelihood method and comparison of the summary areas under the receiver operating characteristic curves (AUCs). Respiratory rate shows significant data-reliability differences. For identifying prehospital casualties who subsequently receive a respiratory intervention (hospital intubation or tube thoracotomy), standard RR yields an AUC of 0.59 (95% confidence interval, 0.48-0.69), whereas reliable RR yields an AUC of 0.67 (0.57-0.77), P < 0.05. For identifying casualties subsequently diagnosed with a major hemorrhagic injury and requiring blood transfusion, standard RR yields an AUC of 0.60 (0.49-0.70), whereas reliable RR yields 0.77 (0.67-0.85), P < 0.001. Reliable RR, as determined by an automated algorithm, is a useful parameter for the diagnosis of respiratory pathology and major hemorrhage in a trauma population. It may be a useful input to a wide variety of clinical scores and automated decision-support algorithms.

Effect of hand and foot surface stroke massage on anxiety and vital signs in patients with acute coronary syndrome: A randomized clinical trial.

PubMed

Alimohammad, Hasheminia Seyyed; Ghasemi, Zahra; Shahriar, Salehi; Morteza, Sedehi; Arsalan, Khaledifar

2018-05-01

Anxiety affects various body systems, which leads to an increase in respiratory rate, heart rate, blood pressure, and myocardial oxygen demand. The aim of this study was to investigate the effect of hand and foot surface stroke massage on the level of anxiety and vital signs in patients with acute coronary syndrome (ACS). The single-blind clinical trial was performed on 70 patients with ACS. The patients were randomly assigned to the case and control groups. Anxiety levels were controlled 30 min before and 15 min after the intervention. The vital signs were checked in the two groups before, immediately after, 60 min, and 90 min after the intervention. The data were analyzed using SPSS software, descriptive statistics (mean ± standard deviation), independent t-test, paired t-test, and chi-square test. No significant difference was observed in the patients' levels of anxiety, systolic blood pressure, diastolic blood pressure, respiratory rate, and pulse rate before the intervention. However, after the intervention, the mean changes in the levels of anxiety, blood pressure, heart rate, and respiratory rate were significant. Hand and foot massage can be a useful nursing intervention in attenuating anxiety levels and improving the vital signs in patients. Copyright © 2018. Published by Elsevier Ltd.

Effect of inhalation aromatherapy with lavender essential oil on stress and vital signs in patients undergoing coronary artery bypass surgery: A single-blinded randomized clinical trial.

PubMed

Bikmoradi, Ali; Seifi, Zahra; Poorolajal, Jalal; Araghchian, Malihe; Safiaryan, Reza; Oshvandi, Khodayar

2015-06-01

At present, aromatherapy is used widely in medical research. This study aimed to investigate the effects of inhalation aromatherapy using lavender essential oil to reduce mental stress and improve the vital signs of patients after coronary artery bypass surgery (CABG). A single-blinded randomized controlled trial was conducted with 60 patients who had undergone CABG in a 2-day intervention that targeted stress reduction. Sixty subjects following coronary artery bypass surgery in two aromatherapy and control groups. The study was conducted in Ekbatan Therapeutic and Educational Center, Hamadan, Iran, in 2013. On the second and third days after surgery, the aromatherapy group patients received two drops of 2% lavender essential oil for 20min and the control group received two drops of distilled water as a placebo. The primary outcome was mental stress, which was measured before and after the intervention using the DASS-21 questionnaire. The secondary outcomes were vital signs, including the heart rate, respiratory rate, and systolic and diastolic blood pressure, which were measured before and after the intervention. The individual characteristics of the aromatherapy and control groups were the same. There were no significant difference in the mean mental stress scores and vital signs of the aromatherapy and control groups on the second or third days after surgery. Inhalation aromatherapy with lavender essential oil had no significant effects on mental stress and vital signs in patients following CABG, except the systolic blood pressure. Copyright © 2014 Elsevier Ltd. All rights reserved.

Patient attitudes towards remote continuous vital signs monitoring on general surgery wards: An interview study.

PubMed

Downey, C L; Brown, J M; Jayne, D G; Randell, R

2018-06-01

Vital signs monitoring is used to identify deteriorating patients in hospital. The most common tool for vital signs monitoring is an early warning score, although emerging technologies allow for remote, continuous patient monitoring. A number of reviews have examined the impact of continuous monitoring on patient outcomes, but little is known about the patient experience. This study aims to discover what patients think of monitoring in hospital, with a particular emphasis on intermittent early warning scores versus remote continuous monitoring, in order to inform future implementations of continuous monitoring technology. Semi-structured interviews were undertaken with 12 surgical inpatients as part of a study testing a remote continuous monitoring device. All patients were monitored with both an early warning score and the new device. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Patients can see the value in remote, continuous monitoring, particularly overnight. However, patients appreciate the face-to-face aspect of early warning score monitoring as it allows for reassurance, social interaction, and gives them further opportunity to ask questions about their medical care. Early warning score systems are widely used to facilitate detection of the deteriorating patient. Continuous monitoring technologies may provide added reassurance. However, patients value personal contact with their healthcare professionals and remote monitoring should not replace this. We suggest that remote monitoring is best introduced in a phased manner, and initially as an adjunct to usual care, with careful consideration of the patient experience throughout. Copyright © 2018 Elsevier B.V. All rights reserved.

Record review to explore the adequacy of post-operative vital signs monitoring using a local modified early warning score (mews) chart to evaluate outcomes.

PubMed

Kyriacos, Una; Jelsma, Jennifer; Jordan, Sue

2014-01-01

1) To explore the adequacy of: vital signs' recordings (respiratory and heart rate, oxygen saturation, systolic blood pressure (BP), temperature, level of consciousness and urine output) in the first 8 post-operative hours; responses to clinical deterioration. 2) To identify factors associated with death on the ward between transfer from the theatre recovery suite and the seventh day after operation. Retrospective review of records of 11 patients who died plus four controls for each case. We reviewed clinical records of 55 patients who met inclusion criteria (general anaesthetic, age >13, complete records) from six surgical wards in a teaching hospital between 1 May and 31 July 2009. In the absence of guidelines for routine post-operative vital signs' monitoring, nurses' standard practice graphical plots of recordings were recoded into MEWS formats (0 = normal, 1-3 upper or lower limit) and their responses to clinical deterioration were interpreted using MEWS reporting algorithms. No patients' records contained recordings for all seven parameters displayed on the MEWS. There was no evidence of response to: 22/36 (61.1%) abnormal vital signs for patients who died that would have triggered an escalated MEWS reporting algorithm; 81/87 (93.1%) for controls. Death was associated with age, ≥61 years (OR 14.2, 3.0-68.0); ≥2 pre-existing co-morbidities (OR 75.3, 3.7-1527.4); high/low systolic BP on admission (OR 7.2, 1.5-34.2); tachycardia (≥111-129 bpm) (OR 6.6, 1.4-30.0) and low systolic BP (≤81-100 mmHg), as defined by the MEWS (OR 8.0, 1.9-33.1). Guidelines for post-operative vital signs' monitoring and reporting need to be established. The MEWS provides a useful scoring system for interpreting clinical deterioration and guiding intervention. Exploration of the ability of the Cape Town MEWS chart plus reporting algorithm to expedite recognition of signs of clinical and physiological deterioration and securing more skilled assistance is essential.

Effect of Massage Therapy on Vital Signs and GCS Scores of ICU Patients: A Randomized Controlled Clinical Trial

PubMed Central

Vahedian-Azimi, Amir; Ebadi, Abbas; Asghari Jafarabadi, Mohammad; Saadat, Soheil; Ahmadi, Fazlollah

2014-01-01

Background: Unalleviated complications related to hospitalization, including stress, anxiety, and pain, can easily influence different structures, like the neural system, by enhancing the stimulation of sympathetic nervous pathways and causing unstable vital signs and deterioration in the level of consciousness. Objectives: The purpose of this study was to determine the effects of massage therapy by family members on vital signs and Glasgow Coma Scale Score (GCS) of patients hospitalized in the Intensive Care Unit (ICU). Patients and Methods: This randomized controlled clinical trial was conducted at the ICU of the Shariati Hospital during 2012; 45 ICU patients and 45 family members in the experimental group and the same number of patients and family members in the control group were consecutively selected . The data collection instrument consisted of two parts. The first part included demographic data (age, marital status and Body Mass Index) and the second part included a checklist to record the patient’s vital signs (systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), pulse rate (PR)) and GCS. All measurements were done at the same time in both groups before the intervention (full body massage therapy), and 1 hour, 2 hours, 3 hours, and 4 hours after intervention. The patients were provided with a 60-minute full body massage The massage protocol included static, surface tension, stretching, superficial lymph unload, transverse friction, and myofacial releasing techniques. Results: Significant differences were observed between experimental and control groups in the SBP at 1 hour, SBP 2 hours, and SBP 3 hours, and also in GCS at 1 hour to GCS at 4 hours (P < 0.05). Multivariate analysis revealed a significant difference between experimental and control groups in SBP at all time points (P < 0.05). Conclusions: Massage via family members had several positive effects on the patients’ clinical conditions, and therefore, it should

Should predictive scores based on vital signs be used in the same way as those based on laboratory data? A hypothesis generating retrospective evaluation of in-hospital mortality by four different scoring systems.

PubMed

Kellett, John; Murray, Alan

2016-05-01

few studies have compared the discrimination of predictive scores of in-hospital mortality that used vital signs with those using laboratory results in different patient populations. a hypothesis generating retrospective observational cohort study. A score that only used vital signs was compared with three other scores that used laboratory changes in 44,985 medical and 20,432 surgical patients. the discrimination of the score based only on vital signs was highest for the prediction of in-hospital death within 24h. In contrast the, albeit lower, discrimination of scores based only on laboratory data remained constant for the prediction of death up to 30 days after hospital admission. Moreover, the discrimination of scores based only on laboratory data was higher in surgical than in medical patients. in acutely ill medical patients a vital sign based score appears to predict mortality within 24h better than scores using laboratory data. This may be because in acutely ill patients vital sign changes indicate how well a patient is responding to a current insult. In contrast, for patients without acute illness laboratory data may be a more valuable indication of the patient's capacity to respond to insults in the future. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

CDC Vital Signs: Alcohol Poisoning Deaths

MedlinePlus

... role of alcohol in injuries and deaths. Doctors, nurses, and other providers can Screen all adult patients ... signs of alcohol poisoning. Talk to your doctor, nurse, or other health care provider if you think ...

The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials.

PubMed

Schmitt, Jochen; Spuls, Phyllis I; Thomas, Kim S; Simpson, Eric; Furue, Masutaka; Deckert, Stefanie; Dohil, Magdalene; Apfelbacher, Christian; Singh, Jasvinder A; Chalmers, Joanne; Williams, Hywel C

2014-10-01

The lack of core outcome sets for atopic eczema (AE) is a major obstacle for advancing evidence-based treatment. The global Harmonising Outcome Measures for Eczema (HOME) initiative has already defined clinical signs, symptoms, quality of life, and long-term control of flares as core outcome domains for AE trials. This article deals with the standardization of measurement instruments to assess clinical signs of AE. To resolve the current lack of standardization of the assessment of clinical signs of AE, we followed a structured process of systematic reviews and international consensus sessions to identify 1 core outcome measurement instrument for assessment of clinical signs in all future AE trials. Systematic reviews indicated that from 16 different instruments identified to assess clinical signs of AE, only the Eczema Area and Severity Index (EASI) and the objective Scoring Atopic Dermatitis (SCORAD) index were identified as extensively validated. The EASI has adequate validity, responsiveness, internal consistency, and intraobserver reliability. The objective SCORAD index has adequate validity, responsiveness, and interobserver reliability but unclear intraobserver reliability to measure clinical signs of AE. In an international consensus study, patients, physicians, nurses, methodologists, and pharmaceutical industry representatives agreed that the EASI is the preferred core instrument to measure clinical signs in all future AE trials. All stakeholders involved in designing, reporting, and using clinical trials on AE are asked to comply with this consensus to enable better evidence-based decision making, clearer scientific communication, and improved patient care. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Evaluation of Miniature Wireless Vital Signs Monitor in a Trauma Intensive Care Unit.

PubMed

Meizoso, Jonathan P; Allen, Casey J; Ray, Juliet J; Van Haren, Robert M; Teisch, Laura F; Baez, Xiomara Ruiz; Livingstone, Alan S; Namias, Nicholas; Schulman, Carl I; Proctor, Kenneth G

2016-05-01

A previous study demonstrated basic proof of principle of the value of a miniature wireless vital signs monitor (MWVSM, MiniMedic, Athena GTX, Des Moines, Iowa) for battlefield triage However, there were unanswered questions related to sensor reliability and uncontrolled conditions in the prehospital environment. This study determined whether MWVSM sensors track vital signs and allow for appropriate triage compared to a gold standard bedside monitor in trauma patients. This was a prospective study in 59 trauma intensive care unit patients. Systolic blood pressure, temperature, heart rate (HR), skin temperature, and pulse oximetry (SpO2) were displayed on a bedside monitor for 60 minutes. Shock index (SI) was calculated. A separate MWVSM monitor was attached to the forehead and finger of each patient. Data from each included pulse wave transit time (PWTT), temperature, HR, SpO2, and a summary status termed "Murphy Factor" (MF), which ranges from 0 to 5. Patients are classified as "routine" if MF = 0 to 1 or SI = 0 to 0.7, "priority" if MF = 2 to 3 or SI = 0.7 to 0.9, and "critical" if MF = 4 to 5 or SI ≥ 0.9. Forehead and finger MWVSM HRs both differed from the monitor (both p < 0.001), but the few beats per minute differences were clinically insignificant. Differences in MWVSM SpO2 (1-7%) and temperature (6-13°F) from the monitor were site specific (all p < 0.001). Forehead PWTT (271 ± 50 ms) was less (p < 0.001) than finger PWTT (315 ± 42 ms); both were dissociated from systolic blood pressure (r(2) < 0.05). The SI distributed patients about equally as "routine," "priority," and "critical," whereas MF overtriaged to "routine" and undertriaged to "critical" for both sensors (all p < 0.001). Our findings suggest that MF does not accurately predict the most critical patients, likely because erroneous PWTT values confound MF calculations. MF and the MWVSM are promising, but require fine-tuning before deployment. Reprint & Copyright © 2016 Association of Military

Engagement, Alignment, and Rigor as Vital Signs of High-Quality Instruction: A Classroom Visit Protocol for Instructional Improvement and Research

ERIC Educational Resources Information Center

Early, Diane M.; Rogge, Ronald D.; Deci, Edward L.

2014-01-01

This paper investigates engagement (E), alignment (A), and rigor (R) as vital signs of high-quality teacher instruction as measured by the EAR Classroom Visit Protocol, designed by the Institute for Research and Reform in Education (IRRE). Findings indicated that both school leaders and outside raters could learn to score the protocol with…

Multicentre validation of a sepsis prediction algorithm using only vital sign data in the emergency department, general ward and ICU

PubMed Central

Mao, Qingqing; Jay, Melissa; Calvert, Jacob; Barton, Christopher; Shimabukuro, David; Shieh, Lisa; Chettipally, Uli; Fletcher, Grant; Kerem, Yaniv; Zhou, Yifan; Das, Ritankar

2018-01-01

Objectives We validate a machine learning-based sepsis-prediction algorithm (InSight) for the detection and prediction of three sepsis-related gold standards, using only six vital signs. We evaluate robustness to missing data, customisation to site-specific data using transfer learning and generalisability to new settings. Design A machine-learning algorithm with gradient tree boosting. Features for prediction were created from combinations of six vital sign measurements and their changes over time. Setting A mixed-ward retrospective dataset from the University of California, San Francisco (UCSF) Medical Center (San Francisco, California, USA) as the primary source, an intensive care unit dataset from the Beth Israel Deaconess Medical Center (Boston, Massachusetts, USA) as a transfer-learning source and four additional institutions’ datasets to evaluate generalisability. Participants 684 443 total encounters, with 90 353 encounters from June 2011 to March 2016 at UCSF. Interventions None. Primary and secondary outcome measures Area under the receiver operating characteristic (AUROC) curve for detection and prediction of sepsis, severe sepsis and septic shock. Results For detection of sepsis and severe sepsis, InSight achieves an AUROC curve of 0.92 (95% CI 0.90 to 0.93) and 0.87 (95% CI 0.86 to 0.88), respectively. Four hours before onset, InSight predicts septic shock with an AUROC of 0.96 (95% CI 0.94 to 0.98) and severe sepsis with an AUROC of 0.85 (95% CI 0.79 to 0.91). Conclusions InSight outperforms existing sepsis scoring systems in identifying and predicting sepsis, severe sepsis and septic shock. This is the first sepsis screening system to exceed an AUROC of 0.90 using only vital sign inputs. InSight is robust to missing data, can be customised to novel hospital data using a small fraction of site data and retains strong discrimination across all institutions. PMID:29374661

Triage and the Lost Art of Decoding Vital Signs: Restoring Physiologically Based Triage Skills in Complex Humanitarian Emergencies.

PubMed

Burkle, Frederick M

2018-02-01

Triage management remains a major challenge, especially in resource-poor settings such as war, complex humanitarian emergencies, and public health emergencies in developing countries. In triage it is often the disruption of physiology, not anatomy, that is critical, supporting triage methodology based on clinician-assessed physiological parameters as well as anatomy and mechanism of injury. In recent times, too many clinicians from developed countries have deployed to humanitarian emergencies without the physical exam skills needed to assess patients without the benefit of remotely fed electronic monitoring, laboratory, and imaging studies. In triage, inclusion of the once-widely accepted and collectively taught "art of decoding vital signs" with attention to their character and meaning may provide clues to a patient's physiological state, improving triage sensitivity. Attention to decoding vital signs is not a triage methodology of its own or a scoring system, but rather a skill set that supports existing triage methodologies. With unique triage management challenges being raised by an ever-changing variety of humanitarian crises, these once useful skill sets need to be revisited, understood, taught, and utilized by triage planners, triage officers, and teams as a necessary adjunct to physiologically based triage decision-making. (Disaster Med Public Health Preparedness. 2018;12:76-85).

A W-Band MMIC Radar System for Remote Detection of Vital Signs

NASA Astrophysics Data System (ADS)

Diebold, Sebastian; Ayhan, Serdal; Scherr, Steffen; Massler, Hermann; Tessmann, Axel; Leuther, Arnulf; Ambacher, Oliver; Zwick, Thomas; Kallfass, Ingmar

2012-12-01

In medical and personal health systems for vital sign monitoring, contact-free remote detection is favourable compared to wired solutions. For example, they help to avoid severe pain, which is involved when a patient with burned skin has to be examined. Continuous wave (CW) radar systems have proven to be good candidates for this purpose. In this paper a monolithic millimetre-wave integrated circuit (MMIC) based CW radar system operating in the W-band (75-110 GHz) at 96 GHz is presented. The MMIC components are custom-built and make use of 100 nm metamorphic high electron mobility transistors (mHEMTs). The radar system is employing a frequency multiplier-by-twelve MMIC and a receiver MMIC both packaged in split-block modules. They allow for the determination of respiration and heartbeat frequency of a human target sitting in 1 m distance. The analysis of the measured data is carried out in time and frequency domain and each approach is shown to have its advantages and drawbacks.

Vector Autoregressive Models and Granger Causality in Time Series Analysis in Nursing Research: Dynamic Changes Among Vital Signs Prior to Cardiorespiratory Instability Events as an Example.

PubMed

Bose, Eliezer; Hravnak, Marilyn; Sereika, Susan M

Patients undergoing continuous vital sign monitoring (heart rate [HR], respiratory rate [RR], pulse oximetry [SpO2]) in real time display interrelated vital sign changes during situations of physiological stress. Patterns in this physiological cross-talk could portend impending cardiorespiratory instability (CRI). Vector autoregressive (VAR) modeling with Granger causality tests is one of the most flexible ways to elucidate underlying causal mechanisms in time series data. The purpose of this article is to illustrate the development of patient-specific VAR models using vital sign time series data in a sample of acutely ill, monitored, step-down unit patients and determine their Granger causal dynamics prior to onset of an incident CRI. CRI was defined as vital signs beyond stipulated normality thresholds (HR = 40-140/minute, RR = 8-36/minute, SpO2 < 85%) and persisting for 3 minutes within a 5-minute moving window (60% of the duration of the window). A 6-hour time segment prior to onset of first CRI was chosen for time series modeling in 20 patients using a six-step procedure: (a) the uniform time series for each vital sign was assessed for stationarity, (b) appropriate lag was determined using a lag-length selection criteria, (c) the VAR model was constructed, (d) residual autocorrelation was assessed with the Lagrange Multiplier test, (e) stability of the VAR system was checked, and (f) Granger causality was evaluated in the final stable model. The primary cause of incident CRI was low SpO2 (60% of cases), followed by out-of-range RR (30%) and HR (10%). Granger causality testing revealed that change in RR caused change in HR (21%; i.e., RR changed before HR changed) more often than change in HR causing change in RR (15%). Similarly, changes in RR caused changes in SpO2 (15%) more often than changes in SpO2 caused changes in RR (9%). For HR and SpO2, changes in HR causing changes in SpO2 and changes in SpO2 causing changes in HR occurred with equal frequency (18

Vital sign sensing method based on EMD in terahertz band

NASA Astrophysics Data System (ADS)

Xu, Zhengwu; Liu, Tong

2014-12-01

Non-contact respiration and heartbeat rates detection could be applied to find survivors trapped in the disaster or the remote monitoring of the respiration and heartbeat of a patient. This study presents an improved algorithm that extracts the respiration and heartbeat rates of humans by utilizing the terahertz radar, which further lessens the effects of noise, suppresses the cross-term, and enhances the detection accuracy. A human target echo model for the terahertz radar is first presented. Combining the over-sampling method, low-pass filter, and Empirical Mode Decomposition improves the signal-to-noise ratio. The smoothed pseudo Wigner-Ville distribution time-frequency technique and the centroid of the spectrogram are used to estimate the instantaneous velocity of the target's cardiopulmonary motion. The down-sampling method is adopted to prevent serious distortion. Finally, a second time-frequency analysis is applied to the centroid curve to extract the respiration and heartbeat rates of the individual. Simulation results show that compared with the previously presented vital sign sensing method, the improved algorithm enhances the signal-to-noise ratio to 1 dB with a detection accuracy of 80%. The improved algorithm is an effective approach for the detection of respiration and heartbeat signal in a complicated environment.

Audit of transfusion procedures in 660 hospitals. A College of American Pathologists Q-Probes study of patient identification and vital sign monitoring frequencies in 16494 transfusions.

PubMed

Novis, David A; Miller, Karen A; Howanitz, Peter J; Renner, Stephen W; Walsh, Molly K

2003-05-01

Hemolytic transfusion reactions are often the result of failure to follow established identification and monitoring procedures. To measure the frequencies with which health care workers completed specific transfusion procedures required for laboratory and blood bank accreditation. In 2 separate studies, participants in the College of American Pathologists Q-Probes laboratory quality improvement program audited nonemergent red blood cell transfusions prospectively and completed questionnaires profiling their institutions' transfusion policies. A total of 660 institutions, predominantly in the United States, at which transfusion medicine services are provided. The percentages of transfusions for which participants completed 4 specific components of patient and blood unit identifications, and for which participants monitored vital signs at 3 specific intervals during transfusions. In the first study, all components of patient identification procedures were performed in 62.3%, and all required patient vital sign monitoring was performed in 81.6% of 12 448 transfusions audited. The median frequencies with which institutions participating in the first study performed all patient identification and monitoring procedures were 69.0% and 90.2%, respectively. In the second study, all components of patient identification were performed in 25.4% and all patient vital sign monitoring was performed in 88.3% of 4046 transfusions audited. The median frequencies with which institutions participating in the second study performed all patient identification and monitoring procedures were 10.0% and 95.0%, respectively. Individual practices and/or institutional policies associated with greater frequencies of patient identification and/or vital sign monitoring included transporting units of blood directly to patient bedsides, having no more than 1 individual handle blood units in route, checking unit labels against physicians' orders, having patients wear identification tags (wristbands

Aggregate National Early Warning Score (NEWS) values are more important than high scores for a single vital signs parameter for discriminating the risk of adverse outcomes.

PubMed

Jarvis, Stuart; Kovacs, Caroline; Briggs, Jim; Meredith, Paul; Schmidt, Paul E; Featherstone, Peter I; Prytherch, David R; Smith, Gary B

2015-02-01

The Royal College of Physicians (RCPL) National Early Warning Score (NEWS) escalates care to a doctor at NEWS values of ≥5 and when the score for any single vital sign is 3. We calculated the 24-h risk of serious clinical outcomes for vital signs observation sets with NEWS values of 3, 4 and 5, separately determining risks when the score did/did not include a single score of 3. We compared workloads generated by the RCPL's escalation protocol and for aggregate NEWS value alone. Aggregate NEWS values of 3 or 4 (n=142,282) formed 15.1% of all vital signs sets measured; those containing a single vital sign scoring 3 (n=36,207) constituted 3.8% of all sets. Aggregate NEWS values of either 3 or 4 with a component score of 3 have significantly lower risks (OR: 0.26 and 0.53) than an aggregate value of 5 (OR: 1.0). Escalating care to a doctor when any single component of NEWS scores 3 compared to when aggregate NEWS values ≥5, would have increased doctors' workload by 40% with only a small increase in detected adverse outcomes from 2.99 to 3.08 per day (a 3% improvement in detection). The recommended NEWS escalation protocol produces additional work for the bedside nurse and responding doctor, disproportionate to a modest benefit in increased detection of adverse outcomes. It may have significant ramifications for efficient staff resource allocation, distort patient safety focus and risk alarm fatigue. Our findings suggest that the RCPL escalation guidance warrants review. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Vital Signs and Physiologic Derangement in Patients With Thoracic Trauma in Iraq and Afghanistan.

PubMed

Keneally, Ryan J; Szpisjak, Dale F; Hoffmann, Paul J; Park, Edward J; Albergo, Michael S

2017-11-01

Triage is the act of stratifying the need for medical attention. Effective triage must account for injury patterns and severity. Personnel making triage decisions must also consider the patients' physiologic states. Vital signs can possibly be used to assess for the presence of physiological derangements such as coagulopathy, acidosis, or a significant base deficit. Providers could use this knowledge to assist with triage at casualty collection points where laboratory studies or point of care testing may not be available. With institutional approval, data were extracted from the Joint Theater Trauma Registry for all patients with thoracic trauma between 2002 and 2012. Patients were identified by International Statistical Classification of Diseases and Related Health Problems, 9th Revision (ICD-9) codes. Heart rate (HR), systolic blood pressure (SBP), and pulse pressure were correlated with coagulopathy (international normalization ratio ≥ 1.5), acidosis (pH < 7.2) or an elevated base deficit (>6) on admission. Sensitivity, specificity, positive predictive values, negative predictive values, and odds ratios were calculated. HR > 100, SBP < 90, or pulse pressure <30 were associated with an increased risk for acidosis (odds ratio 3.06 [95% confidence interval 2.48-3.78], 4.72 [3.85-5.78], and 2.73 [2.15-3.48], respectively), coagulopathy (2.21 [1.72-2.83], 4.55 [3.57-5.80], and 2.73 [2.15-3.48], respectively), and base deficit >6 (2.17 [1.88-2.50], 3.48 [2.87-4.22], and 2.22 [1.78-2.77], respectively). HR was a moderately sensitive marker (0.74), whereas SBP was a specific marker (0.93). SBP < 90 is an effective marker for ruling in physiologic derangement after thoracic trauma. HR > 100 was associated with over twice the odds for physiologic derangement. Vital signs can be used to assess for physiologic derangement in the population studied and may help in triage. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Quantifying Risk of Adverse Clinical Events With One Set of Vital Signs Among Primary Care Patients with Hypertension

PubMed Central

Tierney, William M; Brunt, Margaret; Kesterson, Joseph; Zhou, Xiao-Hua; L’Italien, Gil; Lapuerta, Pablo

2004-01-01

BACKGROUND Hypertension is often uncontrolled. One reason might be physicians’ reticence to modify therapy in response to single office measurements of vital signs. METHODS Using electronic records from an inner-city primary care practice, we extracted information about vital signs, diagnoses, test results, and drug therapy available on the first primary care visit in 1993 for patients with hypertension. We then identified multivariable predictors of subsequent vascular complications in the ensuing 5 years. RESULTS Of 5,825 patients (mean age 57 years) previously treated for hypertension for 5.6 years, 7% developed myocardial infarctions, 17% had strokes, 24% developed ischemic heart disease, 22% had heart failure, 12% developed renal insufficiency, and 13% died in 5 years. Controlling for other clinical data, a 10-mmHg increase in systolic blood pressure was associated with 13% increased risk (95% confidence interval [CI], 6%–21%) of renal insufficiency, 9% (95% CI, 3%–15%) increased risk of ischemic heart disease, 7% (95% CI, 3%–11%) increased risk of stroke, and 6% (95% CI, 2%–9%) increased risk of first stroke or myocardial infarction. A 10-mmHg elevation in mean blood pressure predicted a 12% (95% CI, 5%–20%) increased risk of heart failure. An increase in heart rate of 10 beats per minute predicted a 16% (95% CI, 2%–5%) increased risk of death. Diastolic blood pressure predicted only a 13% (95% CI, 4%–23%) increased risk of first stroke. CONCLUSIONS Vital signs—especially systolic blood pressure—recorded routinely during a single primary care visit had significant prognostic value for multiple adverse clinical events among patients treated for hypertension and should not be ignored by clinicians. PMID:15209196

The effect of reflexotherapy and massage therapy on vital signs and stress before coronary angiography: An open-label clinical trial.

PubMed

Khaledifar, Ali; Nasiri, Marzeih; Khaledifar, Borzoo; Khaledifar, Arsalan; Mokhtari, Ali

2017-03-01

Complementary medicine interventions are now successfully used to reduce stress as well as to stabilize hemodynamic indices within different procedures. The present study aimed to examine the effect of massage therapy and reflexotherapy on reducing stress in patients before coronary angiography. In this open-label clinical trial, 75 consecutive patients who were candidate for coronary angiography were randomly assigned to receive reflexotherapy (n = 25), or massage therapy (n = 25), or routine care (n = 25) before angiography. The Spielberger State-Trait Anxiety Inventory was used to determine the stress level of patients before and after interventions and vital signs were also measured. Improvement in diastolic blood pressure, heart rate, and respiratory rate was shown in the reflexotherapy group, and similar effects were observed following other interventions including massage therapy and routine resting program. In subjects who received reflexotherapy the level of stress decreased slightly compared with the other two groups. However, following interventions the level of stress in reflexotherapy group was shown to be lower than other study groups. Reflexotherapy before coronary angiography can help to stabilize vital sign as well as reduce the level of stress. The effect of massage therapy was limited to reducing stress.

Frequency-Tracking CW Doppler Radar Solving Small-Angle Approximation and Null Point Issues in Non-Contact Vital Signs Monitoring.

PubMed

Mercuri, Marco; Liu, Yao-Hong; Lorato, Ilde; Torfs, Tom; Bourdoux, Andre; Van Hoof, Chris

2017-06-01

A Doppler radar operating as a Phase-Locked-Loop (PLL) in frequency demodulator configuration is presented and discussed. The proposed radar presents a unique architecture, using a single channel mixer, and allows to detect contactless vital signs parameters while solving the null point issue and without requiring the small angle approximation condition. Spectral analysis, simulations, and experimental results are presented and detailed to demonstrate the feasibility and the operational principle of the proposed radar architecture.

Multicentre validation of a sepsis prediction algorithm using only vital sign data in the emergency department, general ward and ICU.

PubMed

Mao, Qingqing; Jay, Melissa; Hoffman, Jana L; Calvert, Jacob; Barton, Christopher; Shimabukuro, David; Shieh, Lisa; Chettipally, Uli; Fletcher, Grant; Kerem, Yaniv; Zhou, Yifan; Das, Ritankar

2018-01-26

We validate a machine learning-based sepsis-prediction algorithm ( InSight ) for the detection and prediction of three sepsis-related gold standards, using only six vital signs. We evaluate robustness to missing data, customisation to site-specific data using transfer learning and generalisability to new settings. A machine-learning algorithm with gradient tree boosting. Features for prediction were created from combinations of six vital sign measurements and their changes over time. A mixed-ward retrospective dataset from the University of California, San Francisco (UCSF) Medical Center (San Francisco, California, USA) as the primary source, an intensive care unit dataset from the Beth Israel Deaconess Medical Center (Boston, Massachusetts, USA) as a transfer-learning source and four additional institutions' datasets to evaluate generalisability. 684 443 total encounters, with 90 353 encounters from June 2011 to March 2016 at UCSF. None. Area under the receiver operating characteristic (AUROC) curve for detection and prediction of sepsis, severe sepsis and septic shock. For detection of sepsis and severe sepsis, InSight achieves an AUROC curve of 0.92 (95% CI 0.90 to 0.93) and 0.87 (95% CI 0.86 to 0.88), respectively. Four hours before onset, InSight predicts septic shock with an AUROC of 0.96 (95% CI 0.94 to 0.98) and severe sepsis with an AUROC of 0.85 (95% CI 0.79 to 0.91). InSight outperforms existing sepsis scoring systems in identifying and predicting sepsis, severe sepsis and septic shock. This is the first sepsis screening system to exceed an AUROC of 0.90 using only vital sign inputs. InSight is robust to missing data, can be customised to novel hospital data using a small fraction of site data and retains strong discrimination across all institutions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Assessment of the feasibility of an ultra-low power, wireless digital patch for the continuous ambulatory monitoring of vital signs.

PubMed

Hernandez-Silveira, Miguel; Ahmed, Kamran; Ang, Su-Shin; Zandari, Fahriya; Mehta, Tinaz; Weir, Rebecca; Burdett, Alison; Toumazou, Chris; Brett, Stephen J

2015-05-19

Vital signs are usually recorded at 4-8 h intervals in hospital patients, and deterioration between measurements can have serious consequences. The primary study objective was to assess agreement between a new ultra-low power, wireless and wearable surveillance system for continuous ambulatory monitoring of vital signs and a widely used clinical vital signs monitor. The secondary objective was to examine the system's ability to automatically identify and reject invalid physiological data. Single hospital centre. Heart and respiratory rate were recorded over 2 h in 20 patients undergoing elective surgery and a second group of 41 patients with comorbid conditions, in the general ward. Primary outcome measures were limits of agreement and bias. The secondary outcome measure was proportion of data rejected. The digital patch provided reliable heart rate values in the majority of patients (about 80%) with normal sinus rhythm, and in the presence of abnormal ECG recordings (excluding aperiodic arrhythmias such as atrial fibrillation). The mean difference between systems was less than ±1 bpm in all patient groups studied. Although respiratory data were more frequently rejected as invalid because of the high sensitivity of impedance pneumography to motion artefacts, valid rates were reported for 50% of recordings with a mean difference of less than ±1 brpm compared with the bedside monitor. Correlation between systems was statistically significant (p<0.0001) for heart and respiratory rate, apart from respiratory rate in patients with atrial fibrillation (p=0.02). Overall agreement between digital patch and clinical monitor was satisfactory, as was the efficacy of the system for automatic rejection of invalid data. Wireless monitoring technologies, such as the one tested, may offer clinical value when implemented as part of wider hospital systems that integrate and support existing clinical protocols and workflows. Published by the BMJ Publishing Group Limited

Development of a baby friendly non-contact method for measuring vital signs: First results of clinical measurements in an open incubator at a neonatal intensive care unit

NASA Astrophysics Data System (ADS)

Klaessens, John H.; van den Born, Marlies; van der Veen, Albert; Sikkens-van de Kraats, Janine; van den Dungen, Frank A.; Verdaasdonk, Rudolf M.

2014-02-01

For infants and neonates in an incubator vital signs, such as heart rate, breathing, skin temperature and blood oxygen saturation are measured by sensors and electrodes sticking to the skin. This can damage the vulnerable skin of neonates and cause infections. In addition, the wires interfere with the care and hinder the parents in holding and touching the baby. These problems initiated the search for baby friendly 'non-contact' measurement of vital signs. Using a sensitive color video camera and specially developed software, the heart rate was derived from subtle repetitive color changes. Potentially also respiration and oxygen saturation could be obtained. A thermal camera was used to monitor the temperature distribution of the whole body and detect small temperature variations around the nose revealing the respiration rate. After testing in the laboratory, seven babies were monitored (with parental consent) in the neonatal intensive care unit (NICU) simultaneously with the regular monitoring equipment. From the color video recordings accurate heart rates could be derived and the thermal images provided accurate respiration rates. To correct for the movements of the baby, tracking software could be applied. At present, the image processing was performed off-line. Using narrow band light sources also non-contact blood oxygen saturation could be measured. Non-contact monitoring of vital signs has proven to be feasible and can be developed into a real time system. Besides the application on the NICU non-contact vital function monitoring has large potential for other patient groups.

Vector Autoregressive (VAR) Models and Granger Causality in Time Series Analysis in Nursing Research: Dynamic Changes Among Vital Signs Prior to Cardiorespiratory Instability Events as an Example

PubMed Central

Bose, Eliezer; Hravnak, Marilyn; Sereika, Susan M.

2016-01-01

Background Patients undergoing continuous vital sign monitoring (heart rate [HR], respiratory rate [RR], pulse oximetry [SpO2]) in real time display inter-related vital sign changes during situations of physiologic stress. Patterns in this physiological cross-talk could portend impending cardiorespiratory instability (CRI). Vector autoregressive (VAR) modeling with Granger causality tests is one of the most flexible ways to elucidate underlying causal mechanisms in time series data. Purpose The purpose of this article is to illustrate development of patient-specific VAR models using vital sign time series (VSTS) data in a sample of acutely ill, monitored, step-down unit (SDU) patients, and determine their Granger causal dynamics prior to onset of an incident CRI. Approach CRI was defined as vital signs beyond stipulated normality thresholds (HR = 40–140/minute, RR = 8–36/minute, SpO2 < 85%) and persisting for 3 minutes within a 5-minute moving window (60% of the duration of the window). A 6-hour time segment prior to onset of first CRI was chosen for time series modeling in 20 patients using a six-step procedure: (a) the uniform time series for each vital sign was assessed for stationarity; (b) appropriate lag was determined using a lag-length selection criteria; (c) the VAR model was constructed; (d) residual autocorrelation was assessed with the Lagrange Multiplier test; (e) stability of the VAR system was checked; and (f) Granger causality was evaluated in the final stable model. Results The primary cause of incident CRI was low SpO2 (60% of cases), followed by out-of-range RR (30%) and HR (10%). Granger causality testing revealed that change in RR caused change in HR (21%) (i.e., RR changed before HR changed) more often than change in HR causing change in RR (15%). Similarly, changes in RR caused changes in SpO2 (15%) more often than changes in SpO2 caused changes in RR (9%). For HR and SpO2, changes in HR causing changes in SpO2 and changes in SpO2 causing

Patient Adherence to Scheduled Vital Sign Measurements During Home Telemonitoring: Analysis of the Intervention Arm in a Before and After Trial

PubMed Central

2018-01-01

Background In a home telemonitoring trial, patient adherence with scheduled vital signs measurements is an important aspect that has not been thoroughly studied and for which data in the literature are limited. Levels of adherence have been reported as varying from approximately 40% to 90%, and in most cases, the adherence rate usually dropped off steadily over time. This drop is more evident in the first few weeks or months after the start. Higher adherence rates have been reported for simple types of monitoring and for shorter periods of intervention. If patients do not follow the intended procedure, poorer results than expected may be achieved. Hence, analyzing factors that can influence patient adherence is of great importance. Objective The goal of the research was to present findings on patient adherence with scheduled vital signs measurements in the recently completed Commonwealth Scientific and Industrial Research Organisation (CSIRO) national trial of home telemonitoring of patients (mean age 70.5 years, SD 9.3 years) with chronic conditions (chronic obstructive pulmonary disease, coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) carried out at 5 locations along the east coast of Australia. We investigated the ability of chronically ill patients to carry out a daily schedule of vital signs measurements as part of a chronic disease management care plan over periods exceeding 6 months (302 days, SD 135 days) and explored different levels of adherence for different measurements as a function of age, gender, and supervisory models. Methods In this study, 113 patients forming the test arm of a Before and After Control Intervention (BACI) home telemonitoring trial were analyzed. Patients were required to monitor on a daily basis a range of vital signs determined by their chronic condition and comorbidities. Vital signs included noninvasive blood pressure, pulse oximetry, spirometry, electrocardiogram (ECG), blood

Evaluating the validity and reliability of the V-scale instrument (Turkish version) used to determine nurses' attitudes towards vital sign monitoring.

PubMed

Ertuğ, Nurcan

2018-06-01

The aim of this study was to determine the validity and reliability of the Turkish version of the V-scale, which measures nurses' attitudes towards vital signs monitoring in the detection of clinical deterioration. This validity and reliability study was conducted at a tertiary hospital in Ankara, Turkey, in 2016. A total of 169 ward nurses participated in the study. Exploratory factor analysis, Cronbach's alpha coefficient, and the intraclass correlation coefficient were used to determine the validity and reliability of the scale. A 5-factor, 16-item scale explained 60.823% of the total variance according to the validity analysis. Our version matched the original scale in terms of the number of items and factor structure. Cronbach's alpha coefficient of the Turkish version of the V-scale was 0.764. The test-retest reliability results were 0.855 for the overall intraclass correlation coefficient, and the t-test result was P > 0.05. The V-scale is a reliable and valid instrument to measure Turkish nurses' attitudes towards vital signs monitoring in the detection of clinical deterioration. © 2018 John Wiley & Sons Australia, Ltd.

Distributions and Behavior of Vital Signs in Critically Ill Children by Admission Diagnosis.

PubMed

Eytan, Danny; Goodwin, Andrew J; Greer, Robert; Guerguerian, Anne-Marie; Mazwi, Mjaye; Laussen, Peter C

2018-02-01

Define the distributions of heart rate and intraarterial blood pressure in children at admission to an ICU based on admission diagnosis and examine trends in these physiologic signs over 72 hours from admission (or to discharge if earlier). A retrospective analysis of continuously acquired signals. A quaternary and primary referral children's hospital with a general PICU and cardiac critical care unit. One thousand two hundred eighty-nine patients less than 18 years old were analyzed. Data from individual patient admissions were divided into 19 groups by primary admission diagnosis or surgical procedure. None. Distributions at admission are dependent on patient age and admission diagnosis (p < 10). Heart rate decreases over time, whereas arterial blood pressure is relatively stable, with differences seen in the directions and magnitude of these trends when analyzed by diagnosis group (p < 10). Multiple linear regression analysis shows that patient age, diagnosis group, and physiologic vital sign value at admission explain 50-63% of the variation observed for that physiologic signal at 72 hours (or at discharge if earlier) with admission value having the greatest influence. Furthermore, the variance of either heart rate or arterial blood pressure for the individual patient is smaller than the variance measured at the level of the group of patients with the same diagnosis. This is the first study reporting distributions of continuously measured physiologic variables and trends in their behavior according to admission diagnosis in critically ill children. Differences detected between and within diagnostic groups may aid in earlier recognition of outliers as well as allowing refinement of patient monitoring strategies.

Insecticide susceptibility of Aedes albopictus and Ae. aegypti from Brazil and the Swiss-Italian border region.

PubMed

Suter, Tobias; Crespo, Mônica Maria; de Oliveira, Mariana Francelino; de Oliveira, Thaynan Sama Alves; de Melo-Santos, Maria Alice Varjal; de Oliveira, Cláudia Maria Fontes; Ayres, Constância Flávia Junqueira; Barbosa, Rosângela Maria Rodrigues; Araújo, Ana Paula; Regis, Lêda Narcisa; Flacio, Eleonora; Engeler, Lukas; Müller, Pie; Silva-Filha, Maria Helena Neves Lobo

2017-09-19

Aedes aegypti and Ae. albopictus are two highly invasive mosquito species, both vectors of several viruses, including dengue, chikungunya and Zika. While Ae. aegypti is the primary vector in the tropics and sub-tropics, Ae. albopictus is increasingly under the public health watch as it has been implicated in arbovirus-transmission in more temperate regions, including continental Europe. Vector control using insecticides is the pillar of most control programmes; hence development of insecticide resistance is of great concern. As part of a Brazilian-Swiss Joint Research Programme we set out to assess whether there are any signs of existing or incipient insecticide resistance primarily against the larvicide Bacillus thuringiensis svar. israelensis (Bti), but also against currently applied and potentially alternative insecticides in our areas, Recife (Brazil) and the Swiss-Italian border region. Following World Health Organization guidelines, dose-response curves for a range of insecticides were established for both colonized and field caught Ae. aegypti and Ae. albopictus. The larvicides included Bti, two of its toxins, Cry11Aa and Cry4Ba, Lysinibacillus sphaericus, Vectomax CG®, a formulated combination of Bti and L. sphaericus, and diflubenzuron. In addition to the larvicides, the Swiss-Italian Ae. albopictus populations were also tested against five adulticides (bendiocarb, dichlorodiphenyltrichloroethane, malathion, permethrin and λ-cyhalothrin). Showing a similar dose-response, all mosquito populations were fully susceptible to the larvicides tested and, in particular, to Bti which is currently used both in Brazil and Switzerland. In addition, there were no signs of incipient resistance against Bti as larvae were equally susceptible to the individual toxins, Cry11Aa and Cry4Ba. The field-caught Swiss-Italian populations were susceptible to the adulticides tested but DDT mortality rates showed signs of reduced susceptibility. The insecticides currently used for

Pregnancy physiology pattern prediction study (4P study): protocol of an observational cohort study collecting vital sign information to inform the development of an accurate centile-based obstetric early warning score.

PubMed

Kumar, Fiona; Kemp, Jude; Edwards, Clare; Pullon, Rebecca M; Loerup, Lise; Triantafyllidis, Andreas; Salvi, Dario; Gibson, Oliver; Gerry, Stephen; MacKillop, Lucy H; Tarassenko, Lionel; Watkinson, Peter J

2017-09-01

Successive confidential enquiries into maternal deaths in the UK have identified an urgent need to develop a national early warning score (EWS) specifically for pregnant or recently pregnant women to aid more timely recognition, referral and treatment of women who are developing life-threatening complications in pregnancy or the puerperium. Although many local EWS are in use in obstetrics, most have been developed heuristically. No current obstetric EWS has defined the thresholds at which an alert should be triggered using evidence-based normal ranges, nor do they reflect the changing physiology that occurs with gestation during pregnancy. An observational cohort study involving 1000 participants across three UK sites in Oxford, London and Newcastle. Pregnant women will be recruited at approximately 14 weeks' gestation and have their vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation and temperature) measured at 4 to 6-week intervals during pregnancy. Vital signs recorded during labour and delivery will be extracted from hospital records. After delivery, participants will measure and record their own vital signs daily for 2 weeks. During the antenatal and postnatal periods, vital signs will be recorded on an Android tablet computer through a custom software application and transferred via mobile internet connection to a secure database. The data collected will be used to define reference ranges of vital signs across normal pregnancy, labour and the immediate postnatal period. This will inform the design of an evidence-based obstetric EWS. The study has been approved by the NRES committee South East Coast-Brighton and Sussex (14/LO/1312) and is registered with the ISRCTN (10838017). All participants will provide written informed consent and can withdraw from the study at any point. All data collected will be managed anonymously. The findings will be disseminated in international peer-reviewed journals and through research conferences. �

Quick Assessment of Literacy in Primary Care: The Newest Vital Sign

PubMed Central

Weiss, Barry D.; Mays, Mary Z.; Martz, William; Castro, Kelley Merriam; DeWalt, Darren A.; Pignone, Michael P.; Mockbee, Joy; Hale, Frank A.

2005-01-01

PURPOSE Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in English and Spanish. METHODS We administered candidate items for the new instrument and also the Test of Functional Health Literacy in Adults (TOFHLA) to English-speaking and Spanish-speaking primary care patients. We measured internal consistency with Cronbach’s α and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores <75 to define limited literacy, we plotted receiver-operating characteristics (ROC) curves and calculated likelihood ratios for cutoff scores on the new instrument. RESULTS The final instrument, the Newest Vital Sign (NVS), is a nutrition label that is accompanied by 6 questions and requires 3 minutes for administration. It is reliable (Cronbach α >0.76 in English and 0.69 in Spanish) and correlates with the TOFHLA. Area under the ROC curve is 0.88 for English and 0.72 for Spanish versions. Patients with more than 4 correct responses are unlikely to have low literacy, whereas fewer than 4 correct answers indicate the possibility of limited literacy. CONCLUSION NVS is suitable for use as a quick screening test for limited literacy in primary health care settings. PMID:16338915

The Nurse Watch: Design and Evaluation of a Smart Watch Application with Vital Sign Monitoring and Checklist Reminders.

PubMed

Bang, Magnus; Solnevik, Katarina; Eriksson, Henrik

Computerized wearable devices such as smart watches will become valuable nursing tools. This paper describes a smart-watch system developed in close collaboration with a team of nurses working in a Swedish ICU. The smart-watch system provides real-time vital-sign monitoring, threshold alarms, and to-do reminders. Additionally, a Kanban board, visualized on a multitouch screen provides an overview of completed and upcoming tasks. We describe an approach to implement automated checklist systems with smart watches and discuss aspects of importance when implementing such memory and attention support. The paper is finalized with an in-development formative evaluation of the system.

Patient Adherence to Scheduled Vital Sign Measurements During Home Telemonitoring: Analysis of the Intervention Arm in a Before and After Trial.

PubMed

Celler, Branko; Argha, Ahmadreza; Varnfield, Marlien; Jayasena, Rajiv

2018-04-09

In a home telemonitoring trial, patient adherence with scheduled vital signs measurements is an important aspect that has not been thoroughly studied and for which data in the literature are limited. Levels of adherence have been reported as varying from approximately 40% to 90%, and in most cases, the adherence rate usually dropped off steadily over time. This drop is more evident in the first few weeks or months after the start. Higher adherence rates have been reported for simple types of monitoring and for shorter periods of intervention. If patients do not follow the intended procedure, poorer results than expected may be achieved. Hence, analyzing factors that can influence patient adherence is of great importance. The goal of the research was to present findings on patient adherence with scheduled vital signs measurements in the recently completed Commonwealth Scientific and Industrial Research Organisation (CSIRO) national trial of home telemonitoring of patients (mean age 70.5 years, SD 9.3 years) with chronic conditions (chronic obstructive pulmonary disease, coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) carried out at 5 locations along the east coast of Australia. We investigated the ability of chronically ill patients to carry out a daily schedule of vital signs measurements as part of a chronic disease management care plan over periods exceeding 6 months (302 days, SD 135 days) and explored different levels of adherence for different measurements as a function of age, gender, and supervisory models. In this study, 113 patients forming the test arm of a Before and After Control Intervention (BACI) home telemonitoring trial were analyzed. Patients were required to monitor on a daily basis a range of vital signs determined by their chronic condition and comorbidities. Vital signs included noninvasive blood pressure, pulse oximetry, spirometry, electrocardiogram (ECG), blood glucose level, body temperature

Machine learning and new vital signs monitoring in civilian en route care: A systematic review of the literature and future implications for the military.

PubMed

Liu, Nehemiah T; Salinas, Jose

2016-11-01

Although air transport medical services are today an integral part of trauma systems in most developed countries, to date, there are no reviews on recent innovations in civilian en route care. The purpose of this systematic review was to identify potential machine learning and new vital signs monitoring technologies in civilian en route care that could help close civilian and military capability gaps in monitoring and the early detection and treatment of various trauma injuries. MEDLINE, the Cochrane Database of Systematic Reviews, and citation review of relevant primary and review articles were searched for studies involving civilian en route care, air medical transport, and technologies from January 2005 to November 2015. Data were abstracted on study design, population, year, sponsors, innovation category, details of technologies, and outcomes. Thirteen observational studies involving civilian medical transport met inclusion criteria. Studies either focused on machine learning and software algorithms (n = 5), new vital signs monitoring (n = 6), or both (n = 2). Innovations involved continuous digital acquisition of physiologic data and parameter extraction. Importantly, all studies (n = 13) demonstrated improved outcomes where applicable and potential use during civilian and military en route care. However, almost all studies required further validation in prospective and/or randomized controlled trials. Potential machine learning technologies and monitoring of novel vital signs such as heart rate variability and complexity in civilian en route care could help enhance en route care for our nation's war fighters. In a complex global environment, they could potentially fill capability gaps such as monitoring and the early detection and treatment of various trauma injuries. However, the impact of these innovations and technologies will require further validation before widespread acceptance and prehospital use. Systematic review, level V.

The Nurse Watch: Design and Evaluation of a Smart Watch Application with Vital Sign Monitoring and Checklist Reminders

PubMed Central

Bang, Magnus; Solnevik, Katarina; Eriksson, Henrik

2015-01-01

Computerized wearable devices such as smart watches will become valuable nursing tools. This paper describes a smart-watch system developed in close collaboration with a team of nurses working in a Swedish ICU. The smart-watch system provides real-time vital-sign monitoring, threshold alarms, and to-do reminders. Additionally, a Kanban board, visualized on a multitouch screen provides an overview of completed and upcoming tasks. We describe an approach to implement automated checklist systems with smart watches and discuss aspects of importance when implementing such memory and attention support. The paper is finalized with an in-development formative evaluation of the system. PMID:26958162

A ZigBee-based wireless system for monitoring vital signs in hyperbaric chambers: Technical report.

PubMed

Carmona, Cristian; Alorda, Bartomeu; Gracia, Luis; Perez-Vidal, Carlos; Salinas, Antonio

2017-01-01

This paper presents the replacement of a traditional wired communication link of the hyperbaric chambers with a wireless ZigBee-based system. This move allows a reduction in the costs of seals capable of withstanding the internal pressures and gives rise to a more versatile system. The new system is able to capture and process individual vital signs like the electrocardiography signal, and other analog sources, sending the data to an external computer and allowing analysis, representation and sharing with medical staff. This system solves such problems as the attenuation of the signal produced by the metal walls of the hyperbaric chamber and has a coverage area large enough to manage up to six patients with an effective data rate conversion of 2kHz. Furthermore, a battery-based and multiparameter platform is designed for multipatient hyperbaric chambers. Copyright© Undersea and Hyperbaric Medical Society.

Effect of lavender aromatherapy on vital signs and perceived quality of sleep in the intermediate care unit: a pilot study.

PubMed

Lytle, Jamie; Mwatha, Catherine; Davis, Karen K

2014-01-01

Sleep deprivation in hospitalized patients is common and can have serious detrimental effects on recovery from illness. Lavender aromatherapy has improved sleep in a variety of clinical settings, but the effect has not been tested in the intermediate care unit. To determine the effect of inhalation of 100% lavender oil on patients' vital signs and perceived quality of sleep in an intermediate care unit. A randomized controlled pilot study was conducted in 50 patients. Control patients received usual care. The treatment group had 3 mL of 100% pure lavender oil in a glass jar in place at the bedside from 10 pm until 6 am. Vital signs were recorded at intervals throughout the night. At 6 am all patients completed the Richard Campbell Sleep Questionnaire to assess quality of sleep. Blood pressure was significantly lower between midnight and 4 am in the treatment group than in the control group (P = .03) According to the overall mean change score in blood pressure between the baseline and 6 am measurements, the treatment group had a decrease in blood pressure and the control group had an increase; however, the difference between the 2 groups was not significant (P = .12). Mean overall sleep score was higher in the intervention group (48.25) than in the control group (40.10), but the difference was not significant. Lavender aromatherapy may be an effective way to improve sleep in an intermediate care unit.

Educational technology "Anatomy and Vital Signs": Evaluation study of content, appearance and usability.

PubMed

de Góes, Fernanda dos Santos Nogueira; Fonseca, Luciana Mara Monti; de Camargo, Rosangela Andrade Aukar; de Oliveira, Gustavo Faria; Felipe, Helena Reche

2015-11-01

The use of new technology has recently grown considerably as an increasing number of college students using Internet. In nursing education, the personal computer and the Internet facilitate teaching theoretical and practical knowledge. Evaluate an educational technology known as "Anatomy and Vital Signs" with respect to content, appearance and usability. This was a first stage evaluation-by specialists to verify content and functioning, prior to a second validation as to learning by students. A methodological study in which instructional technologists (11 participants) and nursing specialists (17 participants) used the technology in an unguided manner and completed three questionnaires. The evaluation was measured by the difference between disagreement and agreement for each statement in the questionnaires. Most of the items were positively evaluated at a level higher than 70% by most of the evaluators except for the following usability criteria: grouping by shape, minimum actions and user control, which did not attain the 70% agreement level among instructional technologists. The evaluation was useful to improve the technology and guarantee suitable product for nursing education. It may be a reliable educational tool for nursing education that applies technological resources. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Short-Range Vital Signs Sensing Based on EEMD and CWT Using IR-UWB Radar

PubMed Central

Hu, Xikun; Jin, Tian

2016-01-01

The radar sensor described realizes healthcare monitoring capable of detecting subject chest-wall movement caused by cardiopulmonary activities and wirelessly estimating the respiration and heartbeat rates of the subject without attaching any devices to the body. Conventional single-tone Doppler radar can only capture Doppler signatures because of a lack of bandwidth information with noncontact sensors. In contrast, we take full advantage of impulse radio ultra-wideband (IR-UWB) radar to achieve low power consumption and convenient portability, with a flexible detection range and desirable accuracy. A noise reduction method based on improved ensemble empirical mode decomposition (EEMD) and a vital sign separation method based on the continuous-wavelet transform (CWT) are proposed jointly to improve the signal-to-noise ratio (SNR) in order to acquire accurate respiration and heartbeat rates. Experimental results illustrate that respiration and heartbeat signals can be extracted accurately under different conditions. This noncontact healthcare sensor system proves the commercial feasibility and considerable accessibility of using compact IR-UWB radar for emerging biomedical applications. PMID:27916877

Short-Range Vital Signs Sensing Based on EEMD and CWT Using IR-UWB Radar.

PubMed

Hu, Xikun; Jin, Tian

2016-11-30

The radar sensor described realizes healthcare monitoring capable of detecting subject chest-wall movement caused by cardiopulmonary activities and wirelessly estimating the respiration and heartbeat rates of the subject without attaching any devices to the body. Conventional single-tone Doppler radar can only capture Doppler signatures because of a lack of bandwidth information with noncontact sensors. In contrast, we take full advantage of impulse radio ultra-wideband (IR-UWB) radar to achieve low power consumption and convenient portability, with a flexible detection range and desirable accuracy. A noise reduction method based on improved ensemble empirical mode decomposition (EEMD) and a vital sign separation method based on the continuous-wavelet transform (CWT) are proposed jointly to improve the signal-to-noise ratio (SNR) in order to acquire accurate respiration and heartbeat rates. Experimental results illustrate that respiration and heartbeat signals can be extracted accurately under different conditions. This noncontact healthcare sensor system proves the commercial feasibility and considerable accessibility of using compact IR-UWB radar for emerging biomedical applications.

Novel Flexible Wearable Sensor Materials and Signal Processing for Vital Sign and Human Activity Monitoring.

PubMed

Servati, Amir; Zou, Liang; Wang, Z Jane; Ko, Frank; Servati, Peyman

2017-07-13

Advances in flexible electronic materials and smart textile, along with broad availability of smart phones, cloud and wireless systems have empowered the wearable technologies for significant impact on future of digital and personalized healthcare as well as consumer electronics. However, challenges related to lack of accuracy, reliability, high power consumption, rigid or bulky form factor and difficulty in interpretation of data have limited their wide-scale application in these potential areas. As an important solution to these challenges, we present latest advances in novel flexible electronic materials and sensors that enable comfortable and conformable body interaction and potential for invisible integration within daily apparel. Advances in novel flexible materials and sensors are described for wearable monitoring of human vital signs including, body temperature, respiratory rate and heart rate, muscle movements and activity. We then present advances in signal processing focusing on motion and noise artifact removal, data mining and aspects of sensor fusion relevant to future clinical applications of wearable technology.

Cost-efficient speckle interferometry with plastic optical fiber for unobtrusive monitoring of human vital signs.

PubMed

Podbreznik, Peter; Đonlagić, Denis; Lešnik, Dejan; Cigale, Boris; Zazula, Damjan

2013-10-01

A cost-efficient plastic optical fiber (POF) system for unobtrusive monitoring of human vital signs is presented. The system is based on speckle interferometry. A laser diode is butt-coupled to the POF whose exit face projects speckle patterns onto a linear optical sensor array. Sequences of acquired speckle images are transformed into one-dimensional signals by using the phase-shifting method. The signals are analyzed by band-pass filtering and a Morlet-wavelet-based multiresolutional approach for the detection of cardiac and respiratory activities, respectively. The system is tested with 10 healthy nonhospitalized persons, lying supine on a mattress with the embedded POF. Experimental results are assessed statistically: precisions of 98.8% ± 1.5% and 97.9% ± 2.3%, sensitivities of 99.4% ± 0.6% and 95.3% ± 3%, and mean delays between interferometric detections and corresponding referential signals of 116.6 ± 55.5 and 1299.2 ± 437.3 ms for the heartbeat and respiration are obtained, respectively.

Novel Flexible Wearable Sensor Materials and Signal Processing for Vital Sign and Human Activity Monitoring

PubMed Central

Servati, Amir; Wang, Z. Jane; Ko, Frank; Servati, Peyman

2017-01-01

Advances in flexible electronic materials and smart textile, along with broad availability of smart phones, cloud and wireless systems have empowered the wearable technologies for significant impact on future of digital and personalized healthcare as well as consumer electronics. However, challenges related to lack of accuracy, reliability, high power consumption, rigid or bulky form factor and difficulty in interpretation of data have limited their wide-scale application in these potential areas. As an important solution to these challenges, we present latest advances in novel flexible electronic materials and sensors that enable comfortable and conformable body interaction and potential for invisible integration within daily apparel. Advances in novel flexible materials and sensors are described for wearable monitoring of human vital signs including, body temperature, respiratory rate and heart rate, muscle movements and activity. We then present advances in signal processing focusing on motion and noise artifact removal, data mining and aspects of sensor fusion relevant to future clinical applications of wearable technology. PMID:28703744

Amino-terminal enhancer of split gene AES encodes a tumor and metastasis suppressor of prostate cancer.

PubMed

Okada, Yoshiyuki; Sonoshita, Masahiro; Kakizaki, Fumihiko; Aoyama, Naoki; Itatani, Yoshiro; Uegaki, Masayuki; Sakamoto, Hiromasa; Kobayashi, Takashi; Inoue, Takahiro; Kamba, Tomomi; Suzuki, Akira; Ogawa, Osamu; Taketo, M Mark

2017-04-01

A major cause of cancer death is its metastasis to the vital organs. Few effective therapies are available for metastatic castration-resistant prostate cancer (PCa), and progressive metastatic lesions such as lymph nodes and bones cause mortality. We recently identified AES as a metastasis suppressor for colon cancer. Here, we have studied the roles of AES in PCa progression. We analyzed the relationship between AES expression and PCa stages of progression by immunohistochemistry of human needle biopsy samples. We then performed overexpression and knockdown of AES in human PCa cell lines LNCaP, DU145 and PC3, and determined the effects on proliferation, invasion and metastasis in culture and in a xenograft model. We also compared the PCa phenotypes of Aes/Pten compound knockout mice with those of Pten simple knockout mice. Expression levels of AES were inversely correlated with clinical stages of human PCa. Exogenous expression of AES suppressed the growth of LNCaP cells, whereas the AES knockdown promoted it. We also found that AES suppressed transcriptional activities of androgen receptor and Notch signaling. Notably, AES overexpression in AR-defective DU145 and PC3 cells reduced invasion and metastasis to lymph nodes and bones without affecting proliferation in culture. Consistently, prostate epithelium-specific inactivation of Aes in Pten flox/flox mice increased expression of Snail and MMP9, and accelerated growth, invasion and lymph node metastasis of the mouse prostate tumor. These results suggest that AES plays an important role in controlling tumor growth and metastasis of PCa by regulating both AR and Notch signaling pathways. © 2017 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

Comparison of smartphone application-based vital sign monitors without external hardware versus those used in clinical practice: a prospective trial.

PubMed

Alexander, John C; Minhajuddin, Abu; Joshi, Girish P

2017-08-01

Use of healthcare-related smartphone applications is common. However, there is concern that inaccurate information from these applications may lead patients to make erroneous healthcare decisions. The objective of this study is to study smartphone applications purporting to measure vital sign data using only onboard technology compared with monitors used routinely in clinical practice. This is a prospective trial comparing correlation between a clinically utilized vital sign monitor (Propaq CS, WelchAllyn, Skaneateles Falls, NY, USA) and four smartphone application-based monitors Instant Blood Pressure, Instant Blood Pressure Pro, Pulse Oximeter, and Pulse Oximeter Pro. We performed measurements of heart rate (HR), systolic blood pressures (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO 2 ) using standard monitor and four smartphone applications. Analysis of variance was used to compare measurements from the applications to the routine monitor. The study was completed on 100 healthy volunteers. Comparison of routine monitor with the smartphone applications shows significant differences in terms of HR, SpO 2 and DBP. The SBP values from the applications were not significantly different from those from the routine monitor, but had wide limits of agreement signifying a large degree of variation in the compared values. The degree of correlation between monitors routinely used in clinical practice and the smartphone-based applications studied is insufficient to recommend clinical utilization. This lack of correlation suggests that the applications evaluated do not provide clinically meaningful data. The inaccurate data provided by these applications can potentially contribute to patient harm.

Do patients with blunt thoracic aortic injury present to hospital with unstable vital signs? A systematic review and meta-analysis.

PubMed

Bade-Boon, Jordan; Mathew, Joseph K; Fitzgerald, Mark C; Mitra, Biswadev

2018-04-01

Blunt thoracic aortic injury (BTAI) is an uncommon diagnosis, usually developing as a consequence of high-impact acceleration-deceleration mechanisms. Timely diagnosis may enable early resuscitation and reduction of shear forces, essential to prevent worsening of the injury prior to definitive management. Death is commonly due to haemorrhagic shock, but clinical features may be absent until sudden and massive haemorrhage. The aim of this systematic review was to determine the proportion of patients with BTAI who present with unstable vital signs. Manuscripts were identified through a search of MEDLINE, EMBASE and the Cochrane Library databases, focusing on subject headings and keywords related to the aorta and trauma. Mechanisms of injury, haemodynamic status and mortality from the included manuscripts were reviewed. Meta-analysis of presenting haemodynamic status among a select group of similar papers was conducted. Nineteen studies were included, with five selected for meta-analysis. Most reported cases of BTAI (80.0%-100%) were caused by road traffic incidents, with mortality consistently higher among initially unstable patients. There was statistically significant heterogeneity among the included studies (P<0.01). The pooled proportion of patients with haemodynamic instability in the setting of BTAI was 48.8% (95% CI 8.3 to 89.4). Normal vital signs do not rule out aortic injury. A high degree of clinical suspicion and liberal use of imaging is necessary to prevent missed or delayed diagnoses. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Vital signs monitoring on general wards: clinical staff perceptions of current practices and the planned introduction of continuous monitoring technology.

PubMed

Prgomet, Mirela; Cardona-Morrell, Magnolia; Nicholson, Margaret; Lake, Rebecca; Long, Janet; Westbrook, Johanna; Braithwaite, Jeffrey; Hillman, Ken

2016-09-01

Early detection of patient deterioration and prevention of adverse events are key challenges to patient safety. This study investigated clinical staff perceptions of current monitoring practices and the planned introduction of continuous monitoring devices on general wards. Multi-method study comprising structured surveys, in-depth interviews and device trial with log book feedback. Two general wards in a large urban teaching hospital in Sydney, Australia. Respiratory and neurosurgery nursing staff and two doctors. Nurses were confident about their abilities to identify patients at risk of deterioration, using a combination of vital signs and visual assessment. There were concerns about the accuracy of current vital signs monitoring equipment and frequency of intermittent observation. Both the nurses and the doctors were enthusiastic about the prospect of continuous monitoring and perceived it would allow earlier identification of patient deterioration; provide reassurance to patients; and support interdisciplinary communication. There were also reservations about continuous monitoring, including potential decrease in bedside nurse-patient interactions; increase in inappropriate escalations of patient care; and discomfort to patients. While continuous monitoring devices were seen as a potentially positive tool to support the identification of patient deterioration, drawbacks, such as the potential for reduced patient contact, revealed key areas that will require close surveillance following the implementation of devices. Training and improved interdisciplinary communication were identified as key requisites for successful implementation. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Vital sign monitoring for elderly at home: development of a compound sensor for pulse rate and motion.

PubMed

Sum, K W; Zheng, Y P; Mak, A F T

2005-01-01

This paper describes the development of a miniaturized wearable vital sign monitor which is aimed for use by elderly at home. The development of a compound sensor for pulse rate, motion, and skin temperature is reported. A pair of infrared sensor working in reflection mode was used to detect the pulse rate from various sites over the body including the wrist and finger. Meanwhile, a motion sensor was used to detect the motion of the body. In addition, the temperature on the skin surface was sensed by a semiconductor temperature sensor. A prototype has been built into a box with a dimension of 2 x 2.5 x 4 cm3. The device includes the sensors, microprocessor, circuits, battery, and a wireless transceiver for communicating data with a data terminal.

The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study

PubMed Central

Jansen, Tim C; van Bommel, Jasper; Mulder, Paul G; Rommes, Johannes H; Schieveld, Selma JM; Bakker, Jan

2008-01-01

Introduction A limitation of pre-hospital monitoring is that vital signs often do not change until a patient is in a critical stage. Blood lactate levels are suggested as a more sensitive parameter to evaluate a patient's condition. The aim of this pilot study was to find presumptive evidence for a relation between pre-hospital lactate levels and in-hospital mortality, corrected for vital sign abnormalities. Methods In this prospective observational study (n = 124), patients who required urgent ambulance dispatching and had a systolic blood pressure below 100 mmHg, a respiratory rate less than 10 or more than 29 breaths/minute, or a Glasgow Coma Scale (GCS) below 14 were enrolled. Nurses from Emergency Medical Services measured capillary or venous lactate levels using a hand-held device on arrival at the scene (T1) and just before or on arrival at the emergency department (T2). The primary outcome measured was in-hospital mortality. Results The average (standard deviation) time from T1 to T2 was 27 (10) minutes. Non-survivors (n = 32, 26%) had significantly higher lactate levels than survivors at T1 (5.3 vs 3.7 mmol/L) and at T2 (5.4 vs 3.2 mmol/L). Mortality was significantly higher in patients with lactate levels of 3.5 mmol/L or higher compared with those with lactate levels below 3.5 mmol/L (T1: 41 vs 12% and T2: 47 vs 15%). Also in the absence of hypotension, mortality was higher in those with higher lactate levels. In a multivariable Cox proportional hazard analysis including systolic blood pressure, heart rate, GCS (all at T1) and delta lactate level (from T1 to T2), only delta lactate level (hazard ratio (HR) = 0.20, 95% confidence interval (CI) = 0.05 to 0.76, p = 0.018) and GCS (HR = 0.93, 95% CI = 0.88 to 0.99, p = 0.022) were significant independent predictors of in-hospital mortality. Conclusions In a cohort of patients that required urgent ambulance dispatching, pre-hospital blood lactate levels were associated with in-hospital mortality and provided

Wearable, multimodal, vitals acquisition unit for intelligent field triage

PubMed Central

Georgiou, Julius

2016-01-01

In this Letter, the authors describe the characterisation design and development of the authors’ wearable, multimodal vitals acquisition unit for intelligent field triage. The unit is able to record the standard electrocardiogram, blood oxygen and body temperature parameters and also has the unique capability to record up to eight custom designed acoustic streams for heart and lung sound auscultation. These acquisition channels are highly synchronised to fully maintain the time correlation of the signals. The unit is a key component enabling systematic and intelligent field triage to continuously acquire vital patient information. With the realised unit a novel data-set with highly synchronised vital signs was recorded. The new data-set may be used for algorithm design in vital sign analysis or decision making. The monitoring unit is the only known body worn system that records standard emergency parameters plus eight multi-channel auscultatory streams and stores the recordings and wirelessly transmits them to mobile response teams. PMID:27733926

Wearable, multimodal, vitals acquisition unit for intelligent field triage.

PubMed

Beck, Christoph; Georgiou, Julius

2016-09-01

In this Letter, the authors describe the characterisation design and development of the authors' wearable, multimodal vitals acquisition unit for intelligent field triage. The unit is able to record the standard electrocardiogram, blood oxygen and body temperature parameters and also has the unique capability to record up to eight custom designed acoustic streams for heart and lung sound auscultation. These acquisition channels are highly synchronised to fully maintain the time correlation of the signals. The unit is a key component enabling systematic and intelligent field triage to continuously acquire vital patient information. With the realised unit a novel data-set with highly synchronised vital signs was recorded. The new data-set may be used for algorithm design in vital sign analysis or decision making. The monitoring unit is the only known body worn system that records standard emergency parameters plus eight multi-channel auscultatory streams and stores the recordings and wirelessly transmits them to mobile response teams.

Computational Depth of Anesthesia via Multiple Vital Signs Based on Artificial Neural Networks.

PubMed

Sadrawi, Muammar; Fan, Shou-Zen; Abbod, Maysam F; Jen, Kuo-Kuang; Shieh, Jiann-Shing

2015-01-01

This study evaluated the depth of anesthesia (DoA) index using artificial neural networks (ANN) which is performed as the modeling technique. Totally 63-patient data is addressed, for both modeling and testing of 17 and 46 patients, respectively. The empirical mode decomposition (EMD) is utilized to purify between the electroencephalography (EEG) signal and the noise. The filtered EEG signal is subsequently extracted to achieve a sample entropy index by every 5-second signal. Then, it is combined with other mean values of vital signs, that is, electromyography (EMG), heart rate (HR), pulse, systolic blood pressure (SBP), diastolic blood pressure (DBP), and signal quality index (SQI) to evaluate the DoA index as the input. The 5 doctor scores are averaged to obtain an output index. The mean absolute error (MAE) is utilized as the performance evaluation. 10-fold cross-validation is performed in order to generalize the model. The ANN model is compared with the bispectral index (BIS). The results show that the ANN is able to produce lower MAE than BIS. For the correlation coefficient, ANN also has higher value than BIS tested on the 46-patient testing data. Sensitivity analysis and cross-validation method are applied in advance. The results state that EMG has the most effecting parameter, significantly.

Computational Depth of Anesthesia via Multiple Vital Signs Based on Artificial Neural Networks

PubMed Central

Sadrawi, Muammar; Fan, Shou-Zen; Abbod, Maysam F.; Jen, Kuo-Kuang; Shieh, Jiann-Shing

2015-01-01

This study evaluated the depth of anesthesia (DoA) index using artificial neural networks (ANN) which is performed as the modeling technique. Totally 63-patient data is addressed, for both modeling and testing of 17 and 46 patients, respectively. The empirical mode decomposition (EMD) is utilized to purify between the electroencephalography (EEG) signal and the noise. The filtered EEG signal is subsequently extracted to achieve a sample entropy index by every 5-second signal. Then, it is combined with other mean values of vital signs, that is, electromyography (EMG), heart rate (HR), pulse, systolic blood pressure (SBP), diastolic blood pressure (DBP), and signal quality index (SQI) to evaluate the DoA index as the input. The 5 doctor scores are averaged to obtain an output index. The mean absolute error (MAE) is utilized as the performance evaluation. 10-fold cross-validation is performed in order to generalize the model. The ANN model is compared with the bispectral index (BIS). The results show that the ANN is able to produce lower MAE than BIS. For the correlation coefficient, ANN also has higher value than BIS tested on the 46-patient testing data. Sensitivity analysis and cross-validation method are applied in advance. The results state that EMG has the most effecting parameter, significantly. PMID:26568957

Utility of Vital Signs, Heart-rate Variability and Complexity, and Machine Learning for Identifying the Need for Life-saving Interventions in Trauma Patients

DTIC Science & Technology

2014-08-01

thumb-mounted pulse oximeter to the WVSM were recorded at rates of 230 and 75 Hz, respectively. For intubated patients, respiration waveform data were...also recorded at a rate of 10 Hz using a handheld capnograph/ oximeter (Microcap; Covidien, Mansfield, Mass). Standard vital signs used during trauma...SI = HR/SBP) and pulse pressure (PP = SBP j DBP). All nonelectronic data were manually recorded on an electronic run sheet (RescueNet ePCR; Zoll

The reliability of vital signs in estimating pain severity among adult patients treated by paramedics.

PubMed

Lord, Bill; Woollard, Malcolm

2011-02-01

The aim of this study was to examine the strength of correlation between initial pain severity score and systolic blood pressure, heart rate and respiratory rates among adults reporting pain in the prehospital setting as a means of validating the presence and severity of pain. A retrospective cohort study was conducted including all adults with a Glasgow Coma Score >12 assessed by paramedics in a metropolitan area over a 7 day period in 2005. Pain was self-scored by patients using a 0-10 numeric rating scale (NRS). Of the patients transported, 1766/3357 (53%) reported pain, and an NRS score was recorded for 1286. Median age was 57 years, 51% were women, and median initial NRS was six. Mean heart rate was 85 (95% CI 84 to 86), mean systolic blood pressure was 139 mmHg (95% CI 138 to 141) and mean respiratory rate was 18 (95% CI 18 to 18). There was no significant correlation between NRS and heart rate (r=0.002, p=0.61, 95% CI -0.007 to +0.011) or blood pressure (r=-0.0007, p=0.81, 95% CI -0.007 to +0.005), although this was statistically significant for initial pain score and respiratory rate (r 0.058, p=0.001, 95% CI 0.024 to 0.093). A lack of any meaningful correlation between pain scores and changes in vital signs in this population demonstrates that these signs cannot be used to validate the severity of pain reported by adult patients.

Peculiarities of the circumstellar envelopes of some Herbig Ae/Be stars

NASA Astrophysics Data System (ADS)

Pogodin, M. A.

1985-10-01

The results of a spectral and photometric investigation of nine Herbig Ae/Be stars in the visible region of the spectrum in the period from 1978 to 1982 are presented. Certain physical and kinematic parameters of the circumstellar envelopes of the investigated objects are determined on the basis of the observational material obtained and Sobolev's (1947) probabilistic method for moving envelopes. It is shown that the observed spectral characteristics of the envelopes of Herbig Ae/Be stars and their variability can be explained by using models of extended isothermal envelopes with varying structural-kinematic parameters. The existence of a correlation between the amount of dust IR excess and the presence of signs of H2O absorption in the spectra of the investigated objects is noted.

The Feasibility of Digital Pen and Paper Technology for Vital Sign Data Capture in Acute Care Settings

PubMed Central

Dykes, Patricia C.; Benoit, Angela; Chang, Frank; Gallagher, Joan; Li, Qi; Spurr, Cindy; McGrath, E. Jan; Kilroy, Susan M.; Prater, Marita

2006-01-01

The transition from paper to electronic documentation systems in acute care settings is often gradual and characterized by a period in which paper and electronic processes coexist. Intermediate technologies are needed to “bridge” the gap between paper and electronic systems as a means to improve work flow efficiency through data acquisition at the point of care in structured formats to inform decision support and facilitate reuse. The purpose of this paper is to report on the findings of a study conducted on three acute care units at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, MA to evaluate the feasibility of digital pen and paper technology as a means to capture vital sign data in the context of acute care workflows and to make data available in a flow sheet in the electronic medical record. PMID:17238337

The feasibility of digital pen and paper technology for vital sign data capture in acute care settings.

PubMed

Dykes, Patricia C; Benoit, Angela; Chang, Frank; Gallagher, Joan; Li, Qi; Spurr, Cindy; McGrath, E Jan; Kilroy, Susan M; Prater, Marita

2006-01-01

The transition from paper to electronic documentation systems in acute care settings is often gradual and characterized by a period in which paper and electronic processes coexist. Intermediate technologies are needed to "bridge" the gap between paper and electronic systems as a means to improve work flow efficiency through data acquisition at the point of care in structured formats to inform decision support and facilitate reuse. The purpose of this paper is to report on the findings of a study conducted on three acute care units at Brigham and Women's Hospital and Massachusetts General Hospital in Boston, MA to evaluate the feasibility of digital pen and paper technology as a means to capture vital sign data in the context of acute care workflows and to make data available in a flow sheet in the electronic medical record.

A Review of Wearable Technologies for Elderly Care that Can Accurately Track Indoor Position, Recognize Physical Activities and Monitor Vital Signs in Real Time

PubMed Central

Wang, Zhihua; Yang, Zhaochu; Dong, Tao

2017-01-01

Rapid growth of the aged population has caused an immense increase in the demand for healthcare services. Generally, the elderly are more prone to health problems compared to other age groups. With effective monitoring and alarm systems, the adverse effects of unpredictable events such as sudden illnesses, falls, and so on can be ameliorated to some extent. Recently, advances in wearable and sensor technologies have improved the prospects of these service systems for assisting elderly people. In this article, we review state-of-the-art wearable technologies that can be used for elderly care. These technologies are categorized into three types: indoor positioning, activity recognition and real time vital sign monitoring. Positioning is the process of accurate localization and is particularly important for elderly people so that they can be found in a timely manner. Activity recognition not only helps ensure that sudden events (e.g., falls) will raise alarms but also functions as a feasible way to guide people’s activities so that they avoid dangerous behaviors. Since most elderly people suffer from age-related problems, some vital signs that can be monitored comfortably and continuously via existing techniques are also summarized. Finally, we discussed a series of considerations and future trends with regard to the construction of “smart clothing” system. PMID:28208620

A Review of Wearable Technologies for Elderly Care that Can Accurately Track Indoor Position, Recognize Physical Activities and Monitor Vital Signs in Real Time.

PubMed

Wang, Zhihua; Yang, Zhaochu; Dong, Tao

2017-02-10

Rapid growth of the aged population has caused an immense increase in the demand for healthcare services. Generally, the elderly are more prone to health problems compared to other age groups. With effective monitoring and alarm systems, the adverse effects of unpredictable events such as sudden illnesses, falls, and so on can be ameliorated to some extent. Recently, advances in wearable and sensor technologies have improved the prospects of these service systems for assisting elderly people. In this article, we review state-of-the-art wearable technologies that can be used for elderly care. These technologies are categorized into three types: indoor positioning, activity recognition and real time vital sign monitoring. Positioning is the process of accurate localization and is particularly important for elderly people so that they can be found in a timely manner. Activity recognition not only helps ensure that sudden events (e.g., falls) will raise alarms but also functions as a feasible way to guide people's activities so that they avoid dangerous behaviors. Since most elderly people suffer from age-related problems, some vital signs that can be monitored comfortably and continuously via existing techniques are also summarized. Finally, we discussed a series of considerations and future trends with regard to the construction of "smart clothing" system.

A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting.

PubMed

Dunham, Mark Peter; Sartorius, Benn; Laing, Grant Llewellyn; Bruce, John Lambert; Clarke, Damian Luiz

2017-09-01

An assessment of physiological status is a key step in the early assessment of trauma patients with implications for triage, investigation and management. This has traditionally been done using vital signs. Previous work from large European trauma datasets has suggested that base deficit (BD) predicts clinically important outcomes better than vital signs (VS). A BD derived classification of haemorrhagic shock appeared superior to one based on VS derived from ATLS criteria in a population of predominantly blunt trauma patients. The initial aim of this study was to see if this observation would be reproduced in penetrating trauma patients. The power of each individual variable (BD, heart rate (HR), systolic blood pressure (SBP), shock index(SI) (HR/SBP) and Glasgow Coma Score (GCS)) to predict mortality was then also compared. A retrospective analysis of adult trauma patients presenting to the Pietermaritzburg Metropolitan Trauma Service was performed. Patients were classified into four "shock" groups using VS or BD and the outcomes compared. Receiver Operator Characteristic (ROC) curves were then generated to compare the predictive power for mortality of each individual variable. 1863 patients were identified. The overall mortality rate was 2.1%. When classified by BD, HR rose and SBP fell as the "shock class" increased but not to the degree suggested by the ATLS classification. The BD classification of haemorrhagic shock appeared to predict mortality better than that based on the ATLS criteria. Mortality increased from 0.2% (Class 1) to 19.7% (Class 4) based on the 4 level BD classification. Mortality increased from 0.3% (Class 1) to 12.6% (Class 4) when classified based by VS. Area under the receiver operator characteristic (AUROC) curve analysis of the individual variables demonstrated that BD predicted mortality significantly better than HR, GCS, SBP and SI. AUROC curve (95% Confidence Interval (CI)) for BD was 0.90 (0.85-0.95) compared to HR 0

Reservoir vital signs monitoring, 1990: Physical and chemical characteristics of water and sediments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meinert, D.L.

1991-05-01

As part of Tennessee Valley Authority`s (TVA`s) Reservoir Vital Signs Monitoring program, physical/chemical measurements of water and sediment were made in 1990 on twelve TVA reservoirs (the nine main steam Tennessee river reservoirs - Kentucky through Fort Loudoun and three major tributary reservoirs - Cherokee, Douglas, and Norris). The objective of this monitoring program is to assess the health or integrity of these aquatic ecosystems. The physical/chemical water quality data collected in 1990 showed the water quality of these reservoirs to be very good. However, hypolimnetic anoxia during the summer months in Watts bars, Douglas, and Cherokee reservoir continues tomore » be a concern. High concentrations of nutrients were measured in the transition zones of Cherokee and Douglas reservoirs, resulting in highly productive and eutrophic conditions in the transition zones of these reservoirs. Fecal coliform organisms were frequently detected in the forebay area of Guntersville reservoir, and higher than expected ammonia nitrogen concentrations were found at the transition zone of Wheeler reservoir. Elevated concentrations of mercury were found in Pickwick and Watts bar reservoir sediment, and high lead concentrations were found in a sediment sample collected from Guntersville reservoir. A TVA Reservoir Water Quality Index (RWQI) was developed and used to summarize water quality conditions on a scale from 0 (worst) to 100 (best).« less

Reservoir vital signs monitoring, 1990: Physical and chemical characteristics of water and sediments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meinert, D.L.

1991-05-01

As part of Tennessee Valley Authority's (TVA's) Reservoir Vital Signs Monitoring program, physical/chemical measurements of water and sediment were made in 1990 on twelve TVA reservoirs (the nine main steam Tennessee river reservoirs - Kentucky through Fort Loudoun and three major tributary reservoirs - Cherokee, Douglas, and Norris). The objective of this monitoring program is to assess the health or integrity of these aquatic ecosystems. The physical/chemical water quality data collected in 1990 showed the water quality of these reservoirs to be very good. However, hypolimnetic anoxia during the summer months in Watts bars, Douglas, and Cherokee reservoir continues tomore » be a concern. High concentrations of nutrients were measured in the transition zones of Cherokee and Douglas reservoirs, resulting in highly productive and eutrophic conditions in the transition zones of these reservoirs. Fecal coliform organisms were frequently detected in the forebay area of Guntersville reservoir, and higher than expected ammonia nitrogen concentrations were found at the transition zone of Wheeler reservoir. Elevated concentrations of mercury were found in Pickwick and Watts bar reservoir sediment, and high lead concentrations were found in a sediment sample collected from Guntersville reservoir. A TVA Reservoir Water Quality Index (RWQI) was developed and used to summarize water quality conditions on a scale from 0 (worst) to 100 (best).« less

Putting vital stains in context.

PubMed

Efron, Nathan

2013-07-01

While vital staining remains a cornerstone in the diagnosis of ocular disease and contact lens complications, there are many misconceptions regarding the properties of commonly used dyes by eye-care practitioners and what is and what is not corneal staining after instillation of sodium fluorescein. Similarly, the proper use and diagnostic utility of rose Bengal and lissamine green B, the other two ophthalmic dyes commonly used for assessing ocular complications, have similarly remained unclear. Due to the limitations of vital stains for definitive diagnosis, concomitant signs and symptoms in addition to a complete patient history are required. Over the past decade, there have been many reports of a type of corneal staining--often referred to as solution-induced corneal staining (SICS)--that is observed with the use of multipurpose solutions in combination with soft lenses, more specifically silicone hydrogel lenses. Some authors believe that SICS is a sign of lens/solution incompatibility; however, new research shows that SICS may be neither a measure of lens/solution biocompatibility nor 'true' corneal staining, as that observed in pathological situations. A large component of SICS may be a benign phenomenon, known as preservative-associated transient hyperfluorescence (PATH). There is a lack of correlated signs and/or symptoms with SICS/PATH. Several properties of SICS/PATH, such as appearance and duration, differentiate it from pathological corneal staining. This paper reviews the properties of vital stains, their use and limitations in assessment of the ocular surface, the aetiology of corneal staining, characteristics of SICS/PATH that differentiate it from pathological corneal staining and what the SICS/PATH phenomenon means for contact lens-wearing patients. © 2012 The Author. Clinical and Experimental Optometry © 2012 Optometrists Association Australia.

The Effect of Aromatherapy with the Essential Oil of Orange on Pain and Vital Signs of Patients with Fractured Limbs Admitted to the Emergency Ward: A Randomized Clinical Trial

PubMed Central

Hekmatpou, Davood; Pourandish, Yasaman; Farahani, Pouran Varvani; Parvizrad, Ramin

2017-01-01

Background and Objective: Pain is an emotional and unpleasant experience associated with actual or potential tissue damage. The literature shows no study on the effect of aromatherapy with the essential oil of orange on unpleasant feelings of patients with fractured limbs. In this regard, this paper aims at studying the effect of aromatherapy with the essential oil of orange on patients with fractured limbs admitted to the emergency ward. Methods: Sixty patients admitted to the emergency ward of Vali-e-Asr Hospital were selected by purposive sampling method and then were divided into two groups of control and experiment by block method. This study was done in one shift work (morning or afternoon). Four drops of the orange oil were poured on a pad and were pinned with a plastic pin to the patient's collar, about 20 cm distant from head. The old pad was replaced by the new one every 1 h. The patients' pain and vital signs were checked every 1 h for at last 6 h. The data were analyzed by SPSS Version 21. Results: Forty (66.7%) patients were male and twenty (33.3%) were female. Their age average was 37.93 ± 18.19 years old. The most fractured cases were in the scapular (11 patients [18.3%]). Friedman test showed that pain in the experiment group (P = 0.0001) decreased significantly rather than the control group (0.339). However, in vital signs, there could be found that no significant change between the two groups was seen. Conclusion: Aromatherapy with orange oil can relieve pain in patients with fractured limbs but has no effect on their vital signs. Therefore, aromatherapy with orange oil can be used as a complementary medicine in these patients. PMID:29123351

Improving the Prediction of Mortality and the Need for Life-Saving Interventions in Trauma Patients Using Standard Vital Signs With Heart-Rate Variability and Complexity

DTIC Science & Technology

2015-06-01

Trauma 69:S10YS13, 2010. 2. Liu NT, Holcomb JB, Wade CE, Darrah MI, Salinas J: Utility of vital signs, heart-rate variability and complexity, and machine ... learning for identifying the need for life-saving interventions in trauma patients. Shock 42:108Y114, 2014. 3. Pickering TG, Shimbo D, Hass D...Ann Emerg Med 45:68Y76, 2005. 8. Liu NT, Holcomb JB, Wade CE, Batchinsky AI, Cancio LC, Darrah MI, Salinas J: Development and validation of a machine

Logistic regression function for detection of suspicious performance during baseline evaluations using concussion vital signs.

PubMed

Hill, Benjamin David; Womble, Melissa N; Rohling, Martin L

2015-01-01

This study utilized logistic regression to determine whether performance patterns on Concussion Vital Signs (CVS) could differentiate known groups with either genuine or feigned performance. For the embedded measure development group (n = 174), clinical patients and undergraduate students categorized as feigning obtained significantly lower scores on the overall test battery mean for the CVS, Shipley-2 composite score, and California Verbal Learning Test-Second Edition subtests than did genuinely performing individuals. The final full model of 3 predictor variables (Verbal Memory immediate hits, Verbal Memory immediate correct passes, and Stroop Test complex reaction time correct) was significant and correctly classified individuals in their known group 83% of the time (sensitivity = .65; specificity = .97) in a mixed sample of young-adult clinical cases and simulators. The CVS logistic regression function was applied to a separate undergraduate college group (n = 378) that was asked to perform genuinely and identified 5% as having possibly feigned performance indicating a low false-positive rate. The failure rate was 11% and 16% at baseline cognitive testing in samples of high school and college athletes, respectively. These findings have particular relevance given the increasing use of computerized test batteries for baseline cognitive testing and return-to-play decisions after concussion.

The primacy of vital signs--acute care nurses' and midwives' use of physical assessment skills: a cross sectional study.

PubMed

Osborne, Sonya; Douglas, Clint; Reid, Carol; Jones, Lee; Gardner, Glenn

2015-05-01

patient plausibly warrants more than vital signs assessment; however, our study confirms nurses' physical assessment core skill set is mainly comprised of vital signs. The focus on these endpoints of deterioration as dictated by early warning and rapid response systems may divert attention from and devalue comprehensive nursing assessment that could detect subtle changes in health status earlier in the patient's hospitalisation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Canadian adaptation of the Newest Vital Sign©, a health literacy assessment tool.

PubMed

Mansfield, Elizabeth D; Wahba, Rana; Gillis, Doris E; Weiss, Barry D; L'Abbé, Mary

2018-04-25

The Newest Vital Sign© (NVS) was developed in the USA to measure patient health literacy in clinical settings. We adapted the NVS for use in Canada, in English and French, and created a computerized version. Our objective was to evaluate the reliability of the Canadian NVS as a self-administered computerized tool. We used a randomized crossover design with a washout period of 3-4 weeks to compare health literacy scores obtained using the computerized version with scores obtained using the standard interviewer-administered NVS. ANOVA models and McNemar's tests assessed differences in outcomes assessed with each version of the NVS and order effects of the testing. Participants were recruited from multicultural catchment areas in Ontario and Nova Scotia. English- and French-speaking adults aged 18 years or older. A total of 180 (81 %) of the 222 adults (112 English/110 French) initially recruited completed both the interviewer-NVS and computer-NVS. Scores for those who completed both assessments ranged from 0 to 6 with a mean of 3·63 (sd 2·11) for the computerized NVS and 3·41 (sd 2·21) for the interview-administered NVS. Few (n 18; seven English, eleven French) participants' health literacy assessments differed between the two versions. Overall, the computerized Canadian NVS performed as well as the interviewer-administered version for assessing health literacy levels of English- and French-speaking participants. This Canadian adaptation of the NVS provides Canadian researchers and public health practitioners with an easily administered health literacy assessment tool that can be used to address the needs of Canadians across health literacy levels and ultimately improve health outcomes.

A Detection Device for the Signs of Human Life in Accident

NASA Astrophysics Data System (ADS)

Ning, Li; Ruilan, Zhang; Jian, Liu; Ruirui, Cheng; Yuhong, Diao

2017-12-01

A detection device for the signs of human life in accidents is a device used in emergency situations, such as the crash site. the scene of natural disasters, the battlefield ruins. it designed to detect the life signs of the distress under the injured ambulance vital signs devices. The device can on human vital signs, including pulse, respiration physiological signals to make rapid and accurate response. After some calculations, and after contrast to normal human physiological parameters given warning signals, in order for them to make timely ambulance judgment. In this case the device is required to do gymnastics convenience, ease of movement, power and detection of small flexible easy realization. This device has the maximum protection of the wounded safety significance.

Safety and tolerability of fexofenadine for the treatment of allergic rhinitis in children 2 to 5 years old.

PubMed

Milgrom, Henry; Kittner, Barbara; Lanier, Robert; Hampel, Frank C

2007-10-01

The safety of fexofenadine has been examined extensively in adults and school-age children. However, the safety of fexofenadine in children younger than 6 years has not been reported to date. To compare the safety and tolerability of twice-daily fexofenadine hydrochloride, 30 mg, and placebo in preschool children aged 2 to 5 years with allergic rhinitis. This was a multicenter, double-blind, randomized, placebo-controlled, parallel-group study, conducted between February 29, 2000, and June 14, 2001. Participants were randomized to either fexofenadine hydrochloride, 30 mg, or placebo twice daily for a 2-week period. To facilitate dosing, capsule content was mixed with applesauce (approximately 10 mL). Safety assessments depended on date of entry into the study because of an amendment to the protocol. Before the amendment, assessments included physical examination, vital signs reporting (oral temperature, heart rate, and respiratory rate), and adverse event (AE) reporting. After the amendment, safety assessments included laboratory testing (blood chemistry and hematology profiles), physical examination, 12-lead electrocardiography, and vital signs (oral temperature, blood pressure, heart rate, and respiratory rate) and AE reporting. Treatment-emergent AEs were observed in 116 of 231 participants receiving placebo and 111 of 222 receiving fexofenadine. These AEs were possibly related to study medication in 19 (8.2%) and 21 (9.5%) of the participants receiving placebo and fexofenadine, respectively, and most frequently involved the digestive system. No clinically relevant differences in laboratory measures, vital signs, and physical examinations were observed. The findings show that fexofenadine hydrochloride, 30 mg, is well tolerated and has a good safety profile in children aged 2 to 5 years with allergic rhinitis.

[Variations of vital signs and peripheral oxygen saturation in critically ill preterm newborn, after sponge bathing].

PubMed

Tapia-Rombo, Carlos Antonio; Mendoza-Cortés, Ulises; Uscanga-Carrasco, Herminia; Sánchez-García, Luisa; Tena-Reyes, Daniel; López-Casillas, Elsa Claudia

2012-01-01

To determine the variability of the vital signs (temperature, heart rate and respiratory frequency), skin coloration and peripheral oxygen saturation in critically ill preterm newborns (CI PTNB) before, during and after sponge bathing as well as to determine the possible presence of secondary complications of this procedure. We performed a quasi-experimental study (experimental, prospective, comparative and clinical study with intervention) May to December 2008, in a Neonatal Intensive Care Unit. We included CI PTNB of 0 to 28 days of extrauterine life who have practiced in the routine sponge bathing. Area of significance was considered when p < 0.05. During or after the events in any of the patients presented any complications after 12 h of monitoring, but it was necessary to increase the inspired fraction of oxygen and temperature in the incubator or radiant heat cradle temporarily. We conclude that the sponge bath is not safe for a CI PTNB and this should be performed in the shortest time possible, and the medical must be very alert to the possibility that patients require more support than they had prior to sponge bathing, mainly in the temperature of the incubator or radiant heat cradle and inspired fraction of oxygen for the required time according to the evolution of these variables.

Is Lhasa Tibetan Sign Language emerging, endangered, or both?

PubMed Central

Hofer, Theresia

2017-01-01

This article offers the first overview of the recent emergence of Tibetan Sign Language (TibSL) in Lhasa, capital of the Tibet Autonomous Region (TAR), China. Drawing on short anthropological fieldwork, in 2007 and 2014, with people and organisations involved in the formalisation and promotion of TibSL, the author discusses her findings within the nine-fold UNESCO model for assessing linguistic vitality and endangerment. She follows the adaptation of this model to assess signed languages by the Institute of Sign Languages and Deaf Studies (iSLanDS) at the University of Central Lancashire. The appraisal shows that TibSL appears to be between “severely” and “definitely” endangered, adding to the extant studies on the widespread phenomenon of sign language endangerment. Possible future influences and developments regarding the vitality and use of TibSL in Central Tibet and across the Tibetan plateau are then discussed and certain additions, not considered within the existing assessment model, suggested. In concluding, the article places the situation of TibSL within the wider circumstances of minority (sign) languages in China, Chinese Sign Language (CSL), and the post-2008 movement to promote and use “pure Tibetan language”. PMID:29033477

Is Lhasa Tibetan Sign Language emerging, endangered, or both?

PubMed

Hofer, Theresia

2017-05-24

This article offers the first overview of the recent emergence of Tibetan Sign Language (TibSL) in Lhasa, capital of the Tibet Autonomous Region (TAR), China. Drawing on short anthropological fieldwork, in 2007 and 2014, with people and organisations involved in the formalisation and promotion of TibSL, the author discusses her findings within the nine-fold UNESCO model for assessing linguistic vitality and endangerment. She follows the adaptation of this model to assess signed languages by the Institute of Sign Languages and Deaf Studies (iSLanDS) at the University of Central Lancashire. The appraisal shows that TibSL appears to be between "severely" and "definitely" endangered, adding to the extant studies on the widespread phenomenon of sign language endangerment. Possible future influences and developments regarding the vitality and use of TibSL in Central Tibet and across the Tibetan plateau are then discussed and certain additions, not considered within the existing assessment model, suggested. In concluding, the article places the situation of TibSL within the wider circumstances of minority (sign) languages in China, Chinese Sign Language (CSL), and the post-2008 movement to promote and use "pure Tibetan language".

Prodromal signs and symptoms of serious infections with tocilizumab treatment for rheumatoid arthritis: Text mining of the Japanese postmarketing adverse event-reporting database.

PubMed

Atsumi, Tatsuya; Ando, Yoshiaki; Matsuda, Shinichi; Tomizawa, Shiho; Tanaka, Riwa; Takagi, Nobuhiro; Nakasone, Ayako

2018-05-01

To search for signs and symptoms before serious infection (SI) occurs in tocilizumab (TCZ)-treated rheumatoid arthritis (RA) patients. Individual case safety reports, including structured (age, sex, adverse event [AE]) and unstructured (clinical narratives) data, were analyzed by automated text mining from a Japanese post-marketing AE-reporting database (16 April 2008-10 April 2015) assuming the following: treated in Japan; TCZ RA treatment; ≥1 SI; unable to exclude causality between TCZ and SIs. The database included 7653 RA patients; 1221 reports met four criteria, encompassing 1591 SIs. Frequent SIs were pneumonia (15.9%), cellulitis (9.9%), and sepsis (5.0%). Reports for 782 patients included SI onset date; 60.7% of patients had signs/symptoms ≤28 days before SI diagnosis, 32.7% had signs/symptoms with date unidentified, 1.7% were asymptomatic, and 4.9% had unknown signs/symptoms. The most frequent signs/symptoms were for skin (swelling and pain) and respiratory (cough and pyrexia) infections. Among 68 patients who had normal laboratory results for C-reactive protein, body temperature, and white blood cell count, 94.1% had signs or symptoms of infection. This study identified prodromal signs and symptoms of SIs in RA patients receiving TCZ. Data mining clinical narratives from post-marketing AE databases may be beneficial in characterizing SIs.

ACOG Committee Opinion No. 651: Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign.

PubMed

2015-12-01

Despite variations worldwide and within the U.S. population, median age at menarche has remained relatively stable-between 12 years and 13 years-across well-nourished populations in developed countries. Environmental factors, including socioeconomic conditions, nutrition, and access to preventive health care, may influence the timing and progression of puberty. A number of medical conditions can cause abnormal uterine bleeding, characterized by unpredictable timing and variable amount of flow. Clinicians should educate girls and their caretakers (eg, parents or guardians) about what to expect of a first menstrual period and the range for normal cycle length of subsequent menses. Identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood. It is important for clinicians to have an understanding of the menstrual patterns of adolescent girls, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate the adolescent girl patient. By including an evaluation of the menstrual cycle as an additional vital sign, clinicians reinforce its importance in assessing overall health status for patients and caretakers.

The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly.

PubMed

Borson, S; Scanlan, J; Brush, M; Vitaliano, P; Dokmak, A

2000-11-01

The Mini-Cog, a composite of three-item recall and clock drawing, was developed as a brief test for discriminating demented from non-demented persons in a community sample of culturally, linguistically, and educationally heterogeneous older adults. All 129 who met criteria for probable dementia based on informant interviews and 120 with no history of cognitive decline were included; 124 were non-English speakers. Sensitivity, specificity, and diagnostic value of the Mini-Cog were compared with those of the Mini-Mental State Exam (MMSE) and Cognitive Abilities Screening Instrument (CASI). The Mini-Cog had the highest sensitivity (99%) and correctly classified the greatest percentage (96%) of subjects. Moreover, its diagnostic value was not influenced by education or language, while that of the CASI was adversely influenced by low education, and both education and language compromised the diagnostic value of the MMSE. Administration time for the Mini-Cog was 3 minutes vs 7 minutes for the MMSE. The Mini-Cog required minimal language interpretation and training to administer, and no test forms of scoring modifications were needed to compensate for the extensive linguistic and educational heterogeneity of the sample. Validation in clinical and population-based samples is warranted, as its brevity and ease of administration suggest that the Mini-Cog might be readily incorporated into general practice and senior care settings as a routine 'cognitive vital signs' measure. Copyright 2000 John Wiley & Sons, Ltd.

VITAL SIGNS AND FIRST OCCURRENCES IN NORMAL AND ABNORMAL NEWBORN ASIAN ELEPHANT ( ELEPHAS MAXIMUS) CALVES.

PubMed

Wiedner, Ellen; Kiso, Wendy K; Aria, Janice; Isaza, Ramiro; Lindsay, William; Jacobson, Gary; Jacobson, Kathy; Schmitt, Dennis

2017-12-01

Sixteen years of medical records documenting 19 births within a herd of Asian elephants ( Elephas maximus) at a private facility in the southeastern United States were reviewed. Of the 19 calves, 11 were normal at birth, requiring no additional veterinary care, and eight were abnormal, requiring veterinary care immediately or within the first week of birth. Descriptive statistics were used to evaluate morphometrics, vital signs, and behavioral milestones in newborn calves both normal and abnormal. Blood work and urinalysis results from all calves were compared to values for adult elephants. Medical management of abnormal calves is described. All calves had faster heart rates and respiratory rates than did adult elephants, but rectal temperatures were the same. Calves were precocious with regard to sitting and standing but could be very slow to nurse. The most-common medical conditions of newborn calves were umbilical abnormalities and problems associated with nursing. Two calves required cardiopulmonary resuscitation after birth but made full recoveries. Some conditions were not apparent at birth but were recognized a few hours or days later. Following veterinary intervention, six of the eight calves made full recoveries, suggesting that early identification and treatment of problems can greatly decrease mortality. This is the first report of multiple veterinary and behavioral parameters in normal and abnormal neonatal Asian elephants from a facility with a calf survival rate above 90%. This information may be helpful to other elephant-holding facilities in providing care to their newborn elephant calves.

Home care decision support using an Arden engine--merging smart home and vital signs data.

PubMed

Marschollek, Michael; Bott, Oliver J; Wolf, Klaus-H; Gietzelt, Matthias; Plischke, Maik; Madiesh, Moaaz; Song, Bianying; Haux, Reinhold

2009-01-01

The demographic change with a rising proportion of very old people and diminishing resources leads to an intensification of the use of telemedicine and home care concepts. To provide individualized decision support, data from different sources, e.g. vital signs sensors and home environmental sensors, need to be combined and analyzed together. Furthermore, a standardized decision support approach is necessary. The aim of our research work is to present a laboratory prototype home care architecture that integrates data from different sources and uses a decision support system based on the HL7 standard Arden Syntax for Medical Logical Modules. Data from environmental sensors connected to a home bus system are stored in a data base along with data from wireless medical sensors. All data are analyzed using an Arden engine with the medical knowledge represented in Medical Logic Modules. Multi-modal data from four different sensors in the home environment are stored in a single data base and are analyzed using an HL7 standard conformant decision support system. Individualized home care decision support must be based on all data available, including context data from smart home systems and medical data from electronic health records. Our prototype implementation shows the feasibility of using an Arden engine for decision support in a home setting. Our future work will include the utilization of medical background knowledge for individualized decision support, as there is no one-size-fits-all knowledge base in medicine.

Vital signs

MedlinePlus

... assessment. In: Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW, eds. Seidel's Guide to Physical Examination . 8th ed. St Louis, MO: Elsevier Mosby; 2015:chap 4. Simel DL. Approach to the patient: history and ...

Vital Signs

MedlinePlus

... or during an emergency room visit. They include Blood pressure, which measures the force of your blood pushing against the walls of your arteries. Blood pressure that is too high or too low can ...

High serum creatinine nonlinearity: a renal vital sign?

PubMed

Palant, Carlos E; Chawla, Lakhmir S; Faselis, Charles; Li, Ping; Pallone, Thomas L; Kimmel, Paul L; Amdur, Richard L

2016-08-01

Patients with chronic kidney disease (CKD) may have nonlinear serum creatinine concentration (SC) trajectories, especially as CKD progresses. Variability in SC is associated with renal failure and death. However, present methods for measuring SC variability are unsatisfactory because they blend information about SC slope and variance. We propose an improved method for defining and calculating a patient's SC slope and variance so that they are mathematically distinct, and we test these methods in a large sample of US veterans, examining the correlation of SC slope and SC nonlinearity (SCNL) and the association of SCNL with time to stage 4 CKD (CKD4) and death. We found a strong correlation between SCNL and rate of CKD progression, time to CKD4, and time to death, even in patients with normal renal function. We therefore argue that SCNL may be a measure of renal autoregulatory dysfunction that provides an early warning sign for CKD progression. Copyright © 2016 the American Physiological Society.

Effects of therapeutic touch on the vital signs of patients before coronary artery bypass graft surgery

PubMed Central

Zare, Zahra; Shahsavari, Hooman; Moeini, Mahin

2010-01-01

BACKGROUND: Currently healthy heart word considered to be the objective of community health applications in many countries of the world because cardiovascular diseases are the most important factor in mortality of humans, worldwide. Coronary artery bypass graft surgery is one of the most common surgery procedures for these patients. The purpose of this study is to assess the impact of therapeutic touch on medical vital signs of patients before coronary artery bypass graft surgery. METHODS: The present study is a clinical trial with 44 samples that were selected by easy sampling method and based on two separate lists of random numbers for both men and women; they were divided into two groups. In the therapeutic touch group, intervention therapy was applied on patents for 20 minutes. Data was analyzed using descriptive and inferential statistics. RESULTS: Test results showed that there was a significant difference between the mean pulse rate before and after intervention in both groups (p < 0.001). Results also showed that there was a significant difference between the average number of breathing before and after intervention in both groups (p < 0.001). CONCLUSIONS: Considering the effects of therapeutic touch therapy as a safe and effective intervention on the patients which were revealed in this study, this technique can be used as a simple, cheap and applicable technique in all health care centers to help these patients. PMID:21589748

Documenting pain as the fifth vital sign: a feasibility study in an oncology ward in Sarawak, Malaysia.

PubMed

Devi, B C R; Tang, T S

2008-01-01

Monitoring acute postoperative pain as the fifth vital sign is currently practiced in many developed countries. In Sarawak, pain is an important symptom as 70% of cancer patients present with advanced disease. As the existing validated pain assessment tools were found to be difficult to use, we studied the feasibility of modifying the use of a pain assessment tool, consisting of the short form of the Brief Pain Inventory and the Wong-Baker Faces Scale. This tool was used to document pain in all 169 patients who were admitted for pain control to the oncology ward between July 2000 and June 2001. Nurses were trained in the use of the modified scale before the start of the study. The method was easy to use, and the mean number of days to reduce pain was found to be 3.1 days (SD: 2.9; median: 2 days; range: 1-31 days). At discharge, none in the group with initially mild pain had pain, and the severity of pain for 98% of patients with moderate pain and 61% with severe pain was downgraded to mild pain. The staff found that the tool allowed continuous pain assessment in an objective manner. Copyright 2008 S. Karger AG, Basel.

Towards the effect of acoustic emission (AE) sensor positioning within AE signal parameters in sliding on bulk ultrafine-grained materials

NASA Astrophysics Data System (ADS)

Filippov, A. V.; Tarasov, S. Yu.; Podgornykh, O. A.; Chazov, P. A.; Shamarin, N. N.; Filippova, E. O.

2017-12-01

The effect of AE sensor positioning on the bulk ultrafine-grained materials used for sliding against steel ball has been investigated. Two versions of AE sensor positioning have been tested and showed the different attenuation levels. The experimentally obtained AE signal waveforms have been analyzed under the AE signal parameters such as a median frequency and AE energy. It was established that the AE sensor positioned on the sample supporting plate in the vicinity of the sample tested allowed redistribution of the signal energy from a low-frequency to high-frequency range as well as extending the median frequency range as compared to those obtained by mounting the sensor on the immobile sample holder.

A&E nursing in Iraq.

PubMed

Thompson, Lieutenant Sarah

2004-01-01

I am an A&E nurse. I work 12-hour shifts on a rotation of 12 hours on, 24 hours off, seven days a week. It takes me five minutes to walk to the A&E department where I work. As well as the scissors and pen torch you would expect a nurse to carry, I take body armour, goggles and a helmet to work. With outdoor temperatures regularly reaching more than 50°C, water is essential for any journey, however short. As I am sure you can tell, I do not work in an ordinary A&E department.

Association appoints new RCN A&E Chair.

PubMed

1999-09-01

Lynda Holt, A&E Clinical Manager at Warwick Hospital has become Chair of the RCN A&E Nursing Association following the resignation of Karen Castille who has been seconded to the Department of Health (England) to work on the A&E modernisation programme.

PDS 144: The First Confirmed Herbig Ae-Herbig Ae Wide Binary

NASA Technical Reports Server (NTRS)

Hornbeck, J. B.; Grady, C. A.; Perrin, M. D.; Wisniewski, J. P.; Tofflemire, B. M.; Brown, A.; Holtzman, J. A.; Arraki, K.; Hamaguchi, K.; Woodgate, B.;

Vitality preservation of an anomalous maxillary central incisor after endodontic therapy.

PubMed

Kaufman, A Y; Kaffe, I; Littner, M M

1984-06-01

Endodontic treatment of a case of fused immature central incisor with a supernumerary tooth with dens in dente is described. Although a chronic dentoalveolar abscess was diagnosed, vitality test signs were positive. Treatment consisted of pulpotomy with calcium hydroxide paste; after 2 1/2 months a permanent root canal filling was placed in the amputated part. Follow-up 2 years postoperatively indicated that the tooth has maintained its vitality. The periapical area is completely healed, and apical closure is evident.

19 CFR 192.11 - Description of the AES.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 2 2012-04-01 2012-04-01 false Description of the AES. 192.11 Section 192.11... TREASURY (CONTINUED) EXPORT CONTROL Filing of Export Information Through the Automated Export System (AES) § 192.11 Description of the AES. AES is a voluntary program that allows all exporters required to report...

15 CFR 758.2 - Automated Export System (AES).

Code of Federal Regulations, 2014 CFR

2014-01-01

... 15 Commerce and Foreign Trade 2 2014-01-01 2014-01-01 false Automated Export System (AES). 758.2... CLEARANCE REQUIREMENTS § 758.2 Automated Export System (AES). The Census Bureau's Foreign Trade Statistics...) electronically using the Automated Export System (AES). In order to use AES, you must apply directly to the...

15 CFR 758.2 - Automated Export System (AES).

Code of Federal Regulations, 2013 CFR

2013-01-01

... 15 Commerce and Foreign Trade 2 2013-01-01 2013-01-01 false Automated Export System (AES). 758.2... CLEARANCE REQUIREMENTS § 758.2 Automated Export System (AES). The Census Bureau's Foreign Trade Statistics...) electronically using the Automated Export System (AES). In order to use AES, you must apply directly to the...

19 CFR 192.11 - Description of the AES.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 2 2014-04-01 2014-04-01 false Description of the AES. 192.11 Section 192.11... TREASURY (CONTINUED) EXPORT CONTROL Filing of Export Information Through the Automated Export System (AES) § 192.11 Description of the AES. AES is a voluntary program that allows all exporters required to report...

19 CFR 192.11 - Description of the AES.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 2 2011-04-01 2011-04-01 false Description of the AES. 192.11 Section 192.11... TREASURY (CONTINUED) EXPORT CONTROL Filing of Export Information Through the Automated Export System (AES) § 192.11 Description of the AES. AES is a voluntary program that allows all exporters required to report...

19 CFR 192.11 - Description of the AES.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 2 2013-04-01 2013-04-01 false Description of the AES. 192.11 Section 192.11... TREASURY (CONTINUED) EXPORT CONTROL Filing of Export Information Through the Automated Export System (AES) § 192.11 Description of the AES. AES is a voluntary program that allows all exporters required to report...

15 CFR 758.2 - Automated Export System (AES).

Code of Federal Regulations, 2012 CFR

2012-01-01

... 15 Commerce and Foreign Trade 2 2012-01-01 2012-01-01 false Automated Export System (AES). 758.2... CLEARANCE REQUIREMENTS § 758.2 Automated Export System (AES). The Census Bureau's Foreign Trade Statistics...) electronically using the Automated Export System (AES). In order to use AES, you must apply directly to the...

Effect of ECAP processing on corrosion resistance of AE21 and AE42 magnesium alloys

NASA Astrophysics Data System (ADS)

Minárik, P.; Král, R.; Janeček, M.

2013-09-01

Corrosion properties of AE21 and AE42 magnesium alloys were investigated in the extruded state and after subsequent 8 passes of Equal Channel Angular Pressing (ECAP) via route Bc, by Electrochemical Impedance Spectroscopy (EIS) in 0.1 M NaCl solution. The resulting microstructure was observed by the Transmission Electron Microscope (TEM) and the Scanning Electron Microscope (SEM). Corrosion layer created after 7 days of immersion was observed by (SEM) in order to explain different evolution of the corrosion resistance after ECAP processing in both alloys. It was found that Al-rich Al11RE3 dispersed particles (present in both alloys) strongly influence the corrosion process and enhance the corrosion resistance. Ultra-fine grained structure was found to reduce the corrosion resistance in AE21. On the other hand, the microstructure of AE42 after ECAP and particularly the better distribution of the alloying elements in the matrix enhance the corrosion resistance when compared to the extruded material.

Assessing the risk of foliar injury from ozone on vegetation in parks in the U.S. National Park Service's Vital Signs Network.

PubMed

Kohut, Robert

2007-10-01

The risk of ozone injury to plants was assessed in support of the National Park Service's Vital Signs Monitoring Network program. The assessment examined bioindicator species, evaluated levels of ozone exposure, and investigated soil moisture conditions during periods of exposure for a 5-year period in each park. The assessment assigned each park a risk rating of high, moderate, or low. For the 244 parks for which assessments were conducted, the risk of foliar injury was high in 65 parks, moderate in 46 parks, and low in 131 parks. Among the well-known parks with a high risk of ozone injury are Gettysburg, Valley Forge, Delaware Water Gap, Cape Cod, Fire Island, Antietam, Harpers Ferry, Manassas, Wolf Trap Farm Park, Mammoth Cave, Shiloh, Sleeping Bear Dunes, Great Smoky Mountains, Joshua Tree, Sequoia and Kings Canyon, and Yosemite.

Educational preparation: Research in A&E.

PubMed

1996-02-01

Just as there is an evergrowing number of educational opportunities for A&E (1), there is growing recognition of the importance of research in the development of the 'art and science' of nursing. In A&E nursing there is a need to develop the science of our specialty to further enhance the treatment and care of patients. This paper asks some fundamental questions about research and researchers in A&E and identifies key research priorities for the coming years.

The AE-8 trapped electron model environment

NASA Technical Reports Server (NTRS)

Vette, James I.

1991-01-01

The machine sensible version of the AE-8 electron model environment was completed in December 1983. It has been sent to users on the model environment distribution list and is made available to new users by the National Space Science Data Center (NSSDC). AE-8 is the last in a series of terrestrial trapped radiation models that includes eight proton and eight electron versions. With the exception of AE-8, all these models were documented in formal reports as well as being available in a machine sensible form. The purpose of this report is to complete the documentation, finally, for AE-8 so that users can understand its construction and see the comparison of the model with the new data used, as well as with the AE-4 model.

Reflective intuition: defining A&E nursing.

PubMed

Cook, A

1996-01-01

A&E nurses may develop intuitive feelings about the condition of their patients. A&E nurses are practising reflective intuition, based on experience. Recognition of this skill could raise the professional status of nursing.

Student nurses' recognition of early signs of abnormal vital sign recordings.

PubMed

Leonard, Martha M; Kyriacos, Una

2015-09-01

There is increasing urgency for nurses to recognize early signs of deterioration in patients and to take appropriate action to prevent serious adverse effects. To assess respondents' ability to identify abnormal recordings for respiratory and heart rate, oxygen saturation level, systolic blood pressure, level of consciousness, urinary output and normal temperature. A descriptive observational survey. A nursing college in Cape Town, South Africa. A sample of 77/212 (36.3%) fourth year students. A self-administered adapted questionnaire was employed to collect demographic data and respondents' selections of recorded physiological values for the purpose of deciding when to call for more skilled help. The median age for 62/77 (80.5%) of the respondents was 25years; 3/76 (3.9%) had a previous certificate in nursing. Most respondents were female (66/76, 85.7%). Afrikaans was the first language preference of 33 (42.9%) respondents, followed by isiXhosa (31/77, 40.3%) and English (10/77, 13.0%). Most respondents (48/77, 62.3%) recognized a normal temperature reading (35-38.4°C). However, overall there would have been delays in calling for more skilled assistance in 288/416 (69.2%) instances of critical illness for a high-score MEWS of 3 and in 226/639 (35.4%) instances at a medium-score MEWS of 2 for physiological parameters. In 96/562 (17.1%) instances, respondents would have called for assistance for a low-score MEWS of 1. Non-recognition of deterioration in patients' clinical status and delayed intervention by nurses has implications for the development of serious adverse events. The MEWS is recommended as a track-and-trigger system for nursing curricula in South Africa and for implementation in practice. Copyright © 2015. Published by Elsevier Ltd.

(abstract) Airborne Emission Spectrometer (AES)

NASA Technical Reports Server (NTRS)

Beer, Reinhard

1994-01-01

AES is a low-cost analog of the TES downlooking modes. Because AES operates at ambient temperature, limb-viewing is not possible. The first flight of AES took place in April 1994 on the NASA P3B aircraft out of Wallops Island, VA. While planned as an engineering test flight, spectra were successfully acquired both over the Atlantic Ocean and the area of the Great Dismal Swamp on the Virginia-North Carolina border. At this writing (July 1994), a second series of flights on the NASA DC8 aircraft out of Ames RC,CA is in progress. By the time of the workshop, a third series using the NASA C130 should have been accomplished.

Incidence and clinical vital parameters in primary ketosis of Murrah buffaloes

PubMed Central

Kumar, Ankit; Sindhu, Neelesh; Kumar, Parmod; Kumar, Tarun; Charaya, Gaurav; Surbhi; Jain, V. K.; Sridhar

2015-01-01

Aim: The present study was undertaken to ascertain the incidence and clinical vital parameters in cases of primary ketosis in Murrah buffaloes brought to teaching veterinary clinical complex, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar and from adjoining villages of the district Hisar, Haryana, India. Materials and Methods: The investigation was conducted on 24 clinical cases (out of total 145 screened) of primary ketosis. The diagnosis was confirmed on the basis of clinical signs and significantly positive two tests for ketone bodies in urine (Rothera’s and Keto-Diastix strip test). Data collected were statistically analyzed using independent Student’s t-test. Results: Overall incidence of disease in these areas was found to be 16.55% and all the animals were recently parturited (mean: 1.42±0.14 month), on an average in their third lactation (mean: 2.38±0.30) and exhibited clinical signs such as selective anorexia (refusal to feed on concentrate diet), drastic reduction in milk yield (mean: 64.4±5.35%), ketotic odor from urine, breath, and milk and rapid loss of body condition. All the clinical vital parameters in ketotic buffaloes (body temperature, heart rate, respiration rate, and rumen movements) were within normal range. Conclusion: Primary ketosis in Murrah buffaloes was the most common seen in the third lactation, within the first 2 months after parturition with characteristics clinical signs and no variability in vital parameters. The disease has severe effect on the production status of affected animal. PMID:27047203

Physical Activity, Sedentary Behaviours, and Cardiovascular Health: When Will Cardiorespiratory Fitness Become a Vital Sign?

PubMed

Després, Jean-Pierre

2016-04-01

Although it is generally agreed upon that a physically active lifestyle and regular exercise are good for heart health, it is much less appreciated by the public that the prolonged hours of sedentary time resulting from sitting at work or screen time are also risk factors for cardiovascular outcomes and other cardiometabolic diseases. In this short narrative review, evidence is discussed and prudent recommendations are made in the context of the sedentary, affluent lifestyle that characterizes a large proportion of our population. It has become overwhelmingly clear that a sedentary lifestyle is a powerful risk factor for cardiovascular and other chronic diseases. In addition, vigorous physical activity and exercise is also associated with metabolic and cardiovascular adaptations that are compatible with cardiovascular health. In that regard, cardiorespiratory fitness, a reliable metric to assess the ability of the cardiovascular system to sustain prolonged physical work, has been shown to be the most powerful predictor of mortality and morbidity, way beyond classical cardiovascular disease (CVD) risk factors such as smoking, cholesterol, hypertension, and diabetes. On the basis of the evidence available, it is proposed that both dimensions of overall physical activity level (reducing sedentary time and performing regular physical activity or endurance type exercise) should be targeted to reduce CVD risk. Finally, because of the robust evidence that poor cardiorespiratory fitness is an independent risk factor for CVD and related mortality, it is proposed that this simple physiological metric should be incorporated as a vital sign in CVD risk factor evaluation and management. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Validity and reliability of the Japanese version of the Newest Vital Sign: a preliminary study.

PubMed

Kogure, Takamichi; Sumitani, Masahiko; Suka, Machi; Ishikawa, Hirono; Odajima, Takeshi; Igarashi, Ataru; Kusama, Makiko; Okamoto, Masako; Sugimori, Hiroki; Kawahara, Kazuo

2014-01-01

Health literacy (HL) refers to the ability to obtain, process, and understand basic health information and services, and is thus needed to make appropriate health decisions. The Newest Vital Sign (NVS) is comprised of 6 questions about an ice cream nutrition label and assesses HL numeracy skills. We developed a Japanese version of the NVS (NVS-J) and evaluated the validity and reliability of the NVS-J in patients with chronic pain. The translation of the original NVS into Japanese was achieved as per the published guidelines. An observational study was subsequently performed to evaluate the validity and reliability of the NVS-J in 43 Japanese patients suffering from chronic pain. Factor analysis with promax rotation, using the Kaiser criterion (eigenvalues ≥1.0), and a scree plot revealed that the main component of the NVS-J consists of three determinative factors, and each factor consists of two NVS-J items. The criterion-related validity of the total NVS-J score was significantly correlated with the total score of Ishikawa et al.'s self-rated HL Questionnaire, the clinical global assessment of comprehensive HL level, cognitive function, and the Brinkman index. In addition, Cronbach's coefficient for the total score of the NVS-J was adequate (alpha = 0.72). This study demonstrated that the NVS-J has good validity and reliability. Further, the NVS-J consists of three determinative factors: "basic numeracy ability," "complex numeracy ability," and "serious-minded ability." These three HL abilities comprise a 3-step hierarchical structure. Adequate HL should be promoted in chronic pain patients to enable coping, improve functioning, and increase activities of daily living (ADLs) and quality of life (QOL).

Diversity of the definition of stable vital sign in trauma patients: results of a nationwide survey.

PubMed

Mun, Seongpyo

2015-12-01

Hemodynamic stability (HS) based on vital sign (VS) is thought to be the most useful criteria for successful non-operative management (NOM) of blunt spleen injury (BSI). However, a consistent definition of HS has not been established. We wanted to evaluate the definition of HS through conducting a nationwide survey and find the factors affectting diversity. The questionnaire regarding the definition of HS was sent to the department of trauma surgery and emergency medicine of level I trauma center between October 2012 and November 2012. Data was compared using analysis of variance, t-test, χ2 test and logistic regression. Among five hundred and sixty-three doctors, 507 responded (90%). Forty-eight responses were incomplete, and hence, 459 (81.5%) responses were analyzed. There was a significant diversity in the definition of HS on the subject of type of blood pressure (BP), cut off value of hypotension, measuring technique of BP, duration of hypotension, whether or not using heart rate (HR) as a determinant of HS, cut off value of hypotension when the patient has comorbidity or when the patient is a pediatric patient. 91.5% replied that they were confused defining HS and felt the need to have more objective determinants. Nevertheless, 90% of the responders were not using laboratory test to define HS. Many trauma doctors are using only VS to define HS. This is why there is a confusion regarding how to define which patient is hemodynamically stable. More objective determinants such as base deficit or lactate can be useful adjuncts.

Low forced vital capacity predicts cytotoxic chemotherapy-associated acute exacerbation of interstitial lung disease in patients with lung cancer.

PubMed

Enomoto, Yasunori; Inui, Naoki; Kato, Terufumi; Baba, Tomohisa; Karayama, Masato; Nakamura, Yutaro; Ogura, Takashi; Suda, Takafumi

2016-06-01

Although acute exacerbation of pre-existing interstitial lung disease (AE-ILD) associated with cytotoxic chemotherapy has been recognized as a severe complication in lung cancer treatment, its risk factors have not been fully studied. Among lung cancer patients receiving cytotoxic chemotherapy, patients with pre-existing ILD were identified based on the pretreatment high-resolution computed tomography (HRCT) findings. Chemotherapy-associated AE-ILD was defined as deterioration or development of dyspnea and HRCT findings of new bilateral ground-glass attenuations with/without non-segmental consolidation superimposed on pre-existing interstitial shadows, without evidence of pulmonary infection, congestion, or pulmonary embolism, within four weeks after the last administration of chemotherapy. Baseline characteristics were reviewed and the risk factors for chemotherapy-associated AE-ILD were evaluated by logistic regression analyses. Among 85 patients identified as having pre-existing ILD, chemotherapy-associated AE-ILD occurred in 26 patients (30.6%); 8 patients died and 11 patients had a severely deteriorated general condition despite intensive treatment. Compared with those without AE-ILD, patients with AE-ILD had significantly lower forced vital capacity (FVC) (median: 91.1% versus 76.6%, P=0.01). Univariate and multivariate logistic regression analyses identified baseline lower FVC and non-small cell lung cancer (NSCLC) as the risk factors for this severe event (odds ratio of FVC: 0.97, 95% confidence interval: 0.94-0.99; odds ratio of NSCLC: 4.65, 95% confidence interval: 1.10-19.76). Chemotherapy-associated AE-ILD was a frequent and lethal complication in lung cancer treatment for patients with pre-existing ILD. Spirometric assessment of pulmonary function may be useful to predict the event. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Multiple Lookup Table-Based AES Encryption Algorithm Implementation

NASA Astrophysics Data System (ADS)

Gong, Jin; Liu, Wenyi; Zhang, Huixin

Anew AES (Advanced Encryption Standard) encryption algorithm implementation was proposed in this paper. It is based on five lookup tables, which are generated from S-box(the substitution table in AES). The obvious advantages are reducing the code-size, improving the implementation efficiency, and helping new learners to understand the AES encryption algorithm and GF(28) multiplication which are necessary to correctly implement AES[1]. This method can be applied on processors with word length 32 or above, FPGA and others. And correspondingly we can implement it by VHDL, Verilog, VB and other languages.

15 CFR Appendix B to Part 30 - AES Filing Codes

Code of Federal Regulations, 2013 CFR

2013-01-01

... 15 Commerce and Foreign Trade 1 2013-01-01 2013-01-01 false AES Filing Codes B Appendix B to Part..., DEPARTMENT OF COMMERCE FOREIGN TRADE REGULATIONS Pt. 30, App. B Appendix B to Part 30—AES Filing Codes Part I... Manifest Use Only by AES Carriers) AE Shipment information filed through AES (See §§ 30.50 through 30.58...

15 CFR Appendix B to Part 30 - AES Filing Codes

Code of Federal Regulations, 2012 CFR

2012-01-01

... 15 Commerce and Foreign Trade 1 2012-01-01 2012-01-01 false AES Filing Codes B Appendix B to Part..., DEPARTMENT OF COMMERCE FOREIGN TRADE REGULATIONS Pt. 30, App. B Appendix B to Part 30—AES Filing Codes Part I... Manifest Use Only by AES Carriers) AE Shipment information filed through AES (See §§ 30.50 through 30.58...

Characterization of Aes nuclear foci in colorectal cancer cells

PubMed Central

Itatani, Yoshiro; Sonoshita, Masahiro; Kakizaki, Fumihiko; Okawa, Katsuya; Stifani, Stefano; Itoh, Hideaki; Sakai, Yoshiharu; Taketo, M. Mark

2016-01-01

Amino-terminal enhancer of split (Aes) is a member of Groucho/Transducin-like enhancer (TLE) family. Aes is a recently found metastasis suppressor of colorectal cancer (CRC) that inhibits Notch signalling, and forms nuclear foci together with TLE1. Although some Notch-associated proteins are known to form subnuclear bodies, little is known regarding the dynamics or functions of these structures. Here, we show that Aes nuclear foci in CRC observed under an electron microscope are in a rather amorphous structure, lacking surrounding membrane. Investigation of their behaviour during the cell cycle by time-lapse cinematography showed that Aes nuclear foci dissolve during mitosis and reassemble after completion of cytokinesis. We have also found that heat shock cognate 70 (HSC70) is an essential component of Aes foci. Pharmacological inhibition of the HSC70 ATPase activity with VER155008 reduces Aes focus formation. These results provide insight into the understanding of Aes-mediated inhibition of Notch signalling. PMID:26229111

Changes in histopathology and cytokeratin AE1/AE3 expression in skin graft with different time on Indonesian local cats.

PubMed

Erwin; Etriwati; Gunanti; Handharyani, Ekowati; Noviana, Deni

2017-06-01

A good skin graft histopathology is followed by formation of hair follicle, sweat gland, sebaceous gland, blood vessel, lightly dense connective tissue, epidermis, and dermis layer. This research aimed to observe histopathology feature and cytokeratin AE1/AE3 expression on cat skin post skin grafting within a different period of time. Nine male Indonesian local cats aged 1-2 years old weighing 3-4 kg were separated into three groups. First surgery created defect wound of 2 cm × 2 cm in size to whole groups. The wounds were left alone for several days, differing in interval between each group, respectively: Group I (for 2 days), Group II (for 4 days), and Group III (for 6 days). The second surgery was done to each group which harvested skin of thoracic area and applied it on recipient wound bed. On day 24 th post skin graft was an examination of histopathology and cytokeratin AE1/AE3 immunohistochemistry. Group I donor skin's epidermis layer had not formed completely whereas epidermis of donor skin of Groups II and III had completely formed. In all group hair follicle, sweat gland, sebaceous gland, and neovascularization were found. The density of connective tissue in Group I was very solid than other groups. Cytokeratin AE1/AE3 expression was found on donor skin's epithelial cell in epidermis and dermis layer with very brown intensity for Group II, brown intensity for Group II, and lightly brown for Group I. Histopathological structure and cytokeratin AE1/AE3 expression post skin graft are better in Groups II and III compared to Group I.

Effects of Reiki on Pain and Vital Signs When Applied to the Incision Area of the Body After Cesarean Section Surgery: A Single-Blinded, Randomized, Double-Controlled Study.

PubMed

Sagkal Midilli, Tulay; Ciray Gunduzoglu, Nazmiye

This study was conducted to determine the effects of Reiki on pain and vital signs when applied for 15 minutes to the incision area of the body after cesarean section surgery. The study was single-blinded, randomized, and double-controlled (Reiki, sham Reiki, and control groups). Forty-five patients, equalized by age and number of births, were randomly assigned to the Reiki, sham Reiki, and control groups. The treatment, which was applied to the patients in these 3 groups, was applied for 15 minutes to the incision area of body in the first 24 and 48 hours after the operation within 4 to 8 hours of the application of standard analgesics. The study data were collected using a patient follow-up form and a visual analog scale. Mean visual analog scale measurement values were significantly different from each other according to groups and times (P < .05). A reduction in pain of 76.06% was determined in the Reiki group patients between day 1 pre-tx and after application on the second day (day 2 post-tx) measurements. Mean breathing rate and systolic blood pressure measurement values were significantly different from each other according to groups (P < .05). The Reiki group was observed to use fewer analgesics throughout the study and to need them after a longer time than the sham Reiki and control groups (P < .05). It was concluded that Reiki applied for 15 minutes to the incision area after a cesarean operation had the expected effects on pain and the need for the use of analgesics, but it had no effect on vital signs.

Ultra-Wide Patch Antenna Array Design at 60 GHz Band for Remote Vital Sign Monitoring with Doppler Radar Principle

NASA Astrophysics Data System (ADS)

Rabbani, Muhammad Saqib; Ghafouri-Shiraz, Hooshang

2017-05-01

In this paper, ultra-wide patch antenna arrays have been presented at 60 GHz band (57.24-65.88 GHz) with improved gain and beam-width capabilities for remote detection of respiration and heart beat rate of a person with Doppler radar principle. The antennas measured and simulation results showed close agreement. The breathing rate (BR) and heart rate (HR) of a 31-year-old man have been accurately detected from various distances ranging from 5 to 200 cm with both single-antenna and dual-antenna operations. In the case of single-antenna operation, the signal is transmitted and received with the same antenna, whereas in dual-antenna operation, two identical antennas are employed, one for signal transmission and the other for reception. It has been found that in case of the single-antenna operation, the accuracy of the remote vital sign monitoring (RVSM) is good for short distance; however, in the case of the dual-antenna operations, the RVSM can be accurately carried out at relatively much longer distance. On the other hand, it has also been seen that the visual results are more obvious with higher gain antennas when the radar beam is confined just on the subject's body area.

Concept and modular telemedicine platform for measuring of vital signs, ADL and behavioral patterns of elderly in home settings.

PubMed

Czabke, A; Loeschke, J; Lueth, T C

2011-01-01

In this contribution a new centralized platform for telemedicine is presented. It combines functions for measuring of vital signs, ADL and behavioral patterns and is especially designed for home care scenarios and the use by elderly people who are not familiar with the use of a PC. Unlike many other approaches we did not use a modified standard PC but developed a new dedicated hardware platform. It comes with various interfaces to communicate with different medical home care systems. We implemented a modular software architecture, which allows managing multiple user accounts with different personal settings. Every account can be adapted individually to the user. Every medical device that can be connected to the platform has its own software module, in which data is analyzed, displayed, stored to an internal database or transmitted to a server. Though the user is not bothered with technical issues such as setting up a connection to the internet, he keeps control on his data because he decides if and when data is transferred to a web server. The device was developed in an iterative process and evaluated in focus groups by n = 31 subjects (average age: 67 years) under the supervision of a psychogerontologist. All findings obtained from those sessions were directly incorporated in the presented work.

Characterization of Aes nuclear foci in colorectal cancer cells.

PubMed

Itatani, Yoshiro; Sonoshita, Masahiro; Kakizaki, Fumihiko; Okawa, Katsuya; Stifani, Stefano; Itoh, Hideaki; Sakai, Yoshiharu; Taketo, M Mark

2016-01-01

Amino-terminal enhancer of split (Aes) is a member of Groucho/Transducin-like enhancer (TLE) family. Aes is a recently found metastasis suppressor of colorectal cancer (CRC) that inhibits Notch signalling, and forms nuclear foci together with TLE1. Although some Notch-associated proteins are known to form subnuclear bodies, little is known regarding the dynamics or functions of these structures. Here, we show that Aes nuclear foci in CRC observed under an electron microscope are in a rather amorphous structure, lacking surrounding membrane. Investigation of their behaviour during the cell cycle by time-lapse cinematography showed that Aes nuclear foci dissolve during mitosis and reassemble after completion of cytokinesis. We have also found that heat shock cognate 70 (HSC70) is an essential component of Aes foci. Pharmacological inhibition of the HSC70 ATPase activity with VER155008 reduces Aes focus formation. These results provide insight into the understanding of Aes-mediated inhibition of Notch signalling. © The Authors 2015. Published by Oxford University Press on behalf of the Japanese Biochemical Society. All rights reserved.

AE Recorder Characteristics and Development.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Partridge, Michael E.; Curtis, Shane Keawe; McGrogan, David Paul

2016-11-01

The Anomalous Environment Recorder (AE Recorder) provides a robust data recording capability for multiple high-shock applications including earth penetrators. The AE Recorder, packaged as a 2.4" di ameter cylinder 3" tall, acquires 12 accelerometer, 2 auxiliary, and 6 discrete signal channels at 250k samples / second. Recording depth is 213 seconds plus 75ms of pre-trigger data. The mechanical, electrical, and firmware are described as well as support electro nics designed for the first use of the recorder.

Vital Recorder-a free research tool for automatic recording of high-resolution time-synchronised physiological data from multiple anaesthesia devices.

PubMed

Lee, Hyung-Chul; Jung, Chul-Woo

2018-01-24

The current anaesthesia information management system (AIMS) has limited capability for the acquisition of high-quality vital signs data. We have developed a Vital Recorder program to overcome the disadvantages of AIMS and to support research. Physiological data of surgical patients were collected from 10 operating rooms using the Vital Recorder. The basic equipment used were a patient monitor, the anaesthesia machine, and the bispectral index (BIS) monitor. Infusion pumps, cardiac output monitors, regional oximeter, and rapid infusion device were added as required. The automatic recording option was used exclusively and the status of recording was frequently checked through web monitoring. Automatic recording was successful in 98.5% (4,272/4,335) cases during eight months of operation. The total recorded time was 13,489 h (3.2 ± 1.9 h/case). The Vital Recorder's automatic recording and remote monitoring capabilities enabled us to record physiological big data with minimal effort. The Vital Recorder also provided time-synchronised data captured from a variety of devices to facilitate an integrated analysis of vital signs data. The free distribution of the Vital Recorder is expected to improve data access for researchers attempting physiological data studies and to eliminate inequalities in research opportunities due to differences in data collection capabilities.

Conventions for sign and speech transcription of child bimodal bilingual corpora in ELAN.

PubMed

Chen Pichler, Deborah; Hochgesang, Julie A; Lillo-Martin, Diane; de Quadros, Ronice Müller

2010-01-01

This article extends current methodologies for the linguistic analysis of sign language acquisition to cases of bimodal bilingual acquisition. Using ELAN, we are transcribing longitudinal spontaneous production data from hearing children of Deaf parents who are learning either American Sign Language (ASL) and American English (AE), or Brazilian Sign Language (Libras, also referred to as Língua de Sinais Brasileira/LSB in some texts) and Brazilian Portuguese (BP). Our goal is to construct corpora that can be mined for a wide range of investigations on various topics in acquisition. Thus, it is important that we maintain consistency in transcription for both signed and spoken languages. This article documents our transcription conventions, including the principles behind our approach. Using this document, other researchers can chose to follow similar conventions or develop new ones using our suggestions as a starting point.

Conventions for sign and speech transcription of child bimodal bilingual corpora in ELAN

PubMed Central

Chen Pichler, Deborah; Hochgesang, Julie A.; Lillo-Martin, Diane; de Quadros, Ronice Müller

2011-01-01

This article extends current methodologies for the linguistic analysis of sign language acquisition to cases of bimodal bilingual acquisition. Using ELAN, we are transcribing longitudinal spontaneous production data from hearing children of Deaf parents who are learning either American Sign Language (ASL) and American English (AE), or Brazilian Sign Language (Libras, also referred to as Língua de Sinais Brasileira/LSB in some texts) and Brazilian Portuguese (BP). Our goal is to construct corpora that can be mined for a wide range of investigations on various topics in acquisition. Thus, it is important that we maintain consistency in transcription for both signed and spoken languages. This article documents our transcription conventions, including the principles behind our approach. Using this document, other researchers can chose to follow similar conventions or develop new ones using our suggestions as a starting point. PMID:21625371

Test and Verification of AES Used for Image Encryption

NASA Astrophysics Data System (ADS)

Zhang, Yong

2018-03-01

In this paper, an image encryption program based on AES in cipher block chaining mode was designed with C language. The encryption/decryption speed and security performance of AES based image cryptosystem were tested and used to compare the proposed cryptosystem with some existing image cryptosystems based on chaos. Simulation results show that AES can apply to image encryption, which refutes the widely accepted point of view that AES is not suitable for image encryption. This paper also suggests taking the speed of AES based image encryption as the speed benchmark of image encryption algorithms. And those image encryption algorithms whose speeds are lower than the benchmark should be discarded in practical communications.

A More Compact AES

NASA Astrophysics Data System (ADS)

Canright, David; Osvik, Dag Arne

We explore ways to reduce the number of bit operations required to implement AES. One way involves optimizing the composite field approach for entire rounds of AES. Another way is integrating the Galois multiplications of MixColumns with the linear transformations of the S-box. Combined with careful optimizations, these reduce the number of bit operations to encrypt one block by 9.0%, compared to earlier work that used the composite field only in the S-box. For decryption, the improvement is 13.5%. This work may be useful both as a starting point for a bit-sliced software implementation, where reducing operations increases speed, and also for hardware with limited resources.

Pharmacokinetic Profile, Safety, and Tolerability of Crisaborole Topical Ointment, 2% in Adolescents with Atopic Dermatitis: An Open-Label Phase 2a Study.

PubMed

Tom, Wynnis L; Van Syoc, Merrie; Chanda, Sanjay; Zane, Lee T

2016-01-01

Phosphodiesterase-4 (PDE4) is an emerging target in treating inflammatory skin diseases. Crisaborole topical ointment, 2% is a novel, boron-based, topical PDE4 inhibitor under investigation for treatment of mild to moderate atopic dermatitis (AD). Adolescent patients aged 12 to 17 years with treatable AD lesions involving ≥ 10% to ≤ 35% body surface area (BSA) were enrolled into a phase 2a, open-label study comprising pharmacokinetic (PK), safety, tolerability, and efficacy assessments. Crisaborole topical ointment, 2% was applied twice daily to affected areas for 28 days, with dosage based on baseline treatable BSA. PK blood samples were collected on days 1, 2, 4, 6, 8, and 9. Safety assessments included adverse events (AEs), laboratory parameters, and vital signs. Efficacy assessments included the Investigator's Static Global Assessment (ISGA) score and severity of AD signs and symptoms. Twenty-three patients were enrolled; 22 completed the study (1 patient discontinued due to an AE [application site dermatitis]). PK analysis demonstrated limited exposure to crisaborole topical ointment, 2% after 8 days of dosing. Ten patients reported a total of 19 AEs, most commonly application site pain and nasopharyngitis (3 patients each). There were no clinically meaningful changes in laboratory or vital sign parameters. Efficacy was demonstrated by reductions in mean ISGA and AD sign and symptom severity scores. At day 29, eight patients (35%) had achieved an ISGA score ≤ 1 with ≥ 2-grade improvement. Mean treatable BSA declined from 17.6% to 8.2%. These results provide preliminary evidence for the limited systemic exposure, safety, and effectiveness of crisaborole topical ointment, 2% in adolescents with mild to moderate AD. © 2016 Wiley Periodicals, Inc.

22 CFR 120.30 - The Automated Export System (AES).

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false The Automated Export System (AES). 120.30 Section 120.30 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.30 The Automated Export System (AES). The Automated Export System (AES) is the Department of...

22 CFR 120.30 - The Automated Export System (AES).

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false The Automated Export System (AES). 120.30 Section 120.30 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.30 The Automated Export System (AES). The Automated Export System (AES) is the Department of...

22 CFR 120.30 - The Automated Export System (AES).

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false The Automated Export System (AES). 120.30 Section 120.30 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.30 The Automated Export System (AES). The Automated Export System (AES) is the Department of...

22 CFR 120.30 - The Automated Export System (AES).

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false The Automated Export System (AES). 120.30 Section 120.30 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.30 The Automated Export System (AES). The Automated Export System (AES) is the Department of...

22 CFR 120.30 - The Automated Export System (AES).

Code of Federal Regulations, 2010 CFR

2010-04-01

... DEFINITIONS § 120.30 The Automated Export System (AES). The Automated Export System (AES) is the Department of Commerce, Bureau of Census, electronic filing of export information. The AES shall serve as the primary...). Also, requests for special reporting may be made by DDTC on a case-by-case basis, (e.g., compliance...

Crack classification in concrete beams using AE parameters

NASA Astrophysics Data System (ADS)

Bahari, N. A. A. S.; Shahidan, S.; Abdullah, S. R.; Ali, N.; Zuki, S. S. Mohd; Ibrahim, M. H. W.; Rahim, M. A.

2017-11-01

The acoustic emission (AE) technique is an effective tool for the evaluation of crack growth. The aim of this study is to evaluate crack classification in reinforced concrete beams using statistical analysis. AE has been applied for the early monitoring of reinforced concrete structures using AE parameters such as average frequency, rise time, amplitude counts and duration. This experimental study focuses on the utilisation of this method in evaluating reinforced concrete beams. Beam specimens measuring 150 mm × 250 mm × 1200 mm were tested using a three-point load flexural test using Universal Testing Machines (UTM) together with an AE monitoring system. The results indicated that RA value can be used to determine the relationship between tensile crack and shear movement in reinforced concrete beams.

Statistical assessment on a combined analysis of GRYN-ROMN-UCBN upland vegetation vital signs

USGS Publications Warehouse

Irvine, Kathryn M.; Rodhouse, Thomas J.

2014-01-01

different results and/or computational instability. However, when only fixed effects are of interest, the survey package (svyglm and svyolr) may be suitable for a model-assisted analysis for trend. We provide possible directions for future research into combined analysis for ordinal and continuous vital sign indictors.

Energy efficiency analysis and implementation of AES on an FPGA

NASA Astrophysics Data System (ADS)

Kenney, David

The Advanced Encryption Standard (AES) was developed by Joan Daemen and Vincent Rjimen and endorsed by the National Institute of Standards and Technology in 2001. It was designed to replace the aging Data Encryption Standard (DES) and be useful for a wide range of applications with varying throughput, area, power dissipation and energy consumption requirements. Field Programmable Gate Arrays (FPGAs) are flexible and reconfigurable integrated circuits that are useful for many different applications including the implementation of AES. Though they are highly flexible, FPGAs are often less efficient than Application Specific Integrated Circuits (ASICs); they tend to operate slower, take up more space and dissipate more power. There have been many FPGA AES implementations that focus on obtaining high throughput or low area usage, but very little research done in the area of low power or energy efficient FPGA based AES; in fact, it is rare for estimates on power dissipation to be made at all. This thesis presents a methodology to evaluate the energy efficiency of FPGA based AES designs and proposes a novel FPGA AES implementation which is highly flexible and energy efficient. The proposed methodology is implemented as part of a novel scripting tool, the AES Energy Analyzer, which is able to fully characterize the power dissipation and energy efficiency of FPGA based AES designs. Additionally, this thesis introduces a new FPGA power reduction technique called Opportunistic Combinational Operand Gating (OCOG) which is used in the proposed energy efficient implementation. The AES Energy Analyzer was able to estimate the power dissipation and energy efficiency of the proposed AES design during its most commonly performed operations. It was found that the proposed implementation consumes less energy per operation than any previous FPGA based AES implementations that included power estimations. Finally, the use of Opportunistic Combinational Operand Gating on an AES cipher

The effects of dietary chromium(III) picolinate on growth performance, vital signs, and blood measurements of pigs during immune stress.

PubMed

Kim, Beob G; Lindemann, Merlin D; Cromwell, Gary L

2010-06-01

This experiment used 24 pigs (26.0 kg) to investigate the effects of dietary chromium (Cr) on pigs challenged with lipopolysaccharide (LPS). Following 35 days of diet exposure, the immune stress treatments were: (1) phosphate-buffered saline (PBS) injection and no Cr, (2) LPS injection and no Cr, (3) LPS injection and Cr 1,000 ppb, and (4) LPS injection and Cr 2,000 ppb. At 0 h, PBS or LPS was injected intraperitoneally in each pig. During the first 12 h post-injection, pigs challenged with LPS lost 951 g, while the PBS group gained 170 g (p < 0.001). Compared with the PBS group, LPS-challenged pigs consumed less feed (p < 0.01) during the first 24 h. The LPS group had higher rectal temperature at 2 and 4 h and higher respiratory rate at 1.3 and 8.5 h than the PBS group (p < 0.05). Plasma collected at 3 h had higher cortisol (p < 0.001) and lower glucose (p < 0.05) concentrations in the LPS group than the PBS group. However, supplemental Cr did not affect the response variables. Overall, the LPS challenge affects growth performance, vital signs, and plasma variables, but dietary Cr is unable to moderate stress-related effects associated with an LPS challenge.

["Crows' feet wrinkles" in high voltage electric accident--a sign of survival?].

PubMed

Grellner, W; Madea, B

1994-01-01

A "crowsfoot-like" pattern is considered as being a sign of vitality in fatalities due to the effects of smoke, fire or high voltage (active or reflex contraction of mimic muscles). Introducing the autopsy results of a high voltage accident (66,600 V) it is discussed, whether this phenomenon and the underlying contraction of the facial muscles could also be caused by electrical current in the agony or supravital period. It seems possible that this mechanism of direct muscle contraction anticipates a nerval indirect stimulation of muscle fibres by innervating motoneurones--active or on the basis of a polysynaptic extraneous reflex. If the electrophysiological course discussed should be right, a "crowsfoot-like" pattern in equivalent cases could be interpreted as a vital sign only with great reserve.

Design of cryptographically secure AES like S-Box using second-order reversible cellular automata for wireless body area network applications.

PubMed

Gangadari, Bhoopal Rao; Rafi Ahamed, Shaik

2016-09-01

In biomedical, data security is the most expensive resource for wireless body area network applications. Cryptographic algorithms are used in order to protect the information against unauthorised access. Advanced encryption standard (AES) cryptographic algorithm plays a vital role in telemedicine applications. The authors propose a novel approach for design of substitution bytes (S-Box) using second-order reversible one-dimensional cellular automata (RCA 2 ) as a replacement to the classical look-up-table (LUT) based S-Box used in AES algorithm. The performance of proposed RCA 2 based S-Box and conventional LUT based S-Box is evaluated in terms of security using the cryptographic properties such as the nonlinearity, correlation immunity bias, strict avalanche criteria and entropy. Moreover, it is also shown that RCA 2 based S-Boxes are dynamic in nature, invertible and provide high level of security. Further, it is also found that the RCA 2 based S-Box have comparatively better performance than that of conventional LUT based S-Box.

Design of cryptographically secure AES like S-Box using second-order reversible cellular automata for wireless body area network applications

PubMed Central

Rafi Ahamed, Shaik

2016-01-01

In biomedical, data security is the most expensive resource for wireless body area network applications. Cryptographic algorithms are used in order to protect the information against unauthorised access. Advanced encryption standard (AES) cryptographic algorithm plays a vital role in telemedicine applications. The authors propose a novel approach for design of substitution bytes (S-Box) using second-order reversible one-dimensional cellular automata (RCA2) as a replacement to the classical look-up-table (LUT) based S-Box used in AES algorithm. The performance of proposed RCA2 based S-Box and conventional LUT based S-Box is evaluated in terms of security using the cryptographic properties such as the nonlinearity, correlation immunity bias, strict avalanche criteria and entropy. Moreover, it is also shown that RCA2 based S-Boxes are dynamic in nature, invertible and provide high level of security. Further, it is also found that the RCA2 based S-Box have comparatively better performance than that of conventional LUT based S-Box. PMID:27733924

Power Consumption and Calculation Requirement Analysis of AES for WSN IoT.

PubMed

Hung, Chung-Wen; Hsu, Wen-Ting

2018-05-23

Because of the ubiquity of Internet of Things (IoT) devices, the power consumption and security of IoT systems have become very important issues. Advanced Encryption Standard (AES) is a block cipher algorithm is commonly used in IoT devices. In this paper, the power consumption and cryptographic calculation requirement for different payload lengths and AES encryption types are analyzed. These types include software-based AES-CB, hardware-based AES-ECB (Electronic Codebook Mode), and hardware-based AES-CCM (Counter with CBC-MAC Mode). The calculation requirement and power consumption for these AES encryption types are measured on the Texas Instruments LAUNCHXL-CC1310 platform. The experimental results show that the hardware-based AES performs better than the software-based AES in terms of power consumption and calculation cycle requirements. In addition, in terms of AES mode selection, the AES-CCM-MIC64 mode may be a better choice if the IoT device is considering security, encryption calculation requirement, and low power consumption at the same time. However, if the IoT device is pursuing lower power and the payload length is generally less than 16 bytes, then AES-ECB could be considered.

AE characteristic for monitoring of fatigue crack in steel bridge members

NASA Astrophysics Data System (ADS)

Yoon, Dong-Jin; Jung, Juong-Chae; Park, Philip; Lee, Seung-Seok

2000-06-01

Acoustic emission technique was employed for the monitoring of crack activity in both steel bridge members and laboratory specimen. Laboratory experiment was carried out to identify AE characteristics of fatigue cracks for compact tension specimen. The relationship between a stress intensity factor and AE signals activity as well as conventional AE parameter analysis was discussed. A field test was also conducted on a railway bridge, which contain several fatigue cracks. Crack activities were investigated while in service with strain measurement. From the results, in the laboratory tests, the features of three parameters such as the length of crack growth, the AE energy, and the cumulative AE events, showed the almost same trend in their increase as the number of fatigue cycle increased. From the comparisons of peak amplitude and AE energy with stress intensity factor, it was verified that the higher stress intensity factors generated AE signals with higher peak amplitude and a large number of AE counts. In the field test, real crack propagation signals were captured and the crack activity was verified in two cases.

Evaluation of Efficiency Improvement in Vital Documentation Using RFID Devices.

PubMed

Kimura, Eizen; Nakai, Miho; Ishihara, Ken

2016-01-01

We introduced medical devices with RFID tags and the terminal with RFID reader in our hospital. Time study was conducted in two phases. In phase I, nurses round as usual, and in phase II, the nurse round the ward with a terminal installed on a cart. This study concluded that RFID system shortens the time for vital sign documentation. However, deploying the terminals at every bedside did not contribute the more time reduction.

A large scale laboratory cage trial of Aedes densonucleosis virus (AeDNV).

PubMed

Wise de Valdez, Megan R; Suchman, Erica L; Carlson, Jonathan O; Black, William C

2010-05-01

Aedes aegypti (L.) (Diptera: Culicidae) the primary vector of dengue viruses (DENV1-4), oviposit in and around human dwellings, including sites difficult to locate, making control of this mosquito challenging. We explored the efficacy and sustainability of Aedes Densonucleosis Virus (AeDNV) as a biocontrol agent for Ae. aegypti in and among oviposition sites in large laboratory cages (> 92 m3) as a prelude to field trials. Select cages were seeded with AeDNV in a single oviposition site (OPS) with unseeded OPSs established at varied distances. Quantitative real-time polymerase chain reaction was used to track dispersal and accumulation of AeDNV among OPSs. All eggs were collected weekly from each cage and counted. We asked: (1) Is AeDNV dispersed over varying distances and can it accumulate and persist in novel OPSs? (2) Are egg densities reduced in AeDNV treated populations? AeDNV was dispersed to and sustained in novel OPSs. Virus accumulation in OPSs was positively correlated with egg densities and proximity to the initial infection source affected the timing of dispersal and maintenance of viral titers. AeDNV did not significantly reduce Ae. aegypti egg densities. The current study documents that adult female Ae. aegypti oviposition behavior leads to successful viral dispersal from treated to novel containers in large-scale cages; however, the AeDNV titers reached were not sufficient to reduce egg densities.

Acoustic emissions (AE) monitoring of large-scale composite bridge components

NASA Astrophysics Data System (ADS)

Velazquez, E.; Klein, D. J.; Robinson, M. J.; Kosmatka, J. B.

2008-03-01

Acoustic Emissions (AE) has been successfully used with composite structures to both locate and give a measure of damage accumulation. The current experimental study uses AE to monitor large-scale composite modular bridge components. The components consist of a carbon/epoxy beam structure as well as a composite to metallic bonded/bolted joint. The bonded joints consist of double lap aluminum splice plates bonded and bolted to carbon/epoxy laminates representing the tension rail of a beam. The AE system is used to monitor the bridge component during failure loading to assess the failure progression and using time of arrival to give insight into the origins of the failures. Also, a feature in the AE data called Cumulative Acoustic Emission counts (CAE) is used to give an estimate of the severity and rate of damage accumulation. For the bolted/bonded joints, the AE data is used to interpret the source and location of damage that induced failure in the joint. These results are used to investigate the use of bolts in conjunction with the bonded joint. A description of each of the components (beam and joint) is given with AE results. A summary of lessons learned for AE testing of large composite structures as well as insight into failure progression and location is presented.

AE3D

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spong, Donald A

AE3D solves for the shear Alfven eigenmodes and eigenfrequencies in a torodal magnetic fusion confinement device. The configuration can be either 2D (e.g. tokamak, reversed field pinch) or 3D (e.g. stellarator, helical reversed field pinch, tokamak with ripple). The equations solved are based on a reduced MHD model and sound wave coupling effects are not currently included.

19 CFR 192.11 - Description of the AES.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Description of the AES. 192.11 Section 192.11 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY (CONTINUED) EXPORT CONTROL Filing of Export Information Through the Automated Export System (AES...

Quick screen of patients’ numeracy and document literacy skills: the factor structure of the Newest Vital Sign

PubMed Central

Huang, Yen-Ming; Shiyanbola, Olayinka O; Smith, Paul D; Chan, Hsun-Yu

2018-01-01

Introduction The Newest Vital Sign (NVS) is a survey designed to measure general health literacy whereby an interviewer asks six questions related to information printed on a nutritional label from an ice cream container. It enables researchers to evaluate several health literacy dimensions in a short period of time, including document literacy, comprehension, quantitative literacy (numeracy), application, and evaluation. No study has empirically examined which items belong to which latent dimensions of health literacy in the NVS using factor analysis. Identifying the factor structure of the NVS would enable health care providers to choose appropriate intervention strategies to address patients’ health literacy as well as improve their health outcomes accordingly. This study aimed to explore the factor structure of the NVS that is used to assess multiple dimensions of health literacy. Methods A cross-sectional study administering the NVS in a face-to-face manner was conducted at two family medicine clinics in the USA. One hundred and seventy four individuals who participated were at least 20 years old, diagnosed with type 2 diabetes, prescribed at least one oral diabetes medicine, and used English as their primary language. Exploratory factor analysis and confirmatory factor analysis were conducted to investigate the factor structure of the NVS. Results Numeracy and document literacy are two dimensions of health literacy that were identified and accounted for 63.05% of the variance in the NVS. Internal consistency (Cronbach’s alpha) of the NVS were 0.78 and 0.91 for numeracy and document literacy, respectively. Conclusion Numeracy and document literacy appropriately represent the factor structure of the NVS and may be used for assessing health literacy in greater detail for patients with type 2 diabetes. PMID:29844661

Health literacy instrument in family medicine: the "newest vital sign" ease of use and correlates.

PubMed

Shah, Lisa Ciccarelli; West, Patricia; Bremmeyr, Katazryna; Savoy-Moore, Ruth T

2010-01-01

Health literacy has been defined as the ability to obtain, process, and understand the basic information needed to make appropriate health decisions. Half of adults lack the health literacy skills needed for our complex health care environment. In 2005, Weiss et al introduced the Newest Vital Sign (NVS), an instrument that can be used to quickly assess health literacy. The purpose of this study was to determine the acceptability and timeliness of using the NVS to measure the level of health literacy in various suburban, urban, and rural primary care settings. A secondary purpose was to determine the influence of taking a health class on one's level of health literacy. In this cross-sectional design, adults were recruited from 4 primary care settings and student athletes were recruited during preparticipation sports physicals. The NVS was administered and health literacy rates were compared with known trends. A subset of 50 patients was timed during test administration, and refusals were logged throughout. The adults and the athletes were analyzed separately. One thousand fourteen patients (including athletes) agreed to participate (response rate, 97.5%). Average time needed to complete the NVS was 2.63 minutes. Of the adults tested, 48.1% demonstrated adequate health literacy. In logistic regression analysis, younger age, more formal education, health class participation, and body mass index were positive predictors of adequate health literacy among adults. An interaction term was used for gender/race, with white women used as the comparator. The gender/race odds ratio negatively affected literacy, with white men at 0.497 (95% CI, 0.328-0.753), non-white women at 0.177 (95% CI, 0.111-0.282), and non-white men at 0.210 (95% CI, 0.110-0.398). Among the participating middle- and high-school athletes, 59.7% had adequate health literacy. In logistic regression of this population, body mass index was a positive predictor whereas gender/race was a negative predictor. The

Development and validation of a measure of health literacy in the UK: the newest vital sign

PubMed Central

2013-01-01

Background Health literacy (HL) is an important public health issue. Current measures have drawbacks in length and/or acceptability. The US-developed Newest Vital Sign (NVS) health literacy instrument measures both reading comprehension and numeracy skills using a nutrition label, takes 3 minutes to administer, and has proven to be acceptable to research subjects. This study aimed to amend and validate it for the UK population. Methods We used a three-stage process; (1) a Delphi study with academic and clinical experts to amend the NVS label to reflect UK nutrition labeling (2) community-based cognitive testing to assess and improve ease of understanding and acceptability of the test (3) validation of the NVS-UK against an accepted standard test of health literacy, the Test of Functional Health Literacy in Adults (TOFHLA) (Pearson’s r and the area under the Receiver Operating Characteristic (ROC) curve) and participant educational level. A sample size calculation indicated that 250 participants would be required. Inclusion criteria were age 18–75 years and ability to converse in English. We excluded people working in the health field and those with impaired vision or inability to undertake the interview due to cognitive impairment or inability to converse in English. Results In the Delphi study, 28 experts reached consensus (3 cycles). Cognitive testing (80 participants) yielded an instrument that needed no further refinement. Validation testing (337 participants) showed high internal consistency (Cronbach’s Alpha = 0.74). Validation against the TOFHLA demonstrated a Pearson’s r of 0.49 and an area under the ROC curve of 0.81. Conclusions The NVS-UK is a valid measure of HL. Its acceptability and ease of application makes it an ideal tool for use in the UK. It has potential uses in public health research including epidemiological surveys and randomized controlled trials, and in enabling practitioners to tailor care to patient need. PMID:23391329

77 FR 15098 - AES Hawaii, Inc.; Notice of Petition for Temporary Waiver

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-14

...] AES Hawaii, Inc.; Notice of Petition for Temporary Waiver Take notice that on March 5, 2012, pursuant... and Procedure, 18 CFR 292.205(c), AES Hawaii, Inc. (AES Hawaii) filed a Request for Temporary Waiver..., Hawaii. AES Hawaii makes such a request because of a forced boiler outage in the fourth quarter of 2011...

The global compendium of Aedes aegypti and Ae. albopictus occurrence

PubMed Central

Kraemer, Moritz U. G.; Sinka, Marianne E.; Duda, Kirsten A.; Mylne, Adrian; Shearer, Freya M.; Brady, Oliver J.; Messina, Jane P.; Barker, Christopher M.; Moore, Chester G.; Carvalho, Roberta G.; Coelho, Giovanini E.; Van Bortel, Wim; Hendrickx, Guy; Schaffner, Francis; Wint, G. R. William; Elyazar, Iqbal R. F.; Teng, Hwa-Jen; Hay, Simon I.

2015-01-01

Aedes aegypti and Ae. albopictus are the main vectors transmitting dengue and chikungunya viruses. Despite being pathogens of global public health importance, knowledge of their vectors’ global distribution remains patchy and sparse. A global geographic database of known occurrences of Ae. aegypti and Ae. albopictus between 1960 and 2014 was compiled. Herein we present the database, which comprises occurrence data linked to point or polygon locations, derived from peer-reviewed literature and unpublished studies including national entomological surveys and expert networks. We describe all data collection processes, as well as geo-positioning methods, database management and quality-control procedures. This is the first comprehensive global database of Ae. aegypti and Ae. albopictus occurrence, consisting of 19,930 and 22,137 geo-positioned occurrence records respectively. Both datasets can be used for a variety of mapping and spatial analyses of the vectors and, by inference, the diseases they transmit. PMID:26175912

The global compendium of Aedes aegypti and Ae. albopictus occurrence

NASA Astrophysics Data System (ADS)

Kraemer, Moritz U. G.; Sinka, Marianne E.; Duda, Kirsten A.; Mylne, Adrian; Shearer, Freya M.; Brady, Oliver J.; Messina, Jane P.; Barker, Christopher M.; Moore, Chester G.; Carvalho, Roberta G.; Coelho, Giovanini E.; van Bortel, Wim; Hendrickx, Guy; Schaffner, Francis; Wint, G. R. William; Elyazar, Iqbal R. F.; Teng, Hwa-Jen; Hay, Simon I.

2015-07-01

Aedes aegypti and Ae. albopictus are the main vectors transmitting dengue and chikungunya viruses. Despite being pathogens of global public health importance, knowledge of their vectors’ global distribution remains patchy and sparse. A global geographic database of known occurrences of Ae. aegypti and Ae. albopictus between 1960 and 2014 was compiled. Herein we present the database, which comprises occurrence data linked to point or polygon locations, derived from peer-reviewed literature and unpublished studies including national entomological surveys and expert networks. We describe all data collection processes, as well as geo-positioning methods, database management and quality-control procedures. This is the first comprehensive global database of Ae. aegypti and Ae. albopictus occurrence, consisting of 19,930 and 22,137 geo-positioned occurrence records respectively. Both datasets can be used for a variety of mapping and spatial analyses of the vectors and, by inference, the diseases they transmit.

15 CFR Appendix D to Part 30 - AES Filing Citation, Exemption and Exclusion Legends

Code of Federal Regulations, 2013 CFR

2013-01-01

... 15 Commerce and Foreign Trade 1 2013-01-01 2013-01-01 false AES Filing Citation, Exemption and... Appendix D to Part 30—AES Filing Citation, Exemption and Exclusion Legends I. USML Proof of Filing Citation AES ITN Example: AES X20060101987654. II. AES Proof of Filing Citation subpart A § 30.7 AES ITN...

15 CFR Appendix D to Part 30 - AES Filing Citation, Exemption and Exclusion Legends

Code of Federal Regulations, 2011 CFR

2011-01-01

... 15 Commerce and Foreign Trade 1 2011-01-01 2011-01-01 false AES Filing Citation, Exemption and... Appendix D to Part 30—AES Filing Citation, Exemption and Exclusion Legends I. USML Proof of Filing Citation AES ITN Example: AES X20060101987654. II. AES Proof of Filing Citation subpart A § 30.7 AES ITN...

15 CFR Appendix D to Part 30 - AES Filing Citation, Exemption and Exclusion Legends

Code of Federal Regulations, 2012 CFR

2012-01-01

... 15 Commerce and Foreign Trade 1 2012-01-01 2012-01-01 false AES Filing Citation, Exemption and... Appendix D to Part 30—AES Filing Citation, Exemption and Exclusion Legends I. USML Proof of Filing Citation AES ITN Example: AES X20060101987654. II. AES Proof of Filing Citation subpart A § 30.7 AES ITN...

15 CFR Appendix D to Part 30 - AES Filing Citation, Exemption and Exclusion Legends

Code of Federal Regulations, 2014 CFR

2014-01-01

... 15 Commerce and Foreign Trade 1 2014-01-01 2014-01-01 false AES Filing Citation, Exemption and... Appendix D to Part 30—AES Filing Citation, Exemption and Exclusion Legends I. USML Proof of Filing Citation AES ITN Example: AES X20060101987654. II. AES Proof of Filing Citation subpart A § 30.7 AES ITN...

Reduced DIDS-sensitive chloride conductance in Ae1-/- mouse erythrocytes

PubMed Central

Alper, Seth L.; Vandorpe, David H.; Peters, Luanne L.; Brugnara, Carlo

2008-01-01

The resting membrane potential of the human erythrocyte is largely determined by a constitutive Cl- conductance ∼100-fold greater than the resting cation conductance. The 4,4′-diisothiocyanostilbene-2,2′-disulfonic acid (DIDS)-sensitive electroneutral Cl- transport mediated by the human erythroid Cl-/HCO3- exchanger, AE1 (SLC4A1, band 3) is ≥10,000-fold greater than can be accounted for by the Cl- conductance of the red cell. The molecular identities of conductive anion pathways across the red cell membrane remain poorly defined. We have examined red cell Cl- conductance in the Ae1-/- mouse as a genetic test of the hypothesis that Ae1 mediates DIDS-sensitive Cl- conductance in mouse red cells. We report here that wildtype mouse red cell membrane potential resembles that of human red cells in the predominance of its Cl- conductance. We show with four technical approaches that the DIDS-sensitive component of erythroid Cl- conductance is reduced or absent from Ae1-/- red cells. These results are consistent with the hypothesis that the Ae1 anion exchanger polypeptide can operate infrequently in a conductive mode. However, the fragile red cell membrane of the Ae1-/- mouse red cell exhibits reduced abundance or loss of multiple polypeptides. Thus, loss of one or more distinct, DIDS-sensitive anion channel polypeptide(s) from the Ae1-/- red cell membrane cannot be ruled out as an explanation for the reduced DIDS-sensitive anion conductance. PMID:18329299

Genome-Wide Identification and Expression Analysis of the UGlcAE Gene Family in Tomato.

PubMed

Ding, Xing; Li, Jinhua; Pan, Yu; Zhang, Yue; Ni, Lei; Wang, Yaling; Zhang, Xingguo

2018-05-27

The UGlcAE has the capability of interconverting UDP-d-galacturonic acid and UDP-d-glucuronic acid, and UDP-d-galacturonic acid is an activated precursor for the synthesis of pectins in plants. In this study, we identified nine UGlcAE protein-encoding genes in tomato. The nine UGlcAE genes that were distributed on eight chromosomes in tomato, and the corresponding proteins contained one or two trans-membrane domains. The phylogenetic analysis showed that SlUGlcAE genes could be divided into seven groups, designated UGlcAE1 to UGlcAE6 , of which the UGlcAE2 were classified into two groups. Expression profile analysis revealed that the SlUGlcAE genes display diverse expression patterns in various tomato tissues. Selective pressure analysis indicated that all of the amino acid sites of SlUGlcAE proteins are undergoing purifying selection. Fifteen stress-, hormone-, and development-related elements were identified in the upstream regions (0.5 kb) of these SlUGlcAE genes. Furthermore, we investigated the expression patterns of SlUGlcAE genes in response to three hormones (indole-3-acetic acid (IAA), gibberellin (GA), and salicylic acid (SA)). We detected firmness, pectin contents, and expression levels of UGlcAE family genes during the development of tomato fruit. Here, we systematically summarize the general characteristics of the SlUGlcAE genes in tomato, which could provide a basis for further function studies of tomato UGlcAE genes.

Validation of the new trapped environment AE9/AP9/SPM at low Earth orbit

NASA Astrophysics Data System (ADS)

Badavi, Francis F.

2014-09-01

The completion of the international space station (ISS) in 2011 has provided the space research community an ideal proving ground for future long duration human activities in space. Ionizing radiation measurements in ISS form the ideal tool for the validation of radiation environmental models, nuclear transport codes and nuclear reaction cross sections. Indeed, prior measurements on the space transportation system (STS; shuttle) provided vital information impacting both the environmental models and the nuclear transport code developments by indicating the need for an improved dynamic model of the low Earth orbit (LEO) trapped environment. Additional studies using thermo-luminescent detector (TLD), tissue equivalent proportional counter (TEPC) area monitors, and computer aided design (CAD) model of earlier ISS configurations, confirmed STS observations that, as input, computational dosimetry requires an environmental model with dynamic and directional (anisotropic) behavior, as well as an accurate six degree of freedom (DOF) definition of the vehicle attitude and orientation along the orbit of ISS. At LEO, a vehicle encounters exposure from trapped particles and attenuated galactic cosmic rays (GCR). Within the trapped field, a challenge arises from properly estimating the amount of exposure acquired. There exist a number of models to define the intensities of the trapped particles during the solar quiet and active times. At active times, solar energetic particles (SEP) generated by solar flare or coronal mass ejection (CME) also contribute to the exposure at high northern and southern latitudes. Among the more established trapped models are the historic and popular AE8/AP8, dating back to the 1980s, the historic and less popular CRRES electron/proton, dating back to 1990s and the recently released AE9/AP9/SPM. The AE9/AP9/SPM model is a major improvement over the older AE8/AP8 and CRRES models. This model is derived from numerous measurements acquired over four

Evaluation of a novel vital sign device to reduce maternal mortality and morbidity in low-resource settings: a mixed method feasibility study for the CRADLE-3 trial.

PubMed

Vousden, Nicola; Lawley, Elodie; Nathan, Hannah L; Seed, Paul T; Brown, Adrian; Muchengwa, Tafadzwa; Charantimath, Umesh; Bellad, Mrutyunjaya; Gidiri, Muchabayiwa Francis; Goudar, Shivaprasad; Chappell, Lucy C; Sandall, Jane; Shennan, Andrew H

2018-04-27

The CRADLE-3 trial is a stepped-wedge randomised controlled trial aiming to reduce maternal mortality and morbidity by implementing a novel vital sign device (CRADLE Vital Sign Alert) and training package into routine maternity care in 10 low-income sites. The MRC Guidance on complex interventions proposes that interventions and implementation strategies be shaped by early phase piloting and development work. We present the findings of a three-month mixed-methodology feasibility study for this trial, describe how this was informed by the MRC guidance and the study design was refined. The fidelity, dose, feasibility and acceptability of implementation and training materials were assessed in three representative non-trial sites (Zimbabwe, Ethiopia, India) using multiple-choice questionnaires, evaluation of clinical management (action log), healthcare provider (HCP) semi-structured interviews and focus groups 4-10 weeks after implementation. Simultaneously, the 10 sites included in the main trial (eight countries) collected primary outcome data to inform the power calculation and randomisation allocation and assess the feasibility of data collection. The package was implemented with high fidelity (85% of HCP trained, n = 204). The questionnaires indicated a good understanding of device use with 75% of participants scoring > 75% (n = 97; 90% of those distributed). Action logs were inconsistently completed but indicated that the majority of HCP responded appropriately to abnormal results. From 18 HCP interviews and two focus groups it was widely reported that the intervention improved capacity to make clinical decisions, escalate care and make appropriate referrals. Nine of the ten main trial sites achieved ethical approval for pilot data collection. Intensive care was an inconsistent marker of morbidity and stroke an infrequent outcome and therefore they were removed from the main trial composite outcome. Tools and methods of data collection were optimized

AE 6: A model environment of trapped electrons for solar maximum

NASA Technical Reports Server (NTRS)

Teague, M. J.; Chan, K. W.; Vette, J. I.

1976-01-01

A projected inner zone electron model environment, AE 6, for the epoch 1980 is presented. It is intended to provide estimates of mission fluxes that spacecraft will encounter in the coming solar maximum years. AE 6 is presented by graphs of omnidirectional integral flux as a function of L shell, the ambient magnetic field B, and the energy E. Results of orbital integrations for altitudes from 150 n.m. to 18,000 n.m. are given for circular orbits with four different inclinations, using the AE 6 and the AE 4 solar maximum models for the inner and outer zones, respectively. The derivation of AE 6 is described, and a brief comparison is given of the radial profiles of equatorial fluxes from several related models. A short summary of the associated computer programs is included.

The Impact of Zodiac Signs on Human Nature and Fate

NASA Astrophysics Data System (ADS)

Gasparyan, Naira

2015-07-01

Horoscope signs have unavoidable impact on human behaviour and interests, health and even fate. Moreover, intermingled with the impact of planets they become a powerful force able to bring about unbelievable changes. The investigation reveals that horoscopes have existed in the Armenian reality since ancient times. The most striking fact about their eistence is that in order to have and use zodiak signs in one's national culture, the nation should first of all have sufficient knowledge in Astrological Sciences since the system of zodiak signs has a direct reference to the cognitive processes and scientific knowledge of the universe, astrological issues and sometimes even there is a hint on hidden signs and messages. Anania Shirakatsi, one of the learned Armenians, had to display much diplomacy with the Armenian Church and religion when discussing the topic in his manuscripts. His observations are still of much importance and vitality even today.

Applications of Advanced, Waveform Based AE Techniques for Testing Composite Materials

NASA Technical Reports Server (NTRS)

Prosser, William H.

1996-01-01

Advanced, waveform based acoustic emission (AE) techniques have been previously used to evaluate damage progression in laboratory tests of composite coupons. In these tests, broad band, high fidelity acoustic sensors were used to detect signals which were then digitized and stored for analysis. Analysis techniques were based on plate mode wave propagation characteristics. This approach, more recently referred to as Modal AE, provides an enhanced capability to discriminate and eliminate noise signals from those generated by damage mechanisms. This technique also allows much more precise source location than conventional, threshold crossing arrival time determination techniques. To apply Modal AE concepts to the interpretation of AE on larger composite structures, the effects of wave propagation over larger distances and through structural complexities must be well characterized and understood. In this research, measurements were made of the attenuation of the extensional and flexural plate mode components of broad band simulated AE signals in large composite panels. As these materials have applications in a cryogenic environment, the effects of cryogenic insulation on the attenuation of plate mode AE signals were also documented.

Star-disk interaction in Herbig Ae/Be stars

NASA Astrophysics Data System (ADS)

Speights, Christa Marie

2012-09-01

The question of the mechanism of certain types of stars is important. Classical T Tauri (CTTS) stars accrete magnetospherically, and Herbig Ae/Be stars (higher-mass analogs to CTTS) are thought to also accrete magnetospherically, but the source of a kG magnetic field is unknown, since these stars have radiative interiors. For magnetospheric accretion, an equation has been derived (Hartmann, 2001) which relates the truncation radius, stellar radius, stellar mass, mass accretion rate and magnetic field strength. Currently the magnetic field of Herbig stars is known to be somewhere between 0.1 kG and 10 kG. One goal of this research is to further constrain the magnetic field. In order to do that, I use the magnetospheric accretion equation. For CTTS, all of the variables used in the equation can be measured, so I gather this data from the literature and test the equation and find that it is consistent. Then I apply the equation to Herbig Ae stars and find that the error introduced from using random inclinations is too large to lower the current upper limit of the magnetic field range. If Herbig Ae stars are higher-mass analogs to CTTS, then they should have a similar magnetic field distribution. I compare the calculated Herbig Ae magnetic field distribution to several typical magnetic field distributions using the Kolmogorov-Smirnov test, and find that the data distribution does not match any of the distributions used. This means that Herbig Ae stars do not have well ordered kG fields like CTTS.

Using Supervised Machine Learning to Classify Real Alerts and Artifact in Online Multi-signal Vital Sign Monitoring Data

PubMed Central

Chen, Lujie; Dubrawski, Artur; Wang, Donghan; Fiterau, Madalina; Guillame-Bert, Mathieu; Bose, Eliezer; Kaynar, Ata M.; Wallace, David J.; Guttendorf, Jane; Clermont, Gilles; Pinsky, Michael R.; Hravnak, Marilyn

2015-01-01

OBJECTIVE Use machine-learning (ML) algorithms to classify alerts as real or artifacts in online noninvasive vital sign (VS) data streams to reduce alarm fatigue and missed true instability. METHODS Using a 24-bed trauma step-down unit’s non-invasive VS monitoring data (heart rate [HR], respiratory rate [RR], peripheral oximetry [SpO2]) recorded at 1/20Hz, and noninvasive oscillometric blood pressure [BP] less frequently, we partitioned data into training/validation (294 admissions; 22,980 monitoring hours) and test sets (2,057 admissions; 156,177 monitoring hours). Alerts were VS deviations beyond stability thresholds. A four-member expert committee annotated a subset of alerts (576 in training/validation set, 397 in test set) as real or artifact selected by active learning, upon which we trained ML algorithms. The best model was evaluated on alerts in the test set to enact online alert classification as signals evolve over time. MAIN RESULTS The Random Forest model discriminated between real and artifact as the alerts evolved online in the test set with area under the curve (AUC) performance of 0.79 (95% CI 0.67-0.93) for SpO2 at the instant the VS first crossed threshold and increased to 0.87 (95% CI 0.71-0.95) at 3 minutes into the alerting period. BP AUC started at 0.77 (95%CI 0.64-0.95) and increased to 0.87 (95% CI 0.71-0.98), while RR AUC started at 0.85 (95%CI 0.77-0.95) and increased to 0.97 (95% CI 0.94–1.00). HR alerts were too few for model development. CONCLUSIONS ML models can discern clinically relevant SpO2, BP and RR alerts from artifacts in an online monitoring dataset (AUC>0.87). PMID:26992068

Real alerts and artifact classification in archived multi-signal vital sign monitoring data: implications for mining big data.

PubMed

Hravnak, Marilyn; Chen, Lujie; Dubrawski, Artur; Bose, Eliezer; Clermont, Gilles; Pinsky, Michael R

2016-12-01

Huge hospital information system databases can be mined for knowledge discovery and decision support, but artifact in stored non-invasive vital sign (VS) high-frequency data streams limits its use. We used machine-learning (ML) algorithms trained on expert-labeled VS data streams to automatically classify VS alerts as real or artifact, thereby "cleaning" such data for future modeling. 634 admissions to a step-down unit had recorded continuous noninvasive VS monitoring data [heart rate (HR), respiratory rate (RR), peripheral arterial oxygen saturation (SpO 2 ) at 1/20 Hz, and noninvasive oscillometric blood pressure (BP)]. Time data were across stability thresholds defined VS event epochs. Data were divided Block 1 as the ML training/cross-validation set and Block 2 the test set. Expert clinicians annotated Block 1 events as perceived real or artifact. After feature extraction, ML algorithms were trained to create and validate models automatically classifying events as real or artifact. The models were then tested on Block 2. Block 1 yielded 812 VS events, with 214 (26 %) judged by experts as artifact (RR 43 %, SpO 2 40 %, BP 15 %, HR 2 %). ML algorithms applied to the Block 1 training/cross-validation set (tenfold cross-validation) gave area under the curve (AUC) scores of 0.97 RR, 0.91 BP and 0.76 SpO 2 . Performance when applied to Block 2 test data was AUC 0.94 RR, 0.84 BP and 0.72 SpO 2 . ML-defined algorithms applied to archived multi-signal continuous VS monitoring data allowed accurate automated classification of VS alerts as real or artifact, and could support data mining for future model building.

Vital signs: teen pregnancy--United States, 1991--2009.

PubMed

2011-04-08

In 2009, approximately 410,000 teens aged 15-19 years gave birth in the United States, and the teen birth rate remains higher than in other developed countries. To describe U.S. trends in teen births and related factors, CDC used data on 1) teen birth rates during 1991-2009 from the National Vital Statistics System, 2) sexual intercourse and contraceptive use among high school students during 1991-2009 from the national Youth Risk Behavior Survey, and 3) sex education, parent communication, use of long-acting reversible contraceptives (LARCs), and receipt of reproductive health services among teens aged 15-19 years from the 2006-2008 National Survey of Family Growth. In 2009, the national teen birth rate was 39.1 births per 1,000 females, a 37% decrease from 61.8 births per 1,000 females in 1991 and the lowest rate ever recorded. State-specific teen birth rates varied from 16.4 to 64.2 births per 1,000 females and were highest among southern states. Birth rates for black and Hispanic teens were 59.0 and 70.1 births per 1,000 females, respectively, compared with 25.6 for white teens. From 1991 to 2009, the percentage of high school students who ever had sexual intercourse decreased from 54% to 46%, and the percentage of students who had sexual intercourse in the past 3 months but did not use any method of contraception at last sexual intercourse decreased from 16% to 12%. From 1999 to 2009, the percentage of students who had sexual intercourse in the past 3 months and used dual methods at last sexual intercourse (condoms with either birth control pills or the injectable contraceptive Depo-Provera) increased from 5% to 9%. During 2006-2008, 65% of female teens and 53% of male teens received formal sex education that covered saying no to sex and provided information on methods of birth control. Overall, 44% of female teens and 27% of male teens had spoken with their parents about both topics, but among teens who had ever had sexual intercourse, 20% of females and 31

Military Vital Sign Monitor.

DTIC Science & Technology

1984-09-30

both the training and the tools to effectively r intervene in crisis during transport. The report also also suggests that new methods for blood pressure...operating evvironment of a Navy or Marine Corps medical evacuation helicopter. 2. Develop methods for determining the safety and effectiveness of all medical...objective identified during the study was to develop methods for determining the safety and effectiveness of all medical equipment used during Navy

Education Vital Signs 1999.

ERIC Educational Resources Information Center

Hardy, Lawrence, Ed.; Bushweller, Kevin, Ed.

1999-01-01

Begins with a look at the year's major education news: implications of the massacre at Columbine High School, major Supreme Court decisions, and pro- and anti-voucher political rhetoric. Following is an analysis of how the nation is doing on the Goals 2000. Other sections take the pulse of public education and analyze the challenges faced by…

Vital Signs - Multiple Languages

MedlinePlus

... this page, please enable JavaScript. Amharic (Amarɨñña / አማርኛ ) Arabic (العربية) Burmese (myanma bhasa) Dari (دری) Farsi (فارسی) ... Chin (Laiholh) Karen (S’gaw Karen) Kinyarwanda (Rwanda) Levantine (Arabic dialect) (الـلَّـهْـجَـةُ الـشَّـامِـيَّـة) Nepali (नेपाली) Pashto (Pax̌tō / ...

Vital signs are good

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stremel, J.

Using the analogy of a medical examination, the author outlines the procedures used to examine the Rawhide Energy Station over a four-week period to determine that it was operating properly. The procedures combined visual examination, cleaning and repairing where necessary, the replacement of worn parts, and the use of diagnostic tools. Ultrasonics, X-rays, magnetic rubber, and other precision technologies help to keep a plant trouble-free. The planning that goes into such a thorough examination results in better performance and a longer service life for the plant.

Education Vital Signs: Population.

ERIC Educational Resources Information Center

Zakariya, Sally Banks

1985-01-01

Population changes and demographics shape the future of public schools. Includes statistics on ethnic makeup of student population, the projected baby boomlet, children of working mothers, households without children, and the aging population. (MD)

Vital Signs Rate Meter.

DTIC Science & Technology

1987-09-01

stethoscope . Auscultation in respiratory medicine, however, has advanced slowly since Laennec established auscultation of lung sounds as a means of... stethoscope and the ear have limitations in their use as instruments for the evaluation of respiratory sounds. Respiratory sounds have a wide spectrum...Amplification, Rectification and Level-shft ing Stage ... 11 Respiratory Sound Circuitry ....... .................. ... 11 Sound Sensor

Effects of different musical stimuli in vital signs and facial expressions in patients with cerebral damage: a pilot study.

PubMed

Ribeiro, Ana Sofia Fernandes; Ramos, Antonio; Bermejo, Emilia; Casero, Mónica; Corrales, José Manuel; Grantham, Sarah

2014-04-01

Along history, music has been used in a variety of ways for therapeutic purposes and has long been recognized for its physiological and psychological effects. Music listening can be an effective nursing intervention, to enhance relaxation, provide distraction, and reduce pain. The aims of this study were to identify changes produced by different musical stimuli in blood pressure (BP), heart rate (HR), respiratory rate (RR), and oxygen saturations (SpO2) and to verify the influence of music listening on patients' facial expressions with severe cerebral damage. A quasiexperimental study was performed in 26 patients with severe cerebral damage, divided into control and case groups. Patients belonging to the case group were exposed to musical stimuli, radio, classical relaxing music (CRM), and relaxing music with nature sounds (RMNS). Patients were evaluated by measuring vital signs before and after exposure to each musical stimulus, as were the patients within the control group. Patients in the control group were exempt from any musical stimulus. Facial expressions were observed in each patient within the case group during the intervention. The results show that radio produced a slight increase in systolic BP, HR, RR, and SpO2. The CRM induced a decrease of RR and an increase of SpO2 and also produced alterations of the facial expression. When RMNS was played, a decrease was displayed in BP, HR, and RR and an increase was displayed in SpO2. Alterations in facial expression were displayed in each patient. The results of the study suggest that the application of musical stimuli such as CRM and RMNS can be used to provide a state of relaxation in patients with severe cerebral damage.

"Storms of crustal stress" and AE earthquake precursors

NASA Astrophysics Data System (ADS)

Gregori, G. P.; Poscolieri, M.; Paparo, G.; de Simone, S.; Rafanelli, C.; Ventrice, G.

2010-02-01

Acoustic emission (AE) displays violent paroxysms preceding strong earthquakes, observed within some large area (several hundred kilometres wide) around the epicentre. We call them "storms of crustal stress" or, briefly "crustal storms". A few case histories are discussed, all dealing with the Italian peninsula, and with the different behaviour shown by the AE records in the Cephalonia island (Greece), which is characterized by a different tectonic setting. AE is an effective tool for diagnosing the state of some wide slab of the Earth's crust, and for monitoring its evolution, by means of AE of different frequencies. The same effect ought to be detected being time-delayed, when referring to progressively lower frequencies. This results to be an effective check for validating the physical interpretation. Unlike a seismic event, which involves a much limited focal volume and therefore affects a restricted area on the Earth's surface, a "crustal storm" typically involves some large slab of lithosphere and crust. In general, it cannot be easily reckoned to any specific seismic event. An earthquake responds to strictly local rheological features of the crust, which are eventually activated, and become crucial, on the occasion of a "crustal storm". A "crustal storm" lasts typically few years, eventually involving several destructive earthquakes that hit at different times, at different sites, within that given lithospheric slab. Concerning the case histories that are here discussed, the lithospheric slab is identified with the Italian peninsula. During 1996-1997 a "crustal storm" was on, maybe elapsing until 2002 (we lack information for the period 1998-2001). Then, a quiet period occurred from 2002 until 26 May 2008, when a new "crustal storm" started, and by the end of 2009 it is still on. During the 1996-1997 "storm" two strong earthquakes occurred (Potenza and Colfiorito) - and (maybe) in 2002 also the Molise earthquake can be reckoned to this "storm". During the

Management of alcohol misuse in Scotland: the role of A&E nurses.

PubMed

Anderson, S; Eadie, D R; MacKintosh, A M; Haw, S

2001-04-01

Despite national targets to reduce excessive drinking in Scotland, rates have increased dramatically since the mid-eighties. The role of Accident and Emergency (A&E) departments in the management of alcohol misuse is much debated. This postal survey was conducted with senior medical and nursing staff in A&E departments and minor injury units throughout Scotland to examine the prevalence of alcohol-related attendances and staff's attitudes towards identifying and responding to alcohol-related attendances. A 57% response rate was achieved, representing 87% of all A&E institutions in Scotland (n = 84). The results reveal an estimated 1 in 7 attendances in A&E in Scotland are alcohol-related, and 1 in 5 of these result in admission. However, over two-fifths of departments do not routinely screen for, or keep records of, patients who attend with alcohol problems. Intervention is normally limited to a brief dialogue and referral to the patient's GP. Despite considerable barriers, A&E nursing staff express a willingness to assume a preventive role, but acknowledge lack of appropriate training and sources of support. It is concluded that there is scope for developing identification and brief intervention services within A&E. However, such developments are dependent upon alcohol issues assuming a higher priority among senior A&E staff.

Ae2Sb2X4F2 (Ae = Sr, Ba): new members of the homologous series Ae2M(1+n)X(3+n)F2 designed from rock salt and fluorite 2D building blocks.

PubMed

Kabbour, Houria; Cario, Laurent

2006-03-20

We have designed new compounds within the homologous series Ae2F2M(1+n)X(3+n) (Ae = Sr, Ba; M = main group metal; n = integer) built up from the stacking of 2D building blocks of rock salt and fluorite types. By incrementally increasing the size of the rock salt 2D building blocks, we have obtained two new n = 1 members of this homologous series, namely, Sr2F2Sb2Se4 and Ba2F2Sb2Se4. We then succeeded in synthesizing these compounds using a high-temperature ceramic method. The structure refinements from the powder or single-crystal X-ray diffraction data confirmed presence of the expected alternating stacking of fluorite [Ae2F2] (Ae = Sr, Ba) and rock salt [Sb2Se4] 2D building blocks. However the Ba derivative shows a strong distortion of the [Sb2Se4] block and a concomitant change of the Sb atom coordination likely related to the lone-pair activity.

Vital signs of life on distant worlds

NASA Astrophysics Data System (ADS)

2003-01-01

Ozone in a planet's spectrum may indicate the presence of life hi-res Size hi-res: 673 kb Credits: ESA 2001. Illustration by Medialab Ozone in a planet's spectrum may indicate the presence of life Darwin will most probably look for the spectral signature of ozone, which is unlikely to exist in any quantity for any length of time in the atmosphere of a planet that is not home to life. The background image is a view of Earth seen by the Apollo 17 crew as they traveled toward the Moon. The white patch at the bottom is Antarctica. Unobscured by clouds, Africa and the Arabian Peninsula are visible at the top of this image. The large island off the coast of Africa is the Malagasy Republic. Looking for Earth-like planets hi-res Size hi-res: 2106 Kb Credits: ESA 2002. Illustration by Medialab Looking for Earth-like planets Darwin has six telescopes that analyse the atmospheres of Earth-like planets Darwin's flotilla hi-res Size hi-res: 902 Kb Credits: ESA 2002. Illustration by Medialab Darwin's flotilla Darwin's six telescopes, a central view-combining spacecraft, and communication satellite (shown bottom left) Our radio and television broadcasts have been leaking into space since the 1930s, when the first powerful emitters were constructed. However, you can do things the other way around as well. The Search for Extraterrestrial Intelligence (SETI) has used radio telescopes to listen to the cosmos for similar signals. Nowadays, astrobiologists are pinpointing more subtle signs that all life, not just intelligent life, might radiate into space. They call these telltale signatures 'biomarkers'. When ESA's Darwin mission begins sending back data in the next decade, biomarkers will help indicate whether neighbouring planets are inhabited. If we only used radio waves as markers of life, this would exclude all forms of life that have not yet developed the means to emit radio waves. Life has been around for thousands of millions of years, but human beings have used radio waves

A Kinect-Based Sign Language Hand Gesture Recognition System for Hearing- and Speech-Impaired: A Pilot Study of Pakistani Sign Language.

PubMed

Halim, Zahid; Abbas, Ghulam

2015-01-01

Sign language provides hearing and speech impaired individuals with an interface to communicate with other members of the society. Unfortunately, sign language is not understood by most of the common people. For this, a gadget based on image processing and pattern recognition can provide with a vital aid for detecting and translating sign language into a vocal language. This work presents a system for detecting and understanding the sign language gestures by a custom built software tool and later translating the gesture into a vocal language. For the purpose of recognizing a particular gesture, the system employs a Dynamic Time Warping (DTW) algorithm and an off-the-shelf software tool is employed for vocal language generation. Microsoft(®) Kinect is the primary tool used to capture video stream of a user. The proposed method is capable of successfully detecting gestures stored in the dictionary with an accuracy of 91%. The proposed system has the ability to define and add custom made gestures. Based on an experiment in which 10 individuals with impairments used the system to communicate with 5 people with no disability, 87% agreed that the system was useful.

Phylodynamic analysis of the dissemination of HIV-1 CRF01_AE in Vietnam.

PubMed

Liao, Huanan; Tee, Kok Keng; Hase, Saiki; Uenishi, Rie; Li, Xiao-Jie; Kusagawa, Shigeru; Thang, Pham Hong; Hien, Nguyen Tran; Pybus, Oliver G; Takebe, Yutaka

2009-08-15

To estimate the epidemic history of HIV-1 CRF01_AE in Vietnam and adjacent Guangxi, China, we determined near full-length nucleotide sequences of CRF01_AE from a total of 33 specimens collected in 1997-1998 from different geographic regions and risk populations in Vietnam. Phylogenetic and Bayesian molecular clock analyses were performed to estimate the date of origin of CRF01_AE lineages. Our study reconstructs the timescale of CRF01_AE expansion in Vietnam and neighboring regions and suggests that the series of CRF01_AE epidemics in Vietnam arose by the sequential introduction of founder strains into new locations and risk groups. CRF01_AE appears to have been present among heterosexuals in South-Vietnam for more than a decade prior to its epidemic spread in the early 1990s. In the late 1980s, the virus spread to IDUs in Southern Vietnam and subsequently in the mid-1990s to IDUs further north. Our results indicate the northward dissemination of CRF01_AE during this time.

Application of TURBO-AE to Flutter Prediction: Aeroelastic Code Development

NASA Technical Reports Server (NTRS)

Hoyniak, Daniel; Simons, Todd A.; Stefko, George (Technical Monitor)

2001-01-01

The TURBO-AE program has been evaluated by comparing the obtained results to cascade rig data and to prediction made from various in-house programs. A high-speed fan cascade, a turbine cascade, a turbine cascade and a fan geometry that shower flutter in torsion mode were analyzed. The steady predictions for the high-speed fan cascade showed the TURBO-AE predictions to match in-house codes. However, the predictions did not match the measured blade surface data. Other researchers also reported similar disagreement with these data set. Unsteady runs for the fan configuration were not successful using TURBO-AE .

Propagation of Flexural Mode AE Signals in GR/EP Composite Plates

NASA Technical Reports Server (NTRS)

Prosser, W. H.; Gorman, M. R.

1992-01-01

It has been documented that AE signals propagate in thin plates as extensional and flexural plate modes. This was demonstrated using simulated AE sources (pencil lead breaks) by Gorman on thin aluminum and gr/ep composite plates and by Gorman and Prosser on thin aluminum plates. A typical signal from a pencil lead break source which identifies these two modes is shown. AE signals from transverse matrix cracking sources in gr/ep composite plates were also shown to propagate as plate modes by Gorman and Ziola. Smith showed that crack growth events in thin aluminum plates under spectrum fatigue loading produced signals that propagated as plate modes. Additionally, Prosser et al. showed that AE signals propagated as plate modes in a thin walled composite tube.

Time studies in A&E departments--a useful tool for management.

PubMed

Aharonson-Daniel, L; Fung, H; Hedley, A J

1996-01-01

A time and motion study was conducted in an accident and emergency (A&E) department in a Hong Kong Government hospital in order to suggest solutions for severe queuing problems found in A&E. The study provided useful information about the patterns of arrival and service; the throughput; and the factors that influence the length of the queue at the A&E department. Plans for building a computerized simulation model were dropped as new intelligence generated by the study enabled problem solving using simple statistical analysis and common sense. Demonstrates some potential benefits for management in applying operations research methods in busy clinical working environments. The implementation of the recommendations made by this study successfully eliminated queues in A&E.

Spectral Variability of the Herbig Ae/Be Star HD 37806

NASA Astrophysics Data System (ADS)

Pogodin, M. A.; Pavlovskiy, S. E.; Kozlova, O. V.; Beskrovnaya, N. G.; Alekseev, I. Yu.; Valyavin, G. G.

2018-03-01

Results are reported from a spectroscopic study of the Herbig Ae/Be star HD 37806 from 2009 through 2017 using high resolution spectrographs at the Crimean Astrophysical Observatory and the OAN SPM Observatory in Mexico. 72 spectra of this object near the Hα, Hβ, HeI 5876 and D NaI lines are analyzed. The following results were obtained: 1. The type of spectral profile of the Hα line can change from P Cyg III to double emission and vice versa over a time scale on the order of a month. 2. Narrow absorption components are observed in the profiles of the Hα and D NaI lines with radial velocities that vary over a characteristic time on the order of a day. 3. On some days, the profiles of the Hβ, HeI 5876, and D NaI lines show signs of accretion of matter to the star with a characteristic lifetime of a few days. A possible interpretation of these phenomena was considered. The transformation of the Hα profile may be related to a change in the outer latitudinal width of the boundary of the wind zone. The narrow variable absorption lines may be caused by the rotation of local azimuthal inhomogeneities in the wind zone owing to the interaction of the disk with the star's magnetosphere in a propeller regime. Several current theoretical papers that predict the formation of similar inhomogeneous wind structures were examined. It is suggested that the episodes with signs of accretion in the spectral line profiles cannot be a consequence of the modulation of these profiles by the star's rotation but are more likely caused by sudden, brief changes in the accretion rate. These spectral observations of HD 37806 should be continued in a search for cyclical variability in the spectral parameters in order to identify direct signs of magnetospheric accretion and detect possible binary behavior in this object.

Suppression of RND3 activity by AES downregulation promotes cancer cell proliferation and invasion.

PubMed

Xia, Hongwei; Li, Mingxing; Chen, Liang; Leng, Weibing; Yuan, Dandan; Pang, Xiaohui; Chen, Liu; Li, Ronghui; Tang, Qiulin; Bi, Feng

2013-05-01

Amino-terminal enhancer of split (AES) is a member of the Groucho/TLE family. Although it has no DNA-binding site, AES can regulate transcriptional activity by interacting with transcriptional factors. Emerging evidence indicates that AES may play an important role in tumor metastasis, but the molecular mechanism is still poorly understood. In this study, we found that knockdown of AES by RNA interference (RNAi) downregulated RND3 expression at the mRNA and protein levels in MDA-MB-231 and HepG2, two cancer cell lines. Furthermore, luciferase assays showed that overexpression of AES significantly enhanced RND3 promoter activity. Moreover, inhibition of AES both in MDA-MB-231 and HepG2 cells by RNAi significantly promoted cell proliferation, cell cycle progression and invasion, consistent with the effects of RNAi-mediated RND3 knockdown in these cells. For the first time, data are presented showing that alteration of the malignant behavior of cancer cells by AES is related to RND3 regulation, and these findings also provide new insights into the mechanism of AES action in regulating tumor malignancy.

The Long-Term Safety of S-Flurbiprofen Plaster for Osteoarthritis Patients: An Open-Label, 52-Week Study.

PubMed

Yataba, Ikuko; Otsuka, Noboru; Matsushita, Isao; Matsumoto, Hideo; Hoshino, Yuichi

2016-08-01

The newly developed S-flurbiprofen plaster (SFPP) is a tape-type patch that shows innovative percutaneous absorption. This study was designed to evaluate the safety of a long-term 52-week SFPP application to osteoarthritis (OA) patients. This was a multi-center, open-label, uncontrolled prospective study that included 201 OA patients. SFPP at 40 mg/day was applied to the site of pain in 101 patients and at 80 mg/day (2 patches) in 100 patients at a total of 301 sites for 52 weeks. The affected sites assessed included the knee (192), lumbar spine (66), cervical spine (26), and others (17). Drug safety was evaluated by medical examination, laboratory tests, and examination of vital signs. Efficacy was evaluated by the patient's and clinician's global assessments and clinical symptoms. Most patients (80.1 %) completed the 52-week SFPP application. The majority of drug-related adverse events (AEs) included mild dermatitis at the application sites and occurred in 46.8 % of the sites. No photosensitive dermatitis was observed. Systemic AEs occurred in 9.0 % of the patients; a serious AE (gastric ulcer hemorrhage) occurred in one patient. No clinically significant changes in the laboratory tests and vital signs were observed. The efficacy evaluation showed an improvement from 2 weeks after the SFPP application, which continued during the 52 weeks' treatment. No apparent safety concerns were observed, even during the long-term SFPP application. Therefore, SFPP could be an additional pharmacotherapy in OA treatment.

Immortalization of human AE pre-leukemia cells by hTERT allows leukemic transformation

PubMed Central

Wunderlich, Mark; Chou, Fu-Sheng; Mulloy, James C.

2016-01-01

Human CD34+ hematopoietic stem and progenitor cells (HSPC) expressing fusion protein AML1-ETO (AE), generated by the t(8;21)(q22;q22) rearrangement, manifest enhanced self-renewal and dysregulated differentiation without leukemic transformation, representing a pre-leukemia stage. Enabling replicative immortalization via telomerase reactivation is a crucial step in cancer development. However, AE expression alone is not sufficient to maintain high telomerase activity to immortalize human HSPC cells, which may hamper transformation. Here, we investigated the cooperativity of telomerase reverse transcriptase (hTERT), the catalytic subunit of telomerase, and AE in disease progression. Enforced expression of hTERT immortalized human AE pre-leukemia cells in a telomere-lengthening independent manner, and improved the pre-leukemia stem cell function by enhancing cell proliferation and survival. AE-hTERT cells retained cytokine dependency and multi-lineage differentiation potential similar to parental AE clones. Over the short-term, AE-hTERT cells did not show features of stepwise transformation, with no leukemogenecity evident upon initial injection into immunodeficient mice. Strikingly, after extended culture, we observed full transformation of one AE-hTERT clone, which recapitulated the disease evolution process in patients and emphasizes the importance of acquiring cooperating mutations in t(8;21) AML leukemogenesis. In summary, achieving unlimited proliferative potential via hTERT activation, and thereby allowing for acquisition of additional mutations, is a critical link for transition from pre-leukemia to overt disease in human cells. AE-hTERT cells represent a tractable model to study cooperating genetic lesions important for t(8;21) AML disease progression. PMID:27509060

To Capture a Face: A Novel Technique for the Analysis and Quantification of Facial Expressions in American Sign Language

ERIC Educational Resources Information Center

Grossman, Ruth B.; Kegl, Judy

2006-01-01

American Sign Language uses the face to express vital components of grammar in addition to the more universal expressions of emotion. The study of ASL facial expressions has focused mostly on the perception and categorization of various expression types by signing and nonsigning subjects. Only a few studies of the production of ASL facial…

Structural and mutational analyses of Aes, an inhibitor of MalT in Escherichia coli.

PubMed

Schiefner, André; Gerber, Kinga; Brosig, Alexander; Boos, Winfried

2014-02-01

The acyl esterase Aes effectively inhibits the transcriptional activity of MalT-the central activator of maltose and maltodextrin utilizing genes in Escherichia coli. To provide better insight into the nature of the interaction between Aes and MalT, we determined two different crystal structures of Aes-in its native form and covalently modified by a phenylmethylsulfonyl moiety at its active site serine. Both structures show distinct space groups and were refined to a resolution of 1.8 Å and 2.3 Å, respectively. The overall structure of Aes resembles a canonical α/β-hydrolase fold, which is extended by a funnel-like cap structure that forms the substrate-binding site. The catalytic triad of Aes, comprising residues Ser165, His292, and Asp262, is located at the bottom of this funnel. Analysis of the crystal-packing contacts of the two different space groups as well as analytical size-exclusion chromatography revealed a homodimeric arrangement of Aes. The Aes dimer adopts an antiparallel contact involving both the hydrolase core and the cap, with its twofold axis perpendicular to the largest dimension of Aes. To identify the surface area of Aes that is responsible for the interaction with MalT, we performed a structure-based alanine-scanning mutagenesis to pinpoint Aes residues that are significantly impaired in MalT inhibition, but still exhibit wild-type expression and enzymatic activity. These residues map to a shallow slightly concave surface patch of Aes at the opposite site of the dimerization interface and indicate the surface area that interacts with MalT. Copyright © 2013 Wiley Periodicals, Inc.

Mid-IR Spectra Herbig Ae/Be Stars

NASA Technical Reports Server (NTRS)

Wooden, Diane; Witteborn, Fred C. (Technical Monitor)

1997-01-01

Herbig Ae/Be stars are intermediate mass pre-main sequence stars, the higher mass analogues to the T Tauri stars. Because of their higher mass, they are expected form more rapidly than the T Tauri stars. Whether the Herbig Ae/Be stars accrete only from collapsing infalling envelopes or whether accrete through geometrically flattened viscous accretion disks is of current debate. When the Herbig Ae/Be stars reach the main sequence they form a class called Vega-like stars which are known from their IR excesses to have debris disks, such as the famous beta Pictoris. The evolutionary scenario between the pre-main sequence Herbig Ae/Be stars and the main sequence Vega-like stars is not yet revealed and it bears on the possibility of the presence of Habitable Zone planets around the A stars. Photometric studies of Herbig Ae/Be stars have revealed that most are variable in the optical, and a subset of stars show non-periodic drops of about 2 magnitudes. These drops in visible light are accompanied by changes in their colors: at first the starlight becomes reddened, and then it becomes bluer, the polarization goes from less than 0.1 % to roughly 1% during these minima. The theory postulated by V. Grinnin is that large cometary bodies on highly eccentric orbits occult the star on their way to being sublimed, for systems that are viewed edge-on. This theory is one of several controversial theories about the nature of Herbig Ae/Be stars. A 5 year mid-IR spectrophotometric monitoring campaign was begun by Wooden and Butner in 1992 to look for correlations between the variations in visible photometry and mid-IR dust emission features. Generally the approximately 20 stars that have been observed by the NASA Ames HIFOGS spectrometer have been steady at 10 microns. There are a handful, however, that have shown variable mid-IR spectra, with 2 showing variations in both the continuum and features anti-correlated with visual photometry, and 3 showing variations in the emission

Mechanisms of Diagonal-Shear Failure in Reinforced Concrete Beams analyzed by AE-SiGMA

NASA Astrophysics Data System (ADS)

Ohno, Kentaro; Shimozono, Shinichiro; Sawada, Yosuke; Ohtsu, Masayasu

Serious shear failures in reinforced concrete (RC) structures were reported in the Hanshin-Awaji Earthquake. In particular, it was demonstrated that a diagonal-shear failure could lead to disastrous damage. However, mechanisms of the diagonal-shear failure in RC beams have not been completely clarified yet. In this study, the diagonal-shear failure in RC beams is investigated, applying acoustic emission (AE) method. To identify source mechanisms of AE signals, SiGMA (Simplified Green's functions for Moment tensor Analysis) procedure was applied. Prior to four-point bending tests of RC beams, theoretical waveforms were calculated to determine the optimal arrangement of AE sensors. Then, cracking mechanisms in experiments were investigated by applying the SiGMA procedure to AE waveforms. From results of the SiGMA analysis, dominant motions of micro-cracks are found to be of shear crack in all the loading stages. As the load increased, the number of tensile cracks increased and eventually the diagonal-shear failure occurred in the shear span. Prior to final failure, AE cluster of micro-cracks was intensely observed in the shear span. To classify AE sources into tensile and shear cracks, AE parameter analysis was also applied. As a result, most of AE hits are classified into tensile cracks. The difference between results obtained by the AE parameter analysis and by the SiGMA analysis is investigated and discussed.

A New Paradigm of Technology-Enabled ‘Vital Signs’ for Early Detection of Health Change for Older Adults.

PubMed

Rantz, Marilyn J; Skubic, Marjorie; Popescu, Mihail; Galambos, Colleen; Koopman, Richelle J; Alexander, Gregory L; Phillips, Lorraine J; Musterman, Katy; Back, Jessica; Miller, Steven J

2015-01-01

Environmentally embedded (nonwearable) sensor technology is in continuous use in elder housing to monitor a new set of ‘vital signs' that continuously measure the functional status of older adults, detect potential changes in health or functional status, and alert healthcare providers for early recognition and treatment of those changes. Older adult participants' respiration, pulse, and restlessness are monitored as they sleep. Gait speed, stride length, and stride time are calculated daily, and automatically assess for increasing fall risk. Activity levels are summarized and graphically displayed for easy interpretation. Falls are detected when they occur and alerts are sent immediately to healthcare providers, so time to rescue may be reduced. Automated health alerts are sent to healthcare staff, based on continuously running algorithms applied to the sensor data, days and weeks before typical signs or symptoms are detected by the person, family members, or healthcare providers. Discovering these new functional status ‘vital signs', developing automated methods for interpreting them, and alerting others when changes occur have the potential to transform chronic illness management and facilitate aging in place through the end of life. Key findings of research in progress at the University of Missouri are discussed in this viewpoint article, as well as obstacles to widespread adoption.

AE8/AP8 Implementations in AE9/AP9, IRBEM, and SPENVIS

DTIC Science & Technology

2014-02-18

period applies to orbit generation only; AE8/AP8 utilizes geomagnetic field models from other epochs as specified in the table below.) SHIELDOSE2 model...finite and semi- infinite slab data tables for Bremsstrahlung have been reversed [Heynderickx, private communication, May 2013]. This correction is...Cain, J. C., S. J. Hendricks, R. A. Langel, and W. V. Hudson (1967), A proposed model for the international geomagnetic reference field, 1965, J

Molecular epidemiological study of HIV-1 CRF01_AE transmission in Hong Kong.

PubMed

Chen, J H K; Wong, K H; Li, P; Chan, K C; Lee, M P; Lam, H Y; Cheng, V C C; Yuen, K Y; Yam, W C

2009-08-15

The objective of this study was to investigate the transmission history of the HIV-1 CRF01_AE epidemics in Hong Kong between 1994 and 2007. A total of 465 HIV-1 CRF01_AE pol sequences were derived from an in-house or a commercial HIV-1 genotyping system. Phylogenies of CRF01_AE sequences were analyzed by the Bayesian coalescent method. CRF01_AE patient population included 363 males (78.1%) and 102 females (21.9%), whereas 65% (314 of 465) were local Chinese. Major transmission routes were heterosexual contact (63%), followed by intravenous drug use (IDU) (19%) and men having sex with men (MSM) (17%). From phylogenetic analysis, local CRF01_AE strains were from multiple origins with 3 separate transmission clusters identified. Cluster 1 consisted mainly of Chinese male IDUs and heterosexuals. Clusters 2 and 3 included mainly local Chinese MSM and non-Chinese Asian IDUs, respectively. Chinese reference isolates available from China (Fujian, Guangxi, or Liaoning) were clonally related to our transmission clusters, demonstrating the epidemiological linkage of CRF01_AE infections between Hong Kong and China. The 3 individual local transmission clusters were estimated to have initiated since late 1980s and late 1990s, causing subsequent epidemics in the early 2000s. This is the first comprehensive molecular epidemiological study of HIV-1 CRF01_AE in Hong Kong. It revealed that MSM contact is becoming a major route of local CRF01_AE transmission in Hong Kong. Epidemiological linkage of CRF01_AE between Hong Kong and China observed in this study indicates the importance of regular molecular epidemiological surveillance for the HIV-1 epidemic in our region.

AES Water Architecture Study Interim Results

NASA Technical Reports Server (NTRS)

Sarguisingh, Miriam J.

2012-01-01

The mission of the Advanced Exploration System (AES) Water Recovery Project (WRP) is to develop advanced water recovery systems in order to enable NASA human exploration missions beyond low earth orbit (LEO). The primary objective of the AES WRP is to develop water recovery technologies critical to near term missions beyond LEO. The secondary objective is to continue to advance mid-readiness level technologies to support future NASA missions. An effort is being undertaken to establish the architecture for the AES Water Recovery System (WRS) that meets both near and long term objectives. The resultant architecture will be used to guide future technical planning, establish a baseline development roadmap for technology infusion, and establish baseline assumptions for integrated ground and on-orbit environmental control and life support systems (ECLSS) definition. This study is being performed in three phases. Phase I of this study established the scope of the study through definition of the mission requirements and constraints, as well as indentifying all possible WRS configurations that meet the mission requirements. Phase II of this study focused on the near term space exploration objectives by establishing an ISS-derived reference schematic for long-duration (>180 day) in-space habitation. Phase III will focus on the long term space exploration objectives, trading the viable WRS configurations identified in Phase I to identify the ideal exploration WRS. The results of Phases I and II are discussed in this paper.

Clinical decision support tools in A&E nursing: a preliminary study.

PubMed

New, T D

This article describes how a large trust in the north east of England is in the process of developing a unique service for non-emergency patients in one of its main A&E departments. The Urgent Need Assessment Service (UNAS), co-located within the main A&E department, features the use of NHS Direct computerised algorithms to enable nurses to recommend the best treatment or course of action accurately and safely, for all patients attending the department who are categorised as blue or green status in accordance with the Manchester triage model of A&E assessment. The UNAS facility incorporates discretely staffed minor injuries and minor ailments services. UNAS assessment nurses are specially trained to use their A&E experience, together with the computer model, and to make an assessment in partnership with the patient, sharing information displayed on the computer screen and working together to reach a jointly agreed treatment plan or outcome. The UNAS pilot and evaluation commenced in September 1999 and results and outcomes are presented for the period from September 3 to December 31 2000. Approximately 75 per cent of all A&E attenders are given blue or green status. UNAS has led to faster treatment and reduced waiting times for these people, increasing patient satisfaction while enabling the A&E department to concentrate its resources on treating more serious cases. This pilot study has proved to be highly satisfactory to the majority of people who have been treated at UNAS. Those previously regarded as 'inappropriate attenders' might be better suited to treatment in a different department, separate from the traditional A&E department, with reduced waiting times, and under the care of specially trained nurses.

Locating the Accretion Footprint on a Herbig Ae Star: MWC 480

NASA Technical Reports Server (NTRS)

Grady, C. A.; Hamaguchi, K.; Schneider, G.; Stecklum, B.; Woodgate, B. E.; McCleary, J. E.; Williger, G. M.; Sitko, M. L.; Menard, F.; Henning, Th.;

Ae Behavior of Smart Stress Memory Patch after Variable Amplitude Loading

NASA Astrophysics Data System (ADS)

Fujino, Y.; Nambu, S.; Enoki, M.

Recently, the structural health monitoring becomes increasingly great important to assure the ease and safety of our life, and it is required significantly to develop non-destructive evaluation for structures such as bridges and tunnels. Some sacrificed specimens have been developed to evaluate the fatigue damage of structures such as fatigue cycles and residual lifetime, but it can be applied only when the stress history is known beforehand. These fatigue sensors need no cable and can be used at low cost in contrast to strain gage. In previous study, a smart stress memory patch was developed as a new fatigue sensor. The patch can measure simultaneously the maximum stress, stress amplitude and the number of fatigue cycles by crack length measurement and Kaiser effect of Acoustic Emission (AE). The crack growth behavior under constant amplitude (CA) loading has been investigated, and AE behavior also has been evaluated only after CA loading. However, AE characteristics after variable amplitude (VA) loading in service are extremely important. Moreover, it is very important to control AE behavior of the smart patch in order to evaluate the applied stress using Kaiser effect. In this study, fatigue test with single overload was investigated to evaluate its influence. Moreover, effect of crack length and heat treatment on AE behavior was also investigated. Finally, AE behavior of the patch was evaluated after fatigue CA loading with overload or VA loading with log-normal distribution and overload.

A double-blind, placebo-controlled, randomised, parallel-group, dose-escalating, repeat dose study in healthy volunteers to evaluate the safety, tolerability, pharmacodynamic effects and pharmacokinetics of the once daily rectal application of NRL001 suppositories for 14 days.

PubMed

Bell, D; Duffin, A; Jacobs, A; Pediconi, C; Gruss, H J

2014-03-01

The 1R,2S stereoisomer of methoxamine hydrochloride, NRL001, is a highly selective α1-adrenoceptor agonist being developed for the local treatment of non-structural faecal incontinence caused by weak internal anal sphincter tone. This study investigated the steady state pharmacokinetics (PK) and safety of 2 g rectal suppositories containing NRL001 in different strengths (7.5, 10, 12.5 or 15 mg). Healthy volunteers aged 18-45 years received 14 daily doses of NRL001 2 g suppositories or matching placebo. In each dose group nine participants received NRL001 and three received placebo. Blood samples to determine NRL001 concentrations were taken on Days 1, 7 and 14. Cardiovascular parameters were collected via electrocardiograms, Holter monitoring (three lead Holter monitor) and vital signs. Forty-eight volunteers were enrolled; 43 completed the study and were included in the PK analysis population. AUC and Cmax broadly increased with increasing dose, Tmax generally occurred between 4.0 and 5.0 h. Although the data did not appear strongly dose proportional, dose proportionality analysis did not provide evidence against dose proportionality as the log(dose) coefficients were not significantly < 1. NRL001 did not accumulate over time for any dose. Increasing NRL001 concentrations were related to changes in vital sign variables, most notably decreased heart rate. The most commonly reported adverse events (AEs) in the active treatment groups were paraesthesia and piloerection. Treatment with NRL001 was generally well tolerated over 14 days once daily dosing and plasma NRL001 did not accumulate over time. Treatment was associated with changes in vital sign variables, most notably decreased heart rate. AEs commonly reported with NRL001 treatment were events indicative of a systemic α-adrenergic effect. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

Applying transpose matrix on advanced encryption standard (AES) for database content

NASA Astrophysics Data System (ADS)

Manurung, E. B. P.; Sitompul, O. S.; Suherman

2018-03-01

Advanced Encryption Standard (AES) is a specification for the encryption of electronic data established by the U.S. National Institute of Standards and Technology (NIST) and has been adopted by the U.S. government and is now used worldwide. This paper reports the impact of transpose matrix integration to AES. Transpose matrix implementation on AES is aimed at first stage of chypertext modifications for text based database security so that the confidentiality improves. The matrix is also able to increase the avalanche effect of the cryptography algorithm 4% in average.

Optimization of DIII-D discharges to avoid AE destabilization

NASA Astrophysics Data System (ADS)

Varela, Jacobo; Spong, Donald; Garcia, Luis; Huang, Juan; Murakami, Masanori

2017-10-01

The aim of the study is to analyze the stability of Alfven Eigenmodes (AE) perturbed by energetic particles (EP) during DIII-D operation. We identify the optimal NBI operational regimes that avoid or minimize the negative effects of AE on the device performance. We use the reduced MHD equations to describe the linear evolution of the poloidal flux and the toroidal component of the vorticity in a full 3D system, coupled with equations of density and parallel velocity moments for the energetic particles, including the effect of the acoustic modes. We add the Landau damping and resonant destabilization effects using a closure relation. We perform parametric studies of the MHD and AE stability, taking into account the experimental profiles of the thermal plasma and EP, also using a range of values of the energetic particles β, density and velocity as well the effect of the toroidal couplings. We reproduce the AE activity observed in high poloidal β discharge at the pedestal and reverse shear discharges. This material based on work is supported both by the U.S. Department of Energy, Office of Science, under Contract DE-AC05-00OR22725 with UT-Battelle, LLC. Research sponsored in part by the Ministerio de Economia y Competitividad of Spain under the project.

AE Monitoring of Diamond Turned Rapidly Soldified Aluminium 443

NASA Astrophysics Data System (ADS)

Onwuka, G.; Abou-El-Hossein, K.; Mkoko, Z.

2017-05-01

The fast replacement of conventional aluminium with rapidly solidified aluminium alloys has become a noticeable trend in the current manufacturing industries involved in the production of optics and optical molding inserts. This is as a result of the improved performance and durability of rapidly solidified aluminium alloys when compared to conventional aluminium. Melt spinning process is vital for manufacturing rapidly solidified aluminium alloys like RSA 905, RSA 6061 and RSA 443 which are common in the industries today. RSA 443 is a newly developed alloy with few research findings and huge research potential. There is no available literature focused on monitoring the machining of RSA 443 alloys. In this research, Acoustic Emission sensing technique was applied to monitor the single point diamond turning of RSA 443 on an ultrahigh precision lathe machine. The machining process was carried out after careful selection of feed, speed and depths of cut. The monitoring process was achieved with a high sampling data acquisition system using different tools while concurrent measurement of the surface roughness and tool wear were initiated after covering a total feed distance of 13km. An increasing trend of raw AE spikes and peak to peak signal were observed with an increase in the surface roughness and tool wear values. Hence, acoustic emission sensing technique proves to be an effective monitoring method for the machining of RSA 443 alloy.

Secure Multiparty AES

NASA Astrophysics Data System (ADS)

Damgård, Ivan; Keller, Marcel

We propose several variants of a secure multiparty computation protocol for AES encryption. The best variant requires 2200 + {{400}over{255}} expected elementary operations in expected 70 + {{20}over{255}} rounds to encrypt one 128-bit block with a 128-bit key. We implemented the variants using VIFF, a software framework for implementing secure multiparty computation (MPC). Tests with three players (passive security against at most one corrupted player) in a local network showed that one block can be encrypted in 2 seconds. We also argue that this result could be improved by an optimized implementation.

A high performance hardware implementation image encryption with AES algorithm

NASA Astrophysics Data System (ADS)

Farmani, Ali; Jafari, Mohamad; Miremadi, Seyed Sohrab

2011-06-01

This paper describes implementation of a high-speed encryption algorithm with high throughput for encrypting the image. Therefore, we select a highly secured symmetric key encryption algorithm AES(Advanced Encryption Standard), in order to increase the speed and throughput using pipeline technique in four stages, control unit based on logic gates, optimal design of multiplier blocks in mixcolumn phase and simultaneous production keys and rounds. Such procedure makes AES suitable for fast image encryption. Implementation of a 128-bit AES on FPGA of Altra company has been done and the results are as follow: throughput, 6 Gbps in 471MHz. The time of encrypting in tested image with 32*32 size is 1.15ms.

Synthesis, Crystal and Electronic Structures of the Pnictides AE 3TrPn 3 (AE = Sr, Ba; Tr = Al, Ga; Pn = P, As)

DOE PAGES

Stoyko, Stanislav; Voss, Leonard; He, Hua; ...

2015-09-24

New ternary arsenides AE 3TrAs 3 (AE = Sr, Ba; Tr = Al, Ga) and their phosphide analogs Sr 3GaP 3 and Ba 3AlP 3 have been prepared by reactions of the respective elements at high temperatures. Single-crystal X-ray diffraction studies reveal that Sr 3AlAs 3 and Ba 3AlAs 3 adopt the Ba 3AlSb 3-type structure (Pearson symbol oC56, space group Cmce, Z = 8). This structure is also realized for Sr 3GaP 3 and Ba 3AlP 3. Likewise, the compounds Sr 3GaAs 3 and Ba 3GaAs 3 crystallize with the Ba 3GaSb 3-type structure (Pearson symbol oP56, space groupmore » Pnma, Z = 8). Both structures are made up of isolated pairs of edge-shared AlPn 4 and GaPn 4 tetrahedra (Pn = pnictogen, i.e., P or As), separated by the alkaline-earth Sr 2+ and Ba 2+ cations. In both cases, there are no homoatomic bonds, hence, regardless of the slightly different atomic arrangements, both structures can be rationalized as valence-precise [AE 2+] 3[Tr 3+][Pn 3-] 3, or rather [AE 2+] 6[Tr 2Pn 6] 12-, i.e., as Zintl phases.« less

AES/GRG5: more than just a dominant-negative TLE/GRG family member.

PubMed

Beagle, Brandon; Johnson, Gail V W

2010-11-01

The human Transducin-like Enhancer of Split (TLE) and mouse homologue, Groucho gene-related protein (GRG), represent a family of conserved non-DNA binding transcriptional modulatory proteins divided into two subgroups based upon size. The long TLE/GRGs consist of four pentadomain proteins that are dedicated co-repressors for multiple transcription factors (TF). The second TLE/GRG subgroup is composed of the Amino-terminal Enhancer of Split (AES) in humans and its mouse homolog GRG5 (AES/GRG5). In contrast to the dedicated co-repressor function of long TLE/GRGs, AES/GRG5 can both positively or negatively modulate various TF as well as non-TF proteins in a long TLE/GRG-dependent or -independent manner. Therefore, AES/GRG5 is a functionally dynamic protein that is not exclusively defined by its role as a long TLE/GRG antagonist. AES/GRG5 may function in various developmental and pathological processes but the functional characteristics of endogenous AES/GRG5 in a physiologically relevant context remains to be determined. © 2010 Wiley-Liss, Inc.

The association of Aedes aegypti and Ae. albopictus in Allende, Nuevo León, Mexico.

PubMed

Mercado-Hernandez, Roberto; Aguilar-Gueta, Juan de Dios; Fernandez-Salas, Ildefoso; Earl, Paul R

2006-03-01

The recent appearance of Aedes Stegomyia albopictus (Skuse) in Nuevo León (NL) worries health officials. It is a vector of dengue fever in Asia and is more resistant to lower temperatures than Ae. aegypti. The objective of this study was to learn about some ecological parameters of Ae. albopictus and their association with Ae. aegypti, and other culicids in Allende, NL, Mexico, during 1999. Allende is a small town close to metropolitan Monterrey, which has 4 million inhabitants. The design was random with monthly sampling of 175 ovitraps. Chi-square analyses were performed with data of presence, absence, frequency, and relative abundances. During the study, the species Culex tarsalis (Coquillet), Cx. thriambus (Dyar), Cx. pipiens (Linnaeus), Cx. coronator (Dyar and Knab), Ae. albopictus, Ae. aegypti, Toxorhynchites rutilus (Coquillet), and Ae. triseriatus (Say) were found. April is the month for large numbers of mosquito species. September had the highest populations in positive ovitraps (66.67%), followed by July (63.27% of traps). Aedes aegypti was the most abundant (65.13%), followed by Ae. albopictus (19.71%). Both Ae. albopictus and Ae. aegypti were found from April until December. Aedes aegypti was more abundant than Ae. albopictus, except in August, when they were similar (chi2 = 0.197, P < 0.05). We found significant association between the presence of both species for every study month (chi2 = 9.837, P < 0.05), with a contingency coefficient of 0.247. September and November were the months having the most mosquitoes in this association. Only considering Ae. albopictus, more were found in ovitraps in July (34.6%), followed by September (33.3%). However, its presence was not significant throughout the year. Of 2 zones, in town and at the river, prevalence indicated that Ae. albopictus preferred the river. This mosquito is in its establishment phase in this area and requires further studies.

/ae/ versus /?/: Vowel Fossilization in the Pronunciation of Turkish English Majors: Rehabilitation 1

ERIC Educational Resources Information Center

Demirezen, Mehmet

2017-01-01

In North American English (NAE) and British English, [ae] and [?] are open vowel phonemes which are articulated by a speaker easily without a build-up of air pressure. Among all English vowels, the greatest problem for most Turkish majors of English is the discrimination of [ae] and [?]. In English, [ae] is called the "short a" or ash,…

Histone deacetylase-related protein inhibits AES-mediated neuronal cell death by direct interaction.

PubMed

Zhang, Xiaoguang; Chen, Hsin-Mei; Jaramillo, Eduardo; Wang, Lulu; D'Mello, Santosh R

2008-08-15

Histone deacetylase-related protein (HDRP), an alternatively spliced and truncated form of histone deacetylase-9 that lacks a C-terminal catalytic domain, protects neurons from death. In an effort to understand the mechanism by which HDRP mediates its neuroprotective effect, we screened for proteins in the brain that interact with HDRP by using a yeast two-hybrid assay. One of the HDRP-interacting proteins identified in this screen was amino enhancer of split (AES), a 197-amino acid protein belonging to the Groucho family. Interaction between HDRP and AES was verified by in vitro binding assays, coimmunoprecipitation, and colocalization studies. To investigate the significance of the HDRP-AES association to the regulation of neuronal survival, we used cultured cerebellar granule neurons, which undergo apoptosis when treated with low potassium (LK) medium. We found that in contrast to HDRP, whose expression is markedly reduced by LK treatment, AES expression was not appreciably altered. Forced expression of AES in healthy neurons results in cell death, an action that is blocked by the coexpression of HDRP. AES is a truncated version of larger Groucho-related proteins, one of which is transducin-like enhancer of split (TLE)-1. We found that the expression of TLE1 is reduced in LK-treated neurons and the forced expression of TLE1 blocks LK-induced neuronal death as well as death induced by AES. Our results show that AES has apoptotic activity in neurons and suggest that neuroprotection by HDRP is mediated by the inhibition of this activity through direct interaction.

Genetic effect of the Aegilops caudata plasmon on the manifestation of the Ae. cylindrica genome.

PubMed

Tsunewaki, Koichiro; Mori, Naoki; Takumi, Shigeo

2014-01-01

In the course of reconstructing Aegilops caudata from its own genome (CC) and its plasmon, which had passed half a century in common wheat (genome AABBDD), we produced alloplasmic Ae. cylindrica (genome CCDD) with the plasmon of Ae. caudata. This line, designated (caudata)-CCDD, was found to express male sterility in its second substitution backcross generation (SB2) of (caudata)-AABBCCDD pollinated three times with the Ae. cylindrica pollen. We repeatedly backcrossed these SB2 plants with the Ae. cylindrica pollen until the SB5 generation, and SB5F2 progeny were produced by self-pollination of the SB5 plants. Thirteen morphological and physiological characters, including pollen and seed fertilities, of the (caudata)-CCDD SB5F2 were compared with those of the euplasmic Ae. cylindrica. The results indicated that the male sterility expressed by (caudata)-CCDD was due to genetic incompatibility between the Ae. cylindrica genome and Ae. caudata plasmon that did not affect any other characters of Ae. cylindrica. Also, we report that the genome integrity functions in keeping the univalent transmission rate high.

The psychometric properties of the cervical nonorganic signs in patients with neck pain: an assessment of pain expression.

PubMed

Lue, Yi-Jing; Chang, Jyh-Jong; Wu, Yuh-Yih; Lin, Rong-Fong; Lu, Yen-Mou

2018-04-01

Neck pain is a common cause of disability. This study investigated the psychometric properties of the cervical nonorganic signs (CNOS), a tool for assessing abnormal illness behaviors in patients with neck pain. The CNOS was administered on patients with neck pain. Reliability and validity analyses were used to evaluate the psychometric properties. Exploratory factor analysis was used to investigate the dimensionality. Correlations with the Short Form-36 were used to investigate the convergent validity. The results supported the reliability (inter-rater reliability intra-class correlation: 0.920), validity (correlated with body pain (|ρ|=0.31) and vitality (|ρ| =0.30), and two-factor dimensionality (χ 2 =   5.904, p= 0.66; χ 2 /df = 0.738; RMSEA< 0.001; CFI = 1.000; TLI = 1.024; SRMR = 0.047) of the scale. The two factors were pain (severe pain) and vitality (poor vitality) expressed by the patients. The CNOS is a reliable and valid instrument for assessing pain and vitality problems. It helps patients to express severe pain and lack of vitality. The rehabilitation discipline could use the scale to understand pain expression and to design proper rehabilitation programs. Implications for Rehabilitation The cervical nonorganic signs has two domains (pain and vitality). The scale is reliable and valid for patients with neck pain. Patients with high scores on the pain domain have severe body pain that may interfere with normal social activities. Clinicians should understand their suffering and try to help them to alleviate the pain.

Psychobiological stress in vital exhaustion. Findings from the Men Stress 40+ study.

PubMed

Noser, Emilou; Fischer, Susanne; Ruppen, Jessica; Ehlert, Ulrike

2018-02-01

Despite the increased risk for cardiovascular morbidity associated with vital exhaustion (VE), the underlying pathophysiological mechanisms remain unclear. Allostatic load may constitute the missing link between VE and cardiovascular diseases. The aim of the present study was to investigate whether men with different degrees of VE would differ in terms of allostatic load, chronic stress, and social support. The Men Stress 40+ study sample consisted of N=121 apparently healthy men aged 40 to 75years. The following allostatic load markers were aggregated to create a cumulative index of biological stress: salivary cortisol, salivary dehydroepiandrosterone sulfate (DHEA-S), waist-to-hip-ratio, systolic and diastolic blood pressure. Long-term cortisol and DHEA were additionally measured in hair. Chronic stress and social support were assessed via validated questionnaires. Groups of mildly, substantially, and severely exhausted men were compared using one-way ANOVAs with appropriate post-hoc tests. Men who reported mild or severe levels of vital exhaustion had the highest scores on the cumulative index of biological stress. Hair cortisol was unrelated to vital exhaustion; hair DHEA was highest in men with substantial levels of exhaustion. Men with mild exhaustion reported the lowest levels of chronic stress, while men with severe exhaustion reported the lowest levels of social support. Signs of allostatic load are detectable in vitally exhausted men at a stage where no major cardiovascular consequences have yet ensued. Copyright © 2017 Elsevier Inc. All rights reserved.

An Improved Recovery Algorithm for Decayed AES Key Schedule Images

NASA Astrophysics Data System (ADS)

Tsow, Alex

A practical algorithm that recovers AES key schedules from decayed memory images is presented. Halderman et al. [1] established this recovery capability, dubbed the cold-boot attack, as a serious vulnerability for several widespread software-based encryption packages. Our algorithm recovers AES-128 key schedules tens of millions of times faster than the original proof-of-concept release. In practice, it enables reliable recovery of key schedules at 70% decay, well over twice the decay capacity of previous methods. The algorithm is generalized to AES-256 and is empirically shown to recover 256-bit key schedules that have suffered 65% decay. When solutions are unique, the algorithm efficiently validates this property and outputs the solution for memory images decayed up to 60%.

Competence of Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus Mosquitoes as Zika Virus Vectors, China.

PubMed

Liu, Zhuanzhuan; Zhou, Tengfei; Lai, Zetian; Zhang, Zhenhong; Jia, Zhirong; Zhou, Guofa; Williams, Tricia; Xu, Jiabao; Gu, Jinbao; Zhou, Xiaohong; Lin, Lifeng; Yan, Guiyun; Chen, Xiao-Guang

2017-07-01

In China, the prevention and control of Zika virus disease has been a public health threat since the first imported case was reported in February 2016. To determine the vector competence of potential vector mosquito species, we experimentally infected Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus mosquitoes and determined infection rates, dissemination rates, and transmission rates. We found the highest vector competence for the imported Zika virus in Ae. aegypti mosquitoes, some susceptibility of Ae. albopictus mosquitoes, but no transmission ability for Cx. quinquefasciatus mosquitoes. Considering that, in China, Ae. albopictus mosquitoes are widely distributed but Ae. aegypti mosquito distribution is limited, Ae. albopictus mosquitoes are a potential primary vector for Zika virus and should be targeted in vector control strategies.

Competence of Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus Mosquitoes as Zika Virus Vectors, China

PubMed Central

Liu, Zhuanzhuan; Zhou, Tengfei; Lai, Zetian; Zhang, Zhenhong; Jia, Zhirong; Zhou, Guofa; Williams, Tricia; Xu, Jiabao; Gu, Jinbao; Zhou, Xiaohong; Lin, Lifeng; Yan, Guiyun

2017-01-01

In China, the prevention and control of Zika virus disease has been a public health threat since the first imported case was reported in February 2016. To determine the vector competence of potential vector mosquito species, we experimentally infected Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus mosquitoes and determined infection rates, dissemination rates, and transmission rates. We found the highest vector competence for the imported Zika virus in Ae. aegypti mosquitoes, some susceptibility of Ae. albopictus mosquitoes, but no transmission ability for Cx. quinquefasciatus mosquitoes. Considering that, in China, Ae. albopictus mosquitoes are widely distributed but Ae. aegypti mosquito distribution is limited, Ae. albopictus mosquitoes are a potential primary vector for Zika virus and should be targeted in vector control strategies. PMID:28430562

Probing the dusty disk around the Herbig Ae star MWC 480

NASA Astrophysics Data System (ADS)

Hamidouche, M.; Looney, L. W.; Shaw, J.

2004-12-01

It is already quite evident that some Herbig AeBe stars are surrounded by circumstellar dusty disk (e.g. Fuente et al 2003, Natta et al. 2004). We present sub-arcsecond resolution observations at λ = 1mm of dust continuum emission from circumstellar structures around the Herbig AeBe star MWC 480. We have detected a disk-like structure around the star. This is the first well resolved Herbig Ae disk at 1.3 mm. We deduced from the best fit Gaussian a FWHM of 100 AU. We deduce a disk mass of ˜ 0.017 M⊙ assuming optically thin emission. We focus the discussion upon the morphology of the disk and use models to infer the physical parameters (e.g. the density profile). In addition, we discuss a new method with which to fit the numerical model to interferometric data of circumstellar structures around Herbig AeBe stars and T Tauri stars. This method allows us to compare complete Fourier dataset to the Model.

Performance analysis of AES-Blowfish hybrid algorithm for security of patient medical record data

NASA Astrophysics Data System (ADS)

Mahmud H, Amir; Angga W, Bayu; Tommy; Marwan E, Andi; Siregar, Rosyidah

2018-04-01

A file security is one method to protect data confidentiality, integrity and information security. Cryptography is one of techniques used to secure and guarantee data confidentiality by doing conversion to the plaintext (original message) to cipher text (hidden message) with two important processes, they are encrypt and decrypt. Some researchers proposed a hybrid method to improve data security. In this research we proposed hybrid method of AES-blowfish (BF) to secure the patient’s medical report data into the form PDF file that sources from database. Generation method of private and public key uses two ways of approach, those are RSA method f RSA and ECC. We will analyze impact of these two ways of approach for hybrid method at AES-blowfish based on time and Throughput. Based on testing results, BF method is faster than AES and AES-BF hybrid, however AES-BF hybrid is better for throughput compared with AES and BF is higher.

Phylogenetic and Temporal Dynamics of Human Immunodeficiency Virus Type 1 CRF01_AE in China

PubMed Central

Su, Xueli; Lu, Hongyan; Pang, Xinghuo; Yan, Hong; Feng, Xia; He, Xiong; Zeng, Yi

2013-01-01

To explore the epidemic history of HIV-1 CRF01_AE in China, 408 fragments of gag gene sequences of CRF01_AE sampled in 2002–2010 were determined from different geographical regions and risk populations in China. Phylogenetic analysis indicates that the CRF01_AE sequences can be grouped into four clusters, suggesting that at least four genetically independent CRF01_AE descendants are circulating in China, of which two were closely related to the isolates from Thailand and Vietnam. Cluster 1 has the most extensive distribution in China. In North China, cluster 1 and cluster 4 were mainly transmitted through homosexuality.The real substance of the recent HIV-1 epidemic in men who have sex with men(MSM) of North China is a rapid spread of CRF01_AE, or rather two distinctive natives CRF01_AE.The time of the most recent common ancestor (tMRCA) of four CRF01_AE clusters ranged from the years 1990.9 to 2003.8 in different regions of China. This is the first phylogenetic and temporal dynamics study of HIV-1 CRF01_AE in China. PMID:23365653

Suppression of colon cancer metastasis by Aes through inhibition of Notch signaling.

PubMed

Sonoshita, Masahiro; Aoki, Masahiro; Fuwa, Haruhiko; Aoki, Koji; Hosogi, Hisahiro; Sakai, Yoshiharu; Hashida, Hiroki; Takabayashi, Arimichi; Sasaki, Makoto; Robine, Sylvie; Itoh, Kazuyuki; Yoshioka, Kiyoko; Kakizaki, Fumihiko; Kitamura, Takanori; Oshima, Masanobu; Taketo, Makoto Mark

2011-01-18

Metastasis is responsible for most cancer deaths. Here, we show that Aes (or Grg5) gene functions as an endogenous metastasis suppressor. Expression of Aes was decreased in liver metastases compared with primary colon tumors in both mice and humans. Aes inhibited Notch signaling by converting active Rbpj transcription complexes into repression complexes on insoluble nuclear matrix. In tumor cells, Notch signaling was triggered by ligands on adjoining blood vessels, and stimulated transendothelial migration. Genetic depletion of Aes in Apc(Δ716) intestinal polyposis mice caused marked tumor invasion and intravasation that were suppressed by Notch signaling inhibition. These results suggest that inhibition of Notch signaling can be a promising strategy for prevention and treatment of colon cancer metastasis. Copyright © 2011 Elsevier Inc. All rights reserved.

Estuarine water quality in parks of the Northeast Coastal and Barrier Network: vital signs estuarine nutrient-enrichment monitoring, 2006-11

USGS Publications Warehouse

Caldwell, James M.; Nixon, Matthew E.; Neckles, Hilary A.; Pooler, Penelope S.

2015-01-01

This report summarizes results of water-quality monitoring within estuaries of the National Park Service Northeast Coastal and Barrier Network (NCBN) from 2006 through 2011. Data collection formed part of the NCBN Vital Signs Monitoring Program implemented to detect threats of estuarine nutrient enrichment. Data included here were collected from six parks at predetermined intervals: Cape Cod National Seashore, Massachusetts (2007, 2008, 2009, 2010, 2011); Fire Island National Seashore, New York (2009, 2011); Gateway National Recreation Area, New York and New Jersey (2010); Assateague Island National Seashore, Maryland and Virginia (2006, 2008, 2010); George Washington Birthplace National Monument, Virginia (2009, 2011); and Colonial National Historic Park, Virginia (2008, 2010). Monitoring variables consisted of dissolved-oxygen concentration, chlorophyll a concentration, attenuation of downwelling photosynthetically available radiation (PAR), turbidity, water temperature, and salinity. All monitoring was conducted during four-week summer index periods. The monitoring design incorporated data collection at multiple, complementary spatial and temporal scales. Within each park, a spatial survey was conducted once during the index period following a probability design using a grid of tessellated hexagons as the basis for sample site selection. The spatial survey was supplemented with weekly measurements at a subset of sites and continuous monitoring at a single reference site. Within parks, data were reported as area-weighted water-quality conditions during each index period, the location and extent of estuarine area within condition categories, and spatial and temporal trends. In addition, we used a repeated measures analysis of variance to determine the extent to which variability in three water quality metrics (chlorophyll a in surface water, dissolved oxygen in bottom water, and water clarity expressed by PAR attenuation) was explained by year to year changes in

Vital signs, QT prolongation, and newly diagnosed cardiovascular disease during severe hypoglycemia in type 1 and type 2 diabetic patients.

PubMed

Tsujimoto, Tetsuro; Yamamoto-Honda, Ritsuko; Kajio, Hiroshi; Kishimoto, Miyako; Noto, Hiroshi; Hachiya, Remi; Kimura, Akio; Kakei, Masafumi; Noda, Mitsuhiko

2014-01-01

OBJECTIVE To assess vital signs, QT intervals, and newly diagnosed cardiovascular disease during severe hypoglycemia in diabetic patients. RESEARCH DESIGN AND METHODS From January 2006 to March 2012, we conducted a retrospective cohort study to assess type 1 and type 2 diabetic patients with severe hypoglycemia at a national center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms that could not be resolved by the patients themselves in prehospital settings. RESULTS A total of 59,602 cases that visited the emergency room by ambulance were screened, and 414 cases of severe hypoglycemia were analyzed. The median (interquartile range) blood glucose levels were not significantly different between the type 1 diabetes mellitus (T1DM) (n = 88) and type 2 diabetes mellitus (T2DM) (n = 326) groups (32 [24-42] vs. 31 [24-39] mg/dL, P = 0.59). During severe hypoglycemia, the incidences of severe hypertension (≥180/120 mmHg), hypokalemia (<3.5 mEq/L), and QT prolongation were 19.8 and 38.8% (P = 0.001), 42.4 and 36.3% (P = 0.30), and 50.0 and 59.9% (P = 0.29) in the T1DM and T2DM groups, respectively. Newly diagnosed cardiovascular disease during severe hypoglycemia and death were only observed in the T2DM group (1.5 and 1.8%, respectively). Blood glucose levels between the deceased and surviving patients in the T2DM group were significantly different (18 [14-33] vs. 31 [24-39] mg/dL, P = 0.02). CONCLUSIONS T1DM and T2DM patients with severe hypoglycemia experienced many critical problems that could lead to cardiovascular disease, fatal arrhythmia, and death.

Evaluating Effects of Language Recognition on Language Rights and the Vitality of New Zealand Sign Language

ERIC Educational Resources Information Center

McKee, Rachel Locker; Manning, Victoria

2015-01-01

Status planning through legislation made New Zealand Sign Language (NZSL) an official language in 2006. But this strong symbolic action did not create resources or mechanisms to further the aims of the act. In this article we discuss the extent to which legal recognition and ensuing language-planning activities by state and community have affected…

Prognostic assessment in COPD without lung function: the B-AE-D indices.

PubMed

Boeck, Lucas; Soriano, Joan B; Brusse-Keizer, Marjolein; Blasi, Francesco; Kostikas, Konstantinos; Boersma, Wim; Milenkovic, Branislava; Louis, Renaud; Lacoma, Alicia; Djamin, Remco; Aerts, Joachim; Torres, Antoni; Rohde, Gernot; Welte, Tobias; Martinez-Camblor, Pablo; Rakic, Janko; Scherr, Andreas; Koller, Michael; van der Palen, Job; Marin, Jose M; Alfageme, Inmaculada; Almagro, Pere; Casanova, Ciro; Esteban, Cristobal; Soler-Cataluña, Juan J; de-Torres, Juan P; Miravitlles, Marc; Celli, Bartolome R; Tamm, Michael; Stolz, Daiana

2016-06-01

Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function.The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988).Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good as BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity), ADO (age, dyspnoea, airflow obstruction) and DOSE (dyspnoea, obstruction, smoking, exacerbation) indices for predicting 2-year all-cause mortality (c-statistic: 0.74, 0.77, 0.69, 0.72 and 0.63, respectively; Hosmer-Lemeshow test all p>0.05). Both indices were COPD specific (c-statistic for predicting COPD-related 2-year mortality: 0.87 and 0.89, respectively). External validation of B-AE-D was performed in COCOMICS and COMIC (c-statistic for 1-year all-cause mortality: 0.68 and 0.74; c-statistic for 2-year all-cause mortality: 0.65 and 0.67; Hosmer-Lemeshow test all p>0.05).The B-AE-D index, plus copeptin if available, allows a simple and accurate assessment of COPD-related risk. Copyright ©ERS 2016.

Prognostic assessment in COPD without lung function: the B-AE-D indices

PubMed Central

Boeck, Lucas; Blasi, Francesco; Kostikas, Konstantinos; Boersma, Wim; Milenkovic, Branislava; Louis, Renaud; Lacoma, Alicia; Djamin, Remco; Aerts, Joachim; Torres, Antoni; Rohde, Gernot; Welte, Tobias; Martinez-Camblor, Pablo; Rakic, Janko; Scherr, Andreas; Koller, Michael; van der Palen, Job; Marin, Jose M.; Alfageme, Inmaculada; Almagro, Pere; Casanova, Ciro; Esteban, Cristobal; Soler-Cataluña, Juan J.; de-Torres, Juan P.; Miravitlles, Marc; Celli, Bartolome R.; Tamm, Michael

2016-01-01

Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function. The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988). Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good as BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity), ADO (age, dyspnoea, airflow obstruction) and DOSE (dyspnoea, obstruction, smoking, exacerbation) indices for predicting 2-year all-cause mortality (c-statistic: 0.74, 0.77, 0.69, 0.72 and 0.63, respectively; Hosmer–Lemeshow test all p>0.05). Both indices were COPD specific (c-statistic for predicting COPD-related 2-year mortality: 0.87 and 0.89, respectively). External validation of B-AE-D was performed in COCOMICS and COMIC (c-statistic for 1-year all-cause mortality: 0.68 and 0.74; c-statistic for 2-year all-cause mortality: 0.65 and 0.67; Hosmer–Lemeshow test all p>0.05). The B-AE-D index, plus copeptin if available, allows a simple and accurate assessment of COPD-related risk. PMID:27103389

Spectral Characteristics of Continuous Acoustic Emission (AE) Data from Laboratory Rock Deformation Experiments

NASA Astrophysics Data System (ADS)

Flynn, J. William; Goodfellow, Sebastian; Reyes-Montes, Juan; Nasseri, Farzine; Young, R. Paul

2016-04-01

Continuous acoustic emission (AE) data recorded during rock deformation tests facilitates the monitoring of fracture initiation and propagation due to applied stress changes. Changes in the frequency and energy content of AE waveforms have been previously observed and were associated with microcrack coalescence and the induction or mobilisation of large fractures which are naturally associated with larger amplitude AE events and lower-frequency components. The shift from high to low dominant frequency components during the late stages of the deformation experiment, as the rate of AE events increases and the sample approaches failure, indicates a transition from the micro-cracking to macro-cracking regime, where large cracks generated result in material failure. The objective of this study is to extract information on the fracturing process from the acoustic records around sample failure, where the fast occurrence of AE events does not allow for identification of individual AE events and phase arrivals. Standard AE event processing techniques are not suitable for extracting this information at these stages. Instead the observed changes in the frequency content of the continuous record can be used to characterise and investigate the fracture process at the stage of microcrack coalescence and sample failure. To analyse and characterise these changes, a detailed non-linear and non-stationary time-frequency analysis of the continuous waveform data is required. Empirical Mode Decomposition (EMD) and Hilbert Spectral Analysis (HSA) are two of the techniques used in this paper to analyse the acoustic records which provide a high-resolution temporal frequency distribution of the data. In this paper we present the results from our analysis of continuous AE data recorded during a laboratory triaxial deformation experiment using the combined EMD and HSA method.

Anisotropic electrical and thermal conductivity in Bi2AE2Co2O8+δ [AE = Ca, Sr1-xBax (x = 0.0, 0.25, 0.5, 0.75, 1.0)] single crystals

NASA Astrophysics Data System (ADS)

Dong, Song-Tao; Zhang, Bin-Bin; Xiong, Ye; Lv, Yang-Yang; Yao, Shu-Hua; Chen, Y. B.; Zhou, Jian; Zhang, Shan-Tao; Chen, Yan-Feng

2015-09-01

Bi2AE2Co2O8+δ (AE represents alkaline earth), constructed by stacking of rock-salt Bi2AE2O4 and triangle CoO2 layers alternatively along c-axis, is one of promising thermoelectric oxides. The most impressive feature of Bi2AE2Co2O8+δ, as reported previously, is their electrical conductivity mainly lying along CoO2 plane, adjusting Bi2AE2O4 layer simultaneously manipulates both thermal conductivity and electrical conductivity. It in turn optimizes thermoelectric performance of these materials. In this work, we characterize the anisotropic thermal and electrical conductivity along both ab-plane and c-direction of Bi2AE2Co2O8+δ (AE = Ca, Sr, Ba, Sr1-xBax) single crystals. The results substantiate that isovalence replacement in Bi2AE2Co2O8+δ remarkably modifies their electrical property along ab-plane; while their thermal conductivity along ab-plane only has a slightly difference. At the same time, both the electrical conductivity and thermal conductivity along c-axis of these materials also have dramatic changes. Certainly, the electrical resistance along c-axis is too high to be used as thermoelectric applications. These results suggest that adjusting nano-block Bi2AE2O4 layer in Bi2AE2Co2O8+δ cannot modify the thermal conductivity along high electrical conductivity plane (ab-plane here). The evolution of electrical property is discussed by Anderson localization and electron-electron interaction U. And the modification of thermal conductivity along c-axis is attributed to the microstructure difference. This work sheds more light on the manipulation of the thermal and electrical conductivity in the layered thermoelectric materials.

Some performance tests of a microarea AES. [Auger Electron Spectroscopy

NASA Technical Reports Server (NTRS)

Todd, G.; Poppa, H.

1978-01-01

An Auger electron spectroscopy (AES) system which has a submicron analysis capability is described. The system provides secondary electron imaging, as well as micro- and macro-area AES. The resolution of the secondary electron image of an oxidized Al contact pad on a charge-coupled device chip indicates a primary beam size of about 1000 A. For Auger mapping, a useful resolution of about 4000 A is reported

A risk scoring model based on vital signs and laboratory data predicting transfer to the intensive care unit of patients admitted to gastroenterology wards.

PubMed

Kim, Won-Young; Lee, Jinmi; Lee, Ju-Ry; Jung, Youn Kyung; Kim, Hwa Jung; Huh, Jin Won; Lim, Chae-Man; Koh, Younsuck; Hong, Sang-Bum

2017-08-01

To compare the ability of a score based on vital signs and laboratory data with that of the modified early warning score (MEWS) to predict ICU transfer of patients with gastrointestinal disorders. Consecutive events triggering medical emergency team activation in adult patients admitted to the gastroenterology wards of the Asan Medical Center were reviewed. Binary logistic regression was used to identify factors predicting transfer to the ICU. Gastrointestinal early warning score (EWS-GI) was calculated as the sum of simplified regression weights (SRW). Of the 1219 included patients, 468 (38%) were transferred to the ICU. Multivariate analysis identified heart rate≥105bpm (SRW 1), respiratory rate≥26bpm (SRW 2), ACDU (Alert, Confused, Drowsy, Unresponsive) score≥1 (SRW 2), SpO 2 /FiO 2 ratio<240 (SRW 2), creatinine ≥2.0mg/dL (SRW 2), total bilirubin ≥9.0mg/dL (SRW 2), prothrombin time/international normalized ratio (INR) ≥1.5 (SRW 2), and lactate ≥3.0mmol/L (SRW 2) for inclusion in EWS-GI. The area under the receiver operating characteristic curve of the EWS-GI was larger than that of MEWS (0.76 vs. 0.64; P<0.001). EWS-GI may predict ICU transfer among patients admitted to gastroenterology wards. The EWS-GI should be prospectively validated. Copyright © 2017 Elsevier Inc. All rights reserved.

Excitation Mechanism of O I Lines in Herbig Ae/Be Stars

NASA Astrophysics Data System (ADS)

Mathew, Blesson; Manoj, P.; Narang, Mayank; Banerjee, D. P. K.; Nayak, Pratheeksha; Muneer, S.; Vig, S.; Pramod Kumar, S.; Paul, K. T.; Maheswar, G.

2018-04-01

We have investigated the role of a few prominent excitation mechanisms viz. collisional excitation, recombination, continuum fluorescence, and Lyman beta fluorescence on the O I line spectra in Herbig Ae/Be stars. The aim is to understand which of them is the central mechanism that explains the observed O I line strengths. The study is based on an analysis of the observed optical spectra of 62 Herbig Ae/Be stars and near-infrared spectra of 17 Herbig Ae/Be stars. The strong correlation observed between the line fluxes of O I λ8446 and O I λ11287, as well as a high positive correlation between the line strengths of O I λ8446 and Hα suggest that Lyman beta fluorescence is the dominant excitation mechanism for the formation of O I emission lines in Herbig Ae/Be stars. Furthermore, from an analysis of the emission line fluxes of O I λλ7774, 8446, and comparing the line ratios with those predicted by theoretical models, we assessed the contribution of collisional excitation in the formation of O I emission lines.

Response characteristics of the cat somatosensory cortex following the mechanical stimulation to non-vital and vital canine.

PubMed

Tao, Jianxiang; Wang, Duo; Ran, Jie; Jin, Anqi; Yu, Hongbo

2017-11-05

Patients sometimes complain that non-vital teeth after root canal treatment (RCT) are paresthesia compared with vital teeth, and previous psychological studies on the tactile sensibility of non-vital teeth remained controversial. In the present study, intrinsic signal optical imaging, which served as an objective tool, was employed to compare the cortex response characteristics following forces applied to the cat non-vital and vital canines. Based on the evoked cortical responses, the response threshold, signal strength, spatial pattern, temporal dynamics and the preference of force direction, they were not significantly different between vital and non-vital canines. It seemed that the tactile sensibility of vital and non-vital teeth was comparable at the cortical response level, and pulpal receptors were not concerned in tactile function. Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

CDC Vital Signs: Trucker Safety

MedlinePlus

... to 84% in 2013). View larger image and text description Infographic View larger image and text description Top of Page What Can Be Done ... to take rest breaks. Prohibiting truck drivers from text messaging or using a handheld cell phone while ...

CDC Vital Signs: Breast Cancer

MedlinePlus

... previously-uninsured Americans. Investing in the use of electronic health records and case management services in federally- ... invested to help networks of health centers adopt electronic health records (EHR) and other health information technology ( ...

CDC Vital Signs: Preventing Melanoma

MedlinePlus

... not use the device. Include warning statements in marketing materials about the risk of using the device. ... MB] en Español [PDF – 1.16 MB] CDC Digital Press Kit Read the MMWR Science Clips Language: ...

CDC Vital Signs: Child Injury

MedlinePlus

... first aid training). Health care systems can Use technology, such as electronic medical records, to improve the speed and quality of care for injured children, and to monitor the number and severity of ...

CDC Vital Signs: Secondhand Smoke

MedlinePlus

... Indoor areas of all public places such as restaurants, bars, casinos, and other private worksites. Multiunit housing ... indoor smoking in worksites and public places, including restaurants and bars. Most people have adopted smokefree rules ...

Vital Signs for Instructional Design

ERIC Educational Resources Information Center

Ley, Kathryn; Gannon-Cook, Ruth

2014-01-01

The purpose of this study was to investigate the relationship between a collaborative design process for selecting instructional graphics and online learner perceptions of graphic appropriateness. At the end of their online graduate course, 9 students ranked how appropriately each of 25 graphics represented 1 of 8 human performance technology…

CDC Vital Signs: Legionnaires' Disease

MedlinePlus

... preventable with more effective water management. Problem Water management problems can lead to Legionnaires’ disease outbreaks. What ... process failures, like not having a Legionella water management program. About 1 in 2 (52%) are due ...

CDC Vital Signs: Binge Drinking

MedlinePlus

... understand the laws and regulations that control the marketing and sale of alcohol. Collaborate with states and ... the Community Guide.* Support local control of the marketing and sale of alcohol. Support the minimum legal ...

CDC Vital Signs: Hispanic Health

MedlinePlus

... regardless of whether or not you have a pre-existing condition and find out if you are eligible for cost savings. Talk to your doctor or other healthcare professional about which cancer screening tests to get and how often, especially if you ...

Complete chloroplast genomes of Aegilops tauschii Coss. and Ae. cylindrica Host sheds light on plasmon D evolution.

PubMed

Gogniashvili, Mari; Jinjikhadze, Tamar; Maisaia, Inesa; Akhalkatsi, Maia; Kotorashvili, Adam; Kotaria, Nato; Beridze, Tengiz; Dudnikov, Alexander Ju

2016-11-01

Hexaploid wheat (Triticum aestivum L., genomes AABBDD) originated in South Caucasus by allopolyploidization of the cultivated Emmer wheat T. dicoccum (genomes AABB) with the Caucasian Ae. tauschii ssp strangulata (genomes DD). Genetic variation of Ae. tauschii is an important natural resource, that is why it is of particular importance to investigate how this variation was formed during Ae. tauschii evolutionary history and how it is presented through the species area. The D genome is also found in tetraploid Ae. cylindrica Host (2n = 28, CCDD). The plasmon diversity that exists in Triticum and Aegilops species is of great significance for understanding the evolution of these genera. In the present investigation the complete nucleotide sequence of plasmon D (chloroplast DNA) of nine accessions of Ae. tauschii and two accessions of Ae. cylindrica are presented. Twenty-eight SNPs are characteristic for both TauL1 and TauL2 accessions of Ae. tauschii using TauL3 as a reference. Four SNPs are additionally observed for TauL2 lineage. The longest (27 bp) indel is located in the intergenic spacer Rps15-ndhF of SSC. This indel can be used for simple determination of TauL3 lineage among Ae. tauschii accessions. In the case of Ae. cylindrica additionally 7 SNPs were observed. The phylogeny tree shows that chloroplast DNA of TauL1 and TauL2 diverged from the TauL3 lineage. TauL1 lineage is relatively older then TauL2. The position of Ae. cylindrica accessions on Ae. tauschii phylogeny tree constructed on chloroplast DNA variation data is intermediate between TauL1 and TauL2. The complete nucleotide sequence of chloroplast DNA of Ae. tauschii and Ae. cylindrica allows to refine the origin and evolution of D plasmon of genus Aegilops.

Vital signs: Repeat births among teens - United States, 2007-2010.

PubMed

2013-04-05

Teen childbearing has potential negative health, economic, and social consequences for mother and child. Repeat teen childbearing further constrains the mother's education and employment possibilities. Rates of preterm and low birth weight are higher in teens with a repeat birth, compared with first births. To assess patterns of repeat childbearing and postpartum contraceptive use among teens, CDC analyzed natality data from the National Vital Statistics System (NVSS) and the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2007-2010. Based on 2010 NVSS data from all 50 states and the District of Columbia, of more than 367,000 births to teens aged 15-19 years, 18.3% were repeat births. The percentage of teen births that represented repeat births decreased by 6.2% between 2007 and 2010. Disparities in repeat teen births exist by race/ethnicity, with the highest percentages found among American Indian/Alaska Natives (21.6%), Hispanics (20.9%), and non-Hispanic blacks (20.4%) and lowest among non-Hispanic whites (14.8%). Wide geographic disparities in the percentage of teen births that were repeat births also exist, ranging from 22% in Texas to 10% in New Hampshire. PRAMS data from 16 reporting areas (15 states and New York City) indicate that 91.2% of teen mothers used a contraceptive method 2-6 months after giving birth, but only 22.4% of teen mothers used the most effective methods. Teens with a previous live birth were significantly more likely to use the most effective methods postpartum compared with those with no prior live birth (29.6% versus 20.9%, respectively). Non-Hispanic white and Hispanic teens were significantly more likely to use the most effective methods than non-Hispanic black teens (24.6% and 27.9% versus 14.3%, respectively). The percentage of teens reporting postpartum use of the most effective methods varied greatly geographically across the PRAMS reporting areas, ranging from 50.3% in Colorado to 7.2% in New York State. Although the

Action stations to relieve A&E.

PubMed

Moore, Alison

Trusts have taken steps to avoid a repeat of list winter's pressures on A&E. Work is also under way on an NHS England blueprint to transform urgent and emergency care. Nurses will play a part in reshaping the system, but all the moment many are stressed by working under excessive pressure all year round.

The excess infrared emission of Herbig Ae/Be stars - Disks or envelopes?

NASA Technical Reports Server (NTRS)

Hartmann, Lee; Kenyon, Scott J.; Calvet, Nuria

1993-01-01

It is suggested that the near-IR emission in many Herbig Ae/Be stars arises in surrounding dusty envelopes, rather than circumstellar disks. It is shown that disks around Ae/Be stars are likely to remain optically thick at the required accretion rates. It is proposed that the IR excesses of many Ae/Be stars originate in surrounding dust nebulae instead of circumstellar disks. It is suggested that the near-IR emission of the envelope is enhanced by the same processes that produce anomalous strong continuum emission at temperatures of about 1000 K in reflection nebulae surrounding hot stars. This near-IR emission could be due to small grains transiently heated by UV photons. The dust envelopes could be associated with the primary star or a nearby companion star. Some Ae/Be stars show evidence for the 3.3-6.3-micron emission features seen in reflection nebulae around hot stars, which lends further support to this suggestion.

Two types of geomagnetic storms and relationship between Dst and AE indexes

NASA Astrophysics Data System (ADS)

Shadrina, Lyudmila P.

2017-10-01

The study of the relationship between Dst and AE indices of the geomagnetic field and its manifestation in geomagnetic storms in the XXIII solar cycle was carried out. It is shown that geomagnetic storms are divided into two groups according to the ratio of the amplitude of Ds index decrease to the sum of the AE index during the main phase of the storm. For the first group it is characteristic that for small depressions of the Dst index, significant amounts of the AE index are observed. Most often these are storms with a gradual beginning and a long main phase associated with recurrent solar wind streams. Storms of the second group differ in large amplitudes of Dst index decrease, shorter duration of main phase and small amounts of AE-index. Usually these are sporadic geomagnetic storms with a sudden commencement caused by interplanetary disturbances of the CME type. The storms of these two types differ also in their geoeffects, including the effect on human health.

On the System of Person-Denoting Signs in Estonian Sign Language: Estonian Name Signs

ERIC Educational Resources Information Center

Paales, Liina

2010-01-01

This article discusses Estonian personal name signs. According to study there are four personal name sign categories in Estonian Sign Language: (1) arbitrary name signs; (2) descriptive name signs; (3) initialized-descriptive name signs; (4) loan/borrowed name signs. Mostly there are represented descriptive and borrowed personal name signs among…

Ontology-Driven Monitoring of Patient's Vital Signs Enabling Personalized Medical Detection and Alert

PubMed Central

Hristoskova, Anna; Sakkalis, Vangelis; Zacharioudakis, Giorgos; Tsiknakis, Manolis; De Turck, Filip

2014-01-01

A major challenge related to caring for patients with chronic conditions is the early detection of exacerbations of the disease. Medical personnel should be contacted immediately in order to intervene in time before an acute state is reached, ensuring patient safety. This paper proposes an approach to an ambient intelligence (AmI) framework supporting real-time remote monitoring of patients diagnosed with congestive heart failure (CHF). Its novelty is the integration of: (i) personalized monitoring of the patients health status and risk stage; (ii) intelligent alerting of the dedicated physician through the construction of medical workflows on-the-fly; and (iii) dynamic adaptation of the vital signs’ monitoring environment on any available device or smart phone located in close proximity to the physician depending on new medical measurements, additional disease specifications or the failure of the infrastructure. The intelligence lies in the adoption of semantics providing for a personalized and automated emergency alerting that smoothly interacts with the physician, regardless of his location, ensuring timely intervention during an emergency. It is evaluated on a medical emergency scenario, where in the case of exceeded patient thresholds, medical personnel are localized and contacted, presenting ad hoc information on the patient's condition on the most suited device within the physician's reach. PMID:24445411

The Subsystem of Numerals in Catalan Sign Language: Description and Examples from a Psycholinguistic Study

ERIC Educational Resources Information Center

Fuentes, Mariana; Tolchinsky, Liliana

2004-01-01

Linguistic descriptions of sign languages are important to the recognition of their linguistic status. These languages are an essential part of the cultural heritage of the communities that create and use them and vital in the education of deaf children. They are also the reference point in language acquisition studies. Ours is exploratory…

Clinician-Driven Design of VitalPAD–An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit

PubMed Central

Flohr, Luisa; Beaudry, Shaylene; Johnson, K Taneille; West, Nicholas; Burns, Catherine M; Ansermino, J Mark; Dumont, Guy A; Wensley, David; Skippen, Peter

2018-01-01

The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD, to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings. PMID:29552425

Clinician-Driven Design of VitalPAD-An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit.

PubMed

Flohr, Luisa; Beaudry, Shaylene; Johnson, K Taneille; West, Nicholas; Burns, Catherine M; Ansermino, J Mark; Dumont, Guy A; Wensley, David; Skippen, Peter; Gorges, Matthias

2018-01-01

The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD , to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings.

Ethnolinguistic Vitality and Intergroup Processes

ERIC Educational Resources Information Center

Ehala, Martin

2010-01-01

The paper argues that ethnolinguistic vitality depends on four crucial social psychological factors: perceived strength differential, intergroup distance, utilitarianism and intergroup discordance. The influence of these factors on the vitality of subordinate and dominant groups is outlined. It is proposed that the vitality of both types of groups…

Preflight and Inflight Calibration of TES and AES

NASA Technical Reports Server (NTRS)

Rider, David M.

1997-01-01

The Thermal Emission Spectrometer (TES), an EOS CHEM platform instrument, and its companion instrument, the Airborne Emission Spectrometer (AES), are both Fourier transform spectrometers designed for remote sensing of the troposphere.

Search for gamma-ray emission from AE Aquarii with seven year of Fermi LAT observations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Jian; Torres, Diego F.; Rea, Nanda

2016-11-14

AE Aquarii (AE Aqr) is a cataclysmic binary hosting one of the fastest rotating (more » $${P}_{\\mathrm{spin}}$$ = 33.08 s) white dwarfs (WDs) known. Based on seven years of Fermi Large Area Telescope (LAT) Pass 8 data, we report on a deep search for gamma-ray emission from AE Aqr. When using X-ray observations from ASCA, XMM-Newton, Chandra, Swift, Suzaku, and NuSTAR, spanning 20 years, we substantially extend and improve the spin ephemeris of AE Aqr. Using this ephemeris, we searched for gamma-ray pulsations at the spin period of the WD. We detected no gamma-ray pulsations above 3σ significance. Neither phase-averaged gamma-ray emission nor gamma-ray variability of AE Aqr is detected by Fermi LAT. We also impose the most restrictive upper limit to the gamma-ray flux from AE Aqr to date: $$1.3\\times {10}^{-12}$$ erg cm -2 s -1 in the 100 MeV–300 GeV energy range, providing constraints on models.« less

AE Geomagnetic Index Predictability for High Speed Solar Wind Streams: A Wavelet Decomposition Technique

NASA Technical Reports Server (NTRS)

Guarnieri, Fernando L.; Tsurutani, Bruce T.; Hajra, Rajkumar; Echer, Ezequiel; Gonzalez, Walter D.; Mannucci, Anthony J.

2014-01-01

High speed solar wind streams cause geomagnetic activity at Earth. In this study we have applied a wavelet interactive filtering and reconstruction technique on the solar wind magnetic field components and AE index series to allowed us to investigate the relationship between the two. The IMF Bz component was found as the most significant solar wind parameter responsible by the control of the AE activity. Assuming magnetic reconnection associated to southward directed Bz is the main mechanism transferring energy into the magnetosphere, we adjust parameters to forecast the AE index. The adjusted routine is able to forecast AE, based only on the Bz measured at the L1 Lagrangian point. This gives a prediction approximately 30-70 minutes in advance of the actual geomagnetic activity. The correlation coefficient between the observed AE data and the forecasted series reached values higher than 0.90. In some cases the forecast reproduced particularities observed in the signal very well.The high correlation values observed and the high efficacy of the forecasting can be taken as a confirmation that reconnection is the main physical mechanism responsible for the energy transfer during HILDCAAs. The study also shows that the IMF Bz component low frequencies are most important for AE prediction.

Island osteoperiosteal flap vitality when isolated from basal bone by silicone interposition: an experimental study in rabbit tibia.

PubMed

Laviv, Amir; Ringeman, Jason; Debecco, Meir; Jensen, Ole T; Casap, Nardy

2014-01-01

This study sought to confirm, through histologic evaluation, the vitality and viability of the island osteoperiosteal flap (i-flap) in a rabbit tibia model. In four rabbits, an osteotomy was performed on the tibial aspect of the right leg. A bone flap was raised, but the periosteal attachment was kept intact. The free-floating i-flap was separated from the rest of the bone by a silicone sheet. The rabbits were to be sacrificed after 1, 2, 4, and 8 weeks and histologic samples examined. All surgeries were accomplished successfully; however, three animals showed fractured tibiae within a few days after surgery and were sacrificed immediately after the fractures were discovered. The fourth rabbit was sacrificed at 4 weeks. Histologic specimens showed vital new bone in the i-flap area and signs of remodeling in the transition zone and the original basal bone. The i-flap remained vital. This suggests potential for use in bone augmentation strategies, particularly for the alveolar split procedure.

A statistical spectropolarimetric study of Herbig Ae/Be stars

NASA Astrophysics Data System (ADS)

Ababakr, K. M.; Oudmaijer, R. D.; Vink, J. S.

2017-11-01

We present H α linear spectropolarimetry of a large sample of Herbig Ae/Be stars. Together with newly obtained data for 17 objects, the sample contains 56 objects, the largest such sample to date. A change in linear polarization across the H α line is detected in 42 (75 per cent) objects, which confirms the previous finding that the circumstellar environment around these stars on small spatial scales has an asymmetric structure, which is typically identified with a disc. A second outcome of this research is that we confirm that Herbig Ae stars are similar to T Tauri stars in displaying a line polarization effect, while depolarization is more common among Herbig Be stars. This finding had been suggested previously to indicate that Herbig Ae stars form in the same manner than T Tauri stars through magnetospheric accretion. It appears that the transition between these two differing polarization line effects occurs around the B7-B8 spectral type. This would in turn not only suggest that Herbig Ae stars accrete in a similar fashion as lower mass stars, but also that this accretion mechanism switches to a different type of accretion for Herbig Be stars. We report that the magnitude of the line effect caused by electron scattering close to the stars does not exceed 2 per cent. Only a very weak correlation is found between the magnitude of the line effect and the spectral type or the strength of the H α line. This indicates that the detection of a line effect only relies on the geometry of the line-forming region and the geometry of the scattering electrons.

Secretome of transmissible Pseudomonas aeruginosa AES-1R grown in a cystic fibrosis lung-like environment.

PubMed

Scott, Nichollas E; Hare, Nathan J; White, Melanie Y; Manos, Jim; Cordwell, Stuart J

2013-12-06

Pseudomonas aeruginosa is the predominant cause of mortality in patients with cystic fibrosis (CF). We examined the secretome of an acute, transmissible CF P. aeruginosa (Australian epidemic strain 1-R; AES-1R) compared with laboratory-adapted PAO1. Culture supernatant proteins from rich (LB) and minimal (M9) media were compared using 2-DE and 2DLC-MS/MS, which revealed elevated abundance of PasP protease and absence of AprA protease in AES-1R. CF lung-like artificial sputum medium (ASMDM) contains serum and mucin that generally preclude proteomics of secreted proteins. ASMDM culture supernatants were subjected to 2DLC-MS/MS, which allowed the identification of 57 P. aeruginosa proteins, and qualitative spectral counting was used to estimate relative abundance. AES-1R-specific AES_7139 and PasP were more abundant in AES-1R ASMDM culture supernatants, while AprA could only be identified in PAO1. Relative quantitation was performed using selected reaction monitoring. Significantly elevated levels of PasP, LasB, chitin-binding protein (CbpD), and PA4495 were identified in AES-1R ASMDM supernatants. Quantitative PCR showed elevated pasP in AES-1R during early (18 h) ASMDM growth, while no evidence of aprA expression could be observed. Genomic screening of CF isolates revealed aes_7139 was present in all AES-1 and one pair of sequential nonepidemic isolates. Secreted proteins may be crucial in aiding CF-associated P. aeruginosa to establish infection and for adaptation to the CF lung.

Matt Rogers on AES Energy Storage

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rogers, Matt

2010-08-02

The Department of Energy and AES Energy Storage recently agreed to a $17.1M conditional loan guarantee commitment. This project will develop the first battery-based energy storage system to provide a more stable and efficient electrical grid for New York State's high-voltage transmission network. Matt Rogers is the Senior Advisor to the Secretary for Recovery Act Implementation.

Matt Rogers on AES Energy Storage

ScienceCinema

Rogers, Matt

2017-12-29

The Department of Energy and AES Energy Storage recently agreed to a $17.1M conditional loan guarantee commitment. This project will develop the first battery-based energy storage system to provide a more stable and efficient electrical grid for New York State's high-voltage transmission network. Matt Rogers is the Senior Advisor to the Secretary for Recovery Act Implementation.

The inner zone electron model AE-5

NASA Technical Reports Server (NTRS)

Teague, M. J.; Vette, J. I.

1972-01-01

A description is given of the work performed in the development of the inner radiation zone electron model, AE-5. A complete description of the omnidirectional flux model is given for energy thresholds E sub T in the range 4.0 E sub T/(MeV) 0.04 and for L values in the range 2.8 L 1.2 for an epoch of October 1967. Confidence codes for certain regions of B-L space and certain energies are given based on data coverage and the assumptions made in the analysis. The electron model programs that can be supplied to a user are referred to. One of these, a program for accessing the model flux at arbitrary points in B-L space and arbitrary energies, includes the latest outer zone electron model and proton model. The model AE-5, is based on data from five satellites, OGO 1, OGO 3, 1963-38C, OV3-3, and Explorer 26, spanning the period December 1964 to December 1967.

19 CFR 192.13 - Revocation of participants' AES post-departure (Option 4) filing privileges; appeal procedures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 2 2011-04-01 2011-04-01 false Revocation of participants' AES post-departure... Filing of Export Information Through the Automated Export System (AES) § 192.13 Revocation of participants' AES post-departure (Option 4) filing privileges; appeal procedures. (a) Reasons for revocation...

19 CFR 192.13 - Revocation of participants' AES post-departure (Option 4) filing privileges; appeal procedures.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 2 2012-04-01 2012-04-01 false Revocation of participants' AES post-departure... Filing of Export Information Through the Automated Export System (AES) § 192.13 Revocation of participants' AES post-departure (Option 4) filing privileges; appeal procedures. (a) Reasons for revocation...

19 CFR 192.13 - Revocation of participants' AES post-departure (Option 4) filing privileges; appeal procedures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 2 2014-04-01 2014-04-01 false Revocation of participants' AES post-departure... Filing of Export Information Through the Automated Export System (AES) § 192.13 Revocation of participants' AES post-departure (Option 4) filing privileges; appeal procedures. (a) Reasons for revocation...