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Sample records for air ambulance service

  1. Microbial Air Quality and Bacterial Surface Contamination in Ambulances During Patient Services

    PubMed Central

    Luksamijarulkul, Pipat; Pipitsangjan, Sirikun

    2015-01-01

    Objectives We sought to assess microbial air quality and bacterial surface contamination on medical instruments and the surrounding areas among 30 ambulance runs during service. Methods We performed a cross-sectional study of 106 air samples collected from 30 ambulances before patient services and 212 air samples collected during patient services to assess the bacterial and fungal counts at the two time points. Additionally, 226 surface swab samples were collected from medical instrument surfaces and the surrounding areas before and after ambulance runs. Groups or genus of isolated bacteria and fungi were preliminarily identified by Gram’s stain and lactophenol cotton blue. Data were analyzed using descriptive statistics, t-test, and Pearson’s correlation coefficient with a p-value of less than 0.050 considered significant. Results The mean and standard deviation of bacterial and fungal counts at the start of ambulance runs were 318±485cfu/m3 and 522±581cfu/m3, respectively. Bacterial counts during patient services were 468±607cfu/m3 and fungal counts were 656±612cfu/m3. Mean bacterial and fungal counts during patient services were significantly higher than those at the start of ambulance runs, p=0.005 and p=0.030, respectively. For surface contamination, the overall bacterial counts before and after patient services were 0.8±0.7cfu/cm2 and 1.3±1.1cfu/cm2, respectively (p<0.001). The predominant isolated bacteria and fungi were Staphylococcus spp. and Aspergillus spp., respectively. Additionally, there was a significantly positive correlation between bacterial (r=0.3, p<0.010) and fungal counts (r=0.2, p=0.020) in air samples and bacterial counts on medical instruments and allocated areas. Conclusions This study revealed high microbial contamination (bacterial and fungal) in ambulance air during services and higher bacterial contamination on medical instrument surfaces and allocated areas after ambulance services compared to the start of ambulance runs

  2. Air ambulance medical transport advertising and marketing.

    PubMed

    2011-01-01

    The National Association of EMS Physicians (NAEMSP), the American College of Emergency Physicians (ACEP), the Air Medical Physician Association (AMPA), the Association of Air Medical Services (AAMS), and the National Association of State EMS Officials (NASEMSO) believe that patient care and outcomes are optimized by using air medical transport services that are licensed air ambulance providers with robust physician medical director oversight and ongoing quality assessment and review. Only air ambulance medical transport services with these credentials should advertise/market themselves as air ambulance services. PMID:21226561

  3. Older people's use of ambulance services: a population based analysis.

    PubMed Central

    Clark, M J; FitzGerald, G

    1999-01-01

    OBJECTIVE: To investigate the use of emergency and non-urgent ambulance transport services by people aged 65 years and over. SETTING: The study was undertaken in Queensland where the Queensland Ambulance Services (QAS) is the sole provider of emergency pre-hospital and non-urgent ambulance services for the entire state. METHODS: The age and sex of 351,000 emergency and non-urgent cases treated and transported by the QAS from July 1995 to June 1996 were analysed. RESULTS: People aged 65 years and over who comprise 12% of the population utilise approximately one third of the emergency and two thirds of the non-urgent ambulance resources provided in Queensland. While the absolute number of occasions of service for females for emergency services is higher than for males, when the data are stratified for age and sex, males have higher rates of emergency ambulance service utilisation than females across every age group, and particularly in older age groups. Gender differences are also found for non-urgent ambulance usage. The absolute number of occasions of service for older females aged 65 and over using non-urgent ambulance transport is high, but utilisation patterns on stratified data reveal similar gender usage patterns across most age groupings, except at the older age groupings where male usage greatly exceeds female usage. CONCLUSIONS: As the aged are disproportionately high users of ambulance services, it will become increasingly important for ambulance services to plan for the projected increase in the aged population. Emergency pre-hospital care is one of the few health services along the continuum of care where male usage patterns are higher than those of females. More information needs to be obtained on the age and presenting characteristics of those people who are multiple users of the ambulance service. Such information will assist service planners. PMID:10191443

  4. Understanding the factors that influence patient satisfaction with ambulance services.

    PubMed

    Bogomolova, Svetlana; Tan, P J; Dunn, S P; Bizjak-Mikic, M

    2016-01-01

    The quality of ambulance services has an immense impact on patients' future well-being and quality of life. Patient satisfaction is one of the key metrics for evaluating the quality of this service. Yet, the patient satisfaction measurement may be limited in its ability to accurately reflect this service quality, and even reflect factors beyond the patient experiences. We analyze 10 years of survey data to reveal a number of factors that systematically bias ambulance satisfaction ratings. Taking into account these biases provides more robust comparison of ambulance performance over time or across different jurisdictions. PMID:27295008

  5. Occupational stress in the ambulance service: a diagnostic study.

    PubMed

    Young, K M; Cooper, C L

    1997-01-01

    The Occupational Stress Indicator (OSI) was used to investigate job stress in an ambulance service in the northwest of England. Seven different aspects of the stress-strain relationship were assessed and the findings compared with those from the fire service. Ambulance service employees were found to be experiencing major stress outcomes of low job satisfaction and poor mental and physical health. Fire service employees revealed significantly poorer physical health. Assesses the sources of job stress, type A behaviour, locus of control and coping styles and discusses them in the light of change in the public services.

  6. Air ambulance and hospital services for critically ill and injured in Greenland, Iceland and the Faroe Islands: how can we improve?

    PubMed Central

    Gunnarsson, Björn; Jensen, Niels S Kieler; Garði, Tummas i; Harðardóttir, Helga; Stefánsdóttir, Lilja; Heimisdóttir, María

    2015-01-01

    The Nordic Atlantic Cooperation (NORA) is an intergovernmental organization under the auspices of the Nordic Council of Ministers. The NORA region comprises Greenland, Iceland, Faroe Islands and western coastal areas of Norway. Historical, cultural and institutional links bind these nations together in multiple ways, and regional co-operation has in recent years become a focus of interest. This commentary addresses air medical services (AMSs) and available advanced hospital services in the 3 smallest NORA countries challenged sparse populations, hereafter referred to as the region. It seems likely that strengthened regional co-operation can help these countries to address common challenges within health care by exchanging know-how and best practices, pooling resources and improving the efficiency of care delivery. The 4 largest hospitals in the region, Dronning Ingrids Hospital in Nuuk (Greenland), Landspítali in Reykjavík and Sjúkrahúsið á Akureyri, (both in Iceland) and Landssjúkrahúsið Tórshavn on the Faroe Islands, have therefore undertaken the project Network for patient transport in the North-West Atlantic (in Danish: Netværk for patienttransport i Vest-Norden). The goal of the project, and of this article, is to exchange information and provide an overview of current AMSs and access to acute hospital care for severely ill or injured patients in the 3 participating countries. Of equal importance is the intention to highlight the need for increased regional co-operation to optimize use of limited resources in the provision of health care services. PMID:26066019

  7. Operational implementation and lessons learned from Haiti's first helicopter air ambulance.

    PubMed

    DeGennaro, Vincent; Owen, Jordan; Chandler, Jerry; McDaniel, Ralph

    2016-05-01

    Critical-care helicopter transport has demonstrated improvements in morbidity and mortality to those patients who utilise the service, but this has largely excluded developing country populations due to set up costs. Haiti Air Ambulance is the first completely publicly-available helicopter ambulance service in a developing country. US standards were adopted for both aviation and aeromedical care in Haiti due to proximity and relationships. In order to implement properly, standards for aviation, critical care, and insurance reimbursement had to be put in place with local authorities. Haiti Air Ambulance worked with the Ministry of Health to author standards for medical procedures, medication usage, and staff training for aeromedical programs in the country. Utilisation criteria for the helicopter were drafted, edited, and constantly updated to ensure the program adapted to the clinical situation while maintaining US standard of care. During the first year, 76 patients were transferred; 13 of whom were children and 3 pregnant women. Three patients were intubated and two required bi-level mask ventilation. Traumatic injury and non-emergency interfacility transfers were the two most common indications for service. More than half of the transfers (54%) originated at one of six hospitals, mostly as a result of highly-involved staff. The program was limited by weather and the lack of weather reporting, radar, visual flight recognition, thus also causing an inability to fly at night. In partnership with the government and other non-governmental organisations, we seek to implement a more robust pre-hospital system in Haiti over the next 12-24 months, including more scene call capabilities.

  8. Operational implementation and lessons learned from Haiti's first helicopter air ambulance.

    PubMed

    DeGennaro, Vincent; Owen, Jordan; Chandler, Jerry; McDaniel, Ralph

    2016-05-01

    Critical-care helicopter transport has demonstrated improvements in morbidity and mortality to those patients who utilise the service, but this has largely excluded developing country populations due to set up costs. Haiti Air Ambulance is the first completely publicly-available helicopter ambulance service in a developing country. US standards were adopted for both aviation and aeromedical care in Haiti due to proximity and relationships. In order to implement properly, standards for aviation, critical care, and insurance reimbursement had to be put in place with local authorities. Haiti Air Ambulance worked with the Ministry of Health to author standards for medical procedures, medication usage, and staff training for aeromedical programs in the country. Utilisation criteria for the helicopter were drafted, edited, and constantly updated to ensure the program adapted to the clinical situation while maintaining US standard of care. During the first year, 76 patients were transferred; 13 of whom were children and 3 pregnant women. Three patients were intubated and two required bi-level mask ventilation. Traumatic injury and non-emergency interfacility transfers were the two most common indications for service. More than half of the transfers (54%) originated at one of six hospitals, mostly as a result of highly-involved staff. The program was limited by weather and the lack of weather reporting, radar, visual flight recognition, thus also causing an inability to fly at night. In partnership with the government and other non-governmental organisations, we seek to implement a more robust pre-hospital system in Haiti over the next 12-24 months, including more scene call capabilities. PMID:26739767

  9. Medicare program; coverage and payment of ambulance services; inflation update for CY 2004. Final rule with comment period.

    PubMed

    2003-12-01

    This final rule provides the sunset date for the interim bonus payment for rural ambulance mileage of 18 through 50 miles as required by the Medicare, Medicaid and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000 (BIPA) and provides notice of the annual Ambulance Inflation Factor (AIF) for ambulance services for calendar year (CY) 2004. The statute requires that this inflation factor be applied in determining the fee schedule amounts and payment limits for ambulance services.

  10. Assessing Pesticide Impact on Human Health in Nebraska: A Survey of Ambulance Services and Rescue Squads. Department Report No. 7.

    ERIC Educational Resources Information Center

    Vitzthum, Edward F.; And Others

    A study examined the employment qualifications, job content, training, and training needs of ambulance service and rescue squad workers in Nebraska. Based on the 268 mail questionnaires that were completed and returned out of a total of 338 sent out, it was concluded that the strengths of the various ambulance and rescue services vary widely. The…

  11. Management and the creation of occupational stressors in an Australian and a UK ambulance service.

    PubMed

    Mahony, K L

    2001-01-01

    Qualitative methods were used to explore the aetiology of occupational stress experienced by on-road ambulance officers. The researcher found that the way in which a service is organised and its officers valued can create and reproduce workplace stressors that are as causative of occupational stress as the often acknowledged occupational specific stressors like night shifts, irregular work hours and witnessing human trauma and tragedy. These stressors thought to be intrinsic to the work of ambulance officers were found to have an organisational dimension.

  12. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... on charges to enrollees for emergency department services that CMS will determine annually, or what... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules for ambulance services, emergency and... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  13. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... on charges to enrollees for emergency department services that CMS will determine annually, or what... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for ambulance services, emergency and... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  14. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... on charges to enrollees for emergency department services that CMS will determine annually, or what... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules for ambulance services, emergency and... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  15. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... on charges to enrollees for emergency department services that CMS will determine annually, or what... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for ambulance services, emergency and... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  16. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....40 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... reporting requirements of § 410.41 and the service meets the medical necessity and origin and destination... be made. (e) Origin and destination requirements. Medicare covers the following...

  17. Emergency call work-load, deprivation and population density: an investigation into ambulance services across England.

    PubMed

    Peacock, Philip J; Peacock, Janet L

    2006-06-01

    Demand for emergency ambulance services has risen steeply over the recent years. This study examined differences in work-load of ambulance services across England and investigated factors linked to high demand. The number of emergency calls received by each ambulance service in 1997 and 2002 and population and area data were used to calculate call rates and population density for each of 27 service areas. Deprivation score and proportion of the population under age 15 and over age 65 were calculated for each service area. There was wide variation in emergency call rates across England, with London having the highest rate both in 1997 (125.6 calls per 1000 persons) and in 2002 (140.1 per 1000). Statistically significant positive associations were observed between call rates and deprivation (1997, r = 0.49; 2002, r = 0.53) and between call rates and population density (1997, r = 0.70; 2002, r = 0.68). Following multivariable regression, the effect of deprivation score was consistently weaker, but the effect of population density was virtually unchanged. We conclude that areas with higher population density have higher call rates, which is not explained by deprivation. Deprivation is associated with higher usage, but its effect is partly due to population density. There is no evidence that these relationships are confounded by age.

  18. Ambulance Services at Hospital Universiti Sains Malaysia and Hospital Kota Bharu: A Retrospective Study of Calls

    PubMed Central

    Shah Che Hamzah, Mohd Shaharudin; Ahmad, Rashidi; Nik Abdul Rahman, Nik Hisamuddin; Pardi, Kasmah Wati; Jaafar, Naimah; Wan Adnan, Wan Aasim; Jaalam, Kamaruddin; Sahil Jamalullail, Syed Mohsin

    2005-01-01

    This retrospective study attempted to identify the pattern of ambulance calls for the past two years at the Hospital Universiti Sains Malaysia (HUSM) and Hospital Kota Bharu (HKB). This study will provide a simple method of acquiring information related to ambulance response time (ART) and to test whether it met the international standards and needs of the client. Additionally, this paper takes into account the management of emergency calls. This included ambulance response time, which was part of Emergency Medical Services (EMS) episode: onset of ART, which started when details like phone number of the caller, exact location of the incident and the nature of the main complaint had been noted. ART ended when the emergency team arrived at the scene of incident. Information regarding ambulance calls from the record offices of HUSM and HKB was recorded for the year 2001 and 2002, tabulated and analyzed. There was a significant difference in the total number of calls managed by HUSM and HKB in the year 2001. It was noted that 645 calls were managed by HUSM while 1069 calls were recorded at HKB. In the year 2002, however, HUSM led with 613 extra numbers of calls as compare to HKB with 1193 numbers of calls. The pattern of ambulance calls observed is thought to possibly be influenced by social activities like local festivities, school holidays and the seasons. Further, it is observed that no studies were previously undertaken to compare the ART at both the HUSM and HKB to that of the international standards. In fact, a literature review undertaken so far showed no similar studies have been done for the whole Malaysia. PMID:22605956

  19. Experience of critical incident stress among ambulance service staff and relationship to psychological symptoms.

    PubMed

    Gallagher, Sharon; McGilloway, Sinéad

    2009-01-01

    This two-stage study was undertaken to assess the extent and nature of Critical Incident Stress (CIS) amongst frontline staff in a large ambulance service in Ireland. In Stage One, 63% (112/180) of participants completed a Screening Questionnaire and the GHQ-12. In Stage Two, 27 participants, who had experienced a critical incident (CI) during the previous year completed several measures to assess PTSD symptomatology, burnout, health-related Quality of Life, and dispositional optimism. Eighty-one per cent (80/94) of the Stage One group reported that their health had been affected by a CI; 42% (44/106) were identified as 'cases' on the GHQ-12. Stage Two results indicated that 12 participants had PTSD symptoms while this entire group showed moderate levels of emotional exhaustion and depersonalization, despite experiencing high levels of personal accomplishment and optimism. The findings suggest a high prevalence of CIS among ambulance personnel in Ireland and a significant impact on overall health and wellbeing. This has important implications for the effective management of CIS and suggests an important role for occupational health and organizational psychologists in providing routine support to ambulance service staff andpossibly other emergency services personnel.

  20. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... to the nearest hospital, CAH, or SNF that is capable of furnishing the required level and type of... SNF to the beneficiary's home. (3) From a SNF to the nearest supplier of medically necessary services not available at the SNF where the beneficiary is a resident, including the return trip. (4) For...

  1. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... to the nearest hospital, CAH, or SNF that is capable of furnishing the required level and type of... SNF to the beneficiary's home. (3) From a SNF to the nearest supplier of medically necessary services not available at the SNF where the beneficiary is a resident, including the return trip. (4) For...

  2. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... transportation: (1) From any point of origin to the nearest hospital, CAH, or SNF that is capable of furnishing... condition. (2) From a hospital, CAH, or SNF to the beneficiary's home. (3) From a SNF to the nearest supplier of medically necessary services not available at the SNF where the beneficiary is a...

  3. 42 CFR 410.40 - Coverage of ambulance services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... transportation: (1) From any point of origin to the nearest hospital, CAH, or SNF that is capable of furnishing... condition. (2) From a hospital, CAH, or SNF to the beneficiary's home. (3) From a SNF to the nearest supplier of medically necessary services not available at the SNF where the beneficiary is a...

  4. Manager-employee interaction in ambulance services: an exploratory study of employee perspectives on management communication.

    PubMed

    Nordby, Halvor

    2015-01-01

    Managers of ambulance stations face many communicative challenges in their interaction with employees working in prehospital first-line services. The article presents an exploratory study of how paramedics experience these challenges in communication with station leaders. On the basis of a dialogue perspective in qualitative method, 24 paramedics were interviewed in one-to-one and focus group settings. Naturalistic and phenomenological approaches were used to analyze the interviews. All the paramedics said that they wished to be more involved in decision processes and that station managers should provide better explanations of information "from above." The paramedics understood that it was difficult for the managers to find time for extensive dialogue, but many thought that the managers should give more priority to communication. The paramedics' views correspond to theoretical assumptions in human resource management. According to this model, employees should be involved in decision processes on management levels, as long as it is realistically possible to do so. Furthermore, expressing emotional support and positive attitudes does not take much time, and the study suggests that many ambulance managers should focus more on interpersonal relations to employees. It has been extensively documented that management communication affects organizational performance. The study indicates that managers of ambulance stations should be more aware of how their leadership style affects professional commitment and motivation in the first-line services.

  5. Manager-employee interaction in ambulance services: an exploratory study of employee perspectives on management communication.

    PubMed

    Nordby, Halvor

    2015-01-01

    Managers of ambulance stations face many communicative challenges in their interaction with employees working in prehospital first-line services. The article presents an exploratory study of how paramedics experience these challenges in communication with station leaders. On the basis of a dialogue perspective in qualitative method, 24 paramedics were interviewed in one-to-one and focus group settings. Naturalistic and phenomenological approaches were used to analyze the interviews. All the paramedics said that they wished to be more involved in decision processes and that station managers should provide better explanations of information "from above." The paramedics understood that it was difficult for the managers to find time for extensive dialogue, but many thought that the managers should give more priority to communication. The paramedics' views correspond to theoretical assumptions in human resource management. According to this model, employees should be involved in decision processes on management levels, as long as it is realistically possible to do so. Furthermore, expressing emotional support and positive attitudes does not take much time, and the study suggests that many ambulance managers should focus more on interpersonal relations to employees. It has been extensively documented that management communication affects organizational performance. The study indicates that managers of ambulance stations should be more aware of how their leadership style affects professional commitment and motivation in the first-line services. PMID:25909398

  6. Regionalization of trauma services in western Sydney: predicted effect on ambulance and hospital utilization rates.

    PubMed

    Lyle, D M; Thomson, P C; Deane, S A; Coulon, L A

    1991-08-01

    A previous study has demonstrated the effectiveness of ambulance staff in identifying the majority of trauma victims who warrant admission to a Level 3 Hospital. This paper applied the results of that study in order to estimate the likely effect of a system of bypass whereby these identified patients are transported to a Level 3 hospital rather than the nearest Level 1 or 2 Hospital. Under the proposed plan whereby both Westmead and Liverpool Hospitals would be granted Level 3 status, the effect of Westmead would be negligible. However, Liverpool's caseload would increase (25% for total admissions, 136% for serious admissions) and, consequently, its level of resources would need to be upgraded before this plan can be put into action. Meanwhile, Level 1 and 2 hospitals would see little change to total patient admissions, although there would be a substantial drop in serious admissions (-63%). Under the proposed system, the effects on the Ambulance Service would also be negligible in terms of both the number of transports and total transport hours. However, the nature of these transports would change. More time would be required in bypass cases, although this would be compensated for by a corresponding fall off in interhospital transfers (28% decline in time spent on transfers). Ultimately, this means that patients would be getting to the hospital of definitive care much sooner. These results have implications for the development of trauma services in other sectors.

  7. Automated personnel-assets-consumables-drug tracking in ambulance services for more effective and efficient medical emergency interventions.

    PubMed

    Utku, Semih; Özcanhan, Mehmet Hilal; Unluturk, Mehmet Suleyman

    2016-04-01

    Patient delivery time is no longer considered as the only critical factor, in ambulatory services. Presently, five clinical performance indicators are used to decide patient satisfaction. Unfortunately, the emergency ambulance services in rapidly growing metropolitan areas do not meet current satisfaction expectations; because of human errors in the management of the objects onboard the ambulances. But, human involvement in the information management of emergency interventions can be reduced by electronic tracking of personnel, assets, consumables and drugs (PACD) carried in the ambulances. Electronic tracking needs the support of automation software, which should be integrated to the overall hospital information system. Our work presents a complete solution based on a centralized database supported by radio frequency identification (RFID) and bluetooth low energy (BLE) identification and tracking technologies. Each object in an ambulance is identified and tracked by the best suited technology. The automated identification and tracking reduces manual paper documentation and frees the personnel to better focus on medical activities. The presence and amounts of the PACD are automatically monitored, warning about their depletion, non-presence or maintenance dates. The computerized two way hospital-ambulance communication link provides information sharing and instantaneous feedback for better and faster diagnosis decisions. A fully implemented system is presented, with detailed hardware and software descriptions. The benefits and the clinical outcomes of the proposed system are discussed, which lead to improved personnel efficiency and more effective interventions.

  8. Automated personnel-assets-consumables-drug tracking in ambulance services for more effective and efficient medical emergency interventions.

    PubMed

    Utku, Semih; Özcanhan, Mehmet Hilal; Unluturk, Mehmet Suleyman

    2016-04-01

    Patient delivery time is no longer considered as the only critical factor, in ambulatory services. Presently, five clinical performance indicators are used to decide patient satisfaction. Unfortunately, the emergency ambulance services in rapidly growing metropolitan areas do not meet current satisfaction expectations; because of human errors in the management of the objects onboard the ambulances. But, human involvement in the information management of emergency interventions can be reduced by electronic tracking of personnel, assets, consumables and drugs (PACD) carried in the ambulances. Electronic tracking needs the support of automation software, which should be integrated to the overall hospital information system. Our work presents a complete solution based on a centralized database supported by radio frequency identification (RFID) and bluetooth low energy (BLE) identification and tracking technologies. Each object in an ambulance is identified and tracked by the best suited technology. The automated identification and tracking reduces manual paper documentation and frees the personnel to better focus on medical activities. The presence and amounts of the PACD are automatically monitored, warning about their depletion, non-presence or maintenance dates. The computerized two way hospital-ambulance communication link provides information sharing and instantaneous feedback for better and faster diagnosis decisions. A fully implemented system is presented, with detailed hardware and software descriptions. The benefits and the clinical outcomes of the proposed system are discussed, which lead to improved personnel efficiency and more effective interventions. PMID:26777434

  9. Satellite communications experiment for the Ontario air ambulance service

    NASA Technical Reports Server (NTRS)

    Butterworth, John S.

    1988-01-01

    A satellite communications experiment was conducted to develop a reliable voice communications system between paramedics and doctors at certain larger medical centers. The experiment used INMARSAT's Atlantic Ocean Region satellite which provides coverage to the western border of Ontario. Forward downlink power from the satellite is in great demand, so two highly power-efficient modulation schemes were chosen for evaluation during the experiment. These were amplitude-companded single-sideband (ACSSB) and linear predictive coding in conjunction with DMSK modulation. Good performance with a signal to noise ratio of about 10 dB was demonstrated from many parts of the province with the evevation angle to the satellite ranging from five to twenty degrees and with the aircraft both in-flight and on the runway.

  10. Satellite communications experiment for the Ontario air ambulance service

    NASA Astrophysics Data System (ADS)

    Butterworth, John S.

    1988-05-01

    A satellite communications experiment was conducted to develop a reliable voice communications system between paramedics and doctors at certain larger medical centers. The experiment used INMARSAT's Atlantic Ocean Region satellite which provides coverage to the western border of Ontario. Forward downlink power from the satellite is in great demand, so two highly power-efficient modulation schemes were chosen for evaluation during the experiment. These were amplitude-companded single-sideband (ACSSB) and linear predictive coding in conjunction with DMSK modulation. Good performance with a signal to noise ratio of about 10 dB was demonstrated from many parts of the province with the evevation angle to the satellite ranging from five to twenty degrees and with the aircraft both in-flight and on the runway.

  11. 42 CFR 424.124 - Conditions for payment for physician services and ambulance services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Special Conditions: Services Furnished in a Foreign Country § 424.124 Conditions for payment for physician services... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions for payment for physician services...

  12. Calls Forecast for the Moscow Ambulance Service. The Impact of Weather Forecast

    NASA Astrophysics Data System (ADS)

    Gordin, Vladimir; Bykov, Philipp

    2015-04-01

    We use the known statistics of the calls for the current and previous days to predict them for tomorrow and for the following days. We assume that this algorithm will work operatively, will cyclically update the available information and will move the horizon of the forecast. Sure, the accuracy of such forecasts depends on their lead time, and from a choice of some group of diagnoses. For comparison we used the error of the inertial forecast (tomorrow there will be the same number of calls as today). Our technology has demonstrated accuracy that is approximately two times better compared to the inertial forecast. We obtained the following result: the number of calls depends on the actual weather in the city as well as on its rate of change. We were interested in the accuracy of the forecast for 12-hour sum of the calls in real situations. We evaluate the impact of the meteorological errors [1] on the forecast errors of the number of Ambulance calls. The weather and the Ambulance calls number both have seasonal tendencies. Therefore, if we have medical information from one city only, we should separate the impacts of such predictors as "annual variations in the number of calls" and "weather". We need to consider the seasonal tendencies (associated, e. g. with the seasonal migration of the population) and the impact of the air temperature simultaneously, rather than sequentially. We forecasted separately the number of calls with diagnoses of cardiovascular group, where it was demonstrated the advantage of the forecasting method, when we use the maximum daily air temperature as a predictor. We have a chance to evaluate statistically the influence of meteorological factors on the dynamics of medical problems. In some cases it may be useful for understanding of the physiology of disease and possible treatment options. We can assimilate some personal archives of medical parameters for the individuals with concrete diseases and the relative meteorological archive. As a

  13. Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

    PubMed Central

    Melton, JTK; Jain, S; Kendrick, B; Deo, SD

    2007-01-01

    INTRODUCTION A retrospective review of all patients transferred by helicopter ambulance to the Great Western Hospital over a 20-month period between January 2003 and September 2004 was undertaken to establish the case-mix of patients (trauma and non-trauma) transferred and the outcome. PATIENTS AND METHODS Details of all Helicopter Emergency Ambulance Service (HEAS) transfers to this unit in the study time period were obtained from the three HEAS providers in the area and case notes were reviewed. RESULTS There were 156 trauma patients transferred (total 193) in the study period with 111 cases identified for analysis with a mean age of 33 years (range, 1–92 years). Average Injury Severity Score on admission was 12 (range, 1–36). Forty-five patients were discharged home from the emergency department, 24 cases had operation, 10 patients required ICU care and 2 were pronounced dead in the emergency department. Average hospital stay following HEAS transfer was 2.97 days (range, 0–18 days). DISCUSSION Helicopter ambulance transfer in the acute setting is of debated value. Triage criteria are at fault if as many as 41% of patients transferred are being discharged home from casualty having incurred the financial cost of helicopter transfer. We suggest that the triage criteria for helicopter emergency transfer should be reviewed. PMID:17688727

  14. Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK

    PubMed Central

    Bevan, Gwyn; Hamblin, Richard

    2009-01-01

    Following devolution, differences developed between UK countries in systems of measuring performance against a common target that ambulance services ought to respond to 75% of calls for what may be immediately life threatening emergencies (category A calls) within 8 minutes. Only in England was this target integral to a ranking system of ‘star rating’, which inflicted reputational damage on services that failed to hit targets, and only in England has this target been met. In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings. The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis. The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries. PMID:19381327

  15. [Air rescue missions at night: Data analysis of primary and secondary missions by the DRF air rescue service in 2014].

    PubMed

    Aschenbrenner, U; Neppl, S; Ahollinger, F; Schweigkofler, U; Weigt, J O; Frank, M; Zimmermann, M; Braun, J

    2015-06-01

    The advantages that are inherent to the air ambulance service are shown in a reduction in mortality of critically ill or injured patients. The air ambulance service ensures quick and efficient medical care to a patient as well as the immediate transport of patients to a suitable hospital. In addition, primary air rescue has proved to be effective as a support for the standard ground-based ambulance services in some regions of Germany during the night. Under certain conditions, such as the strict adherence to established, practiced and coordinated procedures, air rescue at night does not have a significantly higher risk compared to operations in daytime. Particular requirements should be imposed for air rescue operations at night: a strict indication system for alerting, 4-man helicopter crews solely during the night as well as pilots (and copilots) with the correct qualifications and experience in dealing with night vision devices on a regular basis. Moreover, the helicopters need to be suitable and approved for night flying including cabin upgrades and the appropriate medical technology equipment. To increase the benefits of air rescue for specific diseases and injuries, a nationwide review of the processes is needed to further develop the primary air rescue service. PMID:26013391

  16. [Air rescue missions at night: Data analysis of primary and secondary missions by the DRF air rescue service in 2014].

    PubMed

    Aschenbrenner, U; Neppl, S; Ahollinger, F; Schweigkofler, U; Weigt, J O; Frank, M; Zimmermann, M; Braun, J

    2015-06-01

    The advantages that are inherent to the air ambulance service are shown in a reduction in mortality of critically ill or injured patients. The air ambulance service ensures quick and efficient medical care to a patient as well as the immediate transport of patients to a suitable hospital. In addition, primary air rescue has proved to be effective as a support for the standard ground-based ambulance services in some regions of Germany during the night. Under certain conditions, such as the strict adherence to established, practiced and coordinated procedures, air rescue at night does not have a significantly higher risk compared to operations in daytime. Particular requirements should be imposed for air rescue operations at night: a strict indication system for alerting, 4-man helicopter crews solely during the night as well as pilots (and copilots) with the correct qualifications and experience in dealing with night vision devices on a regular basis. Moreover, the helicopters need to be suitable and approved for night flying including cabin upgrades and the appropriate medical technology equipment. To increase the benefits of air rescue for specific diseases and injuries, a nationwide review of the processes is needed to further develop the primary air rescue service.

  17. Superior Ambulance Call Out Rate Forecasting Using Meteorological Data

    NASA Astrophysics Data System (ADS)

    Mahmood, M. A.; Thornes, J. E.; Bloss, W.; Pope, F.

    2015-12-01

    Ambulances are an integral part of a country's infrastructure ensuring its citizens and visitors are kept healthy. The impact of weather, climate and climate change on ambulance services around the world has received increasing attention in recent years but most studies have been area specific and there is a need to establish basic relationships between ambulance data (both response and illness data) and meteorological parameters. In this presentation, the effects of temperature and relative humidity on ambulance call out rates for different medical categories will be investigated. We use call out data obtained from the London Ambulance Service (LAS) and meteorological data from a central London meteorological station. A time-series analysis was utilized to understand the relation between temperature, relative humidity, air pollutants and different call out categories. There are statistically significant relationships between mean temperature and ambulance callout rate for most of the categories investigated. Most categories show a negative dependence on temperature, i.e. call outs increase with decreasing temperature but some categories showed a positive dependence such as alcohol related call outs. Relative humidity is significant for some categories but in general is much less important than temperature. Significant time lag effects were observed for most of the categories related to infectious illnesses, which are transferrable through human contact. These findings support the opinion that ambulance attendance callouts records are an effective and well-timed source of data and can be used for health early warning systems. Furthermore the presented results can much improve our understanding of the relationships between meteorological conditions and human health thereby allowing for better prediction of ambulance use through the application of long and short-term weather forecasts.

  18. Ag-Air Service

    NASA Technical Reports Server (NTRS)

    1981-01-01

    Econ, Inc.'s agricultural aerial application, "ag-air," involves more than 10,000 aircraft spreading insecticides, herbicides, fertilizer, seed and other materials over millions of acres of farmland. Difficult for an operator to estimate costs accurately and decide what to charge or which airplane can handle which assignment most efficiently. Computerized service was designed to improve business efficiency in choice of aircraft and determination of charge rates based on realistic operating cost data. Each subscriber fills out a detailed form which pertains to his needs and then receives a custom-tailored computer printout best suited to his particular business mix.

  19. The effect of active warming in prehospital trauma care during road and air ambulance transportation - a clinical randomized trial

    PubMed Central

    2011-01-01

    Background Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientifical evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients. Methods Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored. Results Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C) to 36.0°C (95% CI; 35.7-36.3°C) (p < 0.05) in patients assigned to passive warming only (n = 22) and from 35.6°C (95% CI; 35.2-36.0°C) to 36.4°C (95% CI; 36.1-36.7°C) (p < 0.05) in patients assigned to additional active warming (n = 26) with no significant differences between the groups. Cold discomfort decreased in 2/3 of patients assigned to passive warming only and in all patients assigned to additional active warming, the difference in cold discomfort change being statistically significant (p < 0.05). Patients assigned to additional active warming also presented a statistically significant decrease in heart rate and respiratory frequency (p < 0.05). Conclusions In mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response. Trial Registration ClinicalTrials.gov: NCT01400152 PMID:22017799

  20. Expected Annual Emergency Miles per Ambulance: An Indicator for Measuring Availability of Emergency Medical Services Resources

    ERIC Educational Resources Information Center

    Patterson, P. Daniel; Probst, Janice C.; Moore, Charity G.

    2006-01-01

    Context: To ensure equitable access to prehospital care, as recommended by the Rural and Frontier Emergency Medical Services (EMS) Agenda for the Future, policymakers will need a uniform measure of EMS infrastructure. Purpose and Methods: This paper proposes a county-level indicator of EMS resource availability that takes into consideration…

  1. The role of the payment vehicle in non-market valuations of a health care service: willingness-to-pay for an ambulance helicopter service.

    PubMed

    Gyrd-Hansen, Dorte

    2016-01-01

    This study analyses the role of the payment vehicle when conducting non-market valuations of health care services using stated preference methods. Based on a contingent valuation study conducted in Denmark encompassing more than 3400 respondents three important conclusions are drawn. Firstly, it is found that the valuation of a publicly financed ambulance helicopter service is higher than for an identical privately financed service. Secondly, the results suggest that the public premium is likely to be partly driven by altruistic preferences, and that some citizens value access to this type of service for all. An important driver is also perceptions of quality of services across the private and public sector. Finally, it is shown that exclusion of protest bidders is problematic and may bias welfare estimates. The take home message is that it is difficult to isolate the value of a good per se, and that analysts should take care in applying the payment vehicle that is likely to be applied in real life when valuing non-market goods. There has been little awareness of the importance of choice of payment vehicle in the literature to date. PMID:25661283

  2. Riding Third: Social Work in Ambulance Work

    ERIC Educational Resources Information Center

    Campbell, Hilary; Rasmussen, Brian

    2012-01-01

    This research explored the possible role of social work alongside emergency ambulance services. An ethnographic study included semistructured interviews and direct observations collected over 300 hours while riding in ambulances in an urban setting. The data suggest that social work could play a role by providing needed psychosocial care during…

  3. Elderly and Nonelderly Use of a Dedicated Ambulance Corps' Emergency Medical Services in Taiwan

    PubMed Central

    Huang, Chien-Chia; Chen, Wei-Lung; Hsu, Chien-Chin; Lin, Hung-Jung; Su, Shih-Bin; Guo, How-Ran

    2016-01-01

    Backgrounds and Aim. Taiwan's population is gradually aging; however, there are no comparative data on emergency medical services (EMS) use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years) and nonelderly (<65 years). Nontransport and transport calls were compared between the groups for demographic characteristics, transport time, reasons for calling EMS, vital signs, and emergency management. Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P < 0.05) fewer (28 (9.2%)) nontransport calls than did the nonelderly (136 (21.4%)). In the transport calls, 276 (35.6%) were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson's disease, and Alzheimer's disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now. PMID:27478825

  4. Elderly and Nonelderly Use of a Dedicated Ambulance Corps' Emergency Medical Services in Taiwan.

    PubMed

    Huang, Chien-Chia; Chen, Wei-Lung; Hsu, Chien-Chin; Lin, Hung-Jung; Su, Shih-Bin; Guo, How-Ran; Huang, Chien-Cheng; Chen, Pi-Ching

    2016-01-01

    Backgrounds and Aim. Taiwan's population is gradually aging; however, there are no comparative data on emergency medical services (EMS) use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years) and nonelderly (<65 years). Nontransport and transport calls were compared between the groups for demographic characteristics, transport time, reasons for calling EMS, vital signs, and emergency management. Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P < 0.05) fewer (28 (9.2%)) nontransport calls than did the nonelderly (136 (21.4%)). In the transport calls, 276 (35.6%) were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson's disease, and Alzheimer's disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now. PMID:27478825

  5. 42 CFR 414.615 - Transition to the ambulance fee schedule.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... inflation factor for ambulance services. (b) 2003 Payment. For services furnished in CY 2003, payment is... inflation factor for ambulance services. (c) 2004 Payment. For services furnished in CY 2004, payment is... inflation factor for ambulance services. (d) 2005 Payment. For services furnished in CY 2005, payment...

  6. 42 CFR 414.615 - Transition to the ambulance fee schedule.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... inflation factor for ambulance services. (b) 2003 Payment. For services furnished in CY 2003, payment is... inflation factor for ambulance services. (c) 2004 Payment. For services furnished in CY 2004, payment is... inflation factor for ambulance services. (d) 2005 Payment. For services furnished in CY 2005, payment...

  7. 42 CFR 414.615 - Transition to the ambulance fee schedule.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the statutory inflation factor for ambulance services. (b) 2003 Payment. For services furnished in CY..., multiplied by the statutory inflation factor for ambulance services. (c) 2004 Payment. For services furnished..., multiplied by the statutory inflation factor for ambulance services. (d) 2005 Payment. For services...

  8. Monitoring the effect of air pollution episodes on health care consultations and ambulance call-outs in England during March/April 2014: A retrospective observational analysis.

    PubMed

    Elliot, Alex J; Smith, Sue; Dobney, Alec; Thornes, John; Smith, Gillian E; Vardoulakis, Sotiris

    2016-07-01

    There is an increasing body of evidence illustrating the negative health effects of air pollution including increased risk of respiratory, cardiac and other morbid conditions. During March and April 2014 there were two air pollution episodes in England that occurred in close succession. We used national real-time syndromic surveillance systems, including general practitioner (GP) consultations, emergency department attendances, telehealth calls and ambulance dispatch calls to further understand the impact of these short term acute air pollution periods on the health seeking behaviour of the general public. Each air pollution period was comparable with respect to particulate matter concentrations (PM10 and PM2.5), however, the second period was longer in duration (6 days vs 3 days) and meteorologically driven 'Sahara dust' contributed to the pollution. Health surveillance data revealed a greater impact during the second period, with GP consultations, emergency department attendances and telehealth (NHS 111) calls increasing for asthma, wheeze and difficulty breathing indicators, particularly in patients aged 15-64 years. Across regions of England there was good agreement between air quality levels and health care seeking behaviour. The results further demonstrate the acute impact of short term air pollution episodes on public health and also illustrate the potential role of mass media reporting in escalating health care seeking behaviour.

  9. Monitoring the effect of air pollution episodes on health care consultations and ambulance call-outs in England during March/April 2014: A retrospective observational analysis.

    PubMed

    Elliot, Alex J; Smith, Sue; Dobney, Alec; Thornes, John; Smith, Gillian E; Vardoulakis, Sotiris

    2016-07-01

    There is an increasing body of evidence illustrating the negative health effects of air pollution including increased risk of respiratory, cardiac and other morbid conditions. During March and April 2014 there were two air pollution episodes in England that occurred in close succession. We used national real-time syndromic surveillance systems, including general practitioner (GP) consultations, emergency department attendances, telehealth calls and ambulance dispatch calls to further understand the impact of these short term acute air pollution periods on the health seeking behaviour of the general public. Each air pollution period was comparable with respect to particulate matter concentrations (PM10 and PM2.5), however, the second period was longer in duration (6 days vs 3 days) and meteorologically driven 'Sahara dust' contributed to the pollution. Health surveillance data revealed a greater impact during the second period, with GP consultations, emergency department attendances and telehealth (NHS 111) calls increasing for asthma, wheeze and difficulty breathing indicators, particularly in patients aged 15-64 years. Across regions of England there was good agreement between air quality levels and health care seeking behaviour. The results further demonstrate the acute impact of short term air pollution episodes on public health and also illustrate the potential role of mass media reporting in escalating health care seeking behaviour. PMID:27179935

  10. Ambulance 3G.

    PubMed

    Banitsas, Konstantinos; Perakis, Konstantinos; Koutsouris, Dimitrios; Konis, Georgios; Tachakra, Sapal

    2005-01-01

    Minimising the time required for a patient to receive primary care has always been the concern of the Accidents and Emergency units. Ambulances are usually the first to arrive on the scene and to administer first aid. However, as the time that it takes to transfer the patient to the hospital increases, so does the fatality rate. In this paper, a mobile teleconsultation system is presented, based primarily on third generation mobile links and on Wi-Fi hotspots around a city. This system can be installed inside an ambulance and will permit high-resolution videoconferencing between the moving vehicle and a doctor or a consultant within a base station (usually a hospital). In addition to video and voice, high quality still images and screenshots from medical equipment can also be sent. The test was carried out in Athens, Greece where a 3G system was recently deployed by Vodafone. The results show that the system can perform satisfactory in most conditions and can effectively increase the patient's quality of service, while having a modest cost.

  11. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... average knowledge of health and medicine, could reasonably expect the absence of immediate medical... temporarily absent from the MA plan's service (or, if applicable, continuation) area (or, under unusual and... offering the MA plan. (2) MA organization financial responsibility. The MA organization is...

  12. A comparison of adherence to correctly documented triage level of critically ill patients between emergency department and the ambulance service nurses.

    PubMed

    Jönsson, Kenneth; Fridlund, Bengt

    2013-07-01

    Priority or triage has always occurred in emergency care. Today it is performed by both nurses in emergency departments (EDs) and ambulance services (ASs) to ensure patient safety. Recent studies have shown that nurses are unlikely to change their first impressions and patients suffering from blunt trauma are undertriaged. Our study aimed to compare and evaluate the adherence to correct triage level documentation, between nurses in the ED and the AS, according to current regulations. Of 592 analysed triage records from a university, a central and a district hospital, the adherence was 64% by ED nurses and 43% by AS nurses (p<0.001), but individual percentages ranged from 27% to 88%. Patient safety is jeopardised when nurses do not adhere to the triage system and do not correctly document the triage level. Internal feedback and control are two approaches to improve the patient outcome, indicating that organisational actions must be taken.

  13. Ambulance Design Survey 2011: A Summary Report

    PubMed Central

    Lee, Y Tina; Kibira, Deogratias; Feeney, Allison Barnard; Marshall, Jennifer

    2013-01-01

    Current ambulance designs are ergonomically inefficient and often times unsafe for practical treatment response to medical emergencies. Thus, the patient compartment of a moving ambulance is a hazardous working environment. As a consequence, emergency medical services (EMS) workers suffer fatalities and injuries that far exceed those of the average work place in the United States. To reduce injury and mortality rates in ambulances, the Department of Homeland Security Science and Technology Directorate has teamed with the National Institute of Standards and Technology, the National Institute for Occupational Safety and Health, and BMT Designers & Planners in a joint project to produce science-based ambulance patient compartment design standards. This project will develop new crash-safety design standards and improved user-design interface guidance for patient compartments that are safer for EMS personnel and patients, and facilitate improved patient care. The project team has been working with practitioners, EMS workers’ organizations, and manufacturers to solicit needs and requirements to address related issues. This paper presents an analysis of practitioners’ concerns, needs, and requirements for improved designs elicited through the web-based survey of ambulance design, held by the National Institute of Standards and Technology. This paper also introduces the survey, analyzes the survey results, and discusses recommendations for future ambulance patient compartments design. PMID:26401439

  14. Energy expenditure during ambulation with ortho crutches and axillary crutches.

    PubMed

    Hinton, C A; Cullen, K E

    1982-06-01

    Thirteen normal male college students were studied during unassisted ambulation and nonweight-bearing ambulation with Ortho crutches and axillary crutches to determine energy expenditure. Subjects walked at self-selected velocities. Energy expenditure was determined by analyzing expired air collected by a calorimeter. Heart rate was monitored by telemetry. During the first 2.5 minutes of walking, heart rate and energy expenditure were significantly greater for ambulation with axillary crutches than with Ortho crutches. After 11.5 minutes of walking, no difference in energy cost was found between crutch types; however, heart rate increased significantly (p less than .01) during ambulation with axillary crutches. Differences in energy cost and heart rate were attributed to increased upper extremity work performed when using axillary crutches. We concluded that during nonweight-bearing ambulation for short periods of time or over a short distance, the Ortho crutch is less taxing in terms of energy cost and heart rate demands.

  15. A study of commuter air service

    NASA Technical Reports Server (NTRS)

    Belina, F. W.; Bush, L. R.

    1977-01-01

    A regionally oriented overview of the commuter air service industry is provided. A framework for an eventual assessment of potential technology directions that may be of benefit to the industry is presented. Data are provided on the industry's market characteristics, service patterns, patronage characteristics, aircraft and airport needs, economic characteristics and institutional issues. Using personal interview and literature survey methods, investigation of a considerable cross-section of the industry was made.

  16. [New possibilities in emergency medical transportation and emergency services of Polish Medical Air Rescue].

    PubMed

    Gałazkowski, Robert

    2010-01-01

    In Poland, two types of medical services are accomplished by the Medical Air Rescue (MAR) operating all over the country: emergency transport from the incident scene to hospital and inter-hospital transport. Helicopters or planes are used for this purpose. In 2009, helicopters performed 4359 flights to incidents and 1537 inter-hospital transports whereas planes performed 589 inter-hospital ambulance and 196 rescue flights. MAR operates from 17 bases of the Helicopter Emergency Medical Service (HEMS) and one airbase. Helicopters are mainly used when medical transport is emergent, within the operational region of a given base whereas planes when the distance between the present and target airports exceeds 250 km. In 2008, new modern aircraft were introduced to HEMS-helicopters EC 135. They fulfil all requirements of air transport regulations and are adjusted to visual (VFR) and instrumental (IFR) flights rules, at day and night. The medical cabin of EC 135 is ergonomic and functional considering the majority of rescue activities under life-saving circumstances. It is equipped with ventilator, defibrillator, infusion pumps etc. Defibrillators have 12-lead ECG, E(T)CO2, SpO2, NIBP, and IBP modules. Transport ventilators can work in a variety of ventilation modes including CMV, SIMV, SVV, BILEVEL, PCV, ASB, PPV and CPAP. The purchase of helicopters with modern avionic and medical configuration ensures high quality services of MAR for many years to come. PMID:21413425

  17. Mathematical model of ambulance resources in Saint-Petersburg

    NASA Astrophysics Data System (ADS)

    Shavidze, G. G.; Balykina, Y. E.; Lejnina, E. A.; Svirkin, M. V.

    2016-06-01

    Emergency medical system is one of the main elements in city infrastructure. The article contains analysis of existing system of ambulance resource distribution. Paper considers the idea of using multiperiodicity as a tool to increase the efficiency of the Emergency Medical Services. The program developed in programming environment Matlab helps to evaluate the changes in the functioning of the system of emergency medical service.

  18. 14 CFR 71.11 - Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Air Traffic Service (ATS) routes. 71.11... (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.11 Air Traffic Service (ATS) routes. Unless otherwise specified, the following...

  19. 14 CFR 71.11 - Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Air Traffic Service (ATS) routes. 71.11... (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.11 Air Traffic Service (ATS) routes. Unless otherwise specified, the following...

  20. Physical workload of ambulance assistants.

    PubMed

    Doormaal, M T; Driessen, A P; Landeweerd, J A; Drost, M R

    1995-02-01

    The physical workload of ambulance assistants was assessed by means of the Ovako Working posture Analysis System (OWAS) observation method and a Work and Health Questionnaire (WHQ) for measuring perceived workload. In addition, a biomechanical model was applied to several specifically strenuous conditions that were simulated in a laboratory situation. Bad postures were identified for a number of activities: 16% to 29% of a work shift was spent in harmful positions. Strenuous situations occur particularly during rides in emergency situations. The results of observed and perceived workload are generally in agreement. A number of practical recommendations are made. They concern, for example, the equipment in ambulance cars, training of ambulance assistants and adaptations in working procedures.

  1. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Requirements for ambulance suppliers. 410.41 Section 410.41 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... origin and destination and indicate on claims form that the physician certification is on file. (2)...

  2. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Requirements for ambulance suppliers. 410.41 Section 410.41 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... origin and destination and indicate on claims form that the physician certification is on file. (2)...

  3. 42 CFR 410.41 - Requirements for ambulance suppliers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... laws. (3) Be equipped with telecommunications equipment as required by State or local law to include... by State or local laws. (b) Vehicle staff—(1) BLS vehicles. A vehicle furnishing ambulance services... certification requirements in accordance with State and local laws. (3) Upon a carrier's request,...

  4. A framework for the design of ambulance sirens.

    PubMed

    Catchpole, K; McKeown, D

    2007-08-01

    Ambulance sirens are essential for assisting the safe and rapid arrival of an ambulance at the scene of an emergency. In this study, the parameters upon which sirens may be designed were examined and a framework for emergency vehicle siren design was proposed. Validity for the framework was supported through acoustic measurements and the evaluation of ambulance transit times over 240 emergency runs using two different siren systems. Modifying existing siren sounds to add high frequency content would improve vehicle penetration, detectability and sound localization cues, and mounting the siren behind the radiator grill, rather than on the light bar or under the wheel arch, would provide less unwanted noise while maintaining or improving the effective distance in front of the vehicle. Ultimately, these considerations will benefit any new attempt to design auditory warnings for the emergency services. PMID:17558670

  5. Crash protection for children in ambulances.

    PubMed

    Bull, M J; Weber, K; Talty, J; Manary, M

    2001-01-01

    The objectives of the study were to determine the most effective and reliable means of restraining children on an ambulance cot and to develop recommended field procedures for emergency medical service providers. A series of crash tests at 48 km/h were conducted using convertible child restraints, car beds, and harness systems tested with 3-year, infant, and 6-year size dummies. Belt configuration and backrest position were varied. A new cot and fastener system significantly improved restraint performance over older systems previously tested. A two-belt attachment with elevated cot backrest was found to be the method with the least performance variability for securing either a convertible child restraint or a car bed. It was concluded that children who weight up to 18 kg, fit in a convertible child restraint, and can tolerate a semi-upright seated position can be restrained in a convertible child restraint secured with two belts to an ambulance cot. Infants who must lie flat can be restrained in a car bed modified for two seatbelt paths and secured to a cot. In each case, the cot backrest must be elevated, and the cot and anchor system must be crashworthy. None of the harness configurations tested proved to be satisfactory, but an effective system could be developed by following accepted restraint design principles. PMID:12214360

  6. 42 CFR 414.620 - Publication of the ambulance fee schedule.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... from incorporation of the annual inflation factor described in § 414.610(f) will be announced by CMS by... to the fee schedule for ambulance services that result from any factors other than the...

  7. Post-traumatic stress among Swedish ambulance personnel

    PubMed Central

    Jonsson, A; Segesten, K; Mattsson, B

    2003-01-01

    Objective: Emergency workers, including ambulance personnel, must cope with a variety of duty related stressors including traumatic incident exposures. Little is known about the variables that might be associated with post-traumatic stress symptom in high risk occupational groups such as ambulance personnel. This study investigated the prevalence of post-traumatic stress disorder among Swedish ambulance personnel. Methods: To estimate the prevalence of trauma related disorders, a representative group of 362 ambulance personal from the county of Västra Götaland in Sweden was surveyed through use of a Swedish version of Antonovsky's 13-item short version of Sense of Coherence Scale, to measure reactions to traumatic events two instruments were used, Impact of Event Scale (IES-15) and the Post Traumatic Symptom Scale (PTSS-10). A total of 223 of the ambulance personnel reported that they had had experience of what they described as traumatic situations. Results: Of those who reported a traumatic situation 15.2% scored 31 or more on the IES-15 sub scale. Scores over 31 indicate a stress reaction with certain likelihood of post-traumatic disorder. On the PTSS-10 subscale 12.1% scored 5 or more, which indicates a relative strong reaction. The study indicates that lower sense of coherence predicts post-traumatic stress. Other predictors for the extent of traumatic stress were longer job experience, age, physical and psychological workload. Conclusions: The high prevalence of post-traumatic stress disorder symptoms in ambulance personnel indicates an inability to cope with stress in daily work. The strong relation between post-traumatic stress and Sense of Coherence Scale may be useful in predicting vulnerability for post-traumatic symptoms among recently employed ambulance service personnel. To prevent or reduce the upcoming of post-traumatic stress disorder symptoms it must be possible to take leave of absence, or for a longer or shorter time be transferred to non

  8. Domestic Refrigeration, Freezer, and Window Air Conditioner Service. Teacher Edition.

    ERIC Educational Resources Information Center

    Clemons, Mark

    This curriculum guide contains six units of instruction for a course in domestic refrigerator, freezer, and window air conditioner service. The units cover the following topics: (1) service fundamentals; (2) mechanical components and functions; (3) electrical components and control devices; (4) refrigerator and freezer service; (5) domestic ice…

  9. Air Conditioning. FOS: Fundamentals of Service.

    ERIC Educational Resources Information Center

    Employment and Training Administration (DOL), Washington, DC. Office of Youth Programs.

    This manual on air conditioning is one of a series of power mechanics texts and visual aids covering theory of operation, diagnosis, and repair. Information is presented for use by vocational students and teachers as well as shop servicemen and laymen. Focus is on air conditioning systems for mobile machines, but most of the information also…

  10. Pilot study on the microbial contamination of conventional vs. silver-impregnated uniforms worn by ambulance personnel during one week of emergency medical service

    PubMed Central

    Groß, Raoul; Hübner, Nils; Assadian, Ojan; Jibson, Bethany; Kramer, Axel

    2010-01-01

    The antimicrobial impregnation of products used everyday, such as surfaces, textiles and clothing – including those used in hospitals – is increasing. In view of potential toxic and environmental risks for users and patients, a careful risk-benefit assessment must be conducted for each newly developed product impregnated or coated with antimicrobial agents, prior to marketing and manufacture. It has been proposed that incorporation of silver threads into the clothing of emergency service workers could reduce microbial contamination over time. As clothing in the emergency services is often not adequately changed, and it is plausible that microbial contamination increases with time in use, a study was conducted in the emergency medical setting in order to test this hypothesis. We compared the contamination rates of newly developed silver-hybrid clothing with that of standard textile clothing. Samples were taken from jackets and pants of 10 emergency workers at day 0 (pre-service), day 3 and day 7 after use over a divided 4-week period to examine this hypothesis. No significant difference in the extent of microbial contamination was detected between these two materials. A larger sample size is required to further verify this result. PMID:20941337

  11. Ambulance clinical placements – A pilot study of students' experience

    PubMed Central

    Boyle, Malcolm J; Williams, Brett; Cooper, Jennifer; Adams, Bridget; Alford, Kassie

    2008-01-01

    Background Undergraduate paramedic students undertake clinical placements in a variety of locations. These placements are considered an essential element for paramedic pre-employment education. However, anecdotal evidence suggests some students have not had positive experiences on their emergency ambulance placements. The objective of this study was to identify the type of experiences had by students during ambulance clinical placements and to provide feedback to the ambulance services. Methods In this pilot study we employed a cross-sectional study methodology, using a convenience sample of undergraduate paramedic students available in semester one of 2007 to ascertain the students' views on their reception by on-road paramedics and their overall experience on emergency ambulance clinical placements. Ethics approval was granted. Results There were 77 students who participated in the survey, 64% were females, with 92% of students < 25 years of age and 55% < 65 Kg in weight. There was a statistically significant difference in average height between the genders (Male 179 cm vs Female 168 cm, p < 0.001). Clinical instructors were available to 44% of students with 30% of students excluded from patient management. Thirty percent of students felt there was a lot of unproductive down time during the placement. Paramedics remarked to 40% of students that they doubted their ability to perform the physical role of a paramedic, of this group 36% were advised this more than once. Conclusion This study demonstrates that for a small group of students, emergency ambulance clinical placements were not a positive experience clinically or educationally. Some qualified paramedics doubt if a number of female students can perform the physical role of a paramedic. PMID:18400111

  12. Emergency Medical Service

    NASA Technical Reports Server (NTRS)

    1980-01-01

    Lewis Research Center helped design the complex EMS Communication System, originating from space operated telemetry, including the telemetry link between ambulances and hospitals for advanced life support services. In emergency medical use telemetry links ambulances and hospitals for advanced life support services and allows transmission of physiological data -- an electrocardiogram from an ambulance to a hospital emergency room where a physician reads the telemetered message and prescribes emergency procedures to ambulance attendants.

  13. Air service to small communities, directions for the future. [conference

    NASA Technical Reports Server (NTRS)

    Vittek, J. F., Jr. (Editor)

    1974-01-01

    The seminar on the problems of providing air service to low and medium density points is reported. National transport policies and programs are discussed along with the technology aspects. Recommendations for ATC, CAB, and FAA are included.

  14. Assessment and Improvement of Related Services (AIRS) Project. Final Report.

    ERIC Educational Resources Information Center

    McClelland, Robert A.; Hirata, Glenn T.

    The document presents the final report of the Assessment and Improvement of Related Services (AIRS) Project, an effort to assess the impact and effectiveness of special education related services in Hawaii. Each of the four project objectives focused on accomplishment of one of the evaluation types specified in the Context-Input-Process-Product…

  15. A national census of ambulance response times to emergency calls in Ireland

    PubMed Central

    Breen, N.; Woods, J.; Bury, G.; Murphy, A.; Brazier, H.

    2000-01-01

    Background—Equity of access to appropriate pre-hospital emergency care is a core principle underlying an effective ambulance service. Care must be provided within a timeframe in which it is likely to be effective. A national census of response times to emergency and urgent calls in statutory ambulance services in Ireland was undertaken to assess current service provision. Methods—A prospective census of response times to all emergency and urgent calls was carried out in the nine ambulance services in the country over a period of one week. The times for call receipt, activation, arrival at and departure from scene and arrival at hospital were analysed. Crew type, location of call and distance from ambulance base were detailed. The type of incident leading to the call was recorded but no further clinical information was gathered. Results—2426 emergency calls were received by the services during the week. Fourteen per cent took five minutes or longer to activate (range 5–33%). Thirty eight per cent of emergencies received a response within nine minutes (range 10–47%). Only 4.5% of emergency calls originating greater than five miles from an ambulance station were responded to within nine minutes (range 0–10%). Median patient care times for "on call" crews were three times longer than "on duty" crews. Conclusion—Without prioritised use of available resources, inappropriately delayed responses to critical incidents will continue. Recommendations are made to improve the effectiveness of emergency medical service utilisation. PMID:11104237

  16. [Design of a mechanical system for the balanceable system of ambulance].

    PubMed

    Zheng, Yi; Luo, Yibin; Zhang, Guangpeng; Zhang, Zhide; Chen, Chaomin

    2010-08-01

    This is the design of a mechanical systems for use in the balanceable system of ambulance, which can keep the medical service bed at the ambulance level, whatever the terrain is. A level detector will detect the level state of the bed and turn it to a signal. The central processing unit will use this signal to analyse and control the movement of the motor. By this design (which uses the rolling rail as a drive transmission and makes three supports of the bed go up and down), the bed will keep level. With the use of this design, the balanceable system of ambulance can counteract 35 degrees. The error is controlled within +/- 1 degree. And the response time is within 0.3 s. The method of registration can be effective for keeping the bed at the ambulance level, and for reducing the chance of making the patient get hurt on the way to hospital.

  17. [Ambulance helicopters in the mountains. An evaluation of the 1-year activity at the Dombås base].

    PubMed

    Karper, S; Stokstad, I; Hjort, P F; Indrebø, T

    1991-01-20

    On 1 January 1988 the Norwegian Air Ambulance Plan was put into effect. The operational base for the regional counties Oppland, parts of South Trøndelag, Møre and Romsdal and Hedmark was established in the township of Dombås. The base had a helicopter staffed with a specialist in emergency medicine. The operation of this base was evaluated for the period 1 February 1988 to 1 February 1989. 242 missions were undertaken. In 27 of 184 primary missions (15%) and in 11 of 32 secondary missions (33%) the service was judged to have given health benefit. It may have prevented the death of 13 patients. The service costs during the year were approximately NOK 10 million. The cost-benefit ratio is judged to be too high. In inland-Norway, with a widely scattered population, it is probably better to improve the quality of the emergency services offered by general practitioners and ordinary road ambulances than to use a helicopter staffed with a specialist in emergency medicine.

  18. Equipment to prevent, diagnose, and treat hypothermia: a survey of Norwegian pre-hospital services

    PubMed Central

    2013-01-01

    Introduction Hypothermia is associated with increased morbidity and mortality in trauma patients and poses a challenge in pre-hospital treatment. The aim of this study was to identify equipment to prevent, diagnose, and treat hypothermia in Norwegian pre-hospital services. Method In the period of April-August 2011, we conducted a survey of 42 respondents representing a total of 543 pre-hospital units, which included all the national ground ambulance services, the fixed wing and helicopter air ambulance service, and the national search and rescue service. The survey explored available insulation materials, active warming devices, and the presence of protocols describing wrapping methods, temperature monitoring, and the use of warm i.v. fluids. Results Throughout the services, hospital duvets, cotton blankets and plastic “bubble-wrap” were the most common insulation materials. Active warming devices were to a small degree available in vehicle ambulances (14%) and the fixed wing ambulance service (44%) but were more common in the helicopter services (58-70%). Suitable thermometers for diagnosing hypothermia were lacking in the vehicle ambulance services (12%). Protocols describing how to insulate patients were present for 73% of vehicle ambulances and 70% of Search and Rescue helicopters. The minority of Helicopter Emergency Medical Services (42%) and Fixed Wing (22%) units was reported to have such protocols. Conclusion The most common equipment types to treat and prevent hypothermia in Norwegian pre-hospital services are duvets, plastic “bubble wrap”, and cotton blankets. Active external heating devices and suitable thermometers are not available in most vehicle ambulance units. PMID:23938145

  19. Medicare program; Medicare ambulance MMA temporary rate increases beginning July 1, 2004. Interim final rule with comment period.

    PubMed

    2004-07-01

    This interim final rule codifies the four payment provisions for Medicare covered ambulance services contained in section 414 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).

  20. 47 CFR 22.805 - Channels for general aviation air-ground service.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 2 2014-10-01 2014-10-01 false Channels for general aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service General Aviation Air-Ground Stations § 22.805 Channels for general aviation air-ground service. The following channels are...

  1. 47 CFR 22.805 - Channels for general aviation air-ground service.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 2 2012-10-01 2012-10-01 false Channels for general aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service General Aviation Air-Ground Stations § 22.805 Channels for general aviation air-ground service. The following channels are...

  2. 47 CFR 22.805 - Channels for general aviation air-ground service.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Channels for general aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service General Aviation Air-Ground Stations § 22.805 Channels for general aviation air-ground service. The following channels are...

  3. 47 CFR 22.805 - Channels for general aviation air-ground service.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Channels for general aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service General Aviation Air-Ground Stations § 22.805 Channels for general aviation air-ground service. The following channels are...

  4. Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns

    PubMed Central

    Doyle, Joseph; Graves, John; Gruber, Jonathan

    2014-01-01

    Medicare spending exceeds 4% of GDP in the US each year, and there are concerns that moral hazard problems have led to overspending. This paper considers whether hospitals that treat patients more aggressively and receive higher payments from Medicare improve health outcomes for their patients. An innovation is a new lens to compare hospital performance for emergency patients: plausibly exogenous variation in ambulance-company assignment among patients who live near one another. Using Medicare data from 2002–2010, we show that ambulance company assignment importantly affects hospital choice for patients in the same ZIP code. Using data for New York State from 2000–2006 that matches exact patient addresses to hospital discharge records, we show that patients who live very near each other but on either side of ambulance service area boundaries go to different types of hospitals. Both identification strategies show that higher-cost hospitals achieve better patient outcomes for a variety of emergency conditions. Using our Medicare sample, the estimates imply that a one standard deviation increase in Medicare reimbursement leads to a 4 percentage point reduction in mortality (10% compared to the mean). Taking into account one-year spending after the health shock, the implied cost per at least one year of life saved is approximately $80,000. These results are found across different types of hospitals and patients, as well across both identification strategies. PMID:25750459

  5. Weather factors in the short-term forecasting of daily ambulance calls.

    PubMed

    Wong, Ho-Ting; Lai, Poh-Chin

    2014-07-01

    The daily ambulance demand for Hong Kong is rising, and it has been shown that weather factors (temperature and humidity) play a role in the demand for ambulance services. This study aimed at developing short-term forecasting models of daily ambulance calls using the 7-day weather forecast data as predictors. We employed the autoregressive integrated moving average (ARIMA) method to analyze over 1.3 million cases of emergency attendance in May 2006 through April 2009 and the 7-day weather forecast data for the same period. Our results showed that the ARIMA model could offer reasonably accurate forecasts of daily ambulance calls at 1-7 days ahead of time and with improved accuracy by including weather factors. Specifically, the inclusion of average temperature alone in our ARIMA model improved the predictability of the 1-day forecast when compared to that of a simple ARIMA model (8.8% decrease in the root mean square error, RMSE=53 vs 58). The improvement in the 7-day forecast with average temperature as a predictor was more pronounced, with a 10% drop in prediction error (RMSE=62 vs 69). These findings suggested that weather forecast data can improve the 1- to 7-day forecasts of daily ambulance demand. As weather forecast data are readily accessible from Hong Kong Observatory's official website, there is virtually no cost to including them in the ARIMA models, which yield better prediction for forward planning and deployment of ambulance manpower.

  6. Weather factors in the short-term forecasting of daily ambulance calls

    NASA Astrophysics Data System (ADS)

    Wong, Ho-Ting; Lai, Poh-Chin

    2013-03-01

    The daily ambulance demand for Hong Kong is rising, and it has been shown that weather factors (temperature and humidity) play a role in the demand for ambulance services. This study aimed at developing short-term forecasting models of daily ambulance calls using the 7-day weather forecast data as predictors. We employed the autoregressive integrated moving average (ARIMA) method to analyze over 1.3 million cases of emergency attendance in May 2006 through April 2009 and the 7-day weather forecast data for the same period. Our results showed that the ARIMA model could offer reasonably accurate forecasts of daily ambulance calls at 1-7 days ahead of time and with improved accuracy by including weather factors. Specifically, the inclusion of average temperature alone in our ARIMA model improved the predictability of the 1-day forecast when compared to that of a simple ARIMA model (8.8 % decrease in the root mean square error, RMSE = 53 vs 58). The improvement in the 7-day forecast with average temperature as a predictor was more pronounced, with a 10 % drop in prediction error (RMSE = 62 vs 69). These findings suggested that weather forecast data can improve the 1- to 7-day forecasts of daily ambulance demand. As weather forecast data are readily accessible from Hong Kong Observatory's official website, there is virtually no cost to including them in the ARIMA models, which yield better prediction for forward planning and deployment of ambulance manpower.

  7. Weather factors in the short-term forecasting of daily ambulance calls.

    PubMed

    Wong, Ho-Ting; Lai, Poh-Chin

    2014-07-01

    The daily ambulance demand for Hong Kong is rising, and it has been shown that weather factors (temperature and humidity) play a role in the demand for ambulance services. This study aimed at developing short-term forecasting models of daily ambulance calls using the 7-day weather forecast data as predictors. We employed the autoregressive integrated moving average (ARIMA) method to analyze over 1.3 million cases of emergency attendance in May 2006 through April 2009 and the 7-day weather forecast data for the same period. Our results showed that the ARIMA model could offer reasonably accurate forecasts of daily ambulance calls at 1-7 days ahead of time and with improved accuracy by including weather factors. Specifically, the inclusion of average temperature alone in our ARIMA model improved the predictability of the 1-day forecast when compared to that of a simple ARIMA model (8.8% decrease in the root mean square error, RMSE=53 vs 58). The improvement in the 7-day forecast with average temperature as a predictor was more pronounced, with a 10% drop in prediction error (RMSE=62 vs 69). These findings suggested that weather forecast data can improve the 1- to 7-day forecasts of daily ambulance demand. As weather forecast data are readily accessible from Hong Kong Observatory's official website, there is virtually no cost to including them in the ARIMA models, which yield better prediction for forward planning and deployment of ambulance manpower. PMID:23456448

  8. Weather factors in the short-term forecasting of daily ambulance calls

    NASA Astrophysics Data System (ADS)

    Wong, Ho-Ting; Lai, Poh-Chin

    2014-07-01

    The daily ambulance demand for Hong Kong is rising, and it has been shown that weather factors (temperature and humidity) play a role in the demand for ambulance services. This study aimed at developing short-term forecasting models of daily ambulance calls using the 7-day weather forecast data as predictors. We employed the autoregressive integrated moving average (ARIMA) method to analyze over 1.3 million cases of emergency attendance in May 2006 through April 2009 and the 7-day weather forecast data for the same period. Our results showed that the ARIMA model could offer reasonably accurate forecasts of daily ambulance calls at 1-7 days ahead of time and with improved accuracy by including weather factors. Specifically, the inclusion of average temperature alone in our ARIMA model improved the predictability of the 1-day forecast when compared to that of a simple ARIMA model (8.8 % decrease in the root mean square error, RMSE = 53 vs 58). The improvement in the 7-day forecast with average temperature as a predictor was more pronounced, with a 10 % drop in prediction error (RMSE = 62 vs 69). These findings suggested that weather forecast data can improve the 1- to 7-day forecasts of daily ambulance demand. As weather forecast data are readily accessible from Hong Kong Observatory's official website, there is virtually no cost to including them in the ARIMA models, which yield better prediction for forward planning and deployment of ambulance manpower.

  9. Weather and age-gender effects on the projection of future emergency ambulance demand in Hong Kong.

    PubMed

    Lai, Poh-Chin; Wong, Ho-Ting

    2015-03-01

    An accurate projection for ambulance demand is essential to enable better resource planning for the future that strives to either maintain current levels of services or reconsider future standards and expectations. More than 2 million cases of emergency room attendance in 2008 were obtained from the Hong Kong Hospital Authority to project the demand for its ambulance services in 2036. The projection of ambulance demand in 2036 was computed in consideration of changes in the age-gender structure between 2008 and 2036. The quadratic relation between average daily temperature and daily ambulance demand in 2036 was further explored by including and excluding age-gender demographic changes. Without accounting for changes in the age-gender structure, the 2036 ambulance demand for age groups of 65 and above were consistently underestimated (by 38%-65%), whereas those of younger age groups were overestimated (by 6%-37%). Moreover, changes in the 2008 to 2036 age-gender structure also shift upward and emphasize relationships between average daily temperature and daily ambulance demand at both ends of the quadratic U-shaped curve. Our study reveals a potential societal implication of ageing population on the demand for ambulance services.

  10. Weather and age-gender effects on the projection of future emergency ambulance demand in Hong Kong.

    PubMed

    Lai, Poh-Chin; Wong, Ho-Ting

    2015-03-01

    An accurate projection for ambulance demand is essential to enable better resource planning for the future that strives to either maintain current levels of services or reconsider future standards and expectations. More than 2 million cases of emergency room attendance in 2008 were obtained from the Hong Kong Hospital Authority to project the demand for its ambulance services in 2036. The projection of ambulance demand in 2036 was computed in consideration of changes in the age-gender structure between 2008 and 2036. The quadratic relation between average daily temperature and daily ambulance demand in 2036 was further explored by including and excluding age-gender demographic changes. Without accounting for changes in the age-gender structure, the 2036 ambulance demand for age groups of 65 and above were consistently underestimated (by 38%-65%), whereas those of younger age groups were overestimated (by 6%-37%). Moreover, changes in the 2008 to 2036 age-gender structure also shift upward and emphasize relationships between average daily temperature and daily ambulance demand at both ends of the quadratic U-shaped curve. Our study reveals a potential societal implication of ageing population on the demand for ambulance services. PMID:23070758

  11. Ambulance call-outs and response times in Birmingham and the impact of extreme weather and climate change.

    PubMed

    Thornes, John Edward; Fisher, Paul Anthony; Rayment-Bishop, Tracy; Smith, Christopher

    2014-03-01

    Although there has been some research on the impact of extreme weather on the number of ambulance call-out incidents, especially heat waves, there has been very little research on the impact of cold weather on ambulance call-outs and response times. In the UK, there is a target response rate of 75% of life threatening incidents (Category A) that must be responded to within 8 min. This paper compares daily air temperature data with ambulance call-out data for Birmingham over a 5-year period (2007-2011). A significant relationship between extreme weather and increased ambulance call-out and response times can clearly be shown. Both hot and cold weather have a negative impact on response times. During the heat wave of August 2003, the number of ambulance call-outs increased by up to a third. In December 2010 (the coldest December for more than 100 years), the response rate fell below 50% for 3 days in a row (18 December-20 December 2010) with a mean response time of 15 min. For every reduction of air temperature by 1°C there was a reduction of 1.3% in performance. Improved weather forecasting and the take up of adaptation measures, such as the use of winter tyres, are suggested for consideration as management tools to improve ambulance response resilience during extreme weather. Also it is suggested that ambulance response times could be used as part of the syndromic surveillance system at the Health Protection Agency.

  12. Learning at Air Navigation Services after Initial Training

    ERIC Educational Resources Information Center

    Teperi, Anna-Maria; Leppanen, Anneli

    2010-01-01

    Purpose: This study aims to find out the means used for individual, group and organizational learning at work at one air navigation service provider after the initial training period. The study also aims to find out what practices need to be improved to enhance learning at work. Design/methodology/approach: The data for the study were collected…

  13. Can innovative ambulance transport avert pregnancy–related deaths? One–year operational assessment in Ethiopia

    PubMed Central

    Godefay, Hagos; Kinsman, John; Admasu, Kesetebirhan; Byass, Peter

    2016-01-01

    Background To maximise the potential benefits of maternity care services, pregnant women need to be able to physically get to health facilities in a timely manner. In most of sub–Saharan Africa, transport represents a major practical barrier. Here we evaluate the extent to which an innovative national ambulance service in Ethiopia, together with mobile phones, may have been successful in averting pregnancy–related deaths. Methods An operational assessment of pregnancy–related deaths in relation to utilisation of the new national ambulance service was undertaken in six randomly selected Districts in northern Ethiopia. All 183 286 households in the six randomly selected Districts were visited to identify live–births and deaths among women of reproductive age that occurred over a one–year period. The uptake of the new ambulance transport service for women’s deliveries in the same six randomly selected Districts over the same period was determined retrospectively from ambulance log books. Pregnancy–related deaths as determined by the World Health Organization (WHO 2012) verbal autopsy tool [13] and the InterVA–4 model [14] were analysed against ambulance utilisation by District, month, local area, distance from health facility and mobile network coverage. Findings A total of 51 pregnancy–related deaths and 19 179 live–births were documented. Pregnancy–related mortality for Districts with above average ambulance utilisation was 149 per 100 000 live–births (95% confidence interval CI 77–260), compared with 350 per 100 000 (95% CI 249–479) for below average utilisation (P = 0.01). Distance to a health facility, mobile network availability and ambulance utilisation were all significantly associated with pregnancy–related mortality on a bivariable basis. On a multivariable basis, ambulance non–utilisation uniquely persisted as a significant determinant of mortality (mortality rate ratio 1.97, 95% CI 1.05–3.69; P = 0

  14. Survey of indoor air monitoring services: is there a private demand for healthful indoor air quality

    SciTech Connect

    Sexton, K.

    1985-06-01

    It is becoming increasingly evident that indoor air quality in nonindustrial environments is often less healthful than outdoor air quality. The short- and long-term health consequences of indoor exposures are not well defined, yet private citizens and organizations are becoming more concerned about potential adverse health effects. Questions and complaints about indoor environmental hazards are an expanding problem for federal, state, and local health agencies. This paper describes findings from a national survey of fee-for-service companies which make indoor air measurements in nonindustrial settings. Information is presented on the makeup of these firms, the types and numbers of buildings which have been investigated, typical contaminant measurements, and associated costs. Results indicate that a substantial private demand exists for goods and services which aid building occupants in evaluating and improving indoor air quality.

  15. 47 CFR 22.881 - Air-Ground Radiotelephone Service subject to competitive bidding.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... exclusive initial applications for general aviation Air-Ground Radiotelephone Service licenses and mutually...) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air... competitive bidding. The general competitive bidding procedures set forth in part 1, subpart Q, of...

  16. 47 CFR 22.881 - Air-Ground Radiotelephone Service subject to competitive bidding.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 2 2012-10-01 2012-10-01 false Air-Ground Radiotelephone Service subject to competitive bidding. 22.881 Section 22.881 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.881...

  17. 47 CFR 22.881 - Air-Ground Radiotelephone Service subject to competitive bidding.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 2 2011-10-01 2011-10-01 false Air-Ground Radiotelephone Service subject to competitive bidding. 22.881 Section 22.881 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.881...

  18. 47 CFR 22.881 - Air-Ground Radiotelephone Service subject to competitive bidding.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... exclusive initial applications for general aviation Air-Ground Radiotelephone Service licenses and mutually...) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air... competitive bidding. The general competitive bidding procedures set forth in part 1, subpart Q, of...

  19. Environment and air pollution: health services bequeath to grotesque menace.

    PubMed

    Qureshi, Muhammad Imran; Rasli, Amran Md; Awan, Usama; Ma, Jian; Ali, Ghulam; Faridullah; Alam, Arif; Sajjad, Faiza; Zaman, Khalid

    2015-03-01

    The objective of the study is to establish the link between air pollution, fossil fuel energy consumption, industrialization, alternative and nuclear energy, combustible renewable and wastes, urbanization, and resulting impact on health services in Malaysia. The study employed two-stage least square regression technique on the time series data from 1975 to 2012 to possibly minimize the problem of endogeniety in the health services model. The results in general show that air pollution and environmental indicators act as a strong contributor to influence Malaysian health services. Urbanization and nuclear energy consumption both significantly increases the life expectancy in Malaysia, while fertility rate decreases along with the increasing urbanization in a country. Fossil fuel energy consumption and industrialization both have an indirect relationship with the infant mortality rate, whereas, carbon dioxide emissions have a direct relationship with the sanitation facility in a country. The results conclude that balancing the air pollution, environment, and health services needs strong policy vistas on the end of the government officials.

  20. Environment and air pollution: health services bequeath to grotesque menace.

    PubMed

    Qureshi, Muhammad Imran; Rasli, Amran Md; Awan, Usama; Ma, Jian; Ali, Ghulam; Faridullah; Alam, Arif; Sajjad, Faiza; Zaman, Khalid

    2015-03-01

    The objective of the study is to establish the link between air pollution, fossil fuel energy consumption, industrialization, alternative and nuclear energy, combustible renewable and wastes, urbanization, and resulting impact on health services in Malaysia. The study employed two-stage least square regression technique on the time series data from 1975 to 2012 to possibly minimize the problem of endogeniety in the health services model. The results in general show that air pollution and environmental indicators act as a strong contributor to influence Malaysian health services. Urbanization and nuclear energy consumption both significantly increases the life expectancy in Malaysia, while fertility rate decreases along with the increasing urbanization in a country. Fossil fuel energy consumption and industrialization both have an indirect relationship with the infant mortality rate, whereas, carbon dioxide emissions have a direct relationship with the sanitation facility in a country. The results conclude that balancing the air pollution, environment, and health services needs strong policy vistas on the end of the government officials. PMID:25242593

  1. Ambulance and aeromedical accident rates during emergency retrieval in Great Britain.

    PubMed

    Lutman, D; Montgomery, M; Ramnarayan, P; Petros, A

    2008-05-01

    The retrieval of critically ill patients is frequently done in difficult circumstances and often under considerable time pressures. These adverse conditions have a finite risk of serious injury or death. The level of risk is poorly described in the literature and reliable data on accident rates are hard to find. Most of the information comes from North America. There are no clear published statistics for the UK. We report for the first time data on accidents and casualties involving vehicles classified as having an ambulance body type and air ambulances within Great Britain between 1999 and 2004. PMID:18434473

  2. Ambulance officers' use of online clinical evidence

    PubMed Central

    Westbrook, Johanna I; Westbrook, Mary T; Gosling, A Sophie

    2006-01-01

    Background Hospital-based clinicians have been shown to use and attain benefits from online evidence systems. To our knowledge there have been no studies investigating whether and how ambulance officers use online evidence systems if provided. We surveyed ambulance officers to examine their knowledge and use of the Clinical Information Access Program (CIAP), an online evidence system providing 24-hour access to information to support evidence-based practice. Methods A questionnaire was completed by 278 ambulance officers in New South Wales, Australia. Comparisons were made between those who used CIAP and officers who had heard of, but not used CIAP. Results Half the sample (48.6%) knew of, and 28.8% had used CIAP. Users were more likely to have heard of CIAP from a CIAP representative/presentation, non-users from written information. Compared to ambulance officers who had heard of but had not used CIAP, users were more likely to report better computer skills and that their supervisors regarded use of CIAP as a legitimate part of ambulance officers' clinical role. The main reasons for non-use were lack of access(49.0%) and training(31.4%). Of users, 51.3% rated their skills at finding information as good/very good, 67.5% found the information sought all/most of the time, 87.3% believed CIAP had the potential to improve patient care and 28.2% had directly experienced this. Most access to CIAP occurred at home. The databases frequently accessed were MIMS (A medicines information database) (73.8%) and MEDLINE(67.5%). The major journals accessed were Journal of Emergency Nursing(37.5%), American Journal of Medicine(30.0%) and JAMA(27.5%). Conclusion Over half of ambulance officers had not heard of CIAP. The proportion who knew about and used CIAP was also low. Reasons for this appear to be a work culture not convinced of CIAP's relevance to pre-hospital patient care and lack of access to CIAP at work. Ambulance officers who used CIAP accessed it primarily from home and

  3. 76 FR 61245 - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ... the Federal Register. (Presidential Sig.) THE WHITE HOUSE, Washington, September 28, 2011 [FR Doc... Coverage for Commercial Air Carrier Service in Domestic and International Operations #0; #0; #0... Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International...

  4. Emergency Medical Technician-Ambulance: National Standard Curriculum. Course Guide (Third Edition).

    ERIC Educational Resources Information Center

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This course guide is intended to assist course coordinators in planning and managing a course to train emergency medical technicians to work with ambulance or other specialized rescue services. Materials are presented to enable students to perform the following functions: recognize the nature and seriousness of the patient's condition or extent of…

  5. Assisted ambulation and activities for persons with profound multiple disabilities: assessing different ambulation levels.

    PubMed

    Lancioni, G E; Mantini, M; Groeneweg, J

    2001-06-01

    Two participants with profound multiple disabilities were exposed to two occupational situations, which included 1-min. and 3-min. robot-assisted ambulation prior to each activity, respectively. Analysis showed participants' mean percentages of engagement time (session time they spent ambulating or manipulating objects) were well above 90 in both situations. The amount of deviant behavior was somewhat higher in the latter occupational situation for one participant. Implications of the findings were discussed.

  6. 14 CFR 71.13 - Classification of Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Classification of Air Traffic Service (ATS... TRANSPORTATION (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.13 Classification of Air Traffic Service (ATS) routes. Unless...

  7. 14 CFR 71.13 - Classification of Air Traffic Service (ATS) routes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Classification of Air Traffic Service (ATS... TRANSPORTATION (CONTINUED) AIRSPACE DESIGNATION OF CLASS A, B, C, D, AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS § 71.13 Classification of Air Traffic Service (ATS) routes. Unless...

  8. 14 CFR 272.6 - Considerations in the determination of essential air service.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... § 272.6 Considerations in the determination of essential air service. (a) In the determination of... part. (c) Nothing in this part shall be construed as providing for a level of essential air service... essential air service. 272.6 Section 272.6 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT...

  9. Energy cost of ambulation in healthy and disabled Filipino children.

    PubMed

    Luna-Reyes, O B; Reyes, T M; So, F Y; Matti, B M; Lardizabal, A A

    1988-11-01

    The energy expenditures (Ee) for locomotion by nondisabled and disabled Filipino children aged 7 to 13 were determined and compared using indirect calorimetry. Forty-one controls (20 boys and 21 girls) ambulated at a comfortable pace; 16 children (eight boys and eight girls) with lower extremity poliomyelitis of varying severity ambulated by (1) wheelchair propulsion, (2) bilateral axillary crutches, (3) unilateral lower extremity ankle-foot orthoses or knee-ankle-foot orthoses, and (4) unassisted. Disabled children, regardless of their mode of ambulation, had to expend significantly more energy to ambulate than normal children (p less than 0.05). Wheelchair propulsion cost 16% more energy than the normal gait; crutch ambulation cost 41% more than the control. Children using unilateral braces sacrificed speed to attain near-normal Ee. When they ambulated without orthoses, their Ee increased by 109% over the control. In ascending order, the least energy was expanded by normal ambulation followed by disabled ambulation with unilateral brace, disabled propelling a wheelchair, disabled ambulation with bilateral axillary crutches, and disabled ambulation without brace. Efficiency of locomotion was reflected in the values obtained for Ee in terms of kcal x 10(-3)/kg/m, as demonstrated by the lower Ee but slower ambulation of children with braces, as compared to the nondisabled children.

  10. AIRS Science Data Services at NASA Goddard Earth Sciences Data and Info Services

    NASA Astrophysics Data System (ADS)

    Li, J.; Theobald, M.; Vollmer, B.; Hua, X.; Won, Y.

    2007-12-01

    The Atmospheric Infrared Sounder (AIRS) is a very high spectral resolution passive infrared sounder with more than 2000 well-calibrated spectral channels measuring in the range of 3.74 - 15.4 micron. The AIRS instrument was successfully launched aboard the NASA Aqua spacecraft in May, 2002 and has been providing global coverage ever since. The infrared radiance data product is stable to 10 mK/year and accurate to better than 250 mK. The AIRS product is the most accurate and stable set of hyperspectral infrared radiance spectra measurements made in space to date, and its meets the criteria identified by the National Research Council for climate data records. In addition, working in tandem with an Advanced Microwave Sounding Unit (AMSU-A) instrument, AIRS provides a three-dimensional view of the geophysical properties of the Earth's atmosphere. The geophysical products provide daily global temperature profiles at an accuracy of 1 K per 1 km thick layer in the troposphere and moisture profiles at an accuracy of 20% per 2 km thick layer in the lower troposphere (20% - 60% in the upper troposphere). AIRS standard swath and grid data products are available from the NASA Goddard Earth Sciences Data and Information Services Center (GES DISC). The latest version of AIRS products (Version 5) has many improvements over previous versions including better temperature and water vapor profiles, enhanced Level 2 temperature data products over land and polar regions, first-time retrievals of carbon monoxide and methane, improvements to ozone retrievals, warning 'flags' to identify concentrations of sulfur dioxide and dust and overall improvements error and quality flag parameterization. In addition to the AIRS standard products, the swath-based AIRS products are also produced in near real time (NRT) at the GES DISC facility using the same core science algorithms as in the regular science data production but using predicted ephemeris in place of definitive ephemeris data

  11. Controller evaluation of initial data link terminal air traffic control services

    NASA Astrophysics Data System (ADS)

    1991-01-01

    The results of the first Federal Aviation Administration (FAA) Technical Center investigation of the initial terminal air traffic control services were evaluated in order to identify service delivery methods which optimize controller acceptance, performance, and workload.

  12. 78 FR 26103 - Proposed Standard Operating Procedure (SOP) of the Aircraft Certification Service (AIR) Project...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-03

    ... Service (AIR) Project Prioritization and Resource Management ACTION: Notice of availability and request... process used to prioritize certification projects and manage certification project resources when local... Operating Procedure--Aircraft Certification Service Project Prioritization. FOR FURTHER INFORMATION...

  13. Ambulation Increases Decompression Sickness in Spacewalk Simulations

    NASA Technical Reports Server (NTRS)

    Pollock, N. W.; Natoli, M. J.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. Understanding the relationships is important to evaluate exercise prebreathe protocols and quantify decompression risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS. METHODS Four experiments will replicate the CEVIS exercise-enhanced oxygen prebreathe protocol, each with a different exception. The first of these is currently underway. Experiment 1 - Subjects complete controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining nonambulatory throughout. Experiment 2 - Subjects remain non-ambulatory during the preflight period and ambulatory at 4.3 psi. Experiment 3 - Subjects ambulate during the preflight period and remain non-ambulatory at 4.3 psi. Experiment 4 - The order of heavy and light exercise employed in the CEVIS protocol is

  14. Medical Requirements for Ambulance Design and Equipment. Emergency Health Series.

    ERIC Educational Resources Information Center

    National Academy of Sciences - National Research Council, Washington, DC. Div. of Medical Sciences.

    A vehicle must meet certain specific requirements to be classified as an ambulance if it is to satisfy the demands of the physician in terms of emergency care for which properly trained ambulance attendants can be held responsible. Developed by professional and lay experts for use by automotive designers and manufacturing, this publication would…

  15. 14 CFR 325.10 - Modification of the designated level of essential air service.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Modification of the designated level of essential air service. 325.10 Section 325.10 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) PROCEDURAL REGULATIONS ESSENTIAL AIR SERVICE PROCEDURES § 325.10 Modification of the designated level...

  16. 14 CFR 375.50 - Transit flights; scheduled international air service operations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Transit flights; scheduled international... WITHIN THE UNITED STATES Transit Flights § 375.50 Transit flights; scheduled international air service... to the International Air Services Transit Agreement in transit across the United States may not...

  17. 14 CFR 375.50 - Transit flights; scheduled international air service operations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Transit flights; scheduled international... WITHIN THE UNITED STATES Transit Flights § 375.50 Transit flights; scheduled international air service... to the International Air Services Transit Agreement in transit across the United States may not...

  18. 14 CFR 375.50 - Transit flights; scheduled international air service operations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Transit flights; scheduled international... WITHIN THE UNITED STATES Transit Flights § 375.50 Transit flights; scheduled international air service... to the International Air Services Transit Agreement in transit across the United States may not...

  19. 14 CFR 375.50 - Transit flights; scheduled international air service operations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Transit flights; scheduled international... WITHIN THE UNITED STATES Transit Flights § 375.50 Transit flights; scheduled international air service... to the International Air Services Transit Agreement in transit across the United States may not...

  20. 14 CFR 375.50 - Transit flights; scheduled international air service operations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Transit flights; scheduled international... WITHIN THE UNITED STATES Transit Flights § 375.50 Transit flights; scheduled international air service... to the International Air Services Transit Agreement in transit across the United States may not...

  1. Board Certification. Registered EMT-Paramedic. Registered EMT-Intermediate. Registered EMT-Ambulance. Registered EMT-Non-Ambulance.

    ERIC Educational Resources Information Center

    National Registry of Emergency Medical Technicians, Columbus, OH.

    These three brochures outline entry requirements and certification information for: (1) emergency medical technician (EMT)-ambulance and EMT-non-ambulance; (2) EMT-intermediate; and (3) EMT-paramedic. Each brochure provides information on entry requirements, including provisional registration and expiration date; lapsed registration; examination…

  2. Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in prehospital emergency care – an intervention study

    PubMed Central

    Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

    2015-01-01

    Background The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care. Methods A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Results Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions The use of active heat from underneath increases the patients’ thermal comfort and may prevent the negative consequences of cold stress. PMID:26374468

  3. Pacemaker assessment in the ambulant patient.

    PubMed Central

    Murray, A; Jordan, R S; Gold, R G

    1981-01-01

    A new technique for assessing implanted cardiac pacemaker function in the ambulant patient has been introduced and assessed. A modified portable electrocardiograph recorder is used to store 24 hours of electrocardiograms along with marker pulses indicating the timing of pacemaker impulses. The recorder detects this narrow impulse and records a wider marker pulse on a second channel. The false positive detection rate was estimated from recordings, each of 24 hours, taken from 10 patients. All of these patients were ambulant and none had a cardiac pacemaker. There was on average less than one false positive per 24 hours. When similar recordings were taken from a group of 15 patients with pacemakers, the average false positive rate in 13 of these patients was also less than on per 24 hours. In the two other recordings artefacts resulted in false positive rates of 28 and 960 per 24 hours. Failure to detect pacemaker pulses was confirmed in only one patient. In addition to determining the accuracy of pacemaker pulse detection, the clinical usefulness of this technique was assessed. Two patients had fixed-rate pacemakers and 13 had demand pacemakers. Of the latter, two patients had a total of three episodes of failure to sense, one patient frequently failed to capture, and six patients had episodes of inappropriate inhibition of the pacemaker, the number of episodes ranging from one to 21 in 24 hours. Paced complexes were easily identified even when they occurred as fusion complexes. The frequency of paced complexes was quantified in each patient and varied from 21 to over 100 000 impulses in the 24 hour period. PMID:7317218

  4. Emergency Department Overcrowding and Ambulance Turnaround Time

    PubMed Central

    Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul

    2015-01-01

    Objective The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. Methods This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Results Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). Conclusions In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance. PMID:26115183

  5. Reducing Time to First on Scene: An Ambulance-Community First Responder Scheme.

    PubMed

    Campbell, Alan; Ellington, Matt

    2016-01-01

    The importance of early access to prehospital care has been demonstrated in many medical emergencies. This work aims to describe the potential time benefit of implementing a student Community First Responder scheme to support ambulance services in an inner-city setting in the United Kingdom. Twenty final and penultimate year medical students in the UK were trained in the "First Person on Scene" Business and Technology Education Council (BTEC) qualification. Over 12 months, they attended 89 emergency calls in an inner-city setting as Community First Responders (CFRs), alongside the West Midlands Ambulance Service, UK. At the end of this period, a qualitative survey investigated the perceived educational value of the scheme. The mean CFR response time across all calls was an average of 3 minutes and 8 seconds less than ambulance crew response times. The largest difference was to calls relating to falls (12 min). The difference varied throughout the day, peaking between 16:00 and 18:00. All questionnaire respondents stated that they felt more prepared in assessing and treating acutely unwell patients. In this paper, the authors present a symbiotic solution which has both reduced time to first on scene and provided training and experience in medical emergencies for senior medical students. PMID:27119024

  6. Emergency obstetric referral in rural Sierra Leone: what can motorbike ambulances contribute? A mixed-methods study.

    PubMed

    Bhopal, Sunil S; Halpin, Stephen J; Gerein, Nancy

    2013-08-01

    Giving birth remains a dangerous endeavour for many of the world's women. Progress to improve this has been slow in sub-Saharan Africa. The second delay, where transport infrastructure is key in allowing a woman to reach care, has been a relatively neglected field of study. Six eRanger motorbike ambulances, specifically engineered for use on poor roads in resource-poor situations were provided in 2006 as part of an emergency referral system in rural Sierra Leone. The aim of this study was to evaluate the implementation of this referral system in terms of its use, acceptability and accessibility. Data were collected from usage records, and a series of semi-structured interviews and focus groups conducted to provide deeper understanding of the service. A total of 130 records of patients being transported to a health facility were found, 1/3 of which were for obstetric cases. The ambulance is being used regularly to transport patients to a health care facility. It is well known to the communities, is acceptable and accessible, and is valued by those it serves. District-wide traditional birth attendant training and the sensitisation activities provided a foundation for the introduction of the ambulance service, creating a high level of awareness of the service and its importance, particularly for women in labour. Motorbike ambulances are suited to remote areas and can function on poor roads inaccessible to other vehicles.

  7. Operational evaluation of initial data link air traffic control services, volume 1

    NASA Astrophysics Data System (ADS)

    Talotta, Nicholas J.; Shingledecker, Clark; Reynolds, Michael

    1990-02-01

    The results are detailed of an operational evaluation of initial data link air traffic control (ATC) services. The operational evaluation was conducted at the Federal Aviation Administration (FAA) Technical Center utilizing the data link test bed. Initial data link services were evaluated in order to identify service delivery methods which optimize controller acceptance, performance, and workload.

  8. Ambulation Increases Decompression Sickness in Altitude Exposure

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny; Pollock, N. W.; Natoli, M. J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    INTRODUCTION - Exercise accelerates inert gas elimination during oxygen breathing prior to decompression (prebreathe), but may also promote bubble formation and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of exercise are likely critical to the net effect. The NASA Prebreathe Reduction Program (PRP) combined oxygen prebreathe and exercise preceding a 4.3 psi exposure in non-ambulatory subjects (a microgravity analog) to produce two protocols now used by astronauts preparing for extravehicular activity (CEVIS and ISLE). Additional work is required to investigate whether exercise normal to 1 G environments increases the risk of DCS over microgravity simulation. METHODS - The CEVIS protocol was replicated with one exception. Our subjects completed controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining non-ambulatory throughout. Decompression stress was graded with aural Doppler (Spencer 0-IV scale). Two-dimensional echocardiographic imaging was used to look for left heart gas emboli (the presence of which prompted test termination). Venous blood was collected at three points to correlate Doppler measures of decompression stress with microparticle (cell fragment) accumulation. Fisher Exact Tests compared test and control groups. Trial suspension would occur when DCS risk >15% or grade IV venous gas emboli (VGE) risk >20% (at 70% confidence). RESULTS - Eleven person-trials were completed (9 male, 2 female) when DCS prompted suspension. DCS was greater than in CEVIS trials (3/11 [27%] vs. 0/45 [0%], respectively, p=0.03). Statistical significance was not reached for peak grade IV VGE (2/11 [18%] vs. 3/45 [7%], p=0.149) or cumulative grade IV VGE observations per subject-trial (8/128 [6%] vs. 26/630 [4%], p=0.151). Microparticle data were collected for 5/11 trials (3 with DCS outcomes), with widely varying patterns that could not be resolved statistically

  9. Emerging organizational structures in the ambulance industry in the United States.

    PubMed

    Narad, R A

    2000-01-01

    This analysis seeks to identify emerging forms of organizations in emergency medical services (EMS) in the United States, to provide examples of them, to relate them to changes in healthcare generally, and to apply a classification scheme. Public policy issues related to these new forms of organizations and lessons from other areas of the healthcare system are identified. Recent changes in the healthcare system in the United States have been marked by modifications in the structure of organizations that provide and pay for health services. New forms of organizations and alliances among existing organizations have emerged in an effort to improve the efficiency of the services provided and to improve organizations' market positions. Reflecting increased competition within EMS and the demands of the changing health-care delivery system, several types of organizations have begun to emerge in EMS that resemble those occurring in health care generally. These include forms of horizontal integration, such as consolidated ambulance services and various models of ambulance service networks; and forms of vertical integration, such as demand management programs and public-private joint ventures. The ultimate end might be complete integration with a carve-out of all non-scheduled care. Although changes in EMS organizations result largely from marketplace decisions by sellers and purchasers, this does not mean that there is no public policy role. While new organizational forms may increase the ambulance industry's efficiency, public policy makers must be concerned about quality and access as well. Some policy responses will promote marketplace changes, others will accept them generally, but will seek to correct problems, and a third group will attempt to restrain the market.

  10. Pan American Airways/Naval Air Transport Service/destroyer base site showing brick ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Pan American Airways/Naval Air Transport Service/destroyer base site showing brick and concrete paving of patio, and circular planters. View facing east. - U.S. Naval Base, Pearl Harbor, Pearl City Peninsula, Pearl City, Honolulu County, HI

  11. Pan American Airways/Naval Air Transport Service/destroyer base site showing stone ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Pan American Airways/Naval Air Transport Service/destroyer base site showing stone wall around patio. View facing east-southeast. - U.S. Naval Base, Pearl Harbor, Pearl City Peninsula, Pearl City, Honolulu County, HI

  12. Demand Forecast Using Data Analytics for the Preallocation of Ambulances.

    PubMed

    Chen, Albert Y; Lu, Tsung-Yu; Ma, Matthew Huei-Ming; Sun, Wei-Zen

    2016-07-01

    The objective of prehospital emergency medical services (EMSs) is to have a short response time. By increasing the operational efficiency, the survival rate of patients could potentially be increased. The geographic information system (GIS) is introduced in this study to manage and visualize the spatial distribution of demand data and forecasting results. A flexible model is implemented in GIS, through which training data are prepared with user-desired sizes for the spatial grid and discretized temporal steps. We applied moving average, artificial neural network, sinusoidal regression, and support vector regression for the forecasting of prehospital emergency medical demand. The results from these approaches, as a reference, could be used for the preallocation of ambulances. A case study is conducted for the EMS in New Taipei City, where prehospital EMS data have been collected for three years. The model selection process has chosen different models with different input features for the forecast of different areas. The best daily mean absolute percentage error during testing of the EMS demand forecast is 23.01%, which is a reasonable forecast based on Lewis' definition. With the acceptable prediction performance, the proposed approach has its potential to be applied to the current practice. PMID:26087507

  13. Demand Forecast Using Data Analytics for the Preallocation of Ambulances.

    PubMed

    Chen, Albert Y; Lu, Tsung-Yu; Ma, Matthew Huei-Ming; Sun, Wei-Zen

    2016-07-01

    The objective of prehospital emergency medical services (EMSs) is to have a short response time. By increasing the operational efficiency, the survival rate of patients could potentially be increased. The geographic information system (GIS) is introduced in this study to manage and visualize the spatial distribution of demand data and forecasting results. A flexible model is implemented in GIS, through which training data are prepared with user-desired sizes for the spatial grid and discretized temporal steps. We applied moving average, artificial neural network, sinusoidal regression, and support vector regression for the forecasting of prehospital emergency medical demand. The results from these approaches, as a reference, could be used for the preallocation of ambulances. A case study is conducted for the EMS in New Taipei City, where prehospital EMS data have been collected for three years. The model selection process has chosen different models with different input features for the forecast of different areas. The best daily mean absolute percentage error during testing of the EMS demand forecast is 23.01%, which is a reasonable forecast based on Lewis' definition. With the acceptable prediction performance, the proposed approach has its potential to be applied to the current practice.

  14. Controller evaluation of initial data link en route air traffic control services: Mini study 3

    NASA Astrophysics Data System (ADS)

    Marek, Hank; Shochet, Ephraim; Darby, Evan; Buck, Frank; Sweeney, David; Cratch, Preston

    1991-06-01

    The results of Mini Study 3 conducted November 5-9, 1990 are presented. This Mini Study was conducted at the Federal Aviation Administration (FAA) Technical Center utilizing the Washington Air Route Traffic Control Center (ARTCC) airspace in the Data Link test bed. Initial Data Link en route services were evaluated in order to identify service delivery methods which optimize the human computer interface. Controllers from the Air Traffic Data Link Validation Team participated in this study.

  15. Transition of AIRS Products to the National Weather Service

    NASA Technical Reports Server (NTRS)

    Zavodsky, Bradley

    2012-01-01

    Short-term Prediction Research and Transition Center (SPoRT) is a proven community leader for transitioning satellite products to operational end users and is working hard to bring data from Atmospheric Infrared Sounder (AIRS) to forecasters. SPoRT products using AIRS data are currently or will soon be evaluated at WFOs and National Centers (1) T and q profiles: HWT, Alaska WFOs, HRD/OPC, HMT (2) Ozone profiles: HPC/OPC (3) Carbon Monoxide: Southern and Western Region WFOs SPoRT is actively evaluating differences between V5 and V6 profiles for selected cases and will continue to provide feedback to the AIRS team as V6 development efforts conclude.

  16. Operational factors of air service to small communities

    NASA Technical Reports Server (NTRS)

    1975-01-01

    The feasibility of using 30-passenger jet aircraft to service low density, short haul markets was analyzed. Aircraft characteristics, market potential, and economic factors were among the areas evaluated.

  17. Aeronautical mobile satellite service: Air traffic control applications

    NASA Technical Reports Server (NTRS)

    Sim, Dave

    1990-01-01

    Canada's history both in aviation and in satellite communications development spans several decades. The introduction of aeronautical mobile satellite communications will serve our requirements for airspace management in areas not served by line-of-sight radio and radar facilities. The ensuing improvements in air safety and operating efficiency are eagerly awaited by the aviation community.

  18. 14 CFR 272.6 - Considerations in the determination of essential air service.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... TRANSPORTATION (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS ESSENTIAL AIR SERVICE TO THE FREELY ASSOCIATED STATES... other factors, the following: (1) The demonstrated level of traffic demand; (2) The amount of compensation necessary to maintain a level of service sufficient to meet that demand; (3) The extent to...

  19. 76 FR 55347 - Aerospace Executive Service Trade Mission at Singapore Air Show

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-07

    ... International Trade Administration Aerospace Executive Service Trade Mission at Singapore Air Show AGENCY... organizing an Aerospace Executive Service Trade Mission (AESTM) to Singapore in conjunction with the Singapore Airshow 2012 ( http://www.singaporeairshow.com.sg ). The AESTM is designed to include...

  20. The Public Service of the Official Time at the Observatorio Naval Buenos Aires

    NASA Astrophysics Data System (ADS)

    Cifuentes, A.; Esperón, C.; Osorio, J.; Amenna, J.; Salday, J.; Silva, G.

    2014-06-01

    The Observatorio Naval Buenos Aires (ONBA), through the Public Service of the Official Time Argentina (hereinafter, Time Service) generates, maintains and disseminates UTC (ONBA), which is the basis of the Argentine legal time. We present activities, projects such as time stamping to digital signature and new equipment acquired to improve traceability UTC (ONBA) to UTC.

  1. Ambulation after Deep Vein Thrombosis: A Systematic Review

    PubMed Central

    Overend, Tom J.; Godwin, Julie; Sealy, Christina; Sunderji, Aisha

    2009-01-01

    ABSTRACT Purpose: To systematically review the effects of early ambulation on development of pulmonary embolism (PE) and progression or development of a new thrombus in patients with acute deep vein thrombosis (DVT). Methods: Medline, PubMed, CINAHL, EMBASE, PEDro, and Cochrane Library databases were searched from inception to June 2008. Study quality was appraised using the Jadad and PEDro scales. Meta-analyses were reported as relative risks (RR) and 95% confidence intervals (CI). Results: Four randomized trials were accepted. For development of a PE, the pooled relative risks for ambulation and compression versus bed rest and compression (RR = 0.63, 95% CI: 0.34–1.19) and for ambulation and compression versus bed rest alone (RR = 1.36, 95% CI: 0.57–3.29) were not significant. For progression of an existing thrombus or development of a new thrombus, the independent relative risks for ambulation and compression versus bed rest and compression (RR = 0.39, 95% CI: 0.13–1.14) and for ambulation and compression versus bed rest alone (RR = 0.56, 95% CI: 0.20–1.57) were also not significant. Conclusions: Given the clinical benefits of mobility, and because there was no significant difference between ambulation and bed rest for risk of developing a PE or development and progression of a new DVT in any of the studies, clinicians should be confident in prescribing ambulation in this population. PMID:20514175

  2. 38 CFR 21.240 - Medical treatment, care and services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Vocational Rehabilitation and Employment Under... ambulation, and one-hand typewriting; (ii) Orientation, adjustment, mobility and related services;...

  3. Application of AirCell Cellular AMPS Network and Iridium Satellite System Dual Mode Service to Air Traffic Management

    NASA Technical Reports Server (NTRS)

    Shamma, Mohammed A.

    2004-01-01

    The AirCell/Iridium dual mode service is evaluated for potential applications to Air Traffic Management (ATM) communication needs. The AirCell system which is largely based on the Advanced Mobile Phone System (AMPS) technology, and the Iridium FDMA/TDMA system largely based on the Global System for Mobile Communications(GSM) technology, can both provide communication relief for existing or future aeronautical communication links. Both have a potential to serve as experimental platforms for future technologies via a cost effective approach. The two systems are well established in the entire CONUS and globally hence making it feasible to utilize in all regions, for all altitudes, and all classes of aircraft. Both systems have been certified for air usage. The paper summarizes the specifications of the AirCell/Iridium system, as well as the ATM current and future links, and application specifications. the paper highlights the scenarios, applications, and conditions under which the AirCell/Iridium technology can be suited for ATM Communication.

  4. Effects of a Public Education Campaign on the Association Between Knowledge of Early Stroke Symptoms and Intention to Call an Ambulance at Stroke Onset: The Acquisition of Stroke Knowledge (ASK) Study

    PubMed Central

    Nishikawa, Tomofumi; Okamura, Tomonori; Nakayama, Hirofumi; Miyamatsu, Naomi; Morimoto, Akiko; Toyoda, Kazunori; Suzuki, Kazuo; Toyota, Akihiro; Hata, Takashi; Yamaguchi, Takenori

    2016-01-01

    Background An immediate ambulance call offers the greatest opportunity for acute stroke therapy. Effectively using ambulance services requires strengthening the association between knowledge of early stroke symptoms and intention to call an ambulance at stroke onset, and encouraging the public to use ambulance services. Methods The present study utilized data from the Acquisition of Stroke Knowledge (ASK) study, which administered multiple-choice, mail-in surveys regarding awareness of early stroke symptoms and response to a stroke attack before and after a 2-year stroke education campaign in two areas subject to intensive and moderate intervention, as well as in a control area, in Japan. In these three areas, 3833 individuals (1680, 1088 and 1065 participants in intensive intervention, moderate intervention, and control areas, respectively), aged 40 to 74 years, who responded appropriately to each survey were included in the present study. Results After the intervention, the number of correctly identified symptoms significantly associated with intention to call an ambulance (P < 0.05) increased (eg, from 4 to 5 correctly identified symptoms), without increasing choice of decoy symptoms in the intensive intervention area. Meanwhile, in other areas, rate of identification of not only correct symptoms but also decoy symptoms associated with intention to call an ambulance increased. Furthermore, the association between improvement in the knowledge of stroke symptoms and intention to call an ambulance was observed only in the intensive intervention area (P = 0.009). Conclusions Our results indicate that intensive interventions are useful for strengthening the association between correct knowledge of early stroke symptoms and intention to call an ambulance, without strengthening the association between incorrect knowledge and intention to call an ambulance. PMID:26441211

  5. Non-motor Factors Associated with the Attainment of Community Ambulation after Stroke

    PubMed Central

    Ferreira, Milene Silva; Chamlian, Therezinha Rosane; França, Carolina Nunes; Massaro, Ayrton Roberto

    2015-01-01

    Objective Detect the main predictive non-motor factors related to independent community ambulation after stroke. Furthermore, we propose a scale to estimate the probability of a stroke patient achieving independent community ambulation after 6 months of rehabilitation. Design and Settings Prospective cohort. Subjects treated in a rehabilitation center in a large metropolitan area. Independent community ambulation was evaluated after rehabilitation according to the Hoffer classification. Functional ambulation was assessed at four levels: nonambulatory, nonfunctional ambulation, household ambulation, and community ambulation. Participants Patients (n=201) with a moderate disability after stroke. Results The average time of hospitalization was 19.3 days. However, only 32.8% of the patients started the rehabilitation program during the first 6 months after stroke. We found that 121 patients achieved community ambulation (60.2%), 40 achieved household ambulation (19.9%), 12 achieved therapeutic ambulation (5.9%), and 28 were non-ambulatory after 6 months of treatment. Based on our final model, a scoring scale was created in order to evaluate the probability of stroke patients achieving independent community ambulation after 6 months of rehabilitation. Higher scores were associated with better chances of community ambulation within 6 months. Conclusions The scale that evaluated these factors proved to have acceptable sensitivity and specificity to establish the prognosis of community ambulation after 6 months of rehabilitation. PMID:25380611

  6. Early ambulation after acute deep vein thrombosis: is it safe?

    PubMed

    Blumenstein, Marilyn Slavin

    2007-01-01

    The number of thrombotic events in children, although significantly less than that in adults, is increasing as a result of therapeutic advances in primary illnesses that were previously fatal. When a patient, adult or pediatric, develops a deep vein thrombosis and anticoagulation therapy is initiated, many health professionals ask, "When should this patient have physical therapy and/or ambulate?" Fear of causing a pulmonary embolism with increased activity drives this question. Often, an order for bed rest is prescribed based more on tradition than on evidence-based medicine. A review of the literature has provided an evidence-based answer to the question, and although the studies are all of adult populations, the results have been extrapolated for use with comparable pediatric populations. The majority of studies agree that early ambulation does not increase an anticoagulated patient's risk for pulmonary embolism. Moreover, most studies report that early ambulation carries benefits such as decreased pain and swelling and fewer postthrombotic syndrome symptoms.

  7. Profile of Ambulance Runs at the Kennedy Space Center

    NASA Technical Reports Server (NTRS)

    Scarpa, Philip J.

    1999-01-01

    The Kennedy Space Center (KSC) has four onsite ambulances staffed with Paramedics at two fire stations that respond to 911 Emergency Medical System (EMS) medical dispatches. These ambulances serve over 22,000 NASA, military, government, and contractor employees in an area of approximately 520 square miles. Included in this coverage are several public areas such as beaches, a wildlife refuge and a popular Visitor Center. Reports are filled out on each patient encountered. However. the only element tracked has been the ambulance response time. Now that reports are filed electronically, it is possible to enter them into an electronic database for analysis. Data analyses reveal trends and assist in better allocation of resources.

  8. Muscle coordination of support, progression and balance during stair ambulation.

    PubMed

    Lin, Yi-Chung; Fok, Laurence A; Schache, Anthony G; Pandy, Marcus G

    2015-01-21

    Stair ambulation is more physically demanding than level walking because it requires the lower-limb muscles to generate greater net joint moments. Although lower-limb joint kinematics and kinetics during stair ambulation have been extensively studied, relatively little is known about how the lower-limb muscles accelerate the whole-body center of mass (COM) during stair ascent and descent. The aim of the current study was to evaluate differences in muscle contributions to COM accelerations between level walking and stair ambulation in 15 healthy adults. Three-dimensional quantitative gait analysis and musculoskeletal modeling were used to calculate the contributions of the individual lower-limb muscles to the vertical, fore-aft and mediolateral accelerations of the COM (support, progression, and balance, respectively) during level walking, stair ascent and stair descent. Muscles that contribute most significantly to the acceleration of the COM during level walking (hip, knee, and ankle extensors) also dominate during stair ambulation, but with noticeable differences in coordination. In stair ascent, gluteus maximus accelerates the body forward during the first half of stance and soleus accelerates the body backward during the second half of stance, opposite to the functions displayed by these muscles in level walking. In stair descent, vasti generates backward and medial accelerations of the COM during the second half of stance, whereas it contributes minimally during this period in level walking. Gluteus medius performs similarly in controlling mediolateral balance during level walking and stair ambulation. Differences in lower-limb muscular coordination exist between stair ambulation and level walking, and our results have implications for interventions aimed at preventing stair-related falls. PMID:25498364

  9. A method for the determination of potentially profitable service patterns for commuter air carriers

    NASA Technical Reports Server (NTRS)

    Ransone, R. K.; Kuhlthau, A. R.; Deptula, D. A.

    1975-01-01

    A methodology for estimating market conception was developed as a part of the short-haul air transportation program. It is based upon an analysis of actual documents which provide a record of known travel history. Applying this methodology a forecast was made of the demand for an air feeder service between Charlottesville, Virginia and Dulles International Airport. Local business travel vouchers and local travel agent records were selected to provide the documentation. The market was determined to be profitable for an 8-passenger Cessna 402B aircraft flying a 2-hour daily service pattern designed to mesh to the best extent possible with the connecting schedules at Dulles. The Charlottesville - Dulles air feeder service market conception forecast and its methodology are documented.

  10. A Correlational Study of How Airline Customer Service and Consumer Perception of Airline Customer Service Affect the Air Rage Phenomenon

    NASA Technical Reports Server (NTRS)

    Hunter, Joyce A.

    2007-01-01

    Between 1995 and 2000, customer service declined throughout the airline industry, as reported in February 2001 by the U.S. Department of Transportation (2001). One of the biggest problems today within the airline industry is the constant complaining from customers regarding the deterioraton of service (McCollough, Berry, & Yadav, 2000). Since 1995, unfortunately no airline has been immune from service deterioration, as reported by the Airline Quality Rating, an annual report by two airline industry experts who analyzed Department of Transportation statistics (Harrison & Kleinsasser, 1999). The airline' refusal to recognize the issue of customer service has perpetuated an environment that has become dangerous and detrimental to the traveling public as well as to airline employees, which in turn has fueled a new phenomenon, now referred to as "air rage".

  11. AIRS Version 6 Products and Data Services at NASA GES DISC

    NASA Astrophysics Data System (ADS)

    Ding, F.; Savtchenko, A. K.; Hearty, T. J.; Theobald, M. L.; Vollmer, B.; Esfandiari, E.

    2013-12-01

    The NASA Goddard Earth Sciences Data and Information Services Center (GES DISC) is the home of processing, archiving, and distribution services for data from the Atmospheric Infrared Sounder (AIRS) mission. The AIRS mission is entering its 11th year of global observations of the atmospheric state, including temperature and humidity profiles, outgoing longwave radiation, cloud properties, and trace gases. The GES DISC, in collaboration with the AIRS Project, released data from the Version 6 algorithm in early 2013. The new algorithm represents a significant improvement over previous versions in terms of greater stability, yield, and quality of products. Among the most substantial advances are: improved soundings of Tropospheric and Sea Surface Temperatures; larger improvements with increasing cloud cover; improved retrievals of surface spectral emissivity; near-complete removal of spurious temperature bias trends seen in earlier versions; substantially improved retrieval yield (i.e., number of soundings accepted for output) for climate studies; AIRS-Only retrievals with comparable accuracy to AIRS+AMSU (Advanced Microwave Sounding Unit) retrievals; and more realistic hemispheric seasonal variability and global distribution of carbon monoxide. The GES DISC is working to bring the distribution services up-to-date with these new developments. Our focus is on popular services, like variable subsetting and quality screening, which are impacted by the new elements in Version 6. Other developments in visualization services, such as Giovanni, Near-Real Time imagery, and a granule-map viewer, are progressing along with the introduction of the new data; each service presents its own challenge. This presentation will demonstrate the most significant improvements in Version 6 AIRS products, such as newly added variables (higher resolution outgoing longwave radiation, new cloud property products, etc.), the new quality control schema, and improved retrieval yields. We will also

  12. Effects of weather conditions on emergency ambulance calls for acute coronary syndromes

    NASA Astrophysics Data System (ADS)

    Vencloviene, Jone; Babarskiene, Ruta; Dobozinskas, Paulius; Siurkaite, Viktorija

    2015-08-01

    The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature ( T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October-April) and warm (May-September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June-September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACS.

  13. Effects of weather conditions on emergency ambulance calls for acute coronary syndromes.

    PubMed

    Vencloviene, Jone; Babarskiene, Ruta; Dobozinskas, Paulius; Siurkaite, Viktorija

    2015-08-01

    The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature (T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October-April) and warm (May-September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June-September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACS. PMID:25344902

  14. Air

    MedlinePlus

    ... do to protect yourself from dirty air . Indoor air pollution and outdoor air pollution Air can be polluted indoors and it can ... this chart to see what things cause indoor air pollution and what things cause outdoor air pollution! Indoor ...

  15. STEP-UP: Study of the Effectiveness of a Patient Ambulation Protocol.

    PubMed

    Teodoro, Catherine R; Breault, Katheleen; Garvey, Carolee; Klick, Cheryl; O'Brien, Jennifer; Purdue, Tracy; Stolaronek, Anthony; Wilbur, Heather W; Matney, Laurie

    2016-01-01

    Immobility in hospitalized patients, particularly the elderly, can lead to serious untoward events. A pragmatic ambulation program that could be incorporated easily into clinicians' practice routines significantly improved ambulation in hospitalized patients compared to usual care with no organized emphasis on ambulation. PMID:27323470

  16. 5 CFR 842.811 - Deposits for second-level supervisory air traffic controller service performed before February 10...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES RETIREMENT SYSTEM-BASIC ANNUITY Law Enforcement Officers, Firefighters, and Air Traffic Controllers... to OPM immediately for deposit to the Civil Service Retirement and Disability Fund. (5) Once...

  17. 5 CFR 842.811 - Deposits for second-level supervisory air traffic controller service performed before February 10...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES RETIREMENT SYSTEM-BASIC ANNUITY Law Enforcement Officers, Firefighters, and Air Traffic Controllers... to OPM immediately for deposit to the Civil Service Retirement and Disability Fund. (5) Once...

  18. 4. OVERALL VIEW TO NORTH SHOWING (LEFT TO RIGHT) AMBULANT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. OVERALL VIEW TO NORTH SHOWING (LEFT TO RIGHT) AMBULANT QUARTERS, STOREHOUSE, BOILER HOUSE (LARGELY OBSCURED), SMOKESTACK, STATION GARAGE, ANIMAL HOUSE, AND WATER SOFTENER BUILDING - VA Medical Center, Aspinwall Division, 5103 Delafield Avenue (O'Hara Township), Aspinwall, Allegheny County, PA

  19. Entry overload, emergency department overcrowding, and ambulance bypass

    PubMed Central

    Fatovich, D; Hirsch, R

    2003-01-01

    Objectives: To describe an experience of emergency department (ED) overcrowding and ambulance bypass. Methods: A prospective observational study at Royal Perth Hospital, a major teaching hospital. Episodes of ambulance bypass and their characteristics were recorded. Results: From 1 July 1999 to 30 June 2001, there were 141 episodes of ambulance bypass (mean duration 187 min, range 35–995). Monday was the most common day with 39 (28%) episodes. Entry block alone was the most common reason bypass was activated (n=38, 30.4%). The mean number of patients in ED at these times was 40 (occupancy 174%), including nine in the corridor, seven awaiting admission, and 14 waiting to be seen. Episodes attributable to entry block were typically preceded by a presentation rate of ⩾10 patients per hour for ⩾2 hours (OR 6.2, 95% CI 4.3 to 8.5). Mid-afternoon to early evening was the most common time for activation. Ambulance bypass is increasing in frequency and duration. Conclusions: Entry overload resulting in entry block results from overwhelming numbers of patients presenting to the ED in a short space of time. Entry block impairs access to emergency care. Unless something is done in the near future, the general public may no longer be able to rely on EDs for quality and timely emergency care. A "whole of system" approach is necessary to tackle the problem. PMID:12954675

  20. Emergency ambulance dispatch: is there a case for triage?

    PubMed

    Thakore, S; McGugan, E A; Morrison, W

    2002-03-01

    Emergency telephone calls for an ambulance (999 calls) are usually dealt with first-come first-served. We have devised and assessed criteria that ambulance dispatch might use to prioritize responses. Data were collected retrospectively on consecutive patients presenting to an accident and emergency (A&E) department after a 999 call. An unblinded researcher abstracted data including age, date, time, caller, location, reason for call and A&E diagnosis and each case was examined for ten predetermined criteria necessitating an immediate ambulance response--namely, cardiac arrest; chest pain; shortness of breath; altered mental status/seizure; abdominal/loin pain >65 years old; fresh haematemesis; fall >2m; stabbing; major burns. 471 patients were recruited, 55% male, median age 50 years. 406 calls came from bystanders or the patients themselves, 36 from general practitioners, 8 from other hospitals and 21 from the police. 52% of patients were admitted. 44% met at least one of the above criteria. Most patients did not meet the criteria for an immediate ambulance response but might nonetheless be suitable for an urgent response. The criteria used in this study have the advantage of being based on the history provided by the caller. The introduction of a priority-based dispatch system could reduce response times to those who are seriously ill, and also improve road safety.

  1. Pan American Airways/Naval Air Transport Service/destroyer base site at the ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Pan American Airways/Naval Air Transport Service/destroyer base site at the east side showing walkway and building foundation. View facing west-northwest. - U.S. Naval Base, Pearl Harbor, Pearl City Peninsula, Pearl City, Honolulu County, HI

  2. 75 FR 61031 - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-01

    ... Sig.) THE WHITE HOUSE, Washington, September 29, 2010 [FR Doc. 2010-24900 Filed 9-30-10; 11:15 am... Memorandum of September 29, 2010--Provision of Aviation Insurance Coverage for Commercial Air Carrier Service...;The President ] Memorandum of September 29, 2010 Provision of Aviation Insurance Coverage...

  3. Manpower Requirements for Air Traffic Control and Flight Service Specialists in Indiana.

    ERIC Educational Resources Information Center

    Purdue Univ., Lafayette, IN. Office of Manpower Studies.

    As of January 1, 1968 the Federal Aviation Administration (FAA) of the United States Department of Transportation employed 6,963 controllers in airport towers, 7,617 controllers in Air Route Traffic Control Centers, and 4,459 flight service specialists at airport locations. Projected needs are as follows: (1) Controllers in airport towers:…

  4. 76 FR 52731 - On-Line Complaint Form for Service-Related Issues in Air Transportation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Office of the Secretary On-Line Complaint Form for Service-Related Issues in Air Transportation AGENCY: Office of the Secretary, Department of Transportation. ACTION: Notice and request for comments....

  5. 77 FR 24156 - Proposed Amendment of Air Traffic Service Routes; Southwestern United States

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-23

    ... Policies and Procedures (44 FR 11034; February 26, 1979); and (3) does not warrant preparation of a... continues to read as follows: Authority: 49 U.S.C. 106(g), 40103, 40113, 40120; E.O. 10854, 24 FR 9565, 3... of Air Traffic Service Routes; Southwestern United States AGENCY: Federal Aviation...

  6. Environmental Control System Installer/Servicer (Residential Air Conditioning Mechanic). V-TECS Guide.

    ERIC Educational Resources Information Center

    Meyer, Calvin F.; Benson, Robert T.

    This guide provides job relevant tasks, performance objectives, performance guides, resources, learning activitites, evaluation standards, and achievement testing in the occupation of environmental control system installer/servicer (residential air conditioning mechanic). It is designed to be used with any chosen teaching method. The course…

  7. Getting Down to Business: Air Conditioning and Heating Service, Module 36. [Student Guide]. Entrepreneurship Training Components.

    ERIC Educational Resources Information Center

    Sanderson, Barbara

    This module on owning and operating an air conditioning and heating service is one of 36 in a series on entrepreneurship. The introduction tells the student what topics will be covered and suggests other modules to read in related occupations. Each unit includes student goals, a case study, and a discussion of the unit subject matter. Learning…

  8. 3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 3 The President 1 2013-01-01 2013-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of September 27, 2012 Provision of Aviation Insurance Coverage for...

  9. 3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 3 The President 1 2014-01-01 2014-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of December 27, 2013 Provision of Aviation Insurance Coverage for...

  10. 3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 3 The President 1 2010-01-01 2010-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of August 21, 2009 Provision of Aviation Insurance Coverage for...

  11. 3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 3 The President 1 2011-01-01 2011-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of September 29, 2010 Provision of Aviation Insurance Coverage for...

  12. 3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 3 The President 1 2012-01-01 2012-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of September 28, 2011 Provision of Aviation Insurance Coverage for...

  13. Quantification of NSW Ambulance Record Linkages with Multiple External Datasets.

    PubMed

    Carroll, Therese; Muecke, Sandy; Simpson, Judy; Irvine, Katie; Jenkins, André

    2015-01-01

    This study has two aims: 1) to describe linkage rates between ambulance data and external datasets for "episodes of care" and "patient only" linkages in New South Wales (NSW), Australia; and 2) to detect and report any systematic issues with linkage that relate to patients, and operational or clinical variables that may introduce bias in subsequent studies if not adequately addressed. During 2010-11, the Centre for Health Record Linkage (CHeReL) in NSW, linked the records for patients attended by NSW Ambulance paramedics for the period July 2006 to June 2009, with four external datasets: Emergency Department Data Collection; Admitted Patient Data Collection; NSW Registry of Births, Deaths and Marriages death registration data; and the Australian Bureau of Statistics mortality data. This study reports linkage rates in terms of those "expected" to link and those who were "not expected" to link with external databases within 24 hours of paramedic attendance. Following thorough data preparation processes, 2,041,728 NSW Ambulance care episodes for 1,116,509 patients fulfilled the inclusion criteria. The overall episode-specific hospital linkage rate was 97.2%. Where a patient was not transported to hospital following paramedic care, 8.6% of these episodes resulted in an emergency department attendance within 24 hours. For all care episodes, 5.2% linked to a death record at some time within the 3-year period, with 2.4% of all death episodes occurring within 7 days of a paramedic encounter. For NSW Ambulance episodes of care that were expected to link to an external dataset but did not, nonlinkage to hospital admission records tended to decrease with age. For all other variables, issues relating to rates of linkage and nonlinkage were more indiscriminate. This quantification of the limitations of this large linked dataset will underpin the interpretation and results of ensuing studies that will inform future clinical and operational policies and practices at NSW Ambulance.

  14. AIRS Data Subsetting Service at the Goddard Earth Sciences (GES) DISC/DAAC

    NASA Technical Reports Server (NTRS)

    Vicente, Gilberto A.; Qin, Jianchun; Li, Jason; Gerasimov, Irina; Savtchenko, Andrey

    2004-01-01

    The AIRS mission, as a combination of the Atmospheric Infrared Sounder (AIRS), the Advanced Microwave Sounding Unit (AMSU) and the Humidity Sounder for Brazil (HSB), brings climate research and weather prediction into 21st century. From NASA' Aqua spacecraft, the AIRS/AMSU/HSB instruments measure humidity, temperature, cloud properties and the amounts of greenhouse gases. The AIRS also reveals land and sea- surface temperatures. Measurements from these three instruments are analyzed . jointly to filter out the effects of clouds from the IR data in order to derive clear-column air-temperature profiles and surface temperatures with high vertical resolution and accuracy. Together, they constitute an advanced operational sounding data system that have contributed to improve global modeling efforts and numerical weather prediction; enhance studies of the global energy and water cycles, the effects of greenhouse gases, and atmosphere-surface interactions; and facilitate monitoring of climate variations and trends. The high data volume generated by the AIRS/AMSU/HSB instruments and the complexity of its data format (Hierarchical Data Format, HDF) are barriers to AIRS data use. Although many researchers are interested in only a fraction of the data they receive or request, they are forced to run their algorithms on a much larger data set to extract the information of interest. In order to better server its users, the GES DISC/DAAC, provider of long-term archives and distribution services as well science support for the AIRS/AMSU/HSB data products, has developed various tools for performing channels, variables, parameter, spatial and derived products subsetting, resampling and reformatting operations. This presentation mainly describes the web-enabled subsetting services currently available at the GES DISC/DAAC that provide subsetting functions for all the Level 1B and Level 2 data products from the AIRS/AMSU/HSB instruments.

  15. System considerations, projected requirements and applications for aeronautical mobile satellite communications for air traffic services

    NASA Technical Reports Server (NTRS)

    Mcdonald, K. D.; Miller, C. M.; Scales, W. C.; Dement, D. K.

    1990-01-01

    The projected application and requirements in the near term (to 1995) and far term (to 2010) for aeronautical mobile services supporting air traffic control operations are addressed. The implications of these requirements on spectrum needs, and the resulting effects on the satellite design and operation are discussed. The U.S. is working with international standards and regulatory organizations to develop the necessary aviation standards, signalling protocols, and implementation methods. In the provision of aeronautical safety services, a number of critical issues were identified, including system reliability and availability, access time, channel restoration time, interoperability, pre-emption techniques, and the system network interfaces. Means for accomplishing these critical services in the aeronautical mobile satellite service (AMSS), and the various activities relating to the future provision of aeronautical safety services are addressed.

  16. Is the Ability to Ambulate Associated with Better Employment Outcomes in Participants with Traumatic Spinal Cord Injury?

    ERIC Educational Resources Information Center

    Krause, James S.

    2010-01-01

    The author compares current employment status after spinal cord injury between participants who were independent in ambulation (required no assistance from others) and those who were dependent in ambulation (required assistance from at least one other person to ambulate). Those who were independent of assistance from others in ambulation were…

  17. Acute pain management services: a comparison between Air Force and U.S. hospitals.

    PubMed

    Rayos, C L; McDonough, J P

    1999-12-01

    The purpose of this descriptive study was to assess the prevalence of acute pain management services (APMS) in Air Force medical facilities. There are no published reports on the current status of Air Force pain programs. This study used a telephone survey to all facilities worldwide that house an anesthesia department. Anesthesia providers in charge of pain services or department chiefs were interviewed from December 1996 to May 1997. Respondents were asked questions related to the initiation of a formal APMS, components, and familiarity with the Agency for Health Care Policy and Research guidelines on pain management. Data analysis described current practices and used chi 2 analysis to compare results with a national study of U.S. hospitals. Air Force anesthesia departments (45%) had established as many acute pain services as U.S. hospitals (42%). Formal pain programs are becoming more prevalent in Air Force hospitals. These findings suggest an increased awareness of the need for pain management and future establishment of pain programs.

  18. An Airborne Communications Roadmap for the U.S. Federal Air Marshal Service: Overview and Status

    NASA Technical Reports Server (NTRS)

    Martzaklis, Konstantinos S.

    2007-01-01

    Following the events of September 11, 2001, the responsibilities, operations and numbers of the U.S. Federal Air Marshal Service (FAMS) wer e greatly expanded. With this expansion, new critical research and te chnology needs were identified, including the need for air to ground telecommunications capabilities. To address this need, the FAMS has cr eated a working group to develop, deploy and enhance aviation communi cations with respect to security and law enforcement. This paper presents the working group's progress to date in generating a FAMS air-gro und communications roadmap identifying expected communications servic es, technology maturity, and technology gaps over a timeline. The paper includes a communications preliminary requirements summary and syst em performance characteristics needed to meet identified operational needs. The system engineering process utilized is presented beginning with the identification of users, their operational needs and relevant constraints. The operational needs are translated to desired airbor ne communications services. System technical performance requirements associated with the identified services are summarized. In addition, notional communications architectures addressing the requirements are presented. Finally, future plans to identify and assess potential ca ndidate systems and their associated technical architectures, gaps and barriers to implementation are discussed. The paper addresses the cu rrent, near term (within 5 years) and far term (10 years) timeframes for such an airborne communications system.

  19. Comparing rural ground and air emergency medical services: a level I trauma center's experience.

    PubMed

    von Recklinghausen, Friedrich Maximilian

    2011-01-01

    We sought to compare differences in patients transported by ground and air emergency medical services directly from the scenes of their injuries to a rural level I trauma facility. Variables examined included age, gender, vital signs, Glasgow Coma Scale score, discharge location, length of stay, and survival metrics. Student t tests and odds ratios were used for analysis. Demographics and vital signs differed between trauma patients transported by air versus those transported by ground. Generally, length of stay was longer in air-transported patients, who also had poorer survival metrics with negligible risk of death. Significant differences exist in the markers of physiology such as vital signs, expected survival, and degree of injury. PMID:22157533

  20. Contribution of ecosystem services to air quality and climate change mitigation policies: the case of urban forests in Barcelona, Spain.

    PubMed

    Baró, Francesc; Chaparro, Lydia; Gómez-Baggethun, Erik; Langemeyer, Johannes; Nowak, David J; Terradas, Jaume

    2014-05-01

    Mounting research highlights the contribution of ecosystem services provided by urban forests to quality of life in cities, yet these services are rarely explicitly considered in environmental policy targets. We quantify regulating services provided by urban forests and evaluate their contribution to comply with policy targets of air quality and climate change mitigation in the municipality of Barcelona, Spain. We apply the i-Tree Eco model to quantify in biophysical and monetary terms the ecosystem services "air purification," "global climate regulation," and the ecosystem disservice "air pollution" associated with biogenic emissions. Our results show that the contribution of urban forests regulating services to abate pollution is substantial in absolute terms, yet modest when compared to overall city levels of air pollution and GHG emissions. We conclude that in order to be effective, green infrastructure-based efforts to offset urban pollution at the municipal level have to be coordinated with territorial policies at broader spatial scales.

  1. Application of ESE Data and Tools to Air Quality Management: Services for Helping the Air Quality Community use ESE Data (SHAirED)

    NASA Technical Reports Server (NTRS)

    Falke, Stefan; Husar, Rudolf

    2011-01-01

    The goal of this REASoN applications and technology project is to deliver and use Earth Science Enterprise (ESE) data and tools in support of air quality management. Its scope falls within the domain of air quality management and aims to develop a federated air quality information sharing network that includes data from NASA, EPA, US States and others. Project goals were achieved through a access of satellite and ground observation data, web services information technology, interoperability standards, and air quality community collaboration. In contributing to a network of NASA ESE data in support of particulate air quality management, the project will develop access to distributed data, build Web infrastructure, and create tools for data processing and analysis. The key technologies used in the project include emerging web services for developing self describing and modular data access and processing tools, and service oriented architecture for chaining web services together to assemble customized air quality management applications. The technology and tools required for this project were developed within DataFed.net, a shared infrastructure that supports collaborative atmospheric data sharing and processing web services. Much of the collaboration was facilitated through community interactions through the Federation of Earth Science Information Partners (ESIP) Air Quality Workgroup. The main activities during the project that successfully advanced DataFed, enabled air quality applications and established community-oriented infrastructures were: develop access to distributed data (surface and satellite), build Web infrastructure to support data access, processing and analysis create tools for data processing and analysis foster air quality community collaboration and interoperability.

  2. United States-Canada air services: The role of alliances in a future bilateral agreement

    SciTech Connect

    Lewis, I.

    1995-12-01

    Transborder air services between the U.S. and Canada represent a mixing of two dynamic domestic markets whose relationships with each other is governed by a diplomatically negotiated agreement between governments. Trying to divide up the pie between the carriers of both nations while promoting economic growth is proving to be very difficult; four years of negotiations have yet to reach fruition. The Canadian government and carriers see the pie as fixed; there is only so much transborder traffic and Canadian airlines need their share. In contrast, U.S. carriers, airport operators, and government negotiators see the airline industry as a major instrument of economic growth. In this view, they are joined by many Canadian communities who believe that increased service can be of considerable benefit. More competition and better service can only lead to higher demand and passenger volume, from which Canadian airlines will benefit. Alliances between U.S. and Canadian carriers can help break the deadlock. The two governments need to recognize that their domestic airline industries are not distinct, and that they will share in any liberalization. Alliances need formal recognition, encouragement, and may be one of the few viable instruments available that will promote a greatly needed bilateral air services agreement between the U.S. and Canada.

  3. The Medical Duty Officer: An Attempt to Mitigate the Ambulance At-Hospital Interval

    PubMed Central

    Halliday, Megan H.; Bouland, Andrew J.; Lawner, Benjamin J.; Comer, Angela C.; Ramos, Daniel C.; Fletcher, Mark

    2016-01-01

    Introduction A lack of coordination between emergency medical services (EMS), emergency departments (ED) and systemwide management has contributed to extended ambulance at-hospital times at local EDs. In an effort to improve communication within the local EMS system, the Baltimore City Fire Department (BCFD) placed a medical duty officer (MDO) in the fire communications bureau. It was hypothesized that any real-time intervention suggested by the MDO would be manifested in a decrease in the EMS at-hospital time. Methods The MDO was implemented on November 11, 2013. A senior EMS paramedic was assigned to the position and was placed in the fire communication bureau from 9 a.m. to 9 p.m., seven days a week. We defined the pre-intervention period as August 2013 – October 2013 and the post-intervention period as December 2013 – February 2014. We also compared the post-intervention period to the “seasonal match control” one year earlier to adjust for seasonal variation in EMS volume. The MDO was tasked with the prospective management of city EMS resources through intensive monitoring of unit availability and hospital ED traffic. The MDO could suggest alternative transport destinations in the event of ED crowding. We collected and analyzed data from BCFD computer-aided dispatch (CAD) system for the following: ambulance response times, ambulance at-hospital interval, hospital diversion and alert status, and “suppression wait time” (defined as the total time suppression units remained on scene until ambulance arrival). The data analysis used a pre/post intervention design to examine the MDO impact on the BCFD EMS system. Results There were a total of 15,567 EMS calls during the pre-intervention period, 13,921 in the post-intervention period and 14,699 in the seasonal match control period one year earlier. The average at-hospital time decreased by 1.35 minutes from pre- to post-intervention periods and 4.53 minutes from the pre- to seasonal match control

  4. The Medical Duty Officer: An Attempt to Mitigate the Ambulance At-Hospital Interval

    PubMed Central

    Halliday, Megan H.; Bouland, Andrew J.; Lawner, Benjamin J.; Comer, Angela C.; Ramos, Daniel C.; Fletcher, Mark

    2016-01-01

    Introduction A lack of coordination between emergency medical services (EMS), emergency departments (ED) and systemwide management has contributed to extended ambulance at-hospital times at local EDs. In an effort to improve communication within the local EMS system, the Baltimore City Fire Department (BCFD) placed a medical duty officer (MDO) in the fire communications bureau. It was hypothesized that any real-time intervention suggested by the MDO would be manifested in a decrease in the EMS at-hospital time. Methods The MDO was implemented on November 11, 2013. A senior EMS paramedic was assigned to the position and was placed in the fire communication bureau from 9 a.m. to 9 p.m., seven days a week. We defined the pre-intervention period as August 2013 – October 2013 and the post-intervention period as December 2013 – February 2014. We also compared the post-intervention period to the “seasonal match control” one year earlier to adjust for seasonal variation in EMS volume. The MDO was tasked with the prospective management of city EMS resources through intensive monitoring of unit availability and hospital ED traffic. The MDO could suggest alternative transport destinations in the event of ED crowding. We collected and analyzed data from BCFD computer-aided dispatch (CAD) system for the following: ambulance response times, ambulance at-hospital interval, hospital diversion and alert status, and “suppression wait time” (defined as the total time suppression units remained on scene until ambulance arrival). The data analysis used a pre/post intervention design to examine the MDO impact on the BCFD EMS system. Results There were a total of 15,567 EMS calls during the pre-intervention period, 13,921 in the post-intervention period and 14,699 in the seasonal match control period one year earlier. The average at-hospital time decreased by 1.35 minutes from pre- to post-intervention periods and 4.53 minutes from the pre- to seasonal match control

  5. [Plea for forensic aftercare--results from an evaluation of forensic ambulances in Germany (area: "Rheinland")].

    PubMed

    Seifert, Dieter; Schiffer, Boris; Leygraf, Norbert

    2003-07-01

    The reintegration of patients from forensic hospitals into society is as difficult as important. At present only a few specialized forensic ambulances can be found in Germany although experts have been demanding an extension of these institutions for years. In the following we will present results from an evaluation study of forensic ambulances in Germany (area: "Rheinland"). Our target is to develop minimum standards or essential pillars for successful ambulance work by taking all participants of the reintegration process into account.

  6. Energy expenditure of trans-tibial amputees during ambulation at self-selected pace.

    PubMed

    Gailey, R S; Wenger, M A; Raya, M; Kirk, N; Erbs, K; Spyropoulos, P; Nash, M S

    1994-08-01

    The purpose of this investigation was two-fold: 1) to compare the metabolic cost (VO2), heart rate (HR), and self-selected speed of ambulation of trans-tibial amputees (TTAs) with those of non-amputee subjects; and 2) to determine whether a correlation exists between either stump length or prosthesis mass and the energy cost of ambulation at the self-selected ambulation pace of TTAs. Subjects were thirty-nine healthy male non-vascular TTAs between the ages of 22 and 75 years (mean +/- sd = 47 +/- 16). All had regularly used their prosthesis for longer than six months and were independent of assistive ambulation devices. Twenty-one healthy non-amputee males aged 27-47 years (31 +/- 6) served as controls. Subjects ambulated at a self-selected pace over an indoor course, with steady-state VO2, HR, and ambulation speed averaged across minutes seven, eight and nine of walking. Results showed that HR and VO2 for TTAs were 16% greater, and the ambulation pace 11% slower than the non-amputee controls. Significant correlations were not observed between stump length or prosthesis mass, and the energy cost of ambulation. However, when the TTA subject pool was stratified on the basis of long and short stump length, the former sustained significantly lower steady-state VO2 and HR than the latter while walking at comparable pace. These data indicate that stump length may influence the metabolic cost of ambulation in TTAs. PMID:7991365

  7. Optimizing Air Transportation Service to Metroplex Airports. Part 1; Analysis of Historical Data

    NASA Technical Reports Server (NTRS)

    Donohue, George; Hoffman, Karla; Sherry, Lance; Ferguson, John; Kara, Abdul Qadar

    2010-01-01

    The air transportation system is a significant driver of the U.S. economy, providing safe, affordable, and rapid transportation. During the past three decades airspace and airport capacity has not grown in step with demand for air transportation (+4% annual growth), resulting in unreliable service and systemic delays. Estimates of the impact of delays and unreliable air transportation service on the economy range from $32B to $41B per year. This report describes the results of an analysis of airline strategic decision-making with regards to: (1) geographic access, (2) economic access, and (3) airline finances. This analysis evaluated markets-served, scheduled flights, aircraft size, airfares, and profit from 2005-2009. During this period, airlines experienced changes in costs of operation (due to fluctuations in hedged fuel prices), changes in travel demand (due to changes in the economy), and changes in infrastructure capacity (due to the capacity limits at EWR, JFK, and LGA). This analysis captures the impact of the implementation of capacity limits at airports, as well as the effect of increased costs of operation (i.e. hedged fuel prices). The increases in costs of operation serve as a proxy for increased costs per flight that might occur if auctions or congestion pricing are imposed.

  8. Non-accidental non-fatal poisonings attended by emergency ambulance crews: an observational study of data sources and epidemiology

    PubMed Central

    John, Ann; Porter, Alison; Moore, Chris; Thomas, Gareth; Whitfield, Richard; Oretti, Rossana

    2016-01-01

    Background Non-accidental non-fatal poisoning (NANFP) is associated with high risk of repeat episodes and fatality. This cross-sectional study aims to describe the data sources and epidemiology of non-fatal poisonings (NFPs) presenting to the emergency ambulance service. Methods We assessed incidents of NFP across Wales from electronic ambulance call centre records and paper records completed by attending ambulance crews, December 2007 to February 2008. We descriptively analysed data completed by attending crews. Results 92 331 calls were made to the ambulance call centre, of which 3923 (4.2%) were coded as ‘overdose’ or ‘poisoning’. During the same period, ambulance crews recorded 1827 attended NANFP incidents in those categories, of which 1287 (70.4%) had been identified in the call centre. 76.1% (1356/1782) were aged 15–44 years and 54.2% (991/1827) were female. 75.0% (1302/1753) of incidents occurred in areas from the lower 2 quintiles of deprivation in Wales. Substance taken was reported in 90% of cases (n=1639). Multiple ingestion was common (n=886, 54.1%). Psychotropic was the most frequently taken group of substances (n=585, 32.0%) and paracetamol (n=484, 26.5%) was the most frequently taken substance prehospital. Almost half of patients had taken alcohol alongside other substances (n=844, 46.2%). Naloxone was the most frequently administered treatment (n=137, 7.5%). Only 142/1827 (7.8%) patients were not transported to hospital, of whom 4 were recorded to have been given naloxone. Conclusions We report new data on the epidemiology of NFP across substance types at national level, highlighting deficiencies in information systems and high levels of multiple ingestion. In order to develop policy and practice for this patient group prehospital and further along the care pathway, information systems need to be developed to allow accurate routine monitoring of volume, presentation and outcomes. PMID:27540098

  9. Effects of weather and heliophysical conditions on emergency ambulance calls for elevated arterial blood pressure.

    PubMed

    Vencloviene, Jone; Babarskiene, Ruta M; Dobozinskas, Paulius; Sakalyte, Gintare; Lopatiene, Kristina; Mikelionis, Nerijus

    2015-03-01

    We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009-2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10-I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS>600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR=1.12; 95% confidence interval (CI) 1.04-1.21); and WS≥3.5 knots during days of T<1.5 °C and T≥12.5 °C by 8% (RR=1.08; CI 1.04-1.12). An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T≥17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population's sensitivity to different weather conditions. PMID:25734792

  10. Effects of weather and heliophysical conditions on emergency ambulance calls for elevated arterial blood pressure.

    PubMed

    Vencloviene, Jone; Babarskiene, Ruta M; Dobozinskas, Paulius; Sakalyte, Gintare; Lopatiene, Kristina; Mikelionis, Nerijus

    2015-02-27

    We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009-2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10-I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS>600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR=1.12; 95% confidence interval (CI) 1.04-1.21); and WS≥3.5 knots during days of T<1.5 °C and T≥12.5 °C by 8% (RR=1.08; CI 1.04-1.12). An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T≥17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population's sensitivity to different weather conditions.

  11. 5 CFR 842.811 - Deposits for second-level supervisory air traffic controller service performed before February 10...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Deposits for second-level supervisory air traffic controller service performed before February 10, 2004. 842.811 Section 842.811 Administrative... Regulations Pertaining to Noncodified Statutes § 842.811 Deposits for second-level supervisory air...

  12. 5 CFR 842.811 - Deposits for second-level supervisory air traffic controller service performed before February 10...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Deposits for second-level supervisory air traffic controller service performed before February 10, 2004. 842.811 Section 842.811 Administrative... Regulations Pertaining to Noncodified Statutes § 842.811 Deposits for second-level supervisory air...

  13. 5 CFR 842.811 - Deposits for second-level supervisory air traffic controller service performed before February 10...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Deposits for second-level supervisory air traffic controller service performed before February 10, 2004. 842.811 Section 842.811 Administrative... Regulations Pertaining to Noncodified Statutes § 842.811 Deposits for second-level supervisory air...

  14. Ambulation without wheelchairs for paraplegics with complete lesions.

    PubMed

    Natvig, H; McAdam, R

    1978-08-01

    Some salient features of the physical training programme for paraplegics at the State Rehabilitation Institute in Oslo are mentioned. A ten-year follow-up study of 42 clients with complete lesions (TI-L3) is presented. After an intensive physical training programme of some 10--15 weeks 74 per cent were able to climb and go down 20 standard stairs and 71 per cent were able to walk 100 metres indoors with crutches. The authors stress the importance of ambulations independent of wheelchairs whenever this is possible. PMID:733293

  15. Pursuing performance. New specs for ambulances and fleet managers.

    PubMed

    Reeder, L

    1994-07-01

    It seems so easy. A call comes in, you get in the ambulance, strap on the seatbelt and turn the key. But there's much more that goes into building the hunk of metal you're sitting in. Each part must meet a design or performance specification. But who sets up these specifications and why? Is it all geared to help you get your patient to the hospital quickly but safely? And what challenges await the maintenance person who must keep that hunk of metal running--and running well? This article will answer some of those questions, but we hope it prompts you to ask even more. PMID:10135485

  16. Towards European-scale Air Quality operational services for GMES Atmosphere

    NASA Astrophysics Data System (ADS)

    Peuch, V.-H.; Rouil, L.; Tarrason, L.; Elbern, H.; Gems/Macc Regional Subprojects Teams

    2009-09-01

    Basing upon the experience gained in national operational or pre-operational air quality forecasting activities, as for instance Prév'Air in France or EURAD in Germany, a range of European scale services have been developing in the context of the EU-funded project GEMS (6th FP) and are now brought a step further in the new project MACC (7th FP). Within the GEMS project, analyses, hindcasts and forecasts from a range of state-of-the-art Regional Air Quality models have been performed on a quasi-operational daily basis since the beginning of 2008. The models cover Europe with horizontal resolutions ranging from 0.2° to 0.5°, and rely on ECMWF operational meteorological forecasts as well as on GEMS global "chemical weather” data, in the form of chemical boundary conditions for key medium to long-lived trace gases and aerosols. They also all consider the same high-resolution (~8km) anthropogenic and biogenic emissions inventories, developed by TNO (The Netherlands) and NKUA (Greece). Access in quasi Near-Real-Time to AQ monitoring data has been obtained for over 15 European countries through fruitful collaborations with national and regional monitoring agencies. This has provided an interesting context, unprecedented to such an extent, to jointly monitor the performances of regional Air Quality forecasts, assess uncertainties and elaborate ensemble products that build upon the models' spread and their respective skills (both in average and for the few days preceding each forecast). Also a hindcast run covering the whole year of 2003 and using chemical boundaries from GEMS global re-analysis of tropospheric reactive gases has been performed and studied. This year 2003 was indeed marked by several episodes in spring and summer (heat wave) with strong health impacts due (at least in part) to bad Air Quality. The GEMS project has ended in May 2009 and the MACC project has started. Within MACC, a stronger emphasis is put on the use of chemical data assimilation and on

  17. Out-of-hospital cardiac arrest due to coronary heart disease: a comparison of survival before and after the introduction of defribrillators in ambulances.

    PubMed Central

    Leslie, W. S.; Fitzpatrick, B.; Morrison, C. E.; Watt, G. C.; Tunstall-Pedoe, H.

    1996-01-01

    OBJECTIVE: To assess the actual impact on coronary mortality of equipping ambulances with defibrillators. DESIGN: Retrospective analysis of routine medical and legal records of all those who had a cardiac arrest attributed to coronary heart disease occurring outside hospital in a defined population before and after the introduction of Heartstart. SETTING: City of Glasgow, North of the River Clyde, 1984 and 1990. PATIENTS: 296 and 267 men and women aged 25-64 inclusive in 1984 and 1990 respectively who had a cardiac arrest outside hospital which was attributed to coronary heart disease (International Classification of Diseases codes 410-414, ninth revision). RESULTS: The impact on coronary mortality in 1990 of equipping ambulances with defibrillators concurred with the earlier prediction of less than 1% of all coronary deaths. The circumstances of cardiac arrest were largely unchanged; most occurred outside hospital in the victim's home and the principal witnesses were members of the victim's family. A call for help before cardiac arrest was made in very few cases and cardiopulmonary resuscitation was attempted by laypersons in less than a third of the deaths they witnessed. There was a significant increase in the number of cardiopulmonary resuscitation attempts made by ambulance crews (16% v 32%, P < 0.01). Ambulance crews, however, still attended less than half of all cases (44% and 47%). CONCLUSION: The impact of equipping ambulances with defibrillators will remain small unless strategies are introduced that focus on improving the public's response to coronary emergencies by calling for help promptly and initiating cardiopulmonary resuscitation before the arrival of the emergency services. PMID:8673761

  18. On-Premise Alcohol Establishments and Ambulance Calls for Trauma, Assault, and Intoxication.

    PubMed

    Ray, Joel G; Turner, Linda; Gozdyra, Piotr; Matheson, Flora I; Robert, Burgess; Bartsch, Emily; Park, Alison L

    2016-05-01

    Alcohol contributes to intentional and unintentional injury. We explored on-premise licensed alcohol establishments (LAEs) and emergency medical service (EMS) ambulance calls.We completed a retrospective population-based study in the Region of Peel, Ontario, 2005 to 2014, where alcohol sales are tightly regulated and healthcare is universally available. We included participants age ≥ 19 years. Longitude-latitude coordinates of all 696 LAEs and all 267,477 EMS ambulance calls were ascertained, and then assigned to 1 of 1568 dissemination areas (DA) in Peel. Relative risks (RRs) described the association between density of on-premise LAEs (by DA deciles) and the rate of EMS calls, adjusted for material deprivation, and density of beer/liquor stores in each DA.There was a curvilinear relation between LAE density and EMS calls for trauma, rising from 45.3 per 1000 in DAs with no LAEs to 381.0 per 1000 in decile-10 (adjusted RR 7.83, 95% confidence interval [CI] 6.15-9.97). This relation was more pronounced for alcohol-focused LAEs, and highest among younger males. Calls for assault (RR 2.67, 95% CI 1.26-5.65) and intoxication (RR 4.00, 95% CI 1.41-11.38) were more likely on the last day of the month and the day thereafter, compared to 1 week prior. At 02:00 hours, when LAEs must stop selling alcohol, there was a considerable rise in assault-related calls in DAs with LAE but not in DAs without LAEs.On-premise LAEs contribute to EMS calls for trauma and assault, especially among young males, around last call, and when monthly pay cheques are cashed. PMID:27175699

  19. On-Premise Alcohol Establishments and Ambulance Calls for Trauma, Assault, and Intoxication

    PubMed Central

    Ray, Joel G.; Turner, Linda; Gozdyra, Piotr; Matheson, Flora I.; Robert, Burgess; Bartsch, Emily; Park, Alison L.

    2016-01-01

    Abstract Alcohol contributes to intentional and unintentional injury. We explored on-premise licensed alcohol establishments (LAEs) and emergency medical service (EMS) ambulance calls. We completed a retrospective population-based study in the Region of Peel, Ontario, 2005 to 2014, where alcohol sales are tightly regulated and healthcare is universally available. We included participants age ≥ 19 years. Longitude–latitude coordinates of all 696 LAEs and all 267,477 EMS ambulance calls were ascertained, and then assigned to 1 of 1568 dissemination areas (DA) in Peel. Relative risks (RRs) described the association between density of on-premise LAEs (by DA deciles) and the rate of EMS calls, adjusted for material deprivation, and density of beer/liquor stores in each DA. There was a curvilinear relation between LAE density and EMS calls for trauma, rising from 45.3 per 1000 in DAs with no LAEs to 381.0 per 1000 in decile-10 (adjusted RR 7.83, 95% confidence interval [CI] 6.15–9.97). This relation was more pronounced for alcohol-focused LAEs, and highest among younger males. Calls for assault (RR 2.67, 95% CI 1.26–5.65) and intoxication (RR 4.00, 95% CI 1.41–11.38) were more likely on the last day of the month and the day thereafter, compared to 1 week prior. At 02:00 hours, when LAEs must stop selling alcohol, there was a considerable rise in assault-related calls in DAs with LAE but not in DAs without LAEs. On-premise LAEs contribute to EMS calls for trauma and assault, especially among young males, around last call, and when monthly pay cheques are cashed. PMID:27175699

  20. On-Premise Alcohol Establishments and Ambulance Calls for Trauma, Assault, and Intoxication.

    PubMed

    Ray, Joel G; Turner, Linda; Gozdyra, Piotr; Matheson, Flora I; Robert, Burgess; Bartsch, Emily; Park, Alison L

    2016-05-01

    Alcohol contributes to intentional and unintentional injury. We explored on-premise licensed alcohol establishments (LAEs) and emergency medical service (EMS) ambulance calls.We completed a retrospective population-based study in the Region of Peel, Ontario, 2005 to 2014, where alcohol sales are tightly regulated and healthcare is universally available. We included participants age ≥ 19 years. Longitude-latitude coordinates of all 696 LAEs and all 267,477 EMS ambulance calls were ascertained, and then assigned to 1 of 1568 dissemination areas (DA) in Peel. Relative risks (RRs) described the association between density of on-premise LAEs (by DA deciles) and the rate of EMS calls, adjusted for material deprivation, and density of beer/liquor stores in each DA.There was a curvilinear relation between LAE density and EMS calls for trauma, rising from 45.3 per 1000 in DAs with no LAEs to 381.0 per 1000 in decile-10 (adjusted RR 7.83, 95% confidence interval [CI] 6.15-9.97). This relation was more pronounced for alcohol-focused LAEs, and highest among younger males. Calls for assault (RR 2.67, 95% CI 1.26-5.65) and intoxication (RR 4.00, 95% CI 1.41-11.38) were more likely on the last day of the month and the day thereafter, compared to 1 week prior. At 02:00 hours, when LAEs must stop selling alcohol, there was a considerable rise in assault-related calls in DAs with LAE but not in DAs without LAEs.On-premise LAEs contribute to EMS calls for trauma and assault, especially among young males, around last call, and when monthly pay cheques are cashed.

  1. AIRS/AMSU-A/HSB Data On-demand Subsetting and Visualization Services at NASA GES DISC DAAC

    NASA Astrophysics Data System (ADS)

    Li, J.; Cho, S.; Sun, D.; Qin, J.; Sharma, A. K.

    2002-12-01

    The Atmospheric Infrared Sounder (AIRS) is a high-resolution infrared sounder closely coupled with AMSU-A (Advanced Microwave Sounding Unit-A) and HSB (Humidity Sounder for Brazil) on EOS Aqua spacecraft launched on May 4, 2002. The data products from AIRS/AMSU-A/HSB will be archived and distributed at the Goddard Distributed Active Archive Center (GDAAC) located in the NASA Goddard Earth Sciences Data and Information Services Center (GES DAAC). The ADDST is developing tools to read, visualize, analyze and reformat AIRS/AMSU-A/HSB data. The web-based AIRS on-the-fly/on-demand subsetter will be available to perform channel/variable subsetting and restructuring for Level1B (Calibrated Radiances) and Level2 (Atmospheric Retrievals) data products. One can narrow down criteria to subset data files with desired channels and variables and then download the subsetted file. AIRS QuickLook allows users to view AIRS/HSB/AMSU Level-1B data online for a specific channel prior to ordering or downloading data. Global map is also provided along with image to show geographic coverage of the granule and flight direction of the spacecraft. The Atmospheric Dynamics Data Support Team (ADDST) at the GES DISC/DAAC is providing various services to assist users in understanding, accessing, and using AIRS data product. Information on AIRS data and data analysis tools can be found at AIRS data support informational web site (http://daac.gsfc.nasa.gov/atmodyn/airs/ ) that provides access to various technical online documents, such as, readmes, user's guides, instrument guides, images from AIRS/AMSU-A/HSB data, product search and ordering interfaces, HDF-EOS format information, format conversion software, online data analysis tools, other AIRS related web links and more. Other data support services provided by the ADDST are assist with data mining, helpdesk for user questions on data and information, data ordering, and educational resources.

  2. Rig safety 9-1-1: what you need to know about ambulance safety & standards.

    PubMed

    Levick, Nadine

    2008-10-01

    What is it that we need to know about ambulance safety? How do we digest the information that's put forward by manufacturers? Does KKK-A-1822 compliance mean the ambulance can endure a crash? What's safe and what isn't? What works and what doesn't? And where do we go to find out?

  3. Estimating service lives of air-purifying respirator cartridges for reactive gas removal.

    PubMed

    Wood, Gerry O

    2005-08-01

    A mathematical model has been developed to estimate service lives of air-purifying respirator cartridges that remove gases reactively from flowing air. Most gases, because of their high volatility and low polarizability, are not effectively removed by physical adsorption on activated carbon. Models previously developed for toxic organic vapors cannot estimate service lives of cartridges for toxic gases. Often, an activated carbon is impregnated with a chemical to enhance gas removal by chemical reaction(s). The kinds of reactions, types and amounts of impregnants, and effects of the presence of water vary; therefore, the model requires user inputs of gas capacity and water effect parameters. Ideally, these should be available from manufacturers of the cartridges. If they are not, they can be extracted from measured breakthrough times using this model. The key to this model is the observation that adsorption rates of gases can be adequately quantified by the same correlations that have been reported for organic vapors. The resulting model has been used to correlate and predict breakthrough times for several common toxic gases. PMID:16012083

  4. AIRS Data Service at NASA Goddard Earth Sciences Data and Information Services (GES DISC) and Its Application to Climate Change Study

    NASA Technical Reports Server (NTRS)

    Won, Young-In; Vollimer, Bruce; Theobald, Mike; Hua, Xin-Min

    2008-01-01

    The Atmospheric Infrared Sounder (AIRS) instrument suite is designed to observe and characterize the entire atmospheric column from the surface to the top of the atmosphere in terms of surface emissivity and temperature, atmospheric temperature and humidity profiles, cloud amount and height, and the spectral outgoing infrared radiation on a global scale. The AIRS Data Support Team at the GES DISC provides data support to assist others in understanding, retrieving and extracting information from the AIRS/AMSU/HSB data products. Because a number of years has passed since its operation started, the amount of data has reached a certain level of maturity where we can address the climate change study utilizing AIRS data, In this presentation we will list various service we provide and to demonstrate how to utilize/apply the existing service to long-term and short-term variability study.

  5. Impacts of temperature change on ambulance dispatches and seasonal effect modification

    NASA Astrophysics Data System (ADS)

    Cheng, Jian; Xu, Zhiwei; Zhao, Desheng; Xie, Mingyu; Yang, Huihui; Wen, Liying; Li, Kesheng; Su, Hong

    2016-05-01

    Ambulance dispatch is a proxy of acute health outcomes, and growing epidemiological evidence documented its relation to extreme temperature events. Research, however, on short-term temperature change and ambulance dispatches is scarce. We aimed to investigate the effect of short-term temperature change on ambulance dispatches and potential modification by season. Daily data on ambulance dispatch and weather factors were collected in Huainan, a Chinese inland city from December 2011 through December 2013. A Poison generalized linear regression model combined with distributed lag nonlinear model was constructed to examine the association of temperature change between neighboring days (TCN) with ambulance dispatches. The effect modification by season was also examined. There were 48,700 ambulance attendances during the study period. A statistically significant association of TCN with ambulance dispatches was observed. Temperature rise between neighboring days (TCN > 0) was associated with elevated adverse risk of ambulance dispatches, and the effects appeared to be acute (lag0, on the current day) and could last for at least a week, while temperature drop between neighboring days (TCN < 0) had a protective effect. For a 1 °C increase of TCN at lag0 and lag06 (on the 7-day moving average), the risk of ambulance dispatches increased by 2 % (95 % CI 1-3 %) and 7 (95 % CI 1-13 %), respectively. Extreme TCN increase (95th percentile, 3.3 °C vs. 0 °C) at lag0 and lag05 was accompanied by 6 (95 % CI 3-8 %) and 27 % (95 % CI 12-44 %) increase in ambulance dispatches. Ambulance dispatches were more vulnerable to extremely great temperature rise in summer and autumn. TCN was adopted for the first time to quantify the impact of short-term temperature change on ambulance dispatches. Temperature drop between neighboring days (TCN < 0) had a protective effect on ambulance dispatches, while temperature rise between neighboring days (TCN > 0) could acutely trigger the increase in

  6. Prognostic Predictors for Ambulation in Thai Children With Cerebral Palsy Aged 2 to 18 Years.

    PubMed

    Keeratisiroj, Orawan; Thawinchai, Nuanlaor; Siritaratiwat, Wantana; Buntragulpoontawee, Montana

    2015-11-01

    The objectives of this study were to determine prognostic predictors for ambulation among Thai children with cerebral palsy and identify their ambulatory status. A retrospective cohort study was performed at 6 special schools or hospitals for children with physical disabilities. The prognostic predictors for ambulation were analyzed by multivariable ordinal continuation ratio logistic regression. The 533 participants aged 2 to 18 years were divided into 3 groups: 186 with independent ambulation (Gross Motor Function Classification System [GMFCS I-II]), 71 with assisted ambulation (Gross Motor Function Classification System III), and 276 with nonambulation (Gross Motor Function Classification System IV-V). The significant positive predictors for ambulation were type of cerebral palsy (spastic diplegia, spastic hemiplegia, dyskinesia, ataxia, hypotonia, and mixed type), sitting independently at age 2 years, and eating independently. These predictors were used to develop clinical scoring for predicting the future ability to walk among Thai children with cerebral palsy.

  7. A novel approach for mental health disease management: the Air Force Medical Service's interdisciplinary model.

    PubMed

    Runyan, Christine N; Fonseca, Vincent P; Meyer, John G; Oordt, Mark S; Talcott, G Wayne

    2003-01-01

    Mental health disorders are one of the most substantial public health problems affecting society today, accounting for roughly 15% of the overall burden of disease from all causes in the United States. Although primary care (PC) has the potential to be the frontline for recognition and management of behavioral health conditions, this has been a challenge historically. In order to more effectively address the broad scope of behavioral health needs, the Air Force Medical Service (AFMS) established a new model of behavioral health care. Through a series of coordinated steps, the AFMS ultimately placed trained behavioral health providers into PC clinics to serve as consultants to PC providers (PCPs). Behavioral Health Consultants (BHCs) provide focused assessments, present healthcare options to patients, and deliver brief collaborative interventions in the PC setting. BHCs see patients at the request of the PCP, in 15-30-min appointments. In the pilot study, patients averaged 1.6 visits to the BHC. Over 70% of patients fell into six categories of presenting problems: situational reactions, depressive disorders, adjustment disorders, anxiety disorders, health promotion, and obesity. Patient data (n = 76) suggest 97% of patients seen were either "satisfied" or "very satisfied" with BHC services, and 100% of the PCPs (n = 23, 68% response rate) were highly satisfied and indicated they would "definitely recommend" others use BHC services for their patients. Both the implications and the limitations of this pilot study are discussed.

  8. 42 CFR 414.5 - Hospital services paid under Medicare Part B when a Part A hospital inpatient claim is denied...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... described in § 419.21(a) of this chapter that do not require an outpatient status. (2) Physical therapy services, speech-language pathology services, and occupational therapy services. (3) Ambulance services,...

  9. 42 CFR 414.5 - Hospital services paid under Medicare Part B when a Part A hospital inpatient claim is denied...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... described in § 419.21(a) of this chapter that do not require an outpatient status. (2) Physical therapy services, speech-language pathology services, and occupational therapy services. (3) Ambulance services,...

  10. 38 CFR 17.101 - Collection or recovery by VA for medical care or services provided or furnished to a veteran for...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... professional charges for anesthesia services and dental services; pathology and laboratory charges; observation..., radiology, cardiology, dialysis, operating room, blood and blood administration, ambulance, MRI, anesthesia... and other professional charges except for anesthesia services and certain dental services. When...

  11. Feasibility of AmbulanCe-Based Telemedicine (FACT) Study: Safety, Feasibility and Reliability of Third Generation In-Ambulance Telemedicine

    PubMed Central

    Yperzeele, Laetitia; Van Hooff, Robbert-Jan; De Smedt, Ann; Valenzuela Espinoza, Alexis; Van Dyck, Rita; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; Lauwaert, Door; De Keyser, Jacques; Brouns, Raf

    2014-01-01

    Background Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third generation. Methods A routine ambulance was equipped with a system for real-time bidirectional audio-video communication, automated transmission of vital parameters, glycemia and electronic patient identification. All patients ( ≥18 years) transported during emergency missions by a Prehospital Intervention Team of the Universitair Ziekenhuis Brussel were eligible for inclusion. To guarantee mobility and to facilitate 24/7 availability, the teleconsultants used lightweight laptop computers to access a dedicated telemedicine platform, which also provided functionalities for neurological assessment, electronic reporting and prehospital notification of the in-hospital team. Key registrations included any safety issue, mobile connectivity, communication of patient information, audiovisual quality, user-friendliness and accuracy of the prehospital diagnosis. Results Prehospital teleconsultation was obtained in 41 out of 43 cases (95.3%). The success rates for communication of blood pressure, heart rate, blood oxygen saturation, glycemia, and electronic patient identification were 78.7%, 84.8%, 80.6%, 64.0%, and 84.2%. A preliminary prehospital diagnosis was formulated in 90.2%, with satisfactory agreement with final in-hospital diagnoses. Communication of a prehospital report to the in-hospital team was successful in 94.7% and prenotification of the in-hospital team via SMS in 90.2%. Failures resulted mainly from limited mobile connectivity and to a lesser extent from software, hardware or human error. The user acceptance was high. Conclusions Ambulance-based telemedicine of the third generation is safe, feasible and reliable but further research and development, especially

  12. Cost characteristics of tilt-rotor, conventional air and high speed rail short-haul intercity passenger service

    NASA Technical Reports Server (NTRS)

    Schoendorfer, David L.; Morlok, Edward K.

    1985-01-01

    The cost analysis done to support an assessment of the potential for a small tilt-rotor aircraft to operate in short-haul intercity passenger service is described in detail. Anticipated costs of tilt-rotor air service were compared to the costs of two alternatives: conventional air and high speed rail (HSR). Costs were developed for corridor service, varying key market characteristics including distance, passenger volumes, and minimum frequency standards. The resulting cost vs output information can then be used to compare modal costs for essentially identical service quality and passenger volume or for different service levels and volumes for each mode, as appropriate. Extensive sensitivity analyses are performed. The cost-output features of these technologies are compared. Tilt-rotor is very attractive compared to HSR in terms of costs over the entire range of volume. It also has costs not dramatically different from conventional air, but tilt-rotor costs are generally higher. Thus some of its other advantages, such as the VTOL capability, must offset the cost disadvantage for it to be a preferred or competitive mode in any given market. These issues are addressed in the companion report which considers strategies for tilt-rotor development in commercial air service.

  13. Conus medullaris stroke. Does F wave predict return of ambulation?

    PubMed

    Alanazy, Mohammed H

    2016-07-01

    Absent F wave in the stage of spinal shock has been described in cases of traumatic spinal cord injury. The role of F wave in predicting prognosis after conus medullaris infarct has not been described. We describe herein a middle aged-man with a conus medullaris infarct. Both tibial and peroneal F waves were absent on day 4. The left tibial F wave reappeared in the following study on day 18. All F waves reappeared on day 56 at which time the patient was still wheelchair bound. He regained walking on day 105. We hypothesize that reappearance of initially absent F waves post conus medullaris infarct is a good prognostic sign for the return of ambulation. The applicability of this observation requires further research. We also discuss clinical and diagnostic caveats in this case.

  14. Conus medullaris stroke. Does F wave predict return of ambulation?

    PubMed

    Alanazy, Mohammed H

    2016-07-01

    Absent F wave in the stage of spinal shock has been described in cases of traumatic spinal cord injury. The role of F wave in predicting prognosis after conus medullaris infarct has not been described. We describe herein a middle aged-man with a conus medullaris infarct. Both tibial and peroneal F waves were absent on day 4. The left tibial F wave reappeared in the following study on day 18. All F waves reappeared on day 56 at which time the patient was still wheelchair bound. He regained walking on day 105. We hypothesize that reappearance of initially absent F waves post conus medullaris infarct is a good prognostic sign for the return of ambulation. The applicability of this observation requires further research. We also discuss clinical and diagnostic caveats in this case. PMID:27356660

  15. Pendular model of paraplegic swing-through crutch ambulation.

    PubMed

    Rovick, J S; Childress, D S

    1988-01-01

    Kinematics of swing-through crutch ambulation for an individual with complete T11-T12 spinal cord injury was examined and quantitative aspects of the body-swing phase used to formulate and evaluate a 3-link pendular model. Model simulation parallels measured kinematics when shoulder motion is forced to follow the measured motion while hips and crutch tips are free pivots. Shoulder control contributes to increased ground clearance, influences timing and stride length, and gives flowing gait. Results indicate that mechanical work requirements during the body-swing phase are low. Metabolic energy demands exceed mechanical work requirements, due particularly to support of the body by the arms and shoulders. Exploiting low mechanical work requirements of the body-swing phase might be achieved through alternative mechanisms to assist ground clearance and to stabilize the wrists, arms, and shoulders while weight bearing.

  16. Development of Training Programs to Optimize Planetary Ambulation

    NASA Technical Reports Server (NTRS)

    Bloomberg, J. J.; Mulavara, A. P.; Peters, B. T.; Cohen, H. S.; Miller, C. A.; Brady, R.; Warren, L. E.; Rutley, T. M.; Kozlovskaya, I. B.

    2007-01-01

    Astronauts experience disturbances in functional mobility following their return to Earth due to adaptive responses that occur during exposure to the microgravity conditions of space flight. Despite significant time spent performing in-flight exercise routines, these training programs have not been able to mitigate postflight alterations in postural and locomotor function. Therefore, the goal of our two inter-related projects (NSBRI-ground based and ISS flight study, "Mobility") is to develop and test gait training programs that will serve to optimize functional mobility during the adaptation period immediately following space flight, thereby improving the safety and efficiency of planetary ambulation. The gait training program entails manipulating the sensory conditions of treadmill exercise to systematically challenge the balance and gait control system. This enhances the overall adaptability of locomotor function enabling rapid reorganization of gait control to respond to ambulation in different gravitational environments. To develop the training program, we are conducting a series of ground-based studies evaluating the training efficacy associated with variation in visual flow, body loading, and support surface stability during treadmill walking. We will also determine the optimal method to present training stimuli within and across training sessions to maximize both the efficacy and efficiency of the training procedure. Results indicate that variations in both visual flow and body unloading during treadmill walking leads to modification in locomotor control and can be used as effective training modalities. Additionally, the composition and timing of sensory challenges experienced during each training session has significant impact on the ability to rapidly reorganize locomotor function when exposed to a novel sensory environment. We have developed the capability of producing support surface variation during gait training by mounting a treadmill on a six

  17. MTBE concentrations in ambient air in the vicinity of service stations

    NASA Astrophysics Data System (ADS)

    Vainiotalo, Sinikka; Peltonen, Yrjö; Pfäffli, Pirkko

    Ambient air concentrations of methyl tertiary-butyl ether (MTBE) were monitored in the vicinity of two self-service stations in May-June and October, 1995. These stations (one urban and one roadside) were located in southwestern Finland and were equipped with "stage I" vapour recovery systems. All the gasoline blends dispensed during the study (95, 98 and 99 RON) contained 11% MTBE. The measurements were carried out 24 h day -1 at stationary sampling points located at the four main compass points on the service station perimeter (about 50 m from the centre of the forecourt). The air samples were collected in charcoal tubes and analysed in laboratory by gas chromatography using mass-selective detection. The concentrations in individual samples ranged from 0.5 to 121 μg m -3, and the highest daily concentrations were usually obtained at the downwind sampling points. The arithmetic mean concentrations for each of the four-day sampling periods were: 7.5 μg m -3 (station 1/May-June), 4.1 μg/m 3 (station 1/October), 12.4 μg m -3 (station 2/June) and 14.1 μg m -3 (station 2/October). The mean concentrations measured in the centre of the pump island (only daytime sampling) ranged from 247 to 1347 μg m -3. The levels of MTBE are station-specific and dependent on many factors, such as volumes of gasolines sold, wind speed, exhaust emissions from passing traffic, and deliveries of gasoline to the station. The mean wind speeds were between 0.7 and 1.5 m s -1, and the temperatures were above 22°C in summer and about 10°C in October. The volume of gasoline sold at the urban service station, station 2, was twice that at the roadside service station, station 1. There was one road with high traffic density adjacent to station 1 and two such roads at station 2. Gasoline was delivered twice to station 1 and 3 times to station 2 during the study.

  18. Benefit-cost evaluation of an intra-regional air service in the Bay area

    NASA Technical Reports Server (NTRS)

    Haefner, L. E.

    1977-01-01

    Utilization of an iterative statistical model is presented to evaluate combinations of commuter airport sites and surface transportation facilities in confunction with service by a given commuter aircraft type in light of Bay Area regional growth alternatives and peak and off-peak regional travel patterns. The model evaluates such transportation options with respect to criteria of airline profitability, public acceptance, and public and private nonuser costs. It incorporates information modal split, peak and off-peak use of the air commuter fleet, terminal and airport cost, development costs and uses of land in proximity to the airport sites, regional population shifts, and induced zonal shifts in travel demand. The model is multimodal in its analytical capability, and performs exhaustive sensitivity analysis.

  19. Association of monthly frequencies of diverse diseases in the calls to the public emergency service of the city of Buenos Aires during 1999-2004 with meteorological variables and seasons.

    PubMed

    Alexander, P

    2013-01-01

    This work aims to study associations between monthly averages of meteorological variables and monthly frequencies of diverse diseases in the calls to the public ambulance emergency service of the city of Buenos Aires during the years 1999-2004. Throughout this time period no changes were made in the classification codes of the illnesses. Heart disease, arrhythmia, heart failure, cardiopulmonary arrest, angina pectoris, psychiatric diseases, stroke, transient ischemic attack, syncope and the total number of calls were analyzed against 11 weather variables and the four seasons. All illnesses exhibited some seasonal behavior, except cardiorespiratory arrest and angina pectoris. The largest frequencies of illnesses that exhibited some association with the meteorological variables used to occur in winter, except the psychiatric cases. Heart failure, stroke, psychiatric diseases and the total number of calls showed significant correlations with the 11 meteorological variables considered, and the largest indices (absolute values above 0.6) were found for the former two pathologies. On the other side, cardiorespiratory arrest and angina pectoris revealed no significant correlations and nearly null indices. Variables associated with temperature were the meteorological proxies with the largest correlations against diseases. Pressure and humidity mostly exhibited positive correlations, which is the opposite of variables related to temperature. Contrary to all other diseases, psychiatric pathologies showed a clear predominance of positive correlations. Finally, the association degree of the medical dataset with recurrent patterns was further evaluated through Fourier analysis, to assess the presence of statistically significant behavior. In the Northern Hemisphere high morbidity and mortality rates in December are usually assigned to diverse factors in relation to the holidays, but such an effect is not observed in the present analysis. There seems to be no clearly preferred

  20. Association of monthly frequencies of diverse diseases in the calls to the public emergency service of the city of Buenos Aires during 1999-2004 with meteorological variables and seasons

    NASA Astrophysics Data System (ADS)

    Alexander, P.

    2013-01-01

    This work aims to study associations between monthly averages of meteorological variables and monthly frequencies of diverse diseases in the calls to the public ambulance emergency service of the city of Buenos Aires during the years 1999-2004. Throughout this time period no changes were made in the classification codes of the illnesses. Heart disease, arrhythmia, heart failure, cardiopulmonary arrest, angina pectoris, psychiatric diseases, stroke, transient ischemic attack, syncope and the total number of calls were analyzed against 11 weather variables and the four seasons. All illnesses exhibited some seasonal behavior, except cardiorespiratory arrest and angina pectoris. The largest frequencies of illnesses that exhibited some association with the meteorological variables used to occur in winter, except the psychiatric cases. Heart failure, stroke, psychiatric diseases and the total number of calls showed significant correlations with the 11 meteorological variables considered, and the largest indices (absolute values above 0.6) were found for the former two pathologies. On the other side, cardiorespiratory arrest and angina pectoris revealed no significant correlations and nearly null indices. Variables associated with temperature were the meteorological proxies with the largest correlations against diseases. Pressure and humidity mostly exhibited positive correlations, which is the opposite of variables related to temperature. Contrary to all other diseases, psychiatric pathologies showed a clear predominance of positive correlations. Finally, the association degree of the medical dataset with recurrent patterns was further evaluated through Fourier analysis, to assess the presence of statistically significant behavior. In the Northern Hemisphere high morbidity and mortality rates in December are usually assigned to diverse factors in relation to the holidays, but such an effect is not observed in the present analysis. There seems to be no clearly preferred

  1. Association of monthly frequencies of diverse diseases in the calls to the public emergency service of the city of Buenos Aires during 1999-2004 with meteorological variables and seasons.

    PubMed

    Alexander, P

    2013-01-01

    This work aims to study associations between monthly averages of meteorological variables and monthly frequencies of diverse diseases in the calls to the public ambulance emergency service of the city of Buenos Aires during the years 1999-2004. Throughout this time period no changes were made in the classification codes of the illnesses. Heart disease, arrhythmia, heart failure, cardiopulmonary arrest, angina pectoris, psychiatric diseases, stroke, transient ischemic attack, syncope and the total number of calls were analyzed against 11 weather variables and the four seasons. All illnesses exhibited some seasonal behavior, except cardiorespiratory arrest and angina pectoris. The largest frequencies of illnesses that exhibited some association with the meteorological variables used to occur in winter, except the psychiatric cases. Heart failure, stroke, psychiatric diseases and the total number of calls showed significant correlations with the 11 meteorological variables considered, and the largest indices (absolute values above 0.6) were found for the former two pathologies. On the other side, cardiorespiratory arrest and angina pectoris revealed no significant correlations and nearly null indices. Variables associated with temperature were the meteorological proxies with the largest correlations against diseases. Pressure and humidity mostly exhibited positive correlations, which is the opposite of variables related to temperature. Contrary to all other diseases, psychiatric pathologies showed a clear predominance of positive correlations. Finally, the association degree of the medical dataset with recurrent patterns was further evaluated through Fourier analysis, to assess the presence of statistically significant behavior. In the Northern Hemisphere high morbidity and mortality rates in December are usually assigned to diverse factors in relation to the holidays, but such an effect is not observed in the present analysis. There seems to be no clearly preferred

  2. Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed

    PubMed Central

    Crilly, Julia; Keijzers, Gerben; Tippett, Vivienne; O’Dwyer, John; Lind, James; Bost, Nerolie; O’Dwyer, Marilla; Shiels, Sue; Wallis, Marianne

    2015-01-01

    Objective To describe and compare characteristics and outcomes of patients who arrive by ambulance to the ED. We aimed to (i) compare patients with a delayed ambulance offload time (AOT) >30 min with those who were not delayed; and (ii) identify predictors of an ED length of stay (LOS) of >4 h for ambulance-arriving patients. Methods A retrospective, multi-site cohort study was undertaken in Australia using 12 months of linked health data (September 2007–2008). Outcomes of AOT delayed and non-delayed presentations were compared. Logistic regression analysis was undertaken to identify predictors of an ED LOS of >4 h. Results Of the 40 783 linked, analysable ambulance presentations, AOT delay of >30 min was experienced by 15%, and 63% had an ED LOS of >4 h. Patients with an AOT <30 min had better outcomes for: time to triage; ambulance time at hospital; time to see healthcare professional; proportion seen within recommended triage time frame; and ED LOS for both admitted and non-admitted patients. In-hospital mortality did not differ. Strong predictors of an ED LOS >4 h included: hospital admission, older age, triage category, and offload delay >30 min. Conclusion Patients arriving to the ED via ambulance and offloaded within 30 min experience better outcomes than those delayed. Given that offload delay is a modifiable predictor of an ED LOS of >4 h, targeted improvements in the ED arrival process for ambulance patients might be useful. PMID:25940975

  3. [The civil ambulances during the Franc-Prussion war (July 19, 1870 to January 28, 1871)].

    PubMed

    Guivarc'h, Marcel

    2007-01-01

    The civil ambulances joined together under the emblem of the Red Cross: the Company of Help to the Wounded Soldiers, directed from the Palate of Industry by Chenu and Le Fort; the Ambulance of the Press, directed by Ricord and Mgr Bailer; and multiple ambulances disseminated in Paris. They brought a decisive help to the French medical military Corps. On the ground, eigtheen civil Ambulances from Countryside formed in Paris looked after the casualties of the two camps: around Sedan, then in the battles of the Loire and the East, where 13 ambulances formed secondarily in province joined them. During the siege of Paris, flying Ambulances went out the ramparts and brought back the wounded to the Palate of Industry or to Longchamp 'street Press ambulancy. They were integrated in November in a great Coordination of 10 hospitals distributors, directed by Hippolyte Larrey. The surgical care, limited to the members, to the head and the neck, were simple, rapids and conservatives, and the number of amputations was limited. But secondary infectious complications were frequent, had a raised mortality, worsened by the associated diseases, infectious (smallpox, typhoid, pneumonia, and by the cold, hunger, denutrition. The war of 1870-1871 brought: a large humane progress due to the neutralization of the casualties, places and actors of care; a better approach of the infection and shown the need for an autonomy of the French Military Corps.

  4. Energy expenditure of ambulation using the Sure-Gait crutch and the standard axillary crutch.

    PubMed

    Annesley, A L; Almada-Norfleet, M; Arnall, D A; Cornwall, M W

    1990-01-01

    Energy expenditure is increased for ambulation with various assistive devices such as canes, walkers, and crutches compared with unassisted ambulation. The purpose of the present investigation was to determine whether a significant difference in oxygen consumption and heart rate existed during ambulation with two different types of crutches. Ten healthy male subjects between the ages of 40 and 60 years participated in this study. Each subject ambulated at 1.5 mph on a treadmill using two different types of crutches--the standard axillary crutch and the Sure-Gait crutch. After walking on the treadmill without an assistive device, subjects ambulated using a three-point, swing-to gait pattern with one of the two types of crutches. This procedure was repeated using the other type of crutch. Oxygen consumption and heart rate were analyzed using an analysis of variance for repeated measures design. The results of the study showed a significant difference (p less than .01) between ambulation with crutches and unassisted ambulation for oxygen consumption and heart rate. No difference, however, was found between the two crutch types.

  5. 14 CFR 93.219 - Allocation of slots for essential air service operations and applicable limitations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... SPECIAL AIR TRAFFIC RULES Allocation of Commuter and Air Carrier IFR Operations at High Density Traffic... or from a High Density Traffic Airport under the Department of Transportation's Essential Air...

  6. 14 CFR 93.219 - Allocation of slots for essential air service operations and applicable limitations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... SPECIAL AIR TRAFFIC RULES Allocation of Commuter and Air Carrier IFR Operations at High Density Traffic... or from a High Density Traffic Airport under the Department of Transportation's Essential Air...

  7. 14 CFR 93.219 - Allocation of slots for essential air service operations and applicable limitations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SPECIAL AIR TRAFFIC RULES Allocation of Commuter and Air Carrier IFR Operations at High Density Traffic... or from a High Density Traffic Airport under the Department of Transportation's Essential Air...

  8. 14 CFR 93.219 - Allocation of slots for essential air service operations and applicable limitations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... SPECIAL AIR TRAFFIC RULES Allocation of Commuter and Air Carrier IFR Operations at High Density Traffic... or from a High Density Traffic Airport under the Department of Transportation's Essential Air...

  9. 14 CFR 93.219 - Allocation of slots for essential air service operations and applicable limitations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SPECIAL AIR TRAFFIC RULES Allocation of Commuter and Air Carrier IFR Operations at High Density Traffic... or from a High Density Traffic Airport under the Department of Transportation's Essential Air...

  10. An evaluation of the Royal Air Force helicopter search and rescue services in Britain with reference to Royal Air Force Valley 1980-1989.

    PubMed Central

    Liskiewicz, W J

    1992-01-01

    The Royal Air Force (RAF) operates a helicopter Search and Rescue (SAR) service in the United Kingdom and territorial waters; it also provides a similar service in several locations abroad. A 10-year retrospective study of the SAR helicopter service operating from the RAF base at Valley on the island of Anglesey in North Wales is presented, with national SAR statistics over a similar period provided for comparison. Analysis of records kept by SAR aircrew at RAF Valley shows that their assistance had been requested on 1490 occasions during the 10-year period studied; most of these requests were the result of incidents involving holidaymakers, particularly in the mountains or along the coast. The results illustrate the versatility and life-saving potential of a highly skilled and motivated service able to work in adverse weather and dangerous locations. In the light of current debate, the value of aeromedical evacuation of seriously ill patients using helicopters is discussed. PMID:1494160

  11. ASME N511-19XX, Standard for periodic in-service testing of nuclear air treatment, heating, ventilating and air conditioning systems

    SciTech Connect

    1997-08-01

    A draft version of the Standard is presented in this document. The Standard covers the requirements for periodic in-service testing of nuclear safety-related air treatment, heating, ventilating, and air conditioning systems in nuclear facilities. The Standard provides a basis for the development of test programs and does not include acceptance criteria, except in cases where the results of one test influence the performance of other tests. The Standard covers general inspection and test requirements, reference values, inspection and test requirements, generic tests, acceptance criteria, in-service test requirements, testing following an abnormal incident, corrective action requirements, and quality assurance. Mandatory appendices provide a visual inspection checklist and four test procedures. Non-mandatory appendices provide additional information and guidance on mounting frame pressure leak test procedure, corrective action, challenge gas substitute selection criteria, and test program development. 8 refs., 10 tabs.

  12. Occupant accelerations and injury potential during an ambulance-to-curb impact.

    PubMed

    Lee, Ellen L; Hayes, Wilson C

    2014-04-01

    This paper presents real world acceleration data for an ambulance driving up and over a curb. A full scale reenactment was performed for a litigated case in which a patient on a gurney in an ambulance claimed a variety of bodily injuries after the ambulance struck a curb. A height and weight matched surrogate rode on the gurney during the tests. Results demonstrated that peak vehicle and occupant accelerations never exceeded 1.1g's. To address the claimed injuries, the accelerations likely sustained by the patient were compared to those experienced during daily life. Since ambulances are wide vehicles that travel fast on potentially narrow arterial, collector or local roadways, curb or median impacts may occur during the normal course of driving. Thus, these results may be useful for forensic experts in dealing with similar cases involving claimed injuries following curb impacts.

  13. Improving Pre-Service Elementary Teachers' Education via a Laboratory Course on Air Pollution: One University's Experience

    ERIC Educational Resources Information Center

    Mandrikas, Achilleas; Parkosidis, Ioannis; Psomiadis, Ploutarchos; Stoumpa, Artemisia; Chalkidis, Anthimos; Mavrikaki, Evangelia; Skordoulis, Constantine

    2013-01-01

    This paper describes the structure of the "Air Pollution Course", an environmental science laboratory course developed at the Science Education Laboratory of the Faculty of Primary Education, University of Athens, as well as the findings resulting from its implementation by pre-service elementary teachers. The course proposed in this study deals…

  14. Field investigation source area ST58 old Quartermaster service station, Eielson Air Force Base, Alaska

    SciTech Connect

    Liikala, T.L.; Evans, J.C.

    1995-01-01

    Source area ST58 is the site of the old Quartermaster service station at Eielson Air Force Base, Alaska. The source area is one of several Source Evaluation Report sites being investigated by Pacific Northwest Laboratory for the US Air Force as candidates for no further remedial action, interim removal action, or a remedial investigation/feasibility study under a Federal Facilities Agreement. The purpose of this work was to characterize source area ST58 and excavate the most contaminated soils for use in composting treatability studies. A field investigation was conducted to determine the nature and extent of soil contamination. The field investigation entailed a records search; grid node location, surface geophysical, and soil gas surveys; and test pit soil sampling. Soil excavation followed based on the results of the field investigation. The site was backfilled with clean soil. Results from this work indicate close spatial correlation between screening instruments, used during the field investigation and soil excavation, and laboratory analyses. Gasoline was identified as the main subsurface contaminant based on the soil gas surveys and test pit soil sampling. A center of contamination was located near the northcentral portion of the source area, and a center was located in the northwestern comer. The contamination typically occurred near or below a former soil horizon probably as a result of surface spills and leaks from discontinuities and/or breaks in the underground piping. Piping locations were delineated during the surface geophysical surveys and corresponded very well to unscaled drawings of the site. The high subsurface concentrations of gasoline detected in the northwestern comer of the source area probably reflect ground-water contamination and/or possibly floating product.

  15. Advances of air pollution science: from forest decline to multiple-stress effects on forest ecosystem services.

    PubMed

    Paoletti, E; Schaub, M; Matyssek, R; Wieser, G; Augustaitis, A; Bastrup-Birk, A M; Bytnerowicz, A; Günthardt-Goerg, M S; Müller-Starck, G; Serengil, Y

    2010-06-01

    Over the past 20 years, the focus of forest science on air pollution has moved from forest decline to a holistic framework of forest health, and from the effects on forest production to the ecosystem services provided by forest ecosystems. Hence, future research should focus on the interacting factorial impacts and resulting antagonistic and synergistic responses of forest trees and ecosystems. The synergistic effects of air pollution and climatic changes, in particular elevated ozone, altered nitrogen, carbon and water availability, must be key issues for research. Present evidence suggests air pollution will become increasingly harmful to forests under climate change, which requires integration amongst various stressors (abiotic and biotic factors, including competition, parasites and fire), effects on forest services (production, biodiversity protection, soil protection, sustained water balance, socio-economical relevance) and assessment approaches (research, monitoring, modeling) to be fostered.

  16. Advances of air pollution science: from forest decline to multiple-stress effects on forest ecosystem services.

    PubMed

    Paoletti, E; Schaub, M; Matyssek, R; Wieser, G; Augustaitis, A; Bastrup-Birk, A M; Bytnerowicz, A; Günthardt-Goerg, M S; Müller-Starck, G; Serengil, Y

    2010-06-01

    Over the past 20 years, the focus of forest science on air pollution has moved from forest decline to a holistic framework of forest health, and from the effects on forest production to the ecosystem services provided by forest ecosystems. Hence, future research should focus on the interacting factorial impacts and resulting antagonistic and synergistic responses of forest trees and ecosystems. The synergistic effects of air pollution and climatic changes, in particular elevated ozone, altered nitrogen, carbon and water availability, must be key issues for research. Present evidence suggests air pollution will become increasingly harmful to forests under climate change, which requires integration amongst various stressors (abiotic and biotic factors, including competition, parasites and fire), effects on forest services (production, biodiversity protection, soil protection, sustained water balance, socio-economical relevance) and assessment approaches (research, monitoring, modeling) to be fostered. PMID:20036449

  17. [Long-haul intensive care transports by air].

    PubMed

    Graf, Jürgen; Seiler, Olivier; Pump, Stefan; Günther, Marion; Albrecht, Roland

    2013-03-01

    The need for inter-hospital transports over long distances aboard air ambulances or airlines has increased in recent years, both in the civil as well as the military sector. More often severely ill intensive care patients with multiple organ failure and appropriate supportive care (e.g. mechanical ventilation, catecholamines, dialysis, cardiac assist devices) are transported by air. Despite the fact that long-haul intensive care transports by air ambulance and airlines via Patient Transport Compartment (PTC) are considered established modes of transport they always provide a number of challenges. Both modes of transport have distinct logistical and medical advantages and disadvantages. These-as well as the principal risks of an air-bound long-haul intensive care transport -have to be included in the risk assessment and selection of means of transport. Very often long-haul intensive care transports are a combination of air ambulance and scheduled airlines utilizing the PTC.

  18. The world's air transportation services : data as to passengers, mail, and goods carried by American and European transportation services

    NASA Technical Reports Server (NTRS)

    1922-01-01

    This report presents detailed descriptions, statistics, and graphs on European and American air transport. The European countries listed are Belgium, Czecho-Slovakia, Denmark, France, Germany, Great Britain, Holland, and Italy.

  19. Amputation and ambulation in diabetic patients: function is the goal.

    PubMed

    Attinger, Christopher E; Brown, Benjamin J

    2012-02-01

    The role of amputation in limb salvage is often poorly defined because the surgeon and the patient often attempt to save all limbs at all costs. The difficulty lies in selecting limb salvage versus early amputation. For the sedentary patient, a poorly functional salvaged limb can provide him/her with a higher quality of life than he/she would have with an amputation. For the active patient, early major amputation may offer the best functional outcome. Our experience with diabetic limb salvage over the last 20 years was retrospectively reviewed and compared with the existing literature in an attempt to better understand the role of amputation versus limb salvage in patients with diabetes. In the process, surgical techniques that we believe optimize foot and leg amputations were reviewed. Utilizing a team approach, limb salvage can yield a 64% ambulation rate and an 80% 2-year survival rate. Below-knee amputation led to a similar ambulatory rate, but the 2-year survival in these patients was 52%. With more severe rear-foot ulcers and osteomyelitis, the ambulatory rate declined with each comorbidity. However, those whose foot was saved had a higher chance of walking than those who underwent amputation. Function and quality of life are the outcomes of interest and may be maximized through either limb salvage or amputation. Our job as physicians is to match the correct solution to the patients' lifestyle and their medical, physical and psychological conditions so they can achieve their desired level of activity as quickly as possible.

  20. 76 FR 54528 - Standard Operating Procedures (SOP) of the Aircraft Certification Service (AIR) Process for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-01

    ... Certification Service, Aircraft Engineering Division, 950 L'Enfant Plaza, 5th Floor, SW., Washington, DC 20024... Administration, Aircraft Certification Service, Aircraft Engineering Division, Technical and Administrative..., Aircraft Engineering Division, Aircraft Certification Service. BILLING CODE 4910-13-P...

  1. Tools for Schools: Filtration for Improved Air Quality. Technical Services Bulletin.

    ERIC Educational Resources Information Center

    2001

    This product bulletin addresses air pollution control in educational facilities to enhance educational performance, provides air quality recommendations for schools, and examines the filtration needs of various school areas. The types of air particles typically present are highlighted, and the use of proper filtration to control gases and vapors…

  2. 76 FR 2744 - Disclosure of Code-Share Service by Air Carriers and Sellers of Air Transportation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-14

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION... agents must inform the consumer of the code-share service ``before booking transportation'' and state... global distribution systems, which may be assisting travel agents to establish airline ticket sales...

  3. Using genetic algorithms to optimise current and future health planning - the example of ambulance locations

    PubMed Central

    2010-01-01

    Background Ambulance response time is a crucial factor in patient survival. The number of emergency cases (EMS cases) requiring an ambulance is increasing due to changes in population demographics. This is decreasing ambulance response times to the emergency scene. This paper predicts EMS cases for 5-year intervals from 2020, to 2050 by correlating current EMS cases with demographic factors at the level of the census area and predicted population changes. It then applies a modified grouping genetic algorithm to compare current and future optimal locations and numbers of ambulances. Sets of potential locations were evaluated in terms of the (current and predicted) EMS case distances to those locations. Results Future EMS demands were predicted to increase by 2030 using the model (R2 = 0.71). The optimal locations of ambulances based on future EMS cases were compared with current locations and with optimal locations modelled on current EMS case data. Optimising the location of ambulance stations locations reduced the average response times by 57 seconds. Current and predicted future EMS demand at modelled locations were calculated and compared. Conclusions The reallocation of ambulances to optimal locations improved response times and could contribute to higher survival rates from life-threatening medical events. Modelling EMS case 'demand' over census areas allows the data to be correlated to population characteristics and optimal 'supply' locations to be identified. Comparing current and future optimal scenarios allows more nuanced planning decisions to be made. This is a generic methodology that could be used to provide evidence in support of public health planning and decision making. PMID:20109172

  4. Recovery of ambulation activity across the first six months post-stroke.

    PubMed

    Mahendran, Niruthikha; Kuys, Suzanne S; Brauer, Sandra G

    2016-09-01

    Stroke survivors commonly adopt sedentary activity behaviours by the chronic phase of recovery. However, the change in activity behaviours from the subacute to chronic phase of stroke is variable. This study explored the recovery of ambulation activity (volume and bouts) at one, three and six months after hospital discharge post-stroke. A total of 42 stroke survivors were recruited at hospital discharge and followed up one, three and six months later. At follow-up, ambulation activity was measured over four days using the ActivPAL™ accelerometer. Measures included volume of activity and frequency and intensity of ambulation activity bouts per day. Linear mixed effects modelling was used to determine changes over time. There was wide variation in activity. Total step counts across all time points were below required levels for health benefits (mean 4592 SD 3411). Most activity was spread across short bouts. While most number of bouts was of low intensity, most time was spent in moderate intensity ambulation across all time points. Daily step count and time spent walking and sitting/lying increased from one month to three and six months. The number of and time spent in short and medium duration bouts increased from one to six months. Time in long duration bouts increased at three months only. Time spent in moderate intensity ambulation increased over time. No change was observed for any other measures. In future, it would be valuable to identify strategies to increase engagement in activity behaviours to improve health outcomes after stroke.

  5. The impact of postoperative pain on early ambulation after hip fracture.

    PubMed

    Dubljanin-Raspopović, E; Marković-Denić, L; Ivković, K; Nedeljković, U; Tomanović, S; Kadija, M; Tulić, G; Bumbasirević, M

    2013-01-01

    Hip fractures are the most serious consequence of falling in older people with osteoporosis. Early ambulation is one of the main goals of inpatient rehabilitation aimed at reducing negative effects of immobilization, and promoting functional recovery. Recognizing the role of different factors that are associated with time to ambulation time after hip fracture surgery may help decrease morbidity and mortality rates. The aim of this study was to examine the impact of postoperative pain time to ambulation following hip fracture surgery. A total of 96 patients who consecutively presented at the Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia during a 6 month period were included in the study. Subjects were assessed regarding socioedemographic characteristics, prefracture functional status, cognitive status, general health status, fracture type, type of anaesthesia, and waiting time for surgery. The VAS scale (0-100) was used to measure pain intensity on the first postoperative day. Our results revealed that patients, whose time to ambulation was = 48 h postoperatively were of worse physical health, and had significantly higher VAS score on the first postoperative day. Unrelieved pain in geriatric hip fracture patients is associated with delayed ambulation. Future research should confirm the posi-tive effects of aggressive pain management programs on early functional outcome in elderly patients who sustain hip fractures.

  6. Ambulation speed and corresponding mechanics are associated with changes in serum cartilage oligomeric matrix protein.

    PubMed

    Denning, W Matt; Becker Pardo, Michael; Winward, Jason G; Hunter, Iain; Ridge, Sarah; Hopkins, J Ty; Reese, C Shane; Parcell, Allen C; Seeley, Matthew K

    2016-02-01

    Because serum cartilage oligomeric matrix protein (COMP) has been used to reflect articular cartilage condition, we aimed to identify walking and running mechanics that are associated with changes in serum COMP. Eighteen subjects (9 male, 9 female; age=23 ± 2 yrs.; mass=68.3 ± 9.6 kg; height=1.70 ± 0.08 m) completed 4000 steps on an instrumented treadmill on three separate days. Each day corresponded to a different ambulation speed: slow (preferred walking speed), medium (+50% of slow), and fast (+100% of slow). Synchronized ground reaction force and video data were collected to evaluate walking mechanics. Blood samples were collected pre-, post-, 30-minute post-, and 60-minute post-ambulation to determine serum COMP concentration at these times. Serum COMP increased 29%, 18%, and 5% immediately post ambulation for the fast, medium, and slow sessions (p<0.01). When the speeds were pooled, peak ankle inversion, knee extension, knee abduction, hip flexion, hip extension, and hip abduction moment, and knee flexion angle at impact explained 61.4% of total variance in COMP concentration change (p<0.001). These results indicate that (1) certain joint mechanics are associated with acute change in serum COMP due to ambulation, and (2) increased ambulation speed increases serum COMP concentration. PMID:27004646

  7. Variables Related to Pre-Service Cannabis Use in a Sample of Air Force Enlistees.

    ERIC Educational Resources Information Center

    Mullins, Cecil J.; And Others

    This report is an attempt to add to the existing information about cannabis use, its correlates, and its effects. The sample population consisted of self-admitted abusers of various drugs, identified shortly after entering the Air Force. The subjects (N=4688) were located through the Drug Control Office at Lackland Air Force Base. Variables…

  8. Availability of ambulance patient care reports in the emergency department.

    PubMed

    Shelton, Dominick; Sinclair, Paul

    2016-01-01

    Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses. Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts. A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports. Improvement strategies consisted of: 1. Educating ED clerical staff about the importance of EMS reports 2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients 3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients 4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of

  9. Availability of ambulance patient care reports in the emergency department

    PubMed Central

    Shelton, Dominick; Sinclair, Paul

    2016-01-01

    Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses. Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts. A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports. Improvement strategies consisted of: 1. Educating ED clerical staff about the importance of EMS reports 2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients 3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients 4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of

  10. The effects of assistive devices on the oxygen cost, cardiovascular stress, and perception of nonweight-bearing ambulation.

    PubMed

    Holder, C G; Haskvitz, E M; Weltman, A

    1993-10-01

    Nonweight-bearing ambulation with the aid of an assistive device is often prescribed in the clinical setting. Little is known about the oxygen cost, cardiovascular stress, and perception of effort of these devices when applied to the same sample of subjects. Therefore, the present study compared the oxygen cost, cardiovascular stress [measured by heart rate (HR), blood pressure (BP) responses, and rate pressure product (RPP)], and perception of effort [measured by ratings of perceived exertion (RPE)] of unassisted ambulation (UA), nonweight-bearing ambulation using axillary crutches (AC), a standard walker (SW), and a wheeled walker (WW). Nine female subjects ambulated at self-selected velocities for 7 minutes during each ambulation mode. Oxygen consumption, HR, BP, and RPEs were obtained. As expected, UA resulted in the lowest VO2 (11.2 +/- 1.4 ml/kg.min-1) and greatest velocity (1.24 +/- 0.27 m/sec). Results also indicated that AC ambulation resulted in lower oxygen consumption per meter (0.4 +/- 0.1 ml/kg.m-1) and greater velocity (0.74 +/- 0.18 m/sec) than either SW ambulation (0.6 +/- .1 ml/kg.-1, 0.39 +/- 0.09 m/sec) or WW ambulation (0.6 +/- .1 ml/kg.m-1, 0.40 +/- 0.12 m/sec) (p < .05). No differences were observed among assisted ambulation modes for HR, BP responses, RPP, or RPE values. Because patients typically ambulate for a set distance (rather than a set time) and because the oxygen cost per unit distance was lowest for AC, it is suggested that, when possible, AC should be prescribed for non-weight-bearing ambulation.

  11. A critical review of studies of the association between demands for hospital services and air pollution.

    PubMed Central

    Lipfert, F W

    1993-01-01

    Studies of the associations between air pollution and hospital admissions and emergency room use are reviewed, including studies of air pollution episodes, time-series analyses, and cross-sectional analyses. These studies encompass a variety of methods of analysis and levels of air quality. Findings from all three types of studies were generally consistent in that almost all of the studies reviewed found statistically significant associations between hospital use and air pollution; this unanimity may have resulted in part from publication bias. These associations were characterized by elasticities of the order of 0.20; i.e., a 100% change in air pollution was associated with a change in hospital use of about 20%, for specific diagnoses. Respiratory diagnoses were emphasized by most studies; cardiac diagnoses were included in five of them. The air pollutants most often associated with changes in hospital use were particulate matter, sulfur oxides, and oxidants. Apart from the major air pollution episodes, there was no obvious link between air pollution level and the significance or magnitudes of the associations. Long-term indicators of hospitalization appeared to also be influenced by medical care supply factors, including the numbers of beds and physicians per capita. These nonpathological causal factors could also have influenced the findings of the time-series studies by introducing extraneous factors in the patterns of admissions. Although consistent associations have been shown between hospital use and air pollution, further research is required to distinguish among potentially responsible pollutants and to deduce specific dose-response relationships of general utility. PMID:8243395

  12. Suicidal ideation and suicide attempts in a nationwide sample of operational Norwegian ambulance personnel.

    PubMed

    Sterud, Tom; Hem, Erlend; Lau, Bjørn; Ekeberg, Oivind

    2008-01-01

    This is the first paper on suicidal ideation and attempts among ambulance personnel. This study aimed to investigate levels of suicidal ideation and suicide attempts among ambulance personnel, and to identify important correlates and the factors to which ambulance personnel attribute their serious suicidal ideation. A comprehensive nationwide questionnaire survey of 1,180 operational ambulance personnel was conducted. Measurements included: Paykel's Suicidal Feelings in the General Population questionnaire, the Hospital Anxiety and Depression scale, the Subjective Health Complaints Questionnaire, the Maslach Burnout Inventory, the Job Satisfaction Scale, the Basic Character Inventory, and the Rosenberg Self-Esteem Scale. Lifetime prevalence ranged from 28% for feelings that life was not worth living to 10.4% for seriously considered suicide and 3.1% for a suicide attempt. Serious suicidal ideation was independently associated with job-related emotional exhaustion (feelings of being overextended and depleted of resources) (OR 1.5, 95% CI 1.1-2.0) and bullying at work (OR 1.7, 95% CI 1.02-2.7), younger age, not married/cohabitant, depression symptoms, low self-esteem and the personality trait reality weakness. In general, suicidal thoughts were hardly attributable to working conditions, since only 1.8% of ambulance personnel attributed suicidal ideation to work problems alone. In conclusion, ambulance personnel reported a moderate level of suicidal ideation and suicide attempts. Although serious suicidal ideation was rarely attributed to working conditions in general, this study suggests that job-related factors like emotional exhaustion and bullying may be of importance.

  13. On an ambulance stretcher suspension concerned with the reduction of patient's blood pressure variation.

    PubMed

    Sagawa, K; Inooka, H; Ino-oka, E; Takahashi, T

    1997-01-01

    The design process and control of an ambulance stretcher suspension to reduce patient's blood pressure variation (BPV) is discussed. The BPV caused by applying the vehicle brakes may lead to deterioration of a patient's condition. The proposed method can reduce BPV by tilting the stretcher and counterbalancing back-to-front acceleration of the ambulance with gravity. The experimental results obtained when using a manually controlled stretcher confirm that BPV is reduced by tilting the stretcher. A continuous control method that varies the tilting angle is investigated through simulation analysis. The results show that this control method reduces the BPV effectively and achieves safe transport of the patient.

  14. TECHNOLOGY EVALUATION REPORT CEREX ENVIRONMENTAL SERVICES UV HOUND POINT SAMPLE AIR MONITOR

    EPA Science Inventory

    The USEPA's National Homeland Security Research Center (NHSRC) Technology Testing and Evaluation Program (TTEP) is carrying out performance tests on homeland security technologies. Under TTEP, Battelle evaluated the performance of the Cerex UV Hound point sample air monitor in de...

  15. Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel.

    PubMed

    Aasa, Ulrika; Brulin, Christine; Angquist, Karl-Axel; Barnekow-Bergkvist, Margareta

    2005-09-01

    This study aimed at investigating the relationships between work-related psychosocial factors, worry about work conditions and health complaints (sleeping problems, headache and stomach symptoms) among female and male ambulance personnel. Out of 4000 ambulance personnel in Sweden, 1500 (300 female and 1200 male personnel) were randomly selected. They answered a questionnaire including items on self-reported health complaints, individual characteristics, work-related psychological demands, decision latitude, social support and worry about work conditions. Twenty-five per cent of the female and 20% of the male ambulance personnel reported two or more health complaints sometimes or often. According to the demand-control-support questionnaire, ambulance personnel reported a generally positive psychosocial work environment, although psychological demands were associated with sleeping problems, headache and stomach symptoms among both female and male ambulance personnel. Another factor that was significantly associated with health complaints among both genders was worry about work conditions. When worry about work conditions was added to the regression models, this variable took over the role from psychological demands as a predictor for health complaints among the female ambulance personnel. The prevalence of sleeping problems, headache and stomach symptoms were significantly associated with psychological demands among both female and male ambulance personnel. Notably, worry about work conditions seems to be an important risk factor for health complaints. This suggests that worry about work conditions should not be neglected when considering risk factors among ambulance personnel.

  16. Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel.

    PubMed

    Aasa, Ulrika; Brulin, Christine; Angquist, Karl-Axel; Barnekow-Bergkvist, Margareta

    2005-09-01

    This study aimed at investigating the relationships between work-related psychosocial factors, worry about work conditions and health complaints (sleeping problems, headache and stomach symptoms) among female and male ambulance personnel. Out of 4000 ambulance personnel in Sweden, 1500 (300 female and 1200 male personnel) were randomly selected. They answered a questionnaire including items on self-reported health complaints, individual characteristics, work-related psychological demands, decision latitude, social support and worry about work conditions. Twenty-five per cent of the female and 20% of the male ambulance personnel reported two or more health complaints sometimes or often. According to the demand-control-support questionnaire, ambulance personnel reported a generally positive psychosocial work environment, although psychological demands were associated with sleeping problems, headache and stomach symptoms among both female and male ambulance personnel. Another factor that was significantly associated with health complaints among both genders was worry about work conditions. When worry about work conditions was added to the regression models, this variable took over the role from psychological demands as a predictor for health complaints among the female ambulance personnel. The prevalence of sleeping problems, headache and stomach symptoms were significantly associated with psychological demands among both female and male ambulance personnel. Notably, worry about work conditions seems to be an important risk factor for health complaints. This suggests that worry about work conditions should not be neglected when considering risk factors among ambulance personnel. PMID:16101853

  17. Guidelines for evaluating air-pollution impacts on Class I wilderness areas in the Pacific Northwest. Forest Service general technical report

    SciTech Connect

    Peterson, J.; Schmoldt, D.; Peterson, D.; Eilers, J.; Fisher, R.

    1992-05-01

    Forest Service air resource managers in the Pacific Northwest are responsible for protecting class 1 wilderness areas from air pollution. To do this, they need scientifically defensible information to determine critical concentrations of air pollution having the potential to impact class 1 wilderness values. This report documents the results of a workshop where current information on air pollution effects on aquatic and terrestrial resources and visibility was gathered from participating scientists and managers. Critical air pollution concentrations were determined for sulfur dioxide, nitrogen dioxide, and ozone. Critical values for sulfur and nitrogen deposition to forest ecosystems are listed.

  18. Effect of fee-for-service air-conditioning management in balancing thermal comfort and energy usage.

    PubMed

    Chen, Chen-Peng; Hwang, Ruey-Lung; Shih, Wen-Mei

    2014-11-01

    Balancing thermal comfort with the requirement of energy conservation presents a challenge in hot and humid areas where air-conditioning (AC) is frequently used in cooling indoor air. A field survey was conducted in Taiwan to demonstrate the adaptive behaviors of occupants in relation to the use of fans and AC in a school building employing mixed-mode ventilation where AC use was managed under a fee-for-service mechanism. The patterns of using windows, fans, and AC as well as the perceptions of students toward the thermal environment were examined. The results of thermal perception evaluation in relation to the indoor thermal conditions were compared to the levels of thermal comfort predicted by the adaptive models described in the American Society of Heating, Refrigerating, and Air-Conditioning Engineers Standard 55 and EN 15251 and to that of a local model for evaluating thermal adaption in naturally ventilated buildings. A thermal comfort-driven adaptive behavior model was established to illustrate the probability of fans/AC use at specific temperature and compared to the temperature threshold approach to illustrate the potential energy saving the fee-for-service mechanism provided. The findings of this study may be applied as a reference for regulating the operation of AC in school buildings of subtropical regions.

  19. Effect of fee-for-service air-conditioning management in balancing thermal comfort and energy usage

    NASA Astrophysics Data System (ADS)

    Chen, Chen-Peng; Hwang, Ruey-Lung; Shih, Wen-Mei

    2014-02-01

    Balancing thermal comfort with the requirement of energy conservation presents a challenge in hot and humid areas where air-conditioning (AC) is frequently used in cooling indoor air. A field survey was conducted in Taiwan to demonstrate the adaptive behaviors of occupants in relation to the use of fans and AC in a school building employing mixed-mode ventilation where AC use was managed under a fee-for-service mechanism. The patterns of using windows, fans, and AC as well as the perceptions of students toward the thermal environment were examined. The results of thermal perception evaluation in relation to the indoor thermal conditions were compared to the levels of thermal comfort predicted by the adaptive models described in the American Society of Heating, Refrigerating, and Air-Conditioning Engineers Standard 55 and EN 15251 and to that of a local model for evaluating thermal adaption in naturally ventilated buildings. A thermal comfort-driven adaptive behavior model was established to illustrate the probability of fans/AC use at specific temperature and compared to the temperature threshold approach to illustrate the potential energy saving the fee-for-service mechanism provided. The findings of this study may be applied as a reference for regulating the operation of AC in school buildings of subtropical regions.

  20. Requirements for regional short-haul air service and the definition of a flight program to determine neighborhood reactions to small transport aircraft

    NASA Technical Reports Server (NTRS)

    Feher, K.; Bollinger, L.; Bowles, J. V.; Waters, M. H.

    1978-01-01

    An evaluation of the current status and future requirements of an intraregional short haul air service is given. A brief definition of the different types of short haul air service is given. This is followed by a historical review of previous attempts to develop short haul air service in high density urban areas and an assessment of the current status. The requirements for intraregional air service, the need for economic and environmental viability and the need for a flight research program are defined. A detailed outline of a research program that would determine urban community reaction to frequent operations of small transport aircraft is also given. Both the operation of such an experiment in a specific region (San Francisco Bay area) and the necessary design modifications of an existing fixed wing aircraft which could be used in the experiment are established. An estimate is made of overall program costs.

  1. Basic Training Program for Emergency Medical Technician: Ambulance Concepts and Recommendations.

    ERIC Educational Resources Information Center

    Fucigna, Joseph T.; And Others

    The main objective was to develop and pilot test a basic course for ambulance personnel with emphasis on the medical aspect of training. This included the identification of a medically acceptable text or manual, and determining the prerequisites for selecting students and instructors. Secondary objectives were to outline the requirements for…

  2. Functional ambulation velocity and distance requirements in rural and urban communities. A clinical report.

    PubMed

    Robinett, C S; Vondran, M A

    1988-09-01

    The purposes of this clinical report are 1) to document the distances and velocities that individuals must ambulate to function independently in their community and 2) to demonstrate the differences in travel distances and velocities among communities of various sizes. In seven communities of different sizes, we measured distances from a designated parking space to commonly frequented sites (eg, stores, post offices, banks, and medical buildings). We also measured street widths and the time allowed by crossing signals to cross streets safely. From these data, we calculated the velocities needed to safely cross streets in each community. The study results showed that ambulation distances and velocities vary depending on the size of the community and that for individuals to function independently within their community, they must ambulate at velocities and distances much greater than the ambulation objectives that may be set at most rehabilitation settings. Based on the results of this study, we suggest that they receive the majority of their patients to more accurately prepare patients for functional independence after rehabilitation discharge.

  3. Promoting Ambulation Responses among Children with Multiple Disabilities through Walkers and Microswitches with Contingent Stimuli

    ERIC Educational Resources Information Center

    Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Oliva, Doretta; Smaldone, Angela; La Martire, Maria L.; Stasolla, Fabrizio; Castagnaro, Francesca; Groeneweg, Jop

    2010-01-01

    Children with severe or profound intellectual and motor disabilities often present problems of balance and ambulation and spend much of their time sitting or lying, with negative consequences for their development and social status. Recent research has shown the possibility of using a walker (support) device and microswitches with preferred…

  4. A new vibration isolation bed stage with magnetorheological dampers for ambulance vehicles

    NASA Astrophysics Data System (ADS)

    Chae, Hee Dong; Choi, Seung-Bok

    2015-01-01

    The vibration experienced in an ambulance can lead to secondary injury to a patient and discourage a paramedic from providing emergency care. In this study, with the goal of resolving this problem, a new vibration isolation bed stage associated with magnetorheological (MR) dampers is proposed to ensure ride quality as well as better care for the patient while he/she is being transported. The bed stage proposed in this work can isolate vibrations in the vertical, rolling and pitching directions to reflect the reality that occurs in the ambulance. Firstly, an appropriate-sized MR damper is designed based on the field-dependent rheological properties of MR fluid, and the damping force characteristics of a MR damper are evaluated as a function of the current. A mechanical model of the proposed vibration isolation bed stage is then established to derive the governing equations of motion. Subsequently, a sliding mode controller is formulated to control the vibrations caused from the imposed excitation signals; those signals are directly measured using a real ambulance subjected to bump-and-curve road conditions. Using the controller based on the dynamic motion of the bed stage, the vibration control performance is evaluated in both the vertical and pitch directions. It is demonstrated that the magnitude of the vibration in the patient compartment of the ambulance can be significantly reduced by applying an input current to the MR dampers installed for the new bed stage.

  5. Functional ability and muscle force in healthy children and ambulant Duchenne muscular dystrophy patients.

    PubMed

    Beenakker, Ernesto A C; Maurits, Natalia M; Fock, Johanna M; Brouwer, Oebele F; van der Hoeven, Johannes H

    2005-01-01

    Neuromuscular disorders are characterised by progressive muscle weakness, which in time causes functional impairment. To quantify the extent of disease progression, muscle force and functional ability can be measured. Which of these parameters changes most depends on the disease stage. In a previous study, we reported normal values for muscle force obtained by hand-held dynamometry in healthy children aged 4-16 years. In the present study, we report normal values for timed functional tests in healthy children aged 4-11 years. These normal values were compared with values obtained in 16 ambulant patients with Duchenne muscular dystrophy (DMD) aged 5-8 years to study the extent of functional impairment. In ambulant patients with DMD, we found that muscle function assessed by timed functional tests (running 9 m and rising up from the floor) and muscle force assessed by hand-held dynamometry were severely impaired. However, a small reduction of muscle force was accompanied by a large reduction in functional ability. Therefore, in our group of ambulant patients with DMD, timed functional testing was the most sensitive parameter to determine the extent of disease progression. Timed functional testing may therefore be considered as an additional outcome measure in drug trials to evaluate the effects of therapy in ambulant patients with DMD and possibly in other neuromuscular disorders.

  6. A non-contact vital sign monitoring system for ambulances using dual-frequency microwave radars.

    PubMed

    Suzuki, Satoshi; Matsui, Takemi; Kawahara, Hiroshi; Ichiki, Hiroto; Shimizu, Jun; Kondo, Yoko; Gotoh, Shinji; Yura, Hirofumi; Takase, Bonpei; Ishihara, Masayuki

    2009-01-01

    We developed a novel non-contact monitoring system to measure the vital signs of casualties inside a moving ambulance. This system was designed to prevent exposure of patients to infectious organisms under biochemical hazard conditions. The system consists of two microwave radars: a 10-GHz respiratory-monitoring radar is positioned 20 cm away from the surface of the isolator. The 24-GHz cardiac-monitoring radar is positioned below the stretcher underneath the isolator. The subject (22.13 +/- 0.99 years) was placed inside the isolator on a stretcher in the simulated ambulance. While the ambulance was in motion at a speed of approximately 10 km/h, the heart rates determined by the cardiac-monitoring radar correlated significantly with those measured by ECG (r = 0.69, p < 0.01), and the respiratory rates derived from the respiratory-monitoring radar correlated with those measured by the respiration curves (r = 0.97, p < 0.0001). The proposed system appears promising for future on-ambulance monitoring of the vital sign of casualties exposed to toxins. PMID:18946695

  7. 5 CFR 9701.232 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Marshal Service. 9701.232 Section 9701.232 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Transitional Provisions §...

  8. 5 CFR 9701.232 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Marshal Service. 9701.232 Section 9701.232 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Transitional Provisions §...

  9. 5 CFR 9701.232 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Marshal Service. 9701.232 Section 9701.232 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Transitional Provisions §...

  10. A Prevalence and Management Study of Acute Pain in Children Attending Emergency Departments by Ambulance.

    PubMed

    Murphy, Adrian; McCoy, Siobhan; O'Reilly, Kay; Fogarty, Eoin; Dietz, Jason; Crispino, Gloria; Wakai, Abel; O'Sullivan, Ronan

    2016-01-01

    Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (<16 years) who had pain as a symptom (regardless of cause) at any stage during the prehospital phase of care were included in this study. Over the study period, 6,371 children attended the four EDs by emergency ambulance, of which 2,635 (41.4%, 95% confidence interval 40.2-42.3%) had pain as a documented symptom on the ambulance patient care report (PCR) form. Overall 32% (n = 856) of children who complained of pain were subject to a formal pain assessment during the prehospital phase of care. Younger age, short transfer time to the ED, and emergency calls between midnight and 6 am were independently associated with decreased likelihood of having a documented assessment of pain intensity during the prehospital phase of care. Of the 2,635 children who had documented pain on the ambulance PCR, 26% (n = 689) received some form of analgesic agent prior to ED arrival. Upon ED arrival 54% (n = 1,422) of children had a documented pain assessment and some form of analgesic agent was administered to 50% (n = 1,324). Approximately 41% of children who attend EDs in Ireland by ambulance have pain documented as their primary symptom. This study suggests that the management of acute pain in children transferred by

  11. 77 FR 23114 - Modification, Revocation and Establishment of Air Traffic Service Routes; Windsor Locks Area; CT

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-18

    ...) routes in the vicinity of Windsor Locks, CT (77 FR 20528). Subsequent to publication, an error was... on April 5, 2010 (77 FR 20528) (FR Doc. 2012-8183) for RNAV route T-300, is corrected under the..., due to the planned decommissioning of the Bradley VHF omnirange/tactical air navigation aid....

  12. 14 CFR 204.4 - Carriers proposing to provide essential air service.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS DATA TO SUPPORT FITNESS DETERMINATIONS Filing Requirements § 204... Department, and these data continue to reflect the current state of the carrier's fitness, the carrier may... contact the Air Carrier Fitness Division to ascertain what information is already available to...

  13. The Library Science Institute of the University of Buenos Aires: Summary of Its Objectives and Services.

    ERIC Educational Resources Information Center

    Gravenhorst, Hans

    The main objectives of the Institute, which was founded in 1941, are to act as a center for bibliographic and documentary information and to be the co-ordinating body for the libraries belonging to the ten schools of the University of Buenos Aires. To fulfill this objective, the Institute library possesses the most important sources of…

  14. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia

    PubMed Central

    Fatovich, D; Nagree, Y; Sprivulis, P

    2005-01-01

    Objective: Access block refers to the situation where patients in the emergency department (ED) requiring inpatient care are unable to gain access to appropriate hospital beds within a reasonable time frame. We systematically evaluated the relationship between access block, ED overcrowding, ambulance diversion, and ED activity. Methods: This was a retrospective analysis of data from the Emergency Department Information System for the three major central metropolitan EDs in Perth, Western Australia, for the calendar years 2001–2. Bivariate analyses were performed in order to study the relationship between a range of emergency department workload variables, including access block (>8 hour total ED stay for admitted patients), ambulance diversion, ED overcrowding, and ED waiting times. Results: We studied 259 580 ED attendances. Total diversion hours increased 74% from 3.39 hours/day in 2001 to 5.90 hours/day in 2002. ED overcrowding (r = 0.96; 95% confidence interval (CI) 0.91 to 0.98), ambulance diversion (r = 0.75; 95% CI 0.49 to 0.88), and ED waiting times for care (r = 0.83; 95% CI 0.65 to 0.93) were strongly correlated with high levels of ED occupancy by access blocked patients. Total attendances, admissions, discharges, and low acuity patient attendances were not associated with ambulance diversion. Conclusion: Reducing access block should be the highest priority in allocating resources to reduce ED overcrowding. This would result in reduced overcrowding, reduced ambulance diversion, and improved ED waiting times. Improving hospital inpatient flow, which would directly reduce access block, is most likely to achieve this. PMID:15843704

  15. Self-paced brain-computer interface control of ambulation in a virtual reality environment

    NASA Astrophysics Data System (ADS)

    Wang, Po T.; King, Christine E.; Chui, Luis A.; Do, An H.; Nenadic, Zoran

    2012-10-01

    Objective. Spinal cord injury (SCI) often leaves affected individuals unable to ambulate. Electroencephalogram (EEG) based brain-computer interface (BCI) controlled lower extremity prostheses may restore intuitive and able-body-like ambulation after SCI. To test its feasibility, the authors developed and tested a novel EEG-based, data-driven BCI system for intuitive and self-paced control of the ambulation of an avatar within a virtual reality environment (VRE). Approach. Eight able-bodied subjects and one with SCI underwent the following 10-min training session: subjects alternated between idling and walking kinaesthetic motor imageries (KMI) while their EEG were recorded and analysed to generate subject-specific decoding models. Subjects then performed a goal-oriented online task, repeated over five sessions, in which they utilized the KMI to control the linear ambulation of an avatar and make ten sequential stops at designated points within the VRE. Main results. The average offline training performance across subjects was 77.2±11.0%, ranging from 64.3% (p = 0.001 76) to 94.5% (p = 6.26×10-23), with chance performance being 50%. The average online performance was 8.5±1.1 (out of 10) successful stops and 303±53 s completion time (perfect = 211 s). All subjects achieved performances significantly different than those of random walk (p < 0.05) in 44 of the 45 online sessions. Significance. By using a data-driven machine learning approach to decode users’ KMI, this BCI-VRE system enabled intuitive and purposeful self-paced control of ambulation after only 10 minutes training. The ability to achieve such BCI control with minimal training indicates that the implementation of future BCI-lower extremity prosthesis systems may be feasible.

  16. Cross-Cultural Perspectives of Service Quality and Risk in Air Transportation

    NASA Technical Reports Server (NTRS)

    Cunningham, Lawrence F.; Young, Clifford E.; Lee, Moonkyu

    2002-01-01

    This study compares US and Korean customers in terms of their perceptions of airline service quality based on SERVPERF and industry-based measures, as well as their perceptions of risks involved in the airline choice. SERVPERF is a set of multi-dimensional measures of customer evaluations of service quality. The results indicate that: (1) US passengers are generally more satisfied with their airline service than Korean customers on most of the SERVPERF dimensions; (2) Koreans are generally more satisfied with the bumping procedures whereas US participants feel more satisfied with the airline's baggage handling, operations/safety, and connections; and (3) US participants perceive higher levels of performance and financial risks whereas Koreans feel greater social risk in choosing an airline. This study also examines the SERVPERF, industry-based measure, and perceived risk in predicting customer satisfaction with, and intention to repatronize the airline. The results suggest that US customers consider service reliability, in-flight comfort, and connections as the key factors determining satisfaction with airline service whereas Korean passengers generally regard reliability, assurance, and risk factors as predictors of satisfaction. The determining factors of customer intention to repatronize the airline are reliability and empathy for US, and reliability and overall risk for Korean customers. The study demonstrates the applicability of SERVPERF as a cross-cultural tool and indicates the importance of perceived risk in cross-cultural studies.

  17. Lichens as bioindicators of air quality. Forest Service general technical report (Final)

    SciTech Connect

    Stolte, K.; Doty, R.; Mangis, D.; Tonnessen, K.; Huckaby, L.S.

    1993-03-01

    The report is the result of a workshop held in Denver, Colorado on April 9-11, 1991. It summarizes the current literature and techniques for using lichens to monitor air quality. Experts in lichenology and ecology contributed information on lichen floristics, characterization of monitoring sites, lichen species and communities, identifying lichen species sensitive to pollutants, active monitoring with transplants, chemical analysis of lichens, and case studies as examples of lichen biomonitoring scenarios.

  18. Optimizing Air Transportation Service to Metroplex Airports. Par 2; Analysis Using the Airline Schedule Optimization Model (ASOM)

    NASA Technical Reports Server (NTRS)

    Donoue, George; Hoffman, Karla; Sherry, Lance; Ferguson, John; Kara, Abdul Qadar

    2010-01-01

    The air transportation system is a significant driver of the U.S. economy, providing safe, affordable, and rapid transportation. During the past three decades airspace and airport capacity has not grown in step with demand for air transportation; the failure to increase capacity at the same rate as the growth in demand results in unreliable service and systemic delay. This report describes the results of an analysis of airline strategic decision-making that affects geographic access, economic access, and airline finances, extending the analysis of these factors using historic data (from Part 1 of the report). The Airline Schedule Optimization Model (ASOM) was used to evaluate how exogenous factors (passenger demand, airline operating costs, and airport capacity limits) affect geographic access (markets-served, scheduled flights, aircraft size), economic access (airfares), airline finances (profit), and air transportation efficiency (aircraft size). This analysis captures the impact of the implementation of airport capacity limits, as well as the effect of increased hedged fuel prices, which serve as a proxy for increased costs per flight that might occur if auctions or congestion pricing are imposed; also incorporated are demand elasticity curves based on historical data that provide information about how passenger demand is affected by airfare changes.

  19. 75 FR 62639 - Air Ambulance and Commercial Helicopter Operations, Part 91 Helicopter Operations, and Part 135...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-12

    ... in the Federal Register published on April 11, 2000 (65 FR 19477-78) or you may visit http://Dockets...). alternate airport weather minimums. Require helicopter pilots to demonstrate competency in recovery from... and to demonstrate their competency during initial and recurrent 14 CFR 135.293 evaluation check...

  20. Idling Reduction for Emergency and Other Service Vehicles

    SciTech Connect

    2015-05-07

    This is a fact sheet about reducing idling for emergency and service vehicles. Emergency vehicles, such as police cars, ambulances, and fire trucks, along with other service vehicles such as armored cars, are often exempt from laws that limit engine idling. However, these vehicles can save fuel and reduce emissions with technologies that allow them to perform vital services without idling.

  1. 5 CFR 9701.374 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Marshal Service. 9701.374 Section 9701.374 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional...

  2. Using Ecosystem Services to Inform Decisions on U.S. Air Quality Standards

    EPA Science Inventory

    The ecosystem services (ES) framework provides a link between changes in a natural system’s structure and function and public welfare. This systematic integration of ecology and economics allows for more consistency and transparency in environmental decision making by enab...

  3. 5 CFR 9701.374 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Marshal Service. 9701.374 Section 9701.374 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional...

  4. 5 CFR 9701.374 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Marshal Service. 9701.374 Section 9701.374 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional...

  5. 5 CFR 9701.374 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional Provisions... Security Administration (TSA) to another organization within DHS, DHS may cover those positions under a pay... Marshal Service. 9701.374 Section 9701.374 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY...

  6. 5 CFR 9701.232 - Special transition rules for Federal Air Marshal Service.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Administration (TSA) to another organization within DHS, DHS may cover those positions under a classification... Marshal Service. 9701.232 Section 9701.232 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN... HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Transitional Provisions §...

  7. 77 FR 50420 - Proposed Provision of Navigation Services for the Next Generation Air Transportation System...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-21

    ... published a Federal Register Notice (76 FR 77939) requesting comments on the FAA's plans for providing PBN... coordination process, the FAA plans to develop a schedule showing the requisite activities associated with the discontinuance of VOR services. These activities will include timely notification for individual facilities...

  8. A Graphic Analysis of the Instructional Service Function of Academic Departments. AIR Forum 1980 Paper.

    ERIC Educational Resources Information Center

    Reichard, Donald J.; And Others

    A modified form of vector analysis is examined that was applied to graphs depicting the number of undergraduate student credit hours taken by majors and nonmajors in each of 18 arts and sciences departments. The analysis permitted the identification of instructional service strategies adopted by various academic units and the evaluation of the…

  9. An overview of the state of the art of noninvasive FES for independent ambulation by thoracic level paraplegics.

    PubMed

    Graupe, Daniel

    2002-07-01

    This paper is an overview of the status of transcutaneous noninvasive (unbraced) functional electrical stimulation (FES) for independent standing and for independent ambulation by traumatic spinal-cord injured (SCI) paraplegics with complete spinal cord lesions at the thoracic level. The paper discusses aspects of patient selection, patient training, system performance, ambulation range, medical benefits and psychological benefits. It also considers problems relating to system adoption and long term system use. Furthermore, the paper discusses the various aspects of transcutaneous noninvasive FES as compared with implanted FES systems for ambulation by thoracic level SCI patients.

  10. Basic Training Program for Emergency Medical Technician Ambulance: Course Guide.

    ERIC Educational Resources Information Center

    Fucigna, Joseph T.; And Others

    In an effort to upgrade or further develop the skills levels of all individuals involved in the emergency medical care service, this training program was developed for the National Highway Safety Bureau. This specific course is an attempt to organize, conduct, and standardize a basic training course for emergency medical technicians (EMTs). The…

  11. Short-term exposure to ambient particulate matter and emergency ambulance dispatch for acute illness in Japan.

    PubMed

    Tasmin, Saira; Ueda, Kayo; Stickley, Andrew; Yasumoto, Shinya; Phung, Vera Ling Hui; Oishi, Mizuki; Yasukouchi, Shusuke; Uehara, Yamato; Michikawa, Takehiro; Nitta, Hiroshi

    2016-10-01

    Short-term exposure to air pollution may be linked to negative health outcomes that require an emergency medical response. However, few studies have been undertaken on this phenomenon to date. The aim of this study therefore was to examine the association between short-term exposure to ambient suspended particulate matter (SPM) and emergency ambulance dispatches (EADs) for acute illness in Japan. Daily EAD data, daily mean SPM and meteorological data were obtained for four prefectures in the Kanto region of Japan for the period from 2007 to 2011. The area-specific association between daily EAD for acute illness and SPM was explored using generalized linear models while controlling for ambient temperature, relative humidity, seasonality, long-term trends, day of the week and public holidays. Stratified analyses were conducted to evaluate the modifying effects of age, sex and medical conditions. Area-specific estimates were combined using meta-analyses. For the total study period the mean level of SPM was 23.7μg/m(3). In general, higher SPM was associated with a significant increase in EAD for acute illness [estimated pooled relative risk (RR): 1.008, 95% CI: 1.007 to 1.010 per 10μg/m(3) increase in SPM at lag 0-1]. The effects of SPM on EAD for acute illness were significantly greater for moderate/mild medical conditions (e.g. cases that resulted in <3weeks hospitalization or no hospitalization) when compared to severe medical conditions (e.g. critical cases, and cases that led to >3weeks hospitalization or which resulted in death). Using EAD data, this study has shown the adverse health effects of ambient air pollution. This highlights the importance of reducing the level of air pollution in order to maintain population health and well-being.

  12. Short-term exposure to ambient particulate matter and emergency ambulance dispatch for acute illness in Japan.

    PubMed

    Tasmin, Saira; Ueda, Kayo; Stickley, Andrew; Yasumoto, Shinya; Phung, Vera Ling Hui; Oishi, Mizuki; Yasukouchi, Shusuke; Uehara, Yamato; Michikawa, Takehiro; Nitta, Hiroshi

    2016-10-01

    Short-term exposure to air pollution may be linked to negative health outcomes that require an emergency medical response. However, few studies have been undertaken on this phenomenon to date. The aim of this study therefore was to examine the association between short-term exposure to ambient suspended particulate matter (SPM) and emergency ambulance dispatches (EADs) for acute illness in Japan. Daily EAD data, daily mean SPM and meteorological data were obtained for four prefectures in the Kanto region of Japan for the period from 2007 to 2011. The area-specific association between daily EAD for acute illness and SPM was explored using generalized linear models while controlling for ambient temperature, relative humidity, seasonality, long-term trends, day of the week and public holidays. Stratified analyses were conducted to evaluate the modifying effects of age, sex and medical conditions. Area-specific estimates were combined using meta-analyses. For the total study period the mean level of SPM was 23.7μg/m(3). In general, higher SPM was associated with a significant increase in EAD for acute illness [estimated pooled relative risk (RR): 1.008, 95% CI: 1.007 to 1.010 per 10μg/m(3) increase in SPM at lag 0-1]. The effects of SPM on EAD for acute illness were significantly greater for moderate/mild medical conditions (e.g. cases that resulted in <3weeks hospitalization or no hospitalization) when compared to severe medical conditions (e.g. critical cases, and cases that led to >3weeks hospitalization or which resulted in death). Using EAD data, this study has shown the adverse health effects of ambient air pollution. This highlights the importance of reducing the level of air pollution in order to maintain population health and well-being. PMID:27235903

  13. A collaborative improvement project by an NHS Emergency Department and Scottish Ambulance Paramedics to improve the identification and delivery of sepsis 6.

    PubMed Central

    Carberry, Martin; Harden, John

    2016-01-01

    Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department (ED) led to delays in antibiotic and sepsis 6 delivery. An alerting tool was developed that provided criteria for Scottish Ambulance Service (SAS) Paramedics to alert the ED of potential sepsis patients. Data from patients presenting to the ED prior to the alerting process commencing (n=50) and during alerting (n=50) were analysed, a questionnaire was used to ascertain feedback from all staff groups; nurses doctors, and paramedics (n=38). Mean Time to triage improved by 82% from 17 minutes to 3 minutes (p=0.01), time to first antibiotic improved by 39% from 49 minutes to 30 minutes. Overall 78% of patients received antibiotics within an hour of leaving their home; no significant increase in workload was reported by staff. In conclusion alerting by paramedics of potential sepsis patients reduced the time taken to deliver the Sepsis 6 Bundle. Process reliability has been sustained over several months. This process has been spread to seven regional ambulance stations in Lanarkshire Scotland. PMID:27752318

  14. NASA Turbulence Technologies In-Service Evaluation: Delta Air Lines Report-Out

    NASA Technical Reports Server (NTRS)

    Amaral, Christian; Dickson, Steve; Watts, Bill

    2007-01-01

    Concluding an in-service evaluation of two new turbulence detection technologies developed in the Turbulence Prediction and Warning Systems (TPAWS) element of the NASA Aviation Safety and Security Program's Weather Accident Prevention Project (WxAP), this report documents Delta's experience working with the technologies, feedback gained from pilots and dispatchers concerning current turbulence techniques and procedures, and Delta's recommendations regarding directions for further efforts by the research community. Technologies evaluated included an automatic airborne turbulence encounter reporting technology called the Turbulence Auto PIREP System (TAPS), and a significant enhancement to the ability of modern airborne weather radars to predict and display turbulence of operational significance, called E-Turb radar.

  15. 10-year experience of CO2-laser application in ambulance gynecology

    NASA Astrophysics Data System (ADS)

    Stachanov, Michael L.; Masychev, Victor I.; Velsher, Leonid Z.; Kirkin, Vladimir V.; Zhashkov, Roman V.; Kocharian, Emilia A.

    2000-10-01

    CO2-laser surgical systems have come to stay in everyday practice of modern physicians and are successfully used in colposcopic and laparoscopic surgery. Results, obtained in ambulance gynecology are especially impressing. CO2- laser provides high medical- and cost-effective treatment. Presented work describes many-years experience of CO2- laser application. 439 patients with various vulvaric and cervix diseases were operated within this period. Laser beam parameters were selected according to requirements ((tau) =4 J/cm2) treatment without carbonization. Analyses of the results showed that the laser successfully destructs uterine cervix erosion, endocervicosis, dysplasia, leukoplakia, eritoplakia of uterine cervix, various benignant pathologies and focus degenerative process in ambulate conditions.

  16. [Ambulant compression therapy for crural ulcers; an effective treatment when applied skilfully].

    PubMed

    de Boer, Edith M; Geerkens, Maud; Mooij, Michael C

    2015-01-01

    The incidence of crural ulcers is high. They reduce quality of life considerably and create a burden on the healthcare budget. The key treatment is ambulant compression therapy (ACT). We describe two patients with crural ulcers whose ambulant compression treatment was suboptimal and did not result in healing. When the bandages were applied correctly healing was achieved. If correctly applied ACT should provide sufficient pressure to eliminate oedema, whilst taking local circumstances such as bony structures and arterial qualities into consideration. To provide pressure-to-measure regular practical training, skills and regular quality checks are needed. Knowledge of the properties of bandages and the proper use of materials for padding under the bandage enables good personalised ACT. In trained hands adequate compression and making use of simple bandages and dressings provides good care for patients suffering from crural ulcers in contrast to inadequate ACT using the same materials. PMID:26374726

  17. Venous Gas Emboli and Ambulation at 4.3 PSIA (Preliminary)

    NASA Technical Reports Server (NTRS)

    Conkin, J.; Pollock, N. W.; Natoli, M. J.; Martina, S. D.; Wessel, J. H., III; Gernhardt, M. L.

    2016-01-01

    Introduction: Ambulation imparts compressive and decompressive forces into the lower body[1], potentially creating quasi-stable micronuclei that influence the outcome of hypobaric depressurizations[2-4]. Hypotheses: ambulation before the conclusion of a denitrogenation (prebreathe) protocol at 14.7 pounds per square inch absolute is not sufficient to increase the incidence of venous gas emboli (VGE) at 4.3 pounds per square inch absolute but is sufficient if performed after tissues become supersaturated with nitrogen at 4.3 pounds per square inch absolute. Methods: VGE results from 45 subjects that performed exercise prebreathe without ambulation before or during a 4-hr exposure to 4.3 pounds per square inch absolute (Phase II control) are compared to 21 subjects that performed the same prebreathe but ambulated before and during the hypobaric exposure (Phase II-1) and to 30 subjects that only ambulated before the hypobaric exposure (Phase II-3). VGE in the pulmonary artery were detected at about 16 min intervals using precordial Doppler ultrasound (2.5 megahertz) and assigned a Spencer 0-IV grade. The highest grade assigned during the exposure is one metric, and Grade III or IV were combined as "high VGE grade". We used Fisher's exact directional chi squared for VGE count data. We evaluated survival curves for onset of high VGE grade using non-parametric Kaplan-Meier. Finally, we used logistic regression (LR) to describe the binary response of high VGE grade during an exposure across the three protocols with the three categorical ambulatory states (k) transformed into k-1 dummy variables, plus the following explanatory variables: gender (74 men and 22 women), age (19-57 years), height (155-191 cm), weight (44-115 kg), body mass index (17.5-35.5, as weight in kg/height as square meters), and aerobic fitness through peak oxygen (O (sub 2)) consumption as the volume of oxygen peak (26.1-64.9 milliliters (O (sub 2 (STPD - standard temperature and pressure, dry)) per

  18. Regional intensive care transports: a prospective analysis of distance, time and cost for road, helicopter and fixed-wing ambulances

    PubMed Central

    2014-01-01

    Background There are three different types of ambulance systems, all of which can manage the same secondary intensive care patient transport mission: road ambulance, rotor-wing ambulance, and fixed-wing ambulance. We hypothesized that costs for specific transport distances would differ between systems. We aimed to analyze distances and observed times for ambulance intensive care secondary transport missions together with system costs to assess this. Methods We prospectively collected data for consecutive urgent intensive care transports into the regional tertiary care hospital in the northern region of Sweden. Distances and transport times were gathered, and a cost model was generated based on these together with fixed and operating costs from the three different ambulance systems. Distance-cost and time–cost estimations were then generated for each transport system. Results Road ambulance cost relatively less for shorter distances (within 250 kilometers/155 miles) but were relatively time ineffective. The rotor-wing systems were most expensive regardless of distance; but were most time-effective up to 400–500 km (248–310 miles). Fixed-wing systems were more cost-effective for longer distance (300 km/186 miles), and time effective for transports over 500 km (310 miles). Conclusions In summary, based on an economic model developed from observed regional ICU patient transports, and cost estimations, different ambulance system cost-distances could be compared. Distance-cost and time results show that helicopters can be effective up to moderate ICU transport distances (400–500), though are expensive to operate. For longer ICU patient transports, fixed-wing transport systems are both cost and time effective compared to helicopter-based systems. PMID:24902480

  19. Determining the Feasibility of Ambulance-Based Randomised Controlled Trials in Patients with Ultra-Acute Stroke: Study Protocol for the "Rapid Intervention with GTN in Hypertensive Stroke Trial" (RIGHT, ISRCTN66434824).

    PubMed

    Ankolekar, Sandeep; Sare, Gillian; Geeganage, Chamila; Fuller, Michael; Stokes, Lynn; Sprigg, Nikola; Parry, Ruth; Siriwardena, A Niroshan; Bath, Philip M W

    2012-01-01

    Background. Time from acute stroke to enrolment in clinical trials needs to be reduced to improve the chances of finding effective treatments. No completed randomised controlled trials of ambulance-based treatment for acute stroke have been reported in the UK, and the practicalities of recruiting, consenting, and treating patients are unknown. Methods. RIGHT is an ambulance based, single-blind, randomised controlled trial with blinded-outcome assessment. The trial will assess feasibility of using ambulance services to deliver ultra-acute stroke treatments; a secondary aim is to assess the effect of glyceryl trinitrate (GTN) on haemodynamic variables and functional outcomes. Initial consent, randomisation, and treatment are performed by paramedics prior to hospitalisation. Patients with ultra-acute stroke (≤4 hours of onset) are randomised to transdermal GTN (5 mg/24 hours) or gauze dressing daily for 7 days. The primary outcome is systolic blood pressure at 2 hours. Secondary outcomes include feasibility, haemodynamics, dependency, and other functional outcomes. A nested qualitative study is included. Trial Status. The trial has all relevant ethics and regulatory approvals and recruitment started on February 15, 2010. The trial stopped recruitment in December 2011 after 41 patients were recruited. Trial Registration. The trial registration number is ISRCTN66434824 and EudraCT number is 2007-004766-40.

  20. Upper limb module in non-ambulant patients with spinal muscular atrophy: 12 month changes.

    PubMed

    Sivo, Serena; Mazzone, Elena; Antonaci, Laura; De Sanctis, Roberto; Fanelli, Lavinia; Palermo, Concetta; Montes, Jacqueline; Pane, Marika; Mercuri, Eugenio

    2015-03-01

    Recent studies have suggested that in non-ambulant patients affected by spinal muscular atrophy the Upper Limb Module can increase the range of activities assessed by the Hammersmith Functional Motor Scale Expanded. The aim of this study was to establish 12-month changes in the Upper Limb Module in a cohort of non-ambulant spinal muscular atrophy patients and their correlation with changes on the Hammersmith Functional Motor Scale Expanded. The Upper Limb Module scores ranged between 0 and 17 (mean 10.23, SD 4.81) at baseline and between 1 and 17 at 12 months (mean 10.27, SD 4.74). The Hammersmith Functional Motor Scale Expanded scores ranged between 0 and 34 (mean 12.43, SD 9.13) at baseline and between 0 and 34 at 12 months (mean 12.08, SD 9.21). The correlation betweeen the two scales was 0.65 at baseline and 0.72 on the 12 month changes. Our results confirm that the Upper Limb Module can capture functional changes in non-ambulant spinal muscular atrophy patients not otherwise captured by the other scale and that the combination of the two measures allows to capture changes in different subgroups of patients in whom baseline scores and functional changes may be influenced by several variables such as age.

  1. Attachment insecurity, responses to critical incident distress, and current emotional symptoms in ambulance workers.

    PubMed

    Halpern, Janice; Maunder, Robert G; Schwartz, Brian; Gurevich, Maria

    2012-02-01

    Ambulance workers are exposed to critical incidents that may evoke intense distress and can result in long-term impairment. Individuals who can regulate distress may experience briefer post-incident distress and fewer long-term emotional difficulties. Attachment research has contributed to our understanding of individual differences in stress regulation, suggesting that secure attachment is associated with effective support-seeking and coping strategies, and fewer long-term difficulties. We tested the effect of attachment insecurity on emotional distress in ambulance workers, hypothesizing that (1) insecure attachment is associated with symptoms of current distress and (2) prolonged recovery from acute post-critical incident distress, coping strategies and supportive contact mediate this relationship. We measured (1) attachment insecurity, (2) acute distress, coping and social contact following an index critical incident and (3) current symptoms of post-traumatic stress, depression, somatization and burnout and tested the hypothesized associations. Fearful-avoidant insecure attachment was associated with all current symptoms, most strongly with depression (R=0.38, p<0.001). Fearful-avoidant attachment insecurity was also associated with maladaptive coping, reduced social support and slower recovery from social withdrawal and physical arousal following the critical incident, but these processes did not mediate the relationship between attachment insecurity and current symptoms. These findings are relevant for optimizing post-incident support for ambulance workers.

  2. Hammersmith Functional Motor Scale and Motor Function Measure-20 in non ambulant SMA patients.

    PubMed

    Mazzone, E; De Sanctis, R; Fanelli, L; Bianco, F; Main, M; van den Hauwe, M; Ash, M; de Vries, R; Fagoaga Mata, J; Schaefer, K; D'Amico, A; Colia, G; Palermo, C; Scoto, M; Mayhew, A; Eagle, M; Servais, L; Vigo, M; Febrer, A; Korinthenberg, R; Jeukens, M; de Viesser, M; Totoescu, A; Voit, T; Bushby, K; Muntoni, F; Goemans, N; Bertini, E; Pane, M; Mercuri, E

    2014-04-01

    The aim of this prospective longitudinal multi centric study was to evaluate the correlation between the Hammersmith Functional Motor Scale and the 20 item version of the Motor Function Measure in non ambulant SMA children and adults at baseline and over a 12 month period. Seventy-four non-ambulant patients performed both measures at baseline and 49 also had an assessment 12 month later. At baseline the scores ranged between 0 and 40 on the Hammersmith Motor function Scale and between 3 and 45 on the Motor Function Measure 20. The correlation between the two scales was 0.733. The 12 month changes ranged between -11 and 4 for the Hammersmith and between -11 and 7 for the Motor Function Measure 20. The correlation between changes was 0.48. Our results suggest that both scales provide useful information although they appeared to work differently at the two extremes of the spectrum of abilities. The Hammersmith Motor Function Scale appeared to be more suitable in strong non ambulant patients, while the Motor Function Measures appeared to be more sensitive to capture activities and possible changes in the very weak patients, including more items capturing axial and upper limb activities. The choice of these measures in clinical trials should therefore depend on inclusion criteria and magnitude of expected changes.

  3. An overhead harness and trolly system for balance and ambulation assessment and training.

    PubMed

    Harburn, K L; Hill, K M; Kramer, J F; Noh, S; Vandervoort, A A; Matheson, J E

    1993-02-01

    Safe assessment of standing balance and gait is often jeopardized by the potential for falls, which may have major physical and legal consequences. This article describes the design and use of a system that enhances the safety of the patient and clinician during balance and gait assessment and training. The system consists of an overhead track and moveable trolly that allows the patient, while secured in a simple body harness, the freedom to ambulate, perform functional types of activities, and fall with minimal risk of injury. As a result, a single therapist can more readily assess balance and ambulation, as well as provide training for these skills. In addition, the therapist is free to observe the patient's movements from any position, without direct physical contact. Practically, the system described may allow ambulation training sooner after injury or surgery, permit training in weight-bearing or partial weight-bearing activities with or without assistive devices, and allow the clinician to focus on assessment and training, rather than on patient safety.

  4. Design and validation of a platform robot for determination of ankle impedance during ambulation.

    PubMed

    Rouse, Elliott J; Hargrove, Levi J; Peshkin, Michael A; Kuiken, Todd A

    2011-01-01

    In order to provide natural, biomimetic control to recently developed powered ankle prostheses, we must characterize the impedance of the ankle during ambulation tasks. To this end, a platform robot was developed that can apply an angular perturbation to the ankle during ambulation and simultaneously acquire ground reaction force data. In this study, we detail the design of the platform robot and characterize the impedance of the ankle during quiet standing. Subjects were perturbed by a 3° dorsiflexive ramp perturbation with a length of 150 ms. The impedance was defined parametrically, using a second order model to map joint angle to the torque response. The torque was determined using the inverted pendulum assumption, and impedance was identified by the least squares best estimate, yielding an average damping coefficient of 0.03 ± 0.01 Nms/° and an average stiffness coefficient of 3.1 ± 1.2 Nm/°. The estimates obtained by the proposed platform robot compare favorably to those published in the literature. Future work will investigate the impedance of the ankle during ambulation for powered prosthesis controller development.

  5. Manual handling risks in the bariatric (obese) patient pathway in acute sector, community and ambulance care and treatment.

    PubMed

    Hignett, Sue; Griffiths, Paula

    2009-01-01

    As part of a larger research project the patient pathway was mapped for an emergency admission to identify the manual handling major risks. Focus group interviews were held with 25 key stakeholders from the acute, community and ambulance healthcare sectors and social services at 3 venues across the United Kingdom (UK). A detailed qualitative iterative analysis used 'cause and effect' or fishbone (Ishikawa) diagrams to identify key issues. Five themes emerged as generic risks throughout the bariatric patient pathway, these were: patient factors including body shape, mobility, pain, co-operation, privacy, comfort and dignity; building (or vehicle) space and design, including space, clearance, floor surface, and safe working load of floor; equipment (manual handling and clinical) and furniture, including fit, maximum weight capacity, availability, suitability, compatibility, size, and effort to move; communication both within and between organisations; and organisational and staff issues, including policies, culture and staff availability and training. It was concluded that buildings, vehicles and equipment need to be designed to 'fit' a range of bariatric shapes and sizes so that bariatric patients could be accommodated in safety and comfort, and with minimal loss of dignity.

  6. 42 CFR 411.9 - Services furnished outside the United States.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... territorial waters adjoining the land areas of the United States. (2) Services furnished on board ship are... for covered inpatient services furnished in a foreign hospital and, on the basis of an itemized bill, for covered physicians' services and ambulance service furnished in connection with those...

  7. Gaps between policy, protocols and practice: a qualitative study of the views and practice of emergency ambulance staff concerning the care of patients with non-urgent needs

    PubMed Central

    Snooks, H; Kearsley, N; Dale, J; Halter, M; Redhead, J; Foster, J

    2005-01-01

    Aim: To describe emergency ambulance crews' views about (1) how they make decisions on whether to convey patients to hospital; (2) an intervention enabling them to triage patients to non-conveyance; and (3) their experience of using new protocols for undertaking such triage. Methods: Two focus groups were held at the outset of an evaluation of Treat and Refer (T&R) protocols: one with staff based at an ambulance station who were to implement the new service (intervention station), and the other with staff from a neighbouring station who would be continuing their normal practice during the study (control station). A third session was held with staff from the intervention station following training and 3 months' experience of protocol usage. Results: Before the introduction of the T&R protocols, crews reported experience, intuition, training, time of call during shift, patient preference, and home situation as influencing their decisions concerning conveyance. Crews were positive about changing practice but foresaw difficulties with advising patients who wanted to go to hospital, and with referral to other agencies. Following experience of T&R protocol use, crews felt they had needed more training than had been provided. Some felt their practice and job satisfaction had improved. Problems with referral and with persuading some patients that they did not need to go to hospital were discussed. There was consensus that the initiative should be introduced across the service. Conclusions: With crews generally positive about this intervention, an opportunity to tackle this difficult area of emergency care now exists. This study has, however, highlighted the complexity of the change in practice and service delivery, and professional and organisational constraints that need to be considered. PMID:16076788

  8. 14 CFR 272.9 - Selection of a carrier to provide essential air service and payment of compensation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... developing an integrated linear system of air transportation whenever such a system most adequately meets the.... air carrier. (g) Any order of the Department selecting a Freely Associated State Air Carrier...

  9. Feasibility, Reliability and Predictive Value Of In-Ambulance Heart Rate Variability Registration

    PubMed Central

    van Hooff, Robbert-Jan; De Smedt, Ann; Nagels, Guy; Hubloue, Ives; De Keyser, Jacques; Brouns, Raf

    2016-01-01

    Background Heart rate variability (HRV) is a parameter of autonomic nervous system function. A decrease of HRV has been associated with disease severity, risk of complications and prognosis in several conditions. Objective We aim to investigate the feasibility and the reliability of in-ambulance HRV registration during emergency interventions, and to evaluate the association between prehospital HRV parameters, patient characteristics, vital parameters and short-term outcome. Methods We conducted a prospective study using a non-invasive 2-lead ECG registration device in 55 patients transported by the paramedic intervention team of the Universitair Ziekenhuis Brussel. HRV assessment included time domain parameters, frequency domain parameters, nonlinear analysis, and time-frequency analysis. The correlation between HRV parameters and patient and outcome characteristics was analyzed and compared to controls. Results Artifact and ectopic detection rates were higher in patients during ambulance transportation compared to controls in resting conditions, yet technical reasons precluding in-ambulance HRV analysis occurred in only 9.6% of cases. HRV acquisition was possible without safety issues or interference with routine emergency care. Reliability of the results was considered sufficient for Sample entropy (SampEn), good for the ratio of low frequency and high frequency components (LF/HF ratio) in the frequency and the time frequency domain, and excellent for the triangular interpolation of the NN interval histogram (TINN), and for the short-term scaling exponent of the detrended fluctuation analysis (DFA α1). HRV indices were significantly reduced inpatients with unfavorable outcome compared to patients with favorable outcome and controls. Multivariate analysis identified lower DFA α1 as an independent predictor of unfavorable outcome (OR, 0.155; 95% CI 0.024–0.966; p = 0.049). Conclusion In-ambulance HRV registration is technically and operationally feasible and

  10. Transfer of sick children by air.

    PubMed

    Aggarwal, N N; Aggarwal, S

    2000-08-01

    The annual growth rate of air traffic is increasing at the rate of about 7% all over the world. Children and adolescents make a significant chunk of travelling population. Some of the neonates too take to civil air and travel under various circumstances. Others travel for the reasons of medical air evacuation and better treatment at some specialized tertiary care centers, within India or abroad or simply as medical emergency. With the increasing availability of air taxis and air ambulances, it has become necessary for the pediatricians to know the consequences and potential hazards of transfer of the sick by air, lest they lose their patients unintentionally despite professional proficiency. Air evacuation of sick child is a highly specialized job, much different from an evacuation by any fast car ambulance. The paper discusses the general impact of aviation stresses in civil aviation with special reference to sick neonates, children and adolescents, and provides general guidelines, which could be applied to any particular clinical condition with knowledge of underlying physiological processes and anticipated alterations in cabin environment. It also brings out the issues of proper pre-flight assessment, fitness to undertake air transfer, general handling of patient under transfer, desirable onboard procedures, do s and don ts during air transfer, limitations of conventional neonatal/child resuscitation kits, available medical support in aircraft cabins, proper use of hardware including physiology monitoring systems, permissible specialized medical aids, and the requirement and use of equipment during air evacuation. The importance of high awareness and preventive measures is reiterated.

  11. Occupational Structures and Profiles in Italy in the Field of Environmental Protection in the Public Service Sector with Reference to Air Pollution Control. CEDEFOP Panorama. National Report.

    ERIC Educational Resources Information Center

    Mannocci, Virgilio; And Others

    A study examined the knowledge and job skills required of persons employed in air pollution control (APC)-related occupations in Italy's public service sector. First, Italian legislation on APC and the functions/powers of Italy's public agencies responsible for APC were reviewed. The organization/operation of the public structures involved in…

  12. The Correlation between Sex, Age, Educational Background, and Hours of Service on Vigilance Level of ATC Officers in Air Nav Surabaya, Indonesia

    ERIC Educational Resources Information Center

    Saleh, Lalu Muhammad; Suwandi, Tjipto; Hamidah

    2016-01-01

    The vigilance of an Air Traffic Control (ATC) officer determines aviation safety. The number of aviation accidents tends to be increasing in recent years. Aviation accidents may be caused by human errors (i.e. errors made by pilot or ATC officer) or unsafe work condition. Sex, age, educational background, and hours of service might affect…

  13. Tractor-Maintenance: Operation & Daily Care [and] Servicing Air Cleaner & Lubrication. Student Materials. V. A. III. [V-C-1 through V-C-4].

    ERIC Educational Resources Information Center

    Texas A and M Univ., College Station. Vocational Instructional Services.

    Designed for use by students in vocational agricultural classes, this manual deals with tractor maintenance. Operation and daily care are the topics of the first section. Safety is also covered. In the final part of the manual, servicing the air cleaner and lubricating the engine are discussed. Both sections conclude with a quiz. (PLB)

  14. INTERSECTING SELF-REPORTED MOBILITY AND GAIT SPEED TO CREATEA MULTI-DIMENSIONAL MEASURE OF AMBULATION: THE “AMBULATION SPEED-ENDURANCE” (ASE) TYPOLOGY

    PubMed Central

    SIORDIA, C.

    2015-01-01

    Background Assessing mobility through readily available and affordable protocols may help advance public health by providing early detection and implementing intervention therapies aimed at mitigating the progression from physiological vitality to disability at older ages. Until now, little attention has been given to how self-reported mobility (SRM) and gait speed can be combined in a categorization scheme. Objectives The specific aim of this report is to introduce the Ambulation Speed-Endurance (ASE) Typology to the literature—a classification system that intersects SRM and gait speed to create a multi-dimensional measure of ambulation. Design Cross-sectional. Setting: Community-dwelling older adults in the United States. Participants Evidence is provided from the National Health and Aging Trends Study (NHATS) that community-dwelling older adults (n=5,403) may be found in each of the ASE Typologies. The discussion is complimented by investigating the cross-sectional predictors of a “Discrepancy Score” (measure of gap between speed and endurance) amongst those with gait speeds < 0.99 m/sec (n=4,521). Results Multivariable linear regression results indicate level of severity in speed-endurance discrepancy is higher amongst: non-Latino-Blacks (β=0.48); Latinos (β=0.42); older ages; and lower educated. Models also show that severity in speed-endurance discrepancy is lower amongst: females (β=−0.38); those with higher body mass index; with more chronic health conditions; and poorer self-rated health. Conclusion Research should continue to investigate how to optimize SRM. PMID:26258113

  15. Services

    ERIC Educational Resources Information Center

    Environmental Science and Technology, 1972

    1972-01-01

    Alphabetical listing of companies which offer analytical sampling and testing services for pollution control and abatement; consultants that also manufacture and distribute products. List of book publishers included. (LK)

  16. Taking services to the streets over the party season.

    PubMed

    Brace, Samantha; Farmer, Christopher; Calow, Phil

    2009-12-01

    Christmas and New Year festivities notoriously result in increased attendance at emergency departments (EDs). The knock-on effect of this in Solihull, in the West Midlands, is that, when ambulance staff and police accompany patients to hospital, the locality is temporarily under-resourced by these services. To address this problem, a collaborative project was implemented to enable advanced clinical practitioners, with consultant support, to assess, treat and potentially discharge patients from a specially constructed emergency facility situated in Solihull town centre. This has reduced the number of ED admissions and transfers, and resulted in significant cost and time savings for the ambulance service.

  17. Quality site seasonal report: Army Air Force Exchange Service Headquarters Building, SFBP 1343, August 1984 through May 1985

    SciTech Connect

    Pollock, E.O. Jr.

    1987-10-15

    The active solar Domestic Hot Water (DHW) system at the HQ Army-Air Force Exchange Service (AAFES) Building was designed and constructed as part of the Solar in Federal Buildings Programs (SFBP). This retrofitted system is one of eight of the systems in the SFBP selected for quality monitoring. The purpose of this monitoring effort is to document the performance of quality state-of-the-art solar systems in large federal building applications. The six-story HQ AAFES Building houses a cafeteria, officer's mess and club and office space for 2400 employees. The siphon-return drainback system uses 1147 ft/sup 2/ of Aircraftsman flat-plate collectors to collect solar energy which is used to preheat domestic hot water. Solar energy is stored in a 1329-gallon tank and transferred to the hot water load through a heat exchanger located in the 356-gallon DHW preheat tank. Auxiliary energy is supplied by two gas fired boilers which boost the temperature to 130/sup 0/F before it is distributed to the load. Highlights of the performance of the HQ AAFES Building solar system during the monitoring period from August 1984 through May 1985 are presented in this report.

  18. [Study of the quality of interhospital transport of sick neonates by selected ambulances in the Witwatersrand area].

    PubMed

    Roux, J C; Nolte, A G; Muller, M E

    1989-12-01

    The quality of the inter hospital transport of ill neonates, by selected ambulances in the Witwatersrand area, was investigated by means of the case study method. Of the fifteen case studies investigated, eleven neonates were transported by a private ambulance and four by provincial ambulances. Data regarding the maternal- and neonatal history, the optimal maintenance of the neonate's condition, the communication system, as well as aspects relating to the transport personnel, were collected by means of a structured instrument. Retrospective auditing of records, structured interviewing and direct observation/inspection were utilised as the research techniques. The quality of the inter hospital transport of ill neonates, especially by the private ambulance, is not up to standard. Deterioration of the neonate's body temperature, heart and respiration rates, as well as the serum glucose values after transport, were of the more important findings. The lack of equipment, especially in the private ambulance, increases the risk of transport. Staff development and formal control by a local committee, as well as a national control body, are recommended.

  19. Configuring a Powered Knee and Ankle Prosthesis for Transfemoral Amputees within Five Specific Ambulation Modes

    PubMed Central

    Simon, Ann M.; Ingraham, Kimberly A.; Fey, Nicholas P.; Finucane, Suzanne B.; Lipschutz, Robert D.; Young, Aaron J.; Hargrove, Levi J.

    2014-01-01

    Lower limb prostheses that can generate net positive mechanical work may restore more ambulation modes to amputees. However, configuration of these devices imposes an additional burden on clinicians relative to conventional prostheses; devices for transfemoral amputees that require configuration of both a knee and an ankle joint are especially challenging. In this paper, we present an approach to configuring such powered devices. We developed modified intrinsic control strategies—which mimic the behavior of biological joints, depend on instantaneous loads within the prosthesis, or set impedance based on values from previous states, as well as a set of starting configuration parameters. We developed tables that include a list of desired clinical gait kinematics and the parameter modifications necessary to alter them. Our approach was implemented for a powered knee and ankle prosthesis in five ambulation modes (level-ground walking, ramp ascent/descent, and stair ascent/descent). The strategies and set of starting configuration parameters were developed using data from three individuals with unilateral transfemoral amputations who had previous experience using the device; this approach was then tested on three novice unilateral transfemoral amputees. Only 17% of the total number of parameters (i.e., 24 of the 140) had to be independently adjusted for each novice user to achieve all five ambulation modes and the initial accommodation period (i.e., time to configure the device for all modes) was reduced by 56%, to 5 hours or less. This approach and subsequent reduction in configuration time may help translate powered prostheses into a viable clinical option where amputees can more quickly appreciate the benefits such devices can provide. PMID:24914674

  20. Configuring a powered knee and ankle prosthesis for transfemoral amputees within five specific ambulation modes.

    PubMed

    Simon, Ann M; Ingraham, Kimberly A; Fey, Nicholas P; Finucane, Suzanne B; Lipschutz, Robert D; Young, Aaron J; Hargrove, Levi J

    2014-01-01

    Lower limb prostheses that can generate net positive mechanical work may restore more ambulation modes to amputees. However, configuration of these devices imposes an additional burden on clinicians relative to conventional prostheses; devices for transfemoral amputees that require configuration of both a knee and an ankle joint are especially challenging. In this paper, we present an approach to configuring such powered devices. We developed modified intrinsic control strategies--which mimic the behavior of biological joints, depend on instantaneous loads within the prosthesis, or set impedance based on values from previous states, as well as a set of starting configuration parameters. We developed tables that include a list of desired clinical gait kinematics and the parameter modifications necessary to alter them. Our approach was implemented for a powered knee and ankle prosthesis in five ambulation modes (level-ground walking, ramp ascent/descent, and stair ascent/descent). The strategies and set of starting configuration parameters were developed using data from three individuals with unilateral transfemoral amputations who had previous experience using the device; this approach was then tested on three novice unilateral transfemoral amputees. Only 17% of the total number of parameters (i.e., 24 of the 140) had to be independently adjusted for each novice user to achieve all five ambulation modes and the initial accommodation period (i.e., time to configure the device for all modes) was reduced by 56%, to 5 hours or less. This approach and subsequent reduction in configuration time may help translate powered prostheses into a viable clinical option where amputees can more quickly appreciate the benefits such devices can provide.

  1. Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton.

    PubMed

    Asselin, Pierre K; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M

    2016-01-01

    Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment. PMID:27340808

  2. The Impact of Ambulance and Patient Diversion on Crowdedness of Multiple Emergency Departments in a Region.

    PubMed

    Kao, Chung-Yao; Yang, Jhen-Ci; Lin, Chih-Hao

    2015-01-01

    Emergency department (ED) overcrowding threatens healthcare quality. Ambulance diversion (AD) may relieve ED overcrowding; however, diverting patients from an overcrowded ED will load neighboring EDs with more patients and may result in regional overcrowding. The purpose of this study was to evaluate the impact of different diversion strategies on the crowdedness of multiple EDs in a region. The importance of regional coordination was also explored. A queuing model for patient flow was utilized to develop a computer program for simulating AD among EDs in a region. Key parameters, including patient arrival rates, percentages of patients of different acuity levels, percentage of patients transported by ambulance, and total resources of EDs, were assigned based on real data. The crowdedness indices of each ED and the regional crowdedness index were assessed to evaluate the effectiveness of various AD strategies. Diverting patients equally to all other EDs in a region is better than diverting patients only to EDs with more resources. The effect of diverting all ambulance-transported patients is similar to that of diverting only low-acuity patients. To minimize regional crowdedness, ambulatory patients should be sent to proper EDs when AD is initiated. Based on a queuing model with parameters calibrated by real data, patient flows of EDs in a region were simulated by a computer program. From a regional point of view, randomly diverting ambulatory patients provides almost no benefit. With regards to minimizing the crowdedness of the whole region, the most promising strategy is to divert all patients equally to all other EDs that are not already crowded. This result implies that communication and coordination among regional hospitals are crucial to relieve overall crowdedness. A regional coordination center may prioritize AD strategies to optimize ED utility. PMID:26659589

  3. Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

    PubMed Central

    Asselin, Pierre K.; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M.

    2016-01-01

    Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment. PMID:27340808

  4. Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton.

    PubMed

    Asselin, Pierre K; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M

    2016-01-01

    Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment.

  5. Lightweight physiologic sensor performance during pre-hospital care delivered by ambulance clinicians.

    PubMed

    Mort, Alasdair J; Fitzpatrick, David; Wilson, Philip M J; Mellish, Chris; Schneider, Anne

    2016-02-01

    The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (SpO2). The second was the RESpeck respiratory rate (RR) sensor, which was wireless-enabled with a Bluetooth(®) Low Energy protocol. Sensor data were recorded from 16 pre-hospital patients, who were monitored for 21.2 ± 9.8 min, on average. Some form of error was identified on almost every HR and SpO2 trace. However, the mean proportion of each trace exhibiting error was <10 % (range <1-50 % for individual patients). There appeared to be no overt impact of the gross motion associated with road ambulance transit on the incidence of HR or SpO2 error. The RESpeck RR sensor delivered an average of 4.2 (±2.2) validated breaths per minute, but did not produce any validated breaths during the gross motion of ambulance transit as its pre-defined motion threshold was exceeded. However, this was many more data points than could be achieved using traditional manual assessment of RR. Error was identified on a majority of pre-hospital physiologic signals, which emphasised the need to ensure consistent sensor attachment in this unstable and unpredictable environment, and in developing intelligent methods of screening out such error.

  6. The Impact of Ambulance and Patient Diversion on Crowdedness of Multiple Emergency Departments in a Region

    PubMed Central

    Kao, Chung-Yao; Yang, Jhen-Ci; Lin, Chih-Hao

    2015-01-01

    Emergency department (ED) overcrowding threatens healthcare quality. Ambulance diversion (AD) may relieve ED overcrowding; however, diverting patients from an overcrowded ED will load neighboring EDs with more patients and may result in regional overcrowding. The purpose of this study was to evaluate the impact of different diversion strategies on the crowdedness of multiple EDs in a region. The importance of regional coordination was also explored. A queuing model for patient flow was utilized to develop a computer program for simulating AD among EDs in a region. Key parameters, including patient arrival rates, percentages of patients of different acuity levels, percentage of patients transported by ambulance, and total resources of EDs, were assigned based on real data. The crowdedness indices of each ED and the regional crowdedness index were assessed to evaluate the effectiveness of various AD strategies. Diverting patients equally to all other EDs in a region is better than diverting patients only to EDs with more resources. The effect of diverting all ambulance-transported patients is similar to that of diverting only low-acuity patients. To minimize regional crowdedness, ambulatory patients should be sent to proper EDs when AD is initiated. Based on a queuing model with parameters calibrated by real data, patient flows of EDs in a region were simulated by a computer program. From a regional point of view, randomly diverting ambulatory patients provides almost no benefit. With regards to minimizing the crowdedness of the whole region, the most promising strategy is to divert all patients equally to all other EDs that are not already crowded. This result implies that communication and coordination among regional hospitals are crucial to relieve overall crowdedness. A regional coordination center may prioritize AD strategies to optimize ED utility. PMID:26659589

  7. The use of intraluminal strain gauges for recording ambulant small bowel motility.

    PubMed

    Gill, R C; Kellow, J E; Browning, C; Wingate, D L

    1990-04-01

    Perfused-tube manometry has hitherto been the standard technique for recording intraluminal intestinal pressure in humans, but it is unsuitable for ambulant use. The aim of our study was to evaluate the ability of resistive strain gauge transducers attached to a fine catheter to detect pressure change. Simultaneous strain gauge and perfused-tube manometry was performed on six fasting subjects; in four, strain gauge activation was continuous and in two, the transducers were activated in a pulsed mode with data encoded as a pulse train with an approximate frequency of 20 Hz. Eight thousand eight hundred eighty-eight pressure waves were recorded by strain gauge, of which 96% were detected by perfused-tube manometry. There was good agreement in both phases II and III of the migrating motor complex. The amplitude of pressure waves recorded by strain gauge was slightly but significantly greater. A proportion (14-17%) of pressure waves recorded by strain gauge were bifid; this was not seen with the perfused tube. These differences are best explained by the greater sensitivity and more rapid rise time of the strain gauges. There was no loss of fidelity in the pulse-interval recording mode. A seventh subject underwent a continuous 72-h recording with the strain gauge catheter attached to a battery-operated encoder and magnetic tape cassette recorder and was freely ambulant during this period. The procedure was well tolerated and motility patterns could be clearly identified. We conclude that intraluminal strain gauge catheters are suitable for prolonged use in ambulant subjects and produce data that are closely comparable to the data acquired from perfused-tube manometry under laboratory conditions. PMID:2333973

  8. Emergency department overcrowding and ambulance transport delays for patients with chest pain

    PubMed Central

    Schull, Michael J.; Morrison, Laurie J.; Vermeulen, Marian; Redelmeier, Donald A.

    2003-01-01

    Objective Emergency department overcrowding sometimes results in diversion of ambulances to other locations. We sought to determine the resulting prehospital delays for cardiac patients. Methods Data on consecutive patients with chest pain who were transported to Toronto hospitals by ambulance were obtained for a 4-month period in 1997 and a 4-month period in 1999, which represented periods of low and high emergency department overcrowding respectively. Multivariate analyses were used to model 90th percentile system response (initiation of 9-1-1 call to arrival on scene), on-scene (arrival on scene to departure from scene) and transport (departure from scene to arrival at hospital) intervals. Predictor variables were study period (1997 or 1999), day of the week, time of day, geographic location of the patient, dispatch priority, case severity, return priority and number of other patients with chest pain transported within 2 hours of the index transport. Results A total of 3609 patients (mean age 66.3 years, 50.3% female) who met the study criteria were transported by ambulance during the 2 study periods. There were no significant differences in patient characteristics between the 2 periods, despite the fact that more patients were transported during the second period (p < 0.001). The 90th percentile system response interval increased by 11.3% from the first to the second period (9.7 v. 10.8 min, p < 0.001), whereas the on-scene interval decreased by 8.2% (28.0 v. 25.7 min, p < 0.001). The longest delay was in the transport interval, which increased by 28.4% from 1997 to 1999 (13.4 v. 17.2 min, p < 0.001). In multivariate analyses, the study period (1997 v. 1999) remained a significant predictor of longer transport interval (p < 0.001) and total prehospital interval (p = 0.004). Interpretation An increase in overcrowding in emergency departments was associated with a substantial increase in the system response interval and the ambulance transport interval for

  9. SUMMARY OF ELECTRIC SERVICE COSTS FOR TOTALLY AIR CONDITIONED SCHOOLS PREPARED FOR HOUSTON INDEPENDENT SCHOOL DISTRICT, MAY 31, 1967.

    ERIC Educational Resources Information Center

    WHITESIDES, M.M.

    THIS REPORT IS A COMPILATION OF DATA ON ELECTRIC AIR CONDITIONING COSTS, OPERATIONS AND MAINTENANCE. AIR CONDITIONING UNITS ARE COMPARED IN TERMS OF ELECTRIC VERSUS NON-ELECTRIC, AUTOMATIC VERSUS OPERATED, AIR COOLED VERSUS WATER COOLED, RECIPROCATING VERSUS CENTRIFUGAL COMPRESSORS, SPACE AND NOISE, REHEAT, MAINTENANCE AND ORIGINAL COST. DATA ARE…

  10. Air resources

    SciTech Connect

    1995-10-01

    This section describes the ambient (surrounding) air quality of the TVA region, discusses TVA emission contributions to ambient air quality, and identifies air quality impacts to human health and welfare. Volume 2 Technical Document 2, Environmental Consequences, describes how changes in TVA emissions could affect regional air quality, human health, environmental resources, and materials. The primary region of the affected environment is broadly defined as the state of Tennessee, as well as southern Kentucky, western Virginia, southern West Virginia, western North Carolina, and northern Georgia, Alabama, and Mississippi. This area represents the watershed of the Tennessee River and the 201 counties of the greater TVA service area. Emissions from outside the Tennessee Valley region contribute to air quality in the Valley. Also, TVA emissions are transported outside the Valley and have some impact on air quality beyond the primary study area. Although the study area experiences a number of air quality problems, overall air quality is good.

  11. Open-field temporal pattern of ambulation in Japanese quail genetically selected for contrasting adrenocortical responsiveness to brief manual restraint.

    PubMed

    Kembro, J M; Satterlee, D G; Schmidt, J B; Perillo, M A; Marin, R H

    2008-11-01

    Japanese quail selected for a low-stress (LS), rather than a high-stress (HS), plasma corticosterone response to brief restraint have been shown to possess lower fearfulness and a nonspecific reduction in stress responsiveness. Detrended fluctuation analysis provides information on the organization and complexity of temporal patterns of behavior. The present study evaluated the temporal pattern of ambulation of LS and HS quail in an open field that represented a novel environment. Time series of 4,200 data points were collected for each bird by registering the distance ambulated every 0.5 s during a 35-min test period. Consistent with their known reduced fearfulness, the LS quail initiated ambulation significantly sooner (P < 0.02) and tended to ambulate more (P < 0.09) than did their HS counterparts. Detrended fluctuation analyses showed a monofractal series (i.e., a series with similar complexity at different temporal scales) in 72% of the birds. These birds initiated their ambulatory activity in less than 600 s. Among these birds, a lower (P < 0.03) autosimilarity coefficient (alpha) was found in the LS quail than in their HS counterparts (alpha = 0.76 +/- 0.03 and 0.87 +/- 0.03, respectively), suggesting a more complex (less regular) ambulatory pattern in the LS quail. However, when the patterns of ambulation were reexamined by considering only the active period of the time series (i.e., after the birds had initiated their ambulatory activity), monofractal patterns were observed in 97% of the birds, and no differences were found between the lines. Collectively, the results suggest that during the active period of open-field testing, during which fear responses are likely less strong and other motivations are the driving forces of ambulation, the LS and HS lines have similar ambulatory organization.

  12. Clinical measures as valid predictors and discriminators of the level of community ambulation of hemiparetic stroke survivors

    PubMed Central

    Lee, GyuChang; An, SeungHeon; Lee, YunBok; Park, Dong-Sik

    2016-01-01

    [Purpose] To investigate clinical measures as valid predictors and discriminators of the level of community ambulation of hemiparetic stroke survivors. [Subjects and Methods] Seventy-five hemiparetic stroke patients were separated into a community ambulation group (>0.8 m/s) and a limited community ambulation group (0.4–0.8 m/s). The dorsiflexor strength of the affected side, Sit to Stand (STS) test, Timed Up & Go (TUG) test, Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA), Falls Efficacy Scale (FES), 2-min step test (2mST), and 6-min walk test (6mWT) were used for evaluation. The discriminative powers of the tests and measures were investigated using the receiver-operating characteristic (ROC) curve, and odd ratios were calculated to predict the level of community ambulation. [Results] The cutoff values for predicting the level of community ambulation (>0.8 m/s) were <14.77 s for TUG, <12.6 s for STS, a score >46.5 for BBS, a score >25.5 for FMA, a score <13.5 for FES, >7.5 kg for dorsiflexor strength, >30 times for 2mST, and >318 m for 6mWT. All clinical measures except FES had moderate accuracy according to the area under the curve of 0.76–0.88 (70–93%). [Conclusion] Clinical measures (except FES) have moderate validity in predicting the level of community ambulation of stroke survivors. PMID:27630394

  13. Clinical measures as valid predictors and discriminators of the level of community ambulation of hemiparetic stroke survivors.

    PubMed

    Lee, GyuChang; An, SeungHeon; Lee, YunBok; Park, Dong-Sik

    2016-08-01

    [Purpose] To investigate clinical measures as valid predictors and discriminators of the level of community ambulation of hemiparetic stroke survivors. [Subjects and Methods] Seventy-five hemiparetic stroke patients were separated into a community ambulation group (>0.8 m/s) and a limited community ambulation group (0.4-0.8 m/s). The dorsiflexor strength of the affected side, Sit to Stand (STS) test, Timed Up & Go (TUG) test, Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA), Falls Efficacy Scale (FES), 2-min step test (2mST), and 6-min walk test (6mWT) were used for evaluation. The discriminative powers of the tests and measures were investigated using the receiver-operating characteristic (ROC) curve, and odd ratios were calculated to predict the level of community ambulation. [Results] The cutoff values for predicting the level of community ambulation (>0.8 m/s) were <14.77 s for TUG, <12.6 s for STS, a score >46.5 for BBS, a score >25.5 for FMA, a score <13.5 for FES, >7.5 kg for dorsiflexor strength, >30 times for 2mST, and >318 m for 6mWT. All clinical measures except FES had moderate accuracy according to the area under the curve of 0.76-0.88 (70-93%). [Conclusion] Clinical measures (except FES) have moderate validity in predicting the level of community ambulation of stroke survivors. PMID:27630394

  14. Clinical measures as valid predictors and discriminators of the level of community ambulation of hemiparetic stroke survivors

    PubMed Central

    Lee, GyuChang; An, SeungHeon; Lee, YunBok; Park, Dong-Sik

    2016-01-01

    [Purpose] To investigate clinical measures as valid predictors and discriminators of the level of community ambulation of hemiparetic stroke survivors. [Subjects and Methods] Seventy-five hemiparetic stroke patients were separated into a community ambulation group (>0.8 m/s) and a limited community ambulation group (0.4–0.8 m/s). The dorsiflexor strength of the affected side, Sit to Stand (STS) test, Timed Up & Go (TUG) test, Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA), Falls Efficacy Scale (FES), 2-min step test (2mST), and 6-min walk test (6mWT) were used for evaluation. The discriminative powers of the tests and measures were investigated using the receiver-operating characteristic (ROC) curve, and odd ratios were calculated to predict the level of community ambulation. [Results] The cutoff values for predicting the level of community ambulation (>0.8 m/s) were <14.77 s for TUG, <12.6 s for STS, a score >46.5 for BBS, a score >25.5 for FMA, a score <13.5 for FES, >7.5 kg for dorsiflexor strength, >30 times for 2mST, and >318 m for 6mWT. All clinical measures except FES had moderate accuracy according to the area under the curve of 0.76–0.88 (70–93%). [Conclusion] Clinical measures (except FES) have moderate validity in predicting the level of community ambulation of stroke survivors.

  15. Frontal plane standing balance with an ambulation aid: Upper limb biomechanics.

    PubMed

    Tung, James Y; Gage, William H; Zabjek, Karl F; Maki, Brian E; McIlroy, William E

    2011-05-17

    Despite widespread acceptance of clinical benefits, empirical evidence to evaluate the advantages and limitations of ambulation aids for balance control is limited. The current study investigates the upper limb biomechanical contributions to the control of frontal plane stability while using a 4-wheeled walker in quiet standing. We hypothesized that: (1) upper limb stabilizing moments would be significant, and (2) would increase under conditions of increased stability demand. Factors influencing upper limb moment generation were also examined. Specifically, the contributions of upper limb center-of-pressure (COP(hands)), vertical and horizontal loads applied to the assistive device were assessed. The results support a significant mechanical role for the upper limbs, generating 27.1% and 58.8% of overall stabilizing moments under baseline and challenged stability demand conditions, respectively. The increased moment was achieved primarily through the preferential use of phasic upper limb control, reflected by increased COP(hands) (baseline vs. challenged conditions: 0.29 vs. 0.72cm). Vertical, but not horizontal, was the primary force direction contributing to stabilizing moments in quiet standing. The key finding that the upper limbs play an important role in effecting frontal plane balance control has important implications for ambulation aid users (e.g., elderly, stroke, and traumatic brain injury).

  16. Benefits of microprocessor-controlled prosthetic knees to limited community ambulators: systematic review.

    PubMed

    Kannenberg, Andreas; Zacharias, Britta; Pröbsting, Eva

    2014-01-01

    The benefits of microprocessor-controlled prosthetic knees (MPKs) have been well established in community ambulators (Medicare Functional Classification Level [MFCL]-3) with a transfemoral amputation (TFA). A systematic review of the literature was performed to analyze whether limited community ambulators (MFCL-2) may also benefit from using an MPK in safety, performance-based function and mobility, and perceived function and satisfaction. We searched 10 scientific databases for clinical trials with MPKs and identified six publications with 57 subjects with TFA and MFCL-2 mobility grade. Using the criteria of a Cochrane Review on prosthetic components, we rated methodological quality moderate in four publications and low in two publications. MPK use may significantly reduce uncontrolled falls by up to 80% as well as significantly improve indicators of fall risk. Performance-based outcome measures suggest that persons with MFCL-2 mobility grade may be able to walk about 14% to 25% faster on level ground, be around 20% quicker on uneven surfaces, and descend a slope almost 30% faster when using an MPK. The results of this systematic review suggest that trial fittings may be used to determine whether or not individuals with TFA and MFCL-2 mobility grade benefit from MPK use. Criteria for patient selection and assessment of trial fitting success or failure are proposed.

  17. Assessing post-anterior cruciate ligament reconstruction ambulation using wireless wearable integrated sensors.

    PubMed

    Arosha Senanayake, S M N; Ahmed Malik, Owais; Mohammad Iskandar, Pg; Zaheer, Dansih

    2013-11-01

    Abstract A hardware/software co-design for assessing post-Anterior Cruciate Ligament (ACL) reconstruction ambulation is presented. The knee kinematics and neuromuscular data during walking (2-6 km h(-1)) have been acquired using wireless wearable motion and electromyography (EMG) sensors, respectively. These signals were integrated by superimposition and mixed signals processing techniques in order to provide visual analyses of bio-signals and identification of the recovery progress of subjects. Monitoring overlapped signals simultaneously helps in detecting variability and correlation of knee joint dynamics and muscles activities for an individual subject as well as for a group. The recovery stages of subjects have been identified based on combined features (knee flexion/extension and EMG signals) using an adaptive neuro-fuzzy inference system (ANFIS). The proposed system has been validated for 28 test subjects (healthy and ACL-reconstructed). Results of ANFIS showed that the ambulation data can be used to distinguish subjects at different levels of recuperation after ACL reconstruction. PMID:24117351

  18. Ambulation and independence among Veterans with nontraumatic bilateral lower-limb loss.

    PubMed

    Sharath, Sherene; Henson, Helene; Flynn, Stacy; Pisimisis, George; Kougias, Panos; Barshes, Neal R

    2015-01-01

    In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17) were bilateral transfemoral amputations (TFAs); bilateral transtibial amputations (TTAs) and TFA-TTA accounted for the rest (33% and 25%, respectively). Of the 19 (48%) patients who were ambulatory prior to bilateral amputation, only 2 (11%) remained ambulatory after the second amputation, while 17 (89%) patients lost ambulatory capabilities. Compared with those who were ambulate precontralateral amputation (p = 0.03). All patients with bilateral TFA were nonambulatory. Independence postcontralateral amputation decreased from 88% (35) to 53% (21). When data were available (58%), pre and post Functional Independence Measure scores showed a decrease in 74% of patients, while 22% showed an increase. In conclusion, bilateral lower-limb amputation among dysvascular Veterans is highly associated with a loss of ambulation. PMID:26745753

  19. Neurotherapeutic and neuroprosthetic effects of implanted functional electrical stimulation for ambulation after incomplete spinal cord injury.

    PubMed

    Bailey, Stephanie Nogan; Hardin, Elizabeth C; Kobetic, Rudi; Boggs, Lisa M; Pinault, Gilles; Triolo, Ronald J

    2010-01-01

    The purpose of this single-subject study was to determine the neurotherapeutic and neuroprosthetic effects of an implanted functional electrical stimulation (FES) system designed to facilitate walking in an individual with a longstanding motor and sensory incomplete spinal cord injury. An implanted pulse generator and eight intramuscular stimulating electrodes were installed unilaterally, activating weak or paralyzed hip flexors, hip and knee extensors, and ankle dorsiflexors during 36 sessions of gait training with FES. The neurotherapeutic effects were assessed by a comparison of pre- and posttraining volitional walking. The neuroprosthetic effects were assessed by a comparison of posttraining volitional and FES-assisted walking. Treatment resulted in significant (p < 0.005) volitional improvements in 6-minute walking distance and speed, speed during maximum walk, double support time, and 10 m walking speed. Posttraining FES-assisted walking resulted in significant additional improvements in all these measures, except 10 m walking speed. When the subject was using FES-assisted gait, maximum walking distance, peak knee flexion in swing, peak ankle dorsiflexion in swing, and knee extension moment also significantly increased. Neuroprosthetic gains were sufficient to enable the subject to advance from household ambulation to limited community ambulation. Additionally, the subject could perform multiple walks per day when using FES-assisted gait, which was impossible with volitional effort alone.

  20. Using HSPA to improve the telemedical links on a moving ambulance.

    PubMed

    Banitsas, Konstantinos; Tachakra, Sapal; Stefanidis, Euclid; Boletis, Konstantinos

    2008-01-01

    As the demand for faster and more effective health care increases, there is a growing need to establish mobile, high-speed communications between a moving ambulance and a consultation point (usually a hospital). The recent addition of HSPA (HSDPA and HSUPA) into the UMTS suite provides higher bandwidth and reduced delays, making this choice ideal for real-time telemedical applications. In this paper, we will describe a set of scenarios that took place in a typical large city area, along with their equivalent results: a moving ambulance was linked with a consultation station using HSPA and several videoconferencing sessions were initiated. Best-case, worst-case and average scenarios were recorded. Furthermore, in areas where the UMTS reception was marginal, a repeater was placed on top of the vehicle to boost up the signal power and thus maintain the higher bandwidth. Finally, treating doctors were asked to evaluate the effectiveness of this system's outputs, based on a variety of objective and subjective criteria.

  1. Transcranial Magnetic Stimulation and Diffusion Tensor Tractography for Evaluating Ambulation after Stroke

    PubMed Central

    Kim, Bo-Ram; Moon, Won-Jin; Kim, Hyuntae; Jung, Eunhwa; Lee, Jongmin

    2016-01-01

    Background and Purpose We aimed to investigate the usefulness of combining transcranial magnetic stimulation (TMS) and diffusion tensor tractography (DTT) to evaluate corticospinal tract (CST) integrity and subsequently predict ambulatory function after middle cerebral artery (MCA) stroke. Methods Forty-three patients with first MCA stroke underwent TMS and DTT to evaluate CST integrity. Patients were classified into four groups according to the presence of motor-evoked potentials (MEPs) obtained from the tibialis anterior muscle and CST integrity. Motor impairment and functional status were assessed using the Fugl-Meyer Assessment, Functional Ambulation Category, and Korean modified Barthel Index, both at the time of admission and after 4 weeks of rehabilitation. Results Patients with the presence of both measurable MEPs and a preserved CST showed better motor recovery and ambulatory function than other groups at the 4-week follow-up. Intact CSTs were not visualized in patients without detectable MEPs. Among the patients displaying MEPs, those with preserved CSTs showed better recovery of paretic lower extremities. Conclusions Combined assessment using TMS and DTT to evaluate CST integrity confers advantages in predicting motor and ambulation recovery in patients with MCA stroke. PMID:27283282

  2. Needs and workflow assessment prior to implementation of a digital pathology infrastructure for the US Air Force Medical Service

    PubMed Central

    Ho, Jonhan; Aridor, Orly; Glinski, David W.; Saylor, Christopher D.; Pelletier, Joseph P.; Selby, Dale M.; Davis, Steven W.; Lancia, Nicholas; Gerlach, Christopher B.; Newberry, Jonathan; Anthony, Leslie; Pantanowitz, Liron; Parwani, Anil V.

    2013-01-01

    Background: Advances in digital pathology are accelerating integration of this technology into anatomic pathology (AP). To optimize implementation and adoption of digital pathology systems within a large healthcare organization, initial assessment of both end user (pathologist) needs and organizational infrastructure are required. Contextual inquiry is a qualitative, user-centered tool for collecting, interpreting, and aggregating such detailed data about work practices that can be employed to help identify specific needs and requirements. Aim: Using contextual inquiry, the objective of this study was to identify the unique work practices and requirements in AP for the United States (US) Air Force Medical Service (AFMS) that had to be targeted in order to support their transition to digital pathology. Subjects and Methods: A pathology-centered observer team conducted 1.5 h interviews with a total of 24 AFMS pathologists and histology lab personnel at three large regional centers and one smaller peripheral AFMS pathology center using contextual inquiry guidelines. Findings were documented as notes and arranged into a hierarchal organization of common themes based on user-provided data, defined as an affinity diagram. These data were also organized into consolidated graphic models that characterized AFMS pathology work practices, structure, and requirements. Results: Over 1,200 recorded notes were grouped into an affinity diagram composed of 27 third-level, 10 second-level, and five main-level (workflow and workload distribution, quality, communication, military culture, and technology) categories. When combined with workflow and cultural models, the findings revealed that AFMS pathologists had needs that were unique to their military setting, when compared to civilian pathologists. These unique needs included having to serve a globally distributed patient population, transient staff, but a uniform information technology (IT) structure. Conclusions: The contextual

  3. Mobile Phones, in Combination with a Computer Locator System, Improve the Response Times of Emergency Medical Services in Central London

    PubMed Central

    Gossage, JA; Frith, DP; Carrell, TWG; Damiani, M; Terris, J; Burnand, KG

    2008-01-01

    INTRODUCTION The aim of this study was to determine whether mobile phones and mobile phone locating devices are associated with improved ambulance response times in central London. PATIENTS AND METHODS All calls from the London Ambulance Service database since 1999 were analysed. In addition, 100 consecutive patients completed a questionnaire on mobile phone use whilst attending the St Thomas's Hospital Emergency Department in central London. RESULTS Mobile phone use for emergencies in central London has increased from 4007 (5% of total) calls in January 1999 to 21,585 (29%) in August 2004. Ambulance response times for mobile phone calls were reduced after the introduction of the mobile phone locating system (mean 469 s versus 444 s; P = 0.0195). The proportion of mobile phone calls made from mobile phones for life-threatening emergencies was higher after injury than for medical emergencies (41% versus 16%, P = 0.0063). Of patients transported to the accident and emergency department by ambulance, 44% contacted the ambulance service by mobile phone. Three-quarters of calls made from outside the home or work-place were by mobile phone and 72% of patients indicated that it would have taken longer to contact the emergency services if they had not used a mobile. CONCLUSIONS Since the introduction of the mobile phone locating system, there has been an improvement in ambulance response times. Mobile locating systems in urban areas across the UK may lead to faster response times and, potentially, improved patient outcomes. PMID:18325208

  4. Lower Extremity Passive Range of Motion in Community-Ambulating Stroke Survivors

    PubMed Central

    Schindler-Ivens, Sheila; Desimone, Davalyn; Grubich, Sarah; Kelley, Carolyn; Sanghvi, Namita; Brown, David A.

    2014-01-01

    Background Physical therapists may prescribe stretching exercises for individuals with stroke to improve joint integrity and to reduce the risk of secondary musculoskeletal impairment. While deficits in passive range of motion (PROM) exist in stroke survivors with severe hemiparesis and spasticity, the extent to which impaired lower extremity PROM occurs in community-ambulating stroke survivors remains unclear. This study compared lower extremity PROM in able-bodied individuals and independent community-ambulatory stroke survivors with residual stroke-related neuromuscular impairments. Our hypothesis was that the stroke group would show decreased lower extremity PROM in the paretic but not the nonparetic side and that decreased PROM would be associated with increased muscle stiffness and decreased muscle length. Methods Individuals with chronic poststroke hemiparesis who reported the ability to ambulate independently in the community (n = 17) and age-matched control subjects (n = 15) participated. PROM during slow (5 degrees/sec) hip extension, hip flexion, and ankle dorsiflexion was examined bilaterally using a dynamometer that measured joint position and torque. The maximum angular position of the joint (ANGmax), torque required to achieve ANGmax (Tmax), and mean joint stiffness (K) were measured. Comparisons were made between able-bodied and paretic and able-bodied and nonparetic limbs. Results Contrary to our expectations, between-group differences in ANGmax were observed only during hip extension in which ANGmax was greater bilaterally in people post-stroke compared to control subjects (P ≤ 0.05; stroke = 13 degrees, able-bodied = −1 degree). Tmax, but not K, was also significantly higher during passive hip extension in paretic and nonparetic limbs compared to control limbs (P ≤ 0.05; stroke = 40 Nm, able-bodied = 29 Nm). Compared to the control group, Tmax was increased during hip flexion in the paretic and nonparetic limbs of post-stroke subjects (P

  5. Development of Key-Pecking, Pause, and Ambulation during Extended Exposure to a Fixed-Interval Schedule of Reinforcement

    ERIC Educational Resources Information Center

    Berry, Meredith S.; Kangas, Brian D.; Branch, Marc N.

    2012-01-01

    Six pigeons key-pecked under a fixed-interval (FI) 3-min schedule of food presentation. Each pigeon was studied for 200 daily sessions with 15 intervals per session (3,000 total food presentations). Analyses included the examination of latency to first peck (pause), mean rate of key pecking, and ambulation. Characterizations of stable performance…

  6. The Effect of Philadelphia and Pennsylvania Clean Indoor Air Act on Food Services and Drinking Places Sales and Numbers, 1998-2011

    PubMed Central

    Fisher, Monica A.

    2013-01-01

    Introduction Philadelphia enacted its Clean Indoor Air Act (CIAA) nearly 2 years before the statewide CIAA. In this study, we assessed the economic impact of CIAAs on 4 types of food services and drinking places and addressed the predominant limitation of previous pre–post ban studies, namely the lack of control for confounders and changes in secular trends over time. Methods We analyzed data from Pennsylvania Department of Revenue Quarterly 1998–2011 taxable county-level revenue sales and number of food services and drinking places. Region-specific and type-specific adjusted sales and number of food services and drinking places accounted for consumer spending as a general economic indicator. Segmented regression analysis of interrupted time-series methodology assessed changes in trend and level. Results Pennsylvania CIAA had no significant effect on adjusted sales or numbers except for an increase in sales in Philadelphia for limited-service eating places and in the surrounding 4 counties for special food services. Philadelphia CIAA was associated with an increase in adjusted numbers of full-service restaurants in Philadelphia and the rest of the state, special food services in Philadelphia, and drinking places in the rest of the state, and a decrease in the number of special food services in the surrounding counties. Philadelphia CIAA had no significant effect on adjusted sales except for an increase in special food services in the rest of the state. Conclusion Overall, CIAAs had no negative business-related impact and, for the most part, suggest a positive impact on restaurant sales and numbers. Our results provide further support for comprehensive CIAA ordinance for restaurants. PMID:24286275

  7. Case Study – Idling Reduction Technologies for Emergency Service Vehicles

    SciTech Connect

    Laughlin, Michael; Owens, Russell J.

    2016-01-01

    This case study explores the use of idle reduction technologies (IRTs) on emergency service vehicles in police, fire, and ambulance applications. Various commercially available IRT systems and approaches can decrease, or ultimately eliminate, engine idling. Fleets will thus save money on fuel, and will also decrease their criteria pollutant emissions, greenhouse gas emissions, and noise.

  8. Fasten their seatbelts: legal restraint of children in car seats and road ambulances.

    PubMed

    Wilson, Phil

    2007-09-01

    Registered nurses transport sick children in ambulances and other road vehicles every day in the United Kingdom (U.K.). Safely restraining the child, the equipment and the accompanying adults is a matter which should be addressed by all departments who transport children. A motor vehicle collision may cause an unrestrained child to be seriously injured. An unrestrained child is likely to inflict serious injury on the accompanying nurse or parent. Recent changes in child seat law require that appropriate measures must be put in place to ensure sick children receive the safest possible care. The use of a Regulation 44 compliant child-seat or an appropriately sized five-point stretcher harness should be the default standard when transporting a child in a road vehicle under any circumstances. Recent research also indicates that young infants must never be allowed to sleep in car seats on the ward because of the increased risk of obstructive sleep apnoea. PMID:17926766

  9. [The evaluation of health of medical personnel of ambulance care and impacting factors].

    PubMed

    2012-01-01

    The analysis of self-assessment of medical personnel of ambulance care revealed that 13.2% of respondents consider themselves as healthy persons, 35.1%--as practically healthy, 39.2%--as rarely being ill, 12%--as often being ill According to the poll data, deterioration of health is promoted by such personal factors as disregard of one's health (35%) and chronic diseases (25.3%). Its own role play such external factors as professional characteristics (34%). ecological conditions (23%), poor conditions of work (22.2%). The amelioration of health is supported mainly by sport exercises (42.8%). The significant role in this process play the improvement of work conditions, the enhancement of quality of medical examninations and the introduction of professional dispanserization.

  10. Outpatient or short-stay skin grafting with early ambulation for lower-extremity burns.

    PubMed

    Dean, S; Press, B

    1990-08-01

    Lower-extremity burns and skin grafts to these wounds have traditionally required extended hospitalization. We have used early tangential excision of the burn wounds and application of an Unna boot to fresh skin grafts in an attempt to shorten the hospitalization for such patients. Over a six-month period, 9 patients were treated with Unna boots to fresh skin grafts on the lower extremity. The average hospital stay was 0.9 days (range, 0 to 3 days). Graft take was 85% to 100%; no regrafting was required. Ambulation was begun 24 hours postoperatively. The technique described is a safe, effective, and inexpensive alternative to prolonged immobilization and hospitalization in patients with lower-extremity skin grafts.

  11. Occupational risk towards blood-borne infections among ambulance personnel in a provincial hospital network in Thailand.

    PubMed

    Luksamijarulkul, Pipat; Pipitsangjan, Sirikun; Vatanasomboon, Pisit

    2014-07-01

    Health-care personnel working in an ambulance may be at risk for work-related infections, especially blood-borne infections. This cross-sectional study was conducted to assess occupational risks and their preventive practices for blood-borne infections among ambulance personnel working in a provincial hospital network. One hundred sixty-one personnel who voluntarily participated were interviewed using a structured questionnaire. The one-month history of risk exposures to blood-borne infections was collected. In order to cover the real situation of patient care practices among ambulance personnel during working, 30 ambulance runs were observed. Data from the questionnaire and field observation were analyzed and presented by descriptive statistics. The results indicated that 82% had a history of contact with jaundiced patients, and 95% had a history of contact with AIDS patients. Approximately, 63.4% had a history of contact with patients' blood through injuries; of these, 64.7% had needle stick injuries, and 24.5% had sharp injuries. Data for blood-borne preventive practices from interviews reported 82.6% wore disposaiole gloves when doing a blood puncture or giving intravenous fluid/blood. Only 54% broke off drug vials with a clean cloth or cotton wool to protect from an injury, in contradiction to recommended procedure. The mean score of preventive practices was 7.6±2.2; a score classified at a moderate level. However, data from field observations demonstrated only 30.3% of observed personnel (3/9) used aprons and goggles when contacting a large amount of blood, and only 11.1% (1/9) broke off drug vials with a clean cloths to protect from an injury. Continuous education and training, as well as the improvement of safety equipment are needed to better protect ambulance personnel from occupational risks. PMID:25427363

  12. Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters?

    PubMed Central

    Mudumbai, Seshadri C.; Ganaway, Toni; Kim, T. Edward; Howard, Steven K.; Giori, Nicholas J.; Shum, Cynthia

    2016-01-01

    Background Adductor canal catheters offer advantages over femoral nerve catheters for knee replacement patients because they produce less quadriceps muscle weakness; however, applying adductor canal catheters in bedside clinical practice remains challenging. There is currently no patient-reported outcome that accurately predicts patients' physical function after knee replacement. The present study evaluates the validity of a relatively new patient-reported outcome, i.e., a numbness score obtained using a numeric rating scale, and assesses its predictive value on postoperative ambulation. Methods We conducted a retrospective cohort study pooling data from two previously-published clinical trials using identical research methodologies. Both studies recruited patients undergoing knee replacement; one studied adductor canal catheters while the other studied femoral nerve catheters. Our primary outcome was patient-reported numbness scores on postoperative day 1. We also examined postoperative day 1 ambulation distance and its association with postoperative numbness using linear regression, adjusting for age, body mass index, and physical status. Results Data from 94 subjects were included (femoral subjects, n = 46; adductor canal subjects, n = 48). Adductor canal patients reported decreased numbness (median [10th–90th percentiles]) compared to femoral patients (0 [0–5] vs. 4 [0–10], P = 0.001). Adductor canal patients also ambulated seven times further on postoperative day 1 relative to femoral patients. There was a significant association between postoperative day 1 total ambulation distance and numbness (Beta = –2.6; 95% CI: –4.5, –0.8, P = 0.01) with R2 = 0.1. Conclusions Adductor canal catheters facilitate improved early ambulation and produce less patient-reported numbness after knee replacement, but the correlation between these two variables is weak. PMID:26885299

  13. Spinal Cord Injury Functional Ambulation Profile: A Preliminary Look at Responsiveness

    PubMed Central

    Musselman, Kristin E.

    2014-01-01

    Background The Spinal Cord Injury Functional Ambulation Profile (SCI-FAP) is a valid, reliable measure of walking skill (eg, walking while negotiating obstacles, doors, and stairs). Objective The responsiveness of the SCI-FAP was assessed at least 7 months after spinal cord injury (SCI) and compared with that of the 10-Meter Walk Test (10MWT) and the Six-Minute Walk Test (6MWT). Design A secondary analysis of data collected during a randomized, single-blind, crossover trial was performed. Methods Participants had incomplete SCI and could walk at least 5 m without manual assistance. After 3 or 4 baseline assessments, participants completed 2 months of precision training (stepping over obstacles and onto targets on the ground) and 2 months of endurance training (treadmill training with body weight support, if needed). Walking function was assessed with the SCI-FAP, 10MWT, and 6MWT. Internal responsiveness was evaluated through change scores and standardized response means (SRMs). External responsiveness was gauged by correlating change scores on the SCI-FAP, 10MWT, and 6MWT. The minimal detectable change was calculated from the standard error of measurement from the baseline assessments. Results The SCI-FAP scores improved with both interventions. The magnitude of change was greater for participants whose pretraining self-selected speed was less than 0.5 m/s. The SCI-FAP had moderate SRMs. The 10MWT (fastest speed) and 6MWT had the largest SRMs after precision training and endurance training, respectively. The minimal detectable change in the SCI-FAP was 96 points. Limitations The convenience sample was small and all participants could ambulate independently (with devices); therefore, the generalizability of the findings is limited. Conclusions The SCI-FAP was responsive to changes in walking ability in participants who had incomplete SCI and walked at slow speeds, but overall the 10MWT and 6MWT were more responsive. PMID:24114437

  14. Longitudinal effect of eteplirsen versus historical control on ambulation in Duchenne muscular dystrophy

    PubMed Central

    Goemans, Nathalie; Lowes, Linda P.; Alfano, Lindsay N.; Berry, Katherine; Shao, James; Kaye, Edward M.; Mercuri, Eugenio; Hamid, Hoda Abdel; Byrne, Barry J.; Connolly, Anne M.; Dracker, Robert A.; Matthew Frank, L.; Heydemann, Peter T.; O'Brien, Kevin C.; Sparks, Susan E.; Specht, Linda A.; Rodino‐Klapac, Louise; Sahenk, Zarife; Al‐Zaidy, Samiah; Cripe, Linda H.; Lewis, Sarah; M, Pane; E, Mazzone; S, Messina; GL, Vita; Bertini, D Amico A; Casimiro, Berardinelli A; Y, Torrente; F, Magri; GP, Comi; G, Baranello; T, Mongini; A, Pini; R, Battini; E, Pegoraro; C, Bruno; L, Politano; S, Previtali

    2016-01-01

    Objective To continue evaluation of the long‐term efficacy and safety of eteplirsen, a phosphorodiamidate morpholino oligomer designed to skip DMD exon 51 in patients with Duchenne muscular dystrophy (DMD). Three‐year progression of eteplirsen‐treated patients was compared to matched historical controls (HC). Methods Ambulatory DMD patients who were ≥7 years old and amenable to exon 51 skipping were randomized to eteplirsen (30/50mg/kg) or placebo for 24 weeks. Thereafter, all received eteplirsen on an open‐label basis. The primary functional assessment in this study was the 6‐Minute Walk Test (6MWT). Respiratory muscle function was assessed by pulmonary function testing (PFT). Longitudinal natural history data were used for comparative analysis of 6MWT performance at baseline and months 12, 24, and 36. Patients were matched to the eteplirsen group based on age, corticosteroid use, and genotype. Results At 36 months, eteplirsen‐treated patients (n = 12) demonstrated a statistically significant advantage of 151m (p < 0.01) on 6MWT and experienced a lower incidence of loss of ambulation in comparison to matched HC (n = 13) amenable to exon 51 skipping. PFT results remained relatively stable in eteplirsen‐treated patients. Eteplirsen was well tolerated. Analysis of HC confirmed the previously observed change in disease trajectory at age 7 years, and more severe progression was observed in patients with mutations amenable to exon skipping than in those not amenable. The subset of patients amenable to exon 51 skipping showed a more severe disease course than those amenable to any exon skipping. Interpretation Over 3 years of follow‐up, eteplirsen‐treated patients showed a slower rate of decline in ambulation assessed by 6MWT compared to untreated matched HC. Ann Neurol 2016;79:257–271 PMID:26573217

  15. Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test.

    PubMed

    Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

    2015-10-01

    The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between -20 and 4 (mean -4.4). The mean changes were -3.79 in the glucocorticoid group, -5.52 in those who stopped at loss of ambulation and -4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. PMID:26248957

  16. Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test

    PubMed Central

    Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

    2015-01-01

    The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between −20 and 4 (mean −4.4). The mean changes were −3.79 in the glucocorticoid group, −5.52 in those who stopped at loss of ambulation and −4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. PMID:26248957

  17. Academic Service Units and University Policy Formulation: A Functional Survival Model for the 1980s. AIR Forum 1981 Paper.

    ERIC Educational Resources Information Center

    Shoemaker, Daniel Paul

    The way in which university academic service units evolved historically is considered, a theoretical framework is outlined representing the present organizational relationship between the managerial perspective of these units and the university policy-making perspective, and a model is proposed for integrating academic service units into…

  18. Economic impact of air pollution on timber markets: Studies from North America and Europe. Forest Service general technical report

    SciTech Connect

    Steiguer, J.E. de.

    1992-04-01

    The impact of air pollution on forest health has in recent years become an issue of major public concern. This is true despite the fact that irrefutable cause-and-effect relationships have in most instances been quite difficult to establish. The purpose of the report is to assist government officials and other concerned parties by contributing to a better understanding of the economics of forest damage from air pollution. The papers presented here were written by seven economists who have studied the forestry air pollution situation and its relationship to timber markets. The first paper explains the economic linkages among fossil fuel consumption, air pollution externalities, and losses in timber markets. The five papers that follow are concerned with the actual estimation of damages across selected large geographic areas. One study deals with the Southeastern United States; three are national studies from Finland, the U.S., and Canada; and one is concerned with the entire European continent. Yet, while each of the studies is concerned with estimating damage within a large geographic area, the methods of analysis are diverse.

  19. 41 CFR 301-10.135 - When must I travel using U.S. flag air carrier service?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... use of the U.S. flag air carrier would at least double your en route travel time; or (g) When the... 41 Public Contracts and Property Management 4 2014-07-01 2014-07-01 false When must I travel using... Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES ALLOWABLE TRAVEL...

  20. 41 CFR 301-10.135 - When must I travel using U.S. flag air carrier service?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... use of the U.S. flag air carrier would at least double your en route travel time; or (g) When the... 41 Public Contracts and Property Management 4 2013-07-01 2012-07-01 true When must I travel using... Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES ALLOWABLE TRAVEL...

  1. 41 CFR 301-10.135 - When must I travel using U.S. flag air carrier service?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... use of the U.S. flag air carrier would at least double your en route travel time; or (g) When the... 41 Public Contracts and Property Management 4 2011-07-01 2011-07-01 false When must I travel using... Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES ALLOWABLE TRAVEL...

  2. The 1980 Guide to the Evaluation of Educational Experiences in the Armed Services. [Volume] 1: Air Force.

    ERIC Educational Resources Information Center

    Sullivan, Eugene J.; And Others

    For more than 35 years, this Guide has been the standard reference work for recognizing learning acquired in military life. All the courses offered by the Air Force are listed and briefly described. Each course description includes the course title and number: the length of the course, and where and when it was offered; the course objectives; the…

  3. Guide to the Evaluation of Educational Experiences in the Armed Services. The 1978 Guide. 1: Air Force.

    ERIC Educational Resources Information Center

    American Council on Education, Washington, DC. Office on Educational Credit.

    Postsecondary educational credit recommendations for formal courses offered by the Air Force and the Department of Defense are provided in this first of a three-volume guide. (Other volumes cover courses offered by the Army and by the Coast Guard, Marine Corps, and Navy. See note.) Following brief sections on use of the guide, the formal course…

  4. 41 CFR 301-10.135 - When must I travel using U.S. flag air carrier service?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... use of the U.S. flag air carrier would at least double your en route travel time; or (g) When the... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false When must I travel using... Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES ALLOWABLE TRAVEL...

  5. 41 CFR 301-10.135 - When must I travel using U.S. flag air carrier service?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... use of the U.S. flag air carrier would at least double your en route travel time; or (g) When the... 41 Public Contracts and Property Management 4 2012-07-01 2012-07-01 false When must I travel using... Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES ALLOWABLE TRAVEL...

  6. 48 CFR 47.403-1 - Availability and unavailability of U.S.-flag air carrier service.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the time in a travel status, including delay at origin and accelerated arrival at destination, by at... gateway airport in the United States would extend time in a travel status by at least 6 hours more than... the time in a travel status by at least 6 hours more than travel by a foreign-flag air...

  7. Predicting Ambulance Time of Arrival to the Emergency Department Using Global Positioning System and Google Maps

    PubMed Central

    Fleischman, Ross J.; Lundquist, Mark; Jui, Jonathan; Newgard, Craig D.; Warden, Craig

    2014-01-01

    Objective To derive and validate a model that accurately predicts ambulance arrival time that could be implemented as a Google Maps web application. Methods This was a retrospective study of all scene transports in Multnomah County, Oregon, from January 1 through December 31, 2008. Scene and destination hospital addresses were converted to coordinates. ArcGIS Network Analyst was used to estimate transport times based on street network speed limits. We then created a linear regression model to improve the accuracy of these street network estimates using weather, patient characteristics, use of lights and sirens, daylight, and rush-hour intervals. The model was derived from a 50% sample and validated on the remainder. Significance of the covariates was determined by p < 0.05 for a t-test of the model coefficients. Accuracy was quantified by the proportion of estimates that were within 5 minutes of the actual transport times recorded by computer-aided dispatch. We then built a Google Maps-based web application to demonstrate application in real-world EMS operations. Results There were 48,308 included transports. Street network estimates of transport time were accurate within 5 minutes of actual transport time less than 16% of the time. Actual transport times were longer during daylight and rush-hour intervals and shorter with use of lights and sirens. Age under 18 years, gender, wet weather, and trauma system entry were not significant predictors of transport time. Our model predicted arrival time within 5 minutes 73% of the time. For lights and sirens transports, accuracy was within 5 minutes 77% of the time. Accuracy was identical in the validation dataset. Lights and sirens saved an average of 3.1 minutes for transports under 8.8 minutes, and 5.3 minutes for longer transports. Conclusions An estimate of transport time based only on a street network significantly underestimated transport times. A simple model incorporating few variables can predict ambulance time of

  8. Genetic modifiers of ambulation in the cooperative international Neuromuscular research group Duchenne natural history study

    PubMed Central

    Bello, Luca; Kesari, Akanchha; Gordish-Dressman, Heather; Cnaan, Avital; Morgenroth, Lauren P; Punetha, Jaya; Duong, Tina; Henricson, Erik K; Pegoraro, Elena; McDonald, Craig M; Hoffman, Eric P

    2015-01-01

    Objective We studied the effects of LTBP4 and SPP1 polymorphisms on age at loss of ambulation (LoA) in a multiethnic Duchenne muscular dystrophy (DMD) cohort. Methods We genotyped SPP1 rs28357094 and LTBP4 haplotype in 283 of 340 participants in the Cooperative International Neuromuscular Research Group Duchenne Natural History Study (CINRG-DNHS). Median ages at LoA were compared by Kaplan–Meier analysis and log-rank test. We controlled polymorphism analyses for concurrent effects of glucocorticoid corticosteroid (GC) treatment (time-varying Cox regression) and for population stratification (multidimensional scaling of genome-wide markers). Results Hispanic and South Asian participants (n = 18, 41) lost ambulation 2.7 and 2 years earlier than Caucasian subjects (p = 0.003, <0.001). The TG/GG genotype at SPP1 rs28357094 was associated to 1.2-year-earlier median LoA (p = 0.048). This difference was greater (1.9 years, p = 0.038) in GC-treated participants, whereas no difference was observed in untreated subjects. Cox regression confirmed a significant effect of SPP1 genotype in GC-treated participants (hazard ratio = 1.61, p = 0.016). LTBP4 genotype showed a direction of association with age at LoA as previously reported, but it was not statistically significant. After controlling for population stratification, we confirmed a strong effect of LTBP4 genotype in Caucasians (2.4 years, p = 0.024). Median age at LoA with the protective LTBP4 genotype in this cohort was 15.0 years, 16.0 for those who were treated with GC. Interpretation SPP1 rs28357094 acts as a pharmacodynamic biomarker of GC response, and LTBP4 haplotype modifies age at LoA in the CINRG-DNHS cohort. Adjustment for GC treatment and population stratification appears crucial in assessing genetic modifiers in DMD. PMID:25641372

  9. Guilt, shame and need for a container: a study of post-traumatic stress among ambulance personnel.

    PubMed

    Jonsson, Anders; Segesten, Kerstin

    2004-10-01

    Post-traumatic stress symptoms among ambulance personnel are regarded as a natural behaviour and reaction to working with the severely injured, suicides, injured children and dead people. The findings show that post-traumatic stress symptoms, guilt, shame and self-reproach are common after duty-related traumatic events. To handle these overwhelming feelings it is necessary to talk about them with fellow workers, friends or family members. By using another person as a container it is possible to internalise the traumatic experience. Poor and un-emphatic behaviour towards a patient and their relatives can have its origin in untreated traumatic experiences. Personnel in ambulance organisations who perform defusing, debriefing and counselling have to be informed of the importance that the roll of guilt and shame may play in the developing of post-traumatic stress symptoms.

  10. Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel – a cross-sectional study

    PubMed Central

    2012-01-01

    Background Reviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance personnel and the core work force in Denmark. In addition, to examine the association between physical and psychosocial work environment factors and different measures of health among ambulance personnel. Methods Data were taken from a nationwide sample of ambulance personnel and fire fighters (n = 1,691) and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality. Results Ambulance personnel have half the prevalence of poor self-rated health compared to the core work force (5% vs. 10%). Levels of mental health were the same across the two samples whereas a substantially higher proportion of the ambulance personnel reported musculoskeletal pain (42% vs. 29%). The ambulance personnel had higher levels of emotional demands and meaningfulness of and commitment to work, and substantially lower levels of quantitative demands and influence at work. Only one out of ten aspects of physical work environment was consistently associated with higher levels of musculoskeletal pain. Emotional demands was the only psychosocial work factor that was associated with both poorer mental health and worse sleep quality. Conclusions Ambulance personnel have similar levels of mental health but substantially higher levels of musculoskeletal pain than the work force in general. They are more exposed to emotional demands and these demands are associated with higher levels of poor mental health and poor sleep quality. To improve work environment, attention should be paid to musculoskeletal problems and the presence

  11. North Star Ambulatory Assessment, 6-minute walk test and timed items in ambulant boys with Duchenne muscular dystrophy.

    PubMed

    Mazzone, Elena; Martinelli, Diego; Berardinelli, Angela; Messina, Sonia; D'Amico, Adele; Vasco, Gessica; Main, Marion; Doglio, Luca; Politano, Luisa; Cavallaro, Filippo; Frosini, Silvia; Bello, Luca; Carlesi, Adelina; Bonetti, Anna Maria; Zucchini, Elisabetta; De Sanctis, Roberto; Scutifero, Marianna; Bianco, Flaviana; Rossi, Francesca; Motta, Maria Chiara; Sacco, Annalisa; Donati, Maria Alice; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Pane, Marika; Pasquini, Elisabetta; Bruno, Claudio; Vita, Giuseppe; de Waure, Chiara; Bertini, Enrico; Mercuri, Eugenio

    2010-11-01

    The North Star Ambulatory Assessment is a functional scale specifically designed for ambulant boys affected by Duchenne muscular dystrophy (DMD). Recently the 6-minute walk test has also been used as an outcome measure in trials in DMD. The aim of our study was to assess a large cohort of ambulant boys affected by DMD using both North Star Assessment and 6-minute walk test. More specifically, we wished to establish the spectrum of findings for each measure and their correlation. This is a prospective multicentric study involving 10 centers. The cohort included 112 ambulant DMD boys of age ranging between 4.10 and 17 years (mean 8.18±2.3 DS). Ninety-one of the 112 were on steroids: 37/91 on intermittent and 54/91 on daily regimen. The scores on the North Star assessment ranged from 6/34 to 34/34. The distance on the 6-minute walk test ranged from 127 to 560.6 m. The time to walk 10 m was between 3 and 15 s. The time to rise from the floor ranged from 1 to 27.5 s. Some patients were unable to rise from the floor. As expected the results changed with age and were overall better in children treated with daily steroids. The North Star assessment had a moderate to good correlation with 6-minute walk test and with timed rising from floor but less with 10 m timed walk/run test. The 6-minute walk test in contrast had better correlation with 10 m timed walk/run test than with timed rising from floor. These findings suggest that a combination of these outcome measures can be effectively used in ambulant DMD boys and will provide information on different aspects of motor function, that may not be captured using a single measure. PMID:20634072

  12. North Star Ambulatory Assessment, 6-minute walk test and timed items in ambulant boys with Duchenne muscular dystrophy.

    PubMed

    Mazzone, Elena; Martinelli, Diego; Berardinelli, Angela; Messina, Sonia; D'Amico, Adele; Vasco, Gessica; Main, Marion; Doglio, Luca; Politano, Luisa; Cavallaro, Filippo; Frosini, Silvia; Bello, Luca; Carlesi, Adelina; Bonetti, Anna Maria; Zucchini, Elisabetta; De Sanctis, Roberto; Scutifero, Marianna; Bianco, Flaviana; Rossi, Francesca; Motta, Maria Chiara; Sacco, Annalisa; Donati, Maria Alice; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Pane, Marika; Pasquini, Elisabetta; Bruno, Claudio; Vita, Giuseppe; de Waure, Chiara; Bertini, Enrico; Mercuri, Eugenio

    2010-11-01

    The North Star Ambulatory Assessment is a functional scale specifically designed for ambulant boys affected by Duchenne muscular dystrophy (DMD). Recently the 6-minute walk test has also been used as an outcome measure in trials in DMD. The aim of our study was to assess a large cohort of ambulant boys affected by DMD using both North Star Assessment and 6-minute walk test. More specifically, we wished to establish the spectrum of findings for each measure and their correlation. This is a prospective multicentric study involving 10 centers. The cohort included 112 ambulant DMD boys of age ranging between 4.10 and 17 years (mean 8.18±2.3 DS). Ninety-one of the 112 were on steroids: 37/91 on intermittent and 54/91 on daily regimen. The scores on the North Star assessment ranged from 6/34 to 34/34. The distance on the 6-minute walk test ranged from 127 to 560.6 m. The time to walk 10 m was between 3 and 15 s. The time to rise from the floor ranged from 1 to 27.5 s. Some patients were unable to rise from the floor. As expected the results changed with age and were overall better in children treated with daily steroids. The North Star assessment had a moderate to good correlation with 6-minute walk test and with timed rising from floor but less with 10 m timed walk/run test. The 6-minute walk test in contrast had better correlation with 10 m timed walk/run test than with timed rising from floor. These findings suggest that a combination of these outcome measures can be effectively used in ambulant DMD boys and will provide information on different aspects of motor function, that may not be captured using a single measure.

  13. Strategies to reduce the configuration time for a powered knee and ankle prosthesis across multiple ambulation modes.

    PubMed

    Simon, Ann M; Fey, Nicholas P; Finucane, Suzanne B; Lipschutz, Robert D; Hargrove, Levi J

    2013-06-01

    Recently developed powered lower limb prostheses allow users to more closely mimic the kinematics and kinetics of non-amputee gait. However, configuring such a device, in particular a combined powered knee and ankle, for individuals with a transfemoral amputation is challenging. Previous attempts have relied on empirical tuning of all control parameters. This paper describes modified stance phase control strategies - which mimic the behavior of biological joints or depend on the instantaneous loads within the prosthesis - developed to reduce the number of control parameters that require individual tuning. Three individuals with unilateral transfemoral amputations walked with a powered knee and ankle prosthesis across five ambulation modes (level ground walking, ramp ascent/descent, and stair ascent/descent). Starting with a nominal set of impedance parameters, the modified control strategies were applied and the devices were individually tuned such that all subjects achieved comfortable and safe ambulation. The control strategies drastically reduced the number of independent parameters that needed to be tuned for each subject (i.e., to 21 parameters instead of a possible 140 or approximately 4 parameters per mode) while relative amplitudes and timing of kinematic and kinetic data remained similar to those previously reported and to those of non-amputee subjects. Reducing the time necessary to configure a powered device across multiple ambulation modes may allow users to more quickly realize the benefits such powered devices can provide.

  14. Use of 3G mobile phone links for teleconsultation between a moving ambulance and a hospital base station.

    PubMed

    Banitsas, Konstantinos A; Perakis, Konstantinos; Tachakra, Sapal; Koutsouris, Dimitrios

    2006-01-01

    We developed a mobile teleconsultation system based on third-generation mobile phone links. The system comprised a laptop computer and a digital camcorder. It was installed inside an ambulance to allow video-conferencing between the moving vehicle and a doctor at a base station. In addition to video and voice, high-quality still images could also be transmitted. A series of 17 trial runs with real ambulance patients was conducted in the city of Athens. In general, the videoconferencing sessions produced relatively clear video. The bandwidth was high enough for a satisfactory video of 10-15 frames/s. During a total testing period of 23 h and in an area of about 180 km2, there were nine instances of signal loss, amounting to a total of 17 min. The general opinion formed by the doctors was that the system produced good results. All initial diagnoses made using the system agreed with the final diagnoses of the patients. The study showed that the mobile system could reduce the time before an ambulance patient is seen by a doctor. PMID:16438775

  15. Neutral Caregivers or Military Support? The British Red Cross, the Friends’ Ambulance Unit, and the Problems of Voluntary Medical Aid in Wartime

    PubMed Central

    2015-01-01

    During the First World War the British Red Cross Society (BRCS) served as the coordinating body for voluntary medical aid giving in Britain. Among the many units which came within its purview was the Friends’ Ambulance Unit (FAU), formed by a group of young men whose desire to serve their nation in wartime conflicted with their pacifist principles. Both the BRCS and the FAU were wracked by ideological conflicts in the years which preceded and throughout the war. These struggles over voluntarist identity highlight the contested meanings of service and conscience in wartime. Through a critical examination of the language of official histories and biographies, this article will argue that the war formed a key moment in the relationship between the British state and voluntary medical aid, with the state’s increasing role in the work of such organizations raising questions about the voluntarist principles to which aid organizations laid claim. The struggles that both organizations and individuals within them faced in reconciling the competing pressures that this new relationship created form a legacy of the war which continues to have important implications for the place of medical voluntarism in wartime today. PMID:26213442

  16. Transcranial Motor Evoked Potentials of Lower Limbs Can Prognosticate Ambulation in Hemiplegic Stroke Patients

    PubMed Central

    2016-01-01

    Objective To examine the association between motor evoked potentials (MEPs) in lower limbs and ambulatory outcomes of hemiplegic stroke patients. Methods Medical records of hemiplegic patients with the first ever stroke who received inpatient rehabilitation from January 2013 to May 2014 were reviewed. Patient who had diabetes, quadriplegia, bilateral lesion, brainstem lesion, severe musculoskeletal problem, and old age over 80 years were excluded. MEPs in lower limbs were measured when they were transferred to the Department of Rehabilitation Medicine. Subjects were categorized into three groups (normal, abnormal, and absent response) according to MEPs findings. Berg Balance Scale (BBS) and Functional Ambulation Category (FAC) at initial and discharge were compared among the three groups by one-way analysis of variance (ANOVA). Correlation was determined using a linear regression model. Results Fifty-eight hemiplegic patients were included. BBS and FAC at discharge were significantly (ANOVA, p<0.001) different according to MEPs findings. In linear regression model of BBS and FAC using stepwise selection, patients' age (p<0.01), BBS at admission (p<0.01), and MEPs (p<0.01) remained significant covariates. In regression assumption model of BBS and FAC at admission, MEPs and gender were significant covariates. Conclusion Initial MEPs of lower limbs can prognosticate the ambulatory outcomes of hemiplegic patients. PMID:27446774

  17. Reliability and validity of the modified functional ambulation category scale in patients with hemiparalysis.

    PubMed

    Park, Chang Sik; An, Seung Heon

    2016-08-01

    [Purpose] This study aimed to examine the inter- and intra-rater reliability and validity of the modified functional ambulation category (mFAC) scale. [Subjects and Methods] The participants were 66 stroke patients with hemiparalysis. The inter- and intra-rater validity of the mFAC was calculated using the Spearman correlation coefficient. A score comparison of the stable or maximum gait speed with regard to mFAC and modified Rivermead Mobility Index (mRMI) performances was performed as a univariate linear regression analysis to determine how the Kruskal-Wallis test affects the mRMI and stable/maximum gait speed with regard to mFAC. [Results] The inter-rater reliability of the mFAC (intraclass coefficient [ICC]) was 0.982 (0.971-0.989), with a kappa coefficient of 0.923 and a consistency ratio of 94%. In contrast, the intra-rater reliability of the mFAC (ICC) was 0.991 (0.986-0.995), with a kappa coefficient of 0.961 and a consistency ratio of 96%, showing higher reliability. Moreover, there was a significant difference in stable/maximum gait speed between the mFAC and the mRMI. [Conclusion] Since the mFAC has sufficient inter- and intra-reliability and high validity, it can be used as an assessment tool that reflects the gait performance and mobility of stroke patients. PMID:27630410

  18. Leg Lengthening as a Means of Improving Ambulation Following an Internal Hemipelvectomy

    PubMed Central

    Okazaki, Hiroshi; Goto, Takahiro

    2016-01-01

    Reconstructive surgery following an internal hemipelvectomy for a malignant pelvic tumor is difficult due to the structural complexity of the pelvis and the massive extension of the tumor. While high complication rates have been encountered in various types of reconstructive surgery, resection without reconstruction reportedly involved fewer complications. However, this method often results in limb shortening with resultant instability during walking. We reported herein leg lengthening performed to correct lower limb shortening after an internal hemipelvectomy, which improved ambulatory stability and overall QOL. An 18-year-old male patient came to our hospital to correct a lower limb discrepancy resulting from a left internal hemipelvectomy. His left pelvis and proximal femur had been resected, and the femur remained without an acetabular roof. His left lower limb was about 8 centimeters shorter. The left tibia was lengthened 8 centimeters with an external fixator. After the lengthening, the patient was able to walk without support and his gait remarkably improved. Additionally he no longer required placing a wallet in his back pocket as a pad as a means of raising the left side of his torso while sitting. Leg lengthening was a useful method of improving ambulation after an internal hemipelvectomy. PMID:27800202

  19. Reliability and validity of the modified functional ambulation category scale in patients with hemiparalysis

    PubMed Central

    Park, Chang Sik; An, Seung Heon

    2016-01-01

    [Purpose] This study aimed to examine the inter- and intra-rater reliability and validity of the modified functional ambulation category (mFAC) scale. [Subjects and Methods] The participants were 66 stroke patients with hemiparalysis. The inter- and intra-rater validity of the mFAC was calculated using the Spearman correlation coefficient. A score comparison of the stable or maximum gait speed with regard to mFAC and modified Rivermead Mobility Index (mRMI) performances was performed as a univariate linear regression analysis to determine how the Kruskal-Wallis test affects the mRMI and stable/maximum gait speed with regard to mFAC. [Results] The inter-rater reliability of the mFAC (intraclass coefficient [ICC]) was 0.982 (0.971–0.989), with a kappa coefficient of 0.923 and a consistency ratio of 94%. In contrast, the intra-rater reliability of the mFAC (ICC) was 0.991 (0.986–0.995), with a kappa coefficient of 0.961 and a consistency ratio of 96%, showing higher reliability. Moreover, there was a significant difference in stable/maximum gait speed between the mFAC and the mRMI. [Conclusion] Since the mFAC has sufficient inter- and intra-reliability and high validity, it can be used as an assessment tool that reflects the gait performance and mobility of stroke patients. PMID:27630410

  20. Ambulation During Periods of Supersaturation Increase Decompression Stress in Spacewalk Simulations

    NASA Technical Reports Server (NTRS)

    Pollock, N. W.; Natoli, M. J.; Martina, S. D.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.

    2016-01-01

    Musculoskeletal activity accelerates inert gas elimination during oxygen breathing prior to decompression (prebreathe), but may also promote bubble formation (nucleation) and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation are likely critical to the net effect. Understanding the relationships is important to evaluate exercise prebreathe protocols and quantify decompression risk in gravity and microgravity environments. The NASA Prebreathe Reduction Program (PRP) combined oxygen prebreathe and exercise preceding a low pressure (4.3 psia; altitude equivalent of 30,300 ft [9,235 m]) simulation exposure of non-ambulatory subjects (a microgravity analog) to produce two protocols now used by astronauts preparing for extravehicular activity. One protocol included both upright cycling and non-cycling exercise (CEVIS: 'cycle ergometer vibration isolation system') and one protocol relied on non-cycling exercise only (ISLE: 'in-suit light exercise'). CEVIS trial data serve as control data for the current study to investigate the influence of ambulation exercise in 1G environments on bubble formation and the subsequent risk of DCS.

  1. Ambulance 12-lead electrocardiography transmission via cell phone technology to cardiologists.

    PubMed

    Hsieh, Jui-Chien; Lin, Bo-Xuan; Wu, Feng-Ren; Chang, Pei-Chann; Tsuei, Yi-Wei; Yang, Chung-Chi

    2010-10-01

    This study demonstrates transmission of 12-lead electrocardiography (ECG) in an ambulance to the cell phone of the attendant emergency medical technician and then to the hospital and to cell phones of off-site cardiologists. The emergency medical technician cell phone receives Extensible Markup Language files generated by a Phillips Extensible Markup Language ECG instrument via Wi-Fi-based wireless network and then sends them to an ECG-processing server at the hospital over the mobile telephone network. After reducing ECG noises and artifacts, the server converts files to Digital Imaging and Communications in Medicine-based ECG reports stored in Picture Archiving and Communication System. These reports are sent to the cell phones of off-site cardiologists. Consequently, on-site Emergency Department physicians and off-site cardiologists can discuss ECG reports via Picture Archiving and Communication System on their computers or cell phones to prepare for the most appropriate treatment while the patient is on the way to the hospital. In conclusion, this 12-lead ECG transmission e-technology expands the functions of a 12-lead ECG instrument and facilitates more efficient prehospital cardiac care.

  2. Reliability and validity of the modified functional ambulation category scale in patients with hemiparalysis

    PubMed Central

    Park, Chang Sik; An, Seung Heon

    2016-01-01

    [Purpose] This study aimed to examine the inter- and intra-rater reliability and validity of the modified functional ambulation category (mFAC) scale. [Subjects and Methods] The participants were 66 stroke patients with hemiparalysis. The inter- and intra-rater validity of the mFAC was calculated using the Spearman correlation coefficient. A score comparison of the stable or maximum gait speed with regard to mFAC and modified Rivermead Mobility Index (mRMI) performances was performed as a univariate linear regression analysis to determine how the Kruskal-Wallis test affects the mRMI and stable/maximum gait speed with regard to mFAC. [Results] The inter-rater reliability of the mFAC (intraclass coefficient [ICC]) was 0.982 (0.971–0.989), with a kappa coefficient of 0.923 and a consistency ratio of 94%. In contrast, the intra-rater reliability of the mFAC (ICC) was 0.991 (0.986–0.995), with a kappa coefficient of 0.961 and a consistency ratio of 96%, showing higher reliability. Moreover, there was a significant difference in stable/maximum gait speed between the mFAC and the mRMI. [Conclusion] Since the mFAC has sufficient inter- and intra-reliability and high validity, it can be used as an assessment tool that reflects the gait performance and mobility of stroke patients.

  3. 38 CFR 3.7 - Individuals and groups considered to have performed active military, naval, or air service.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Individuals and groups... dietetic and physical therapy personnel. (1) Army and Navy nurses (female) on active service under order of... jurisdiction of War or Navy Departments by Executive order under the Act of August 29, 1916. Effective July...

  4. 38 CFR 3.7 - Individuals and groups considered to have performed active military, naval, or air service.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Individuals and groups... dietetic and physical therapy personnel. (1) Army and Navy nurses (female) on active service under order of... jurisdiction of War or Navy Departments by Executive order under the Act of August 29, 1916. Effective July...

  5. 38 CFR 3.7 - Individuals and groups considered to have performed active military, naval, or air service.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Individuals and groups... dietetic and physical therapy personnel. (1) Army and Navy nurses (female) on active service under order of... jurisdiction of War or Navy Departments by Executive order under the Act of August 29, 1916. Effective July...

  6. 38 CFR 3.7 - Individuals and groups considered to have performed active military, naval, or air service.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Individuals and groups... dietetic and physical therapy personnel. (1) Army and Navy nurses (female) on active service under order of... jurisdiction of War or Navy Departments by Executive order under the Act of August 29, 1916. Effective July...

  7. 38 CFR 3.7 - Individuals and groups considered to have performed active military, naval, or air service.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Individuals and groups... dietetic and physical therapy personnel. (1) Army and Navy nurses (female) on active service under order of... jurisdiction of War or Navy Departments by Executive order under the Act of August 29, 1916. Effective July...

  8. The Public-Service Tax Credit: A Proposed Solution to the Problems of Off-Air Videotaping.

    ERIC Educational Resources Information Center

    Troost, F. William

    1982-01-01

    Proposes a public-service tax credit that would allow copyright owners of any television program broadcast on the public airwaves to claim a limited tax credit in exchange for school rights to copy programs and retain them indefinitely for face-to-face, nonprofit, instructional purposes. (Author/MLF)

  9. Privatization and emergency medical services.

    PubMed

    Reissman, S G

    1997-01-01

    Osborne and Gaebler's Reinventing Government has sparked discussion amongst elected officials, civil servants, the media, and the general public regarding advantages of privatizing government services. Its support stems from an effort to provide services to municipalities while reducing taxpayer expenditure. Many echo the sentiment of former New York Governor Mario Cuomo, who said, "It is not government's obligation to provide services, but to see that they're provided." Even in the area of public safety, privatization has found a "market." In many localities, privatizing Emergency Medical Services (EMS) is a popular and successful method for providing ambulance services. Privately owned ambulance services staff and respond to medical emergencies in a given community as part of the 9-1-1 emergency response system. Regulations for acceptable response times, equipment, and other essential components of EMS systems are specified by contract. This allows the municipality oversight of the service provided, but it does not provide the service directly. As will be discussed, this "contracting-out" model has many benefits. Privatizing EMS services is a decision based not only on cost-savings, but on accountability. A thorough evaluation must be utilized in the selection process. Issues of efficiency, effectiveness, quality, customer service, responsiveness, and equity must be considered by the government, in addition to cost of service. The uncertain future of health care in the United States has led those in EMS to look beyond the field's internal market to explore additional opportunities for expanding and redefining its roles beyond emergency care. It is important, however, to consider how emergency medical care, the original role of EMS, can be best delivered. Responding to emergencies is not just one of the functions involved in this field, it is the principal function from which public perception of EMS is formed, and from which support for entering other markets can

  10. A Web Service Tool (SOAR) for the Dynamic Generation of L1 Grids of Coincident AIRS, AMSU and MODIS Satellite Sounding Radiance Data for Climate Studies

    NASA Astrophysics Data System (ADS)

    Halem, M.; Yesha, Y.; Tilmes, C.; Chapman, D.; Goldberg, M.; Zhou, L.

    2007-05-01

    Three decades of Earth remote sensing from NASA, NOAA and DOD operational and research satellites carrying successive generations of improved atmospheric sounder instruments have resulted in petabytes of radiance data with varying spatial and spectral resolutions being stored at different data archives in various data formats by the respective agencies. This evolution of sounders and the diversities of these archived data sets have led to data processing obstacles limiting the science community from readily accessing and analyzing such long-term climate data records. We address this problem by the development of a web based Service Oriented Atmospheric Radiance (SOAR) system built on the SOA paradigm that makes it practical for the science community to dynamically access, manipulate and generate long term records of L1 pre-gridded sounding radiances of coincident multi-sensor data for regions specified according to user chosen criteria. SOAR employs a modification of the standard Client Server interactions that allows users to represent themselves directly to the Process Server through their own web browsers. The browser uses AJAX to request Javascript libraries and DHTML interfaces that define the possible client interactions and communicates the SOAP messages to the Process server allowing for dynamic web dialogs with the user to take place on the fly. The Process Server is also connected to an underlying high performance compute cluster and storage system which provides much of the data processing capabilities required to service the client requests. The compute cluster employs optical communications to NOAA and NASA for accessing the data and under the governance of the Process Server invokes algorithms for on-demand spatial, temporal, and spectral gridding. Scientists can choose from a variety of statistical averaging techniques for compositing satellite observed sounder radiances from the AIRS, AMSU or MODIS instruments to form spatial-temporal grids for

  11. Successful trans-Atlantic air ambulance transfer of a patient supported by a bi-ventricular assist device.

    PubMed

    McLean, Neilson; Copeland, Ryan; Casey, Neil; Samoukovic, Gordon; Quigley, Robert

    2011-08-01

    The ventricular assist device (VAD) is a hemodynamic support device that augments cardiac output for patients with severe ventricular dysfunction. With improved reliability and technological advances, the use of VADs to support patients is increasing. Many VAD-dependent patients ultimately require heart transplants that are only available in specialized centers, necessitating an interhospital transfer. To date there are few reports of long-distance fixed wing aeromedical transport of patients dependent on a VAD. Here we describe the successful transfer of a patient supported by a biventricular assist device (BiVAD) from Cambridge, UK, to Durham, NC, via fixed-wing jet aircraft. During this transfer, we observed hemodynamic alterations secondary to gravitational forces, which should be anticipated and may be mitigated with simple maneuvers. With high-level logistical planning and appropriate medical oversight, patients dependant on BiVADs can be safely transported by fixed wing aircraft over long distances.

  12. Energy expenditure and fatiguability in paraplegic ambulation using reciprocating gait orthosis and electric stimulation.

    PubMed

    Hirokawa, S; Solomonow, M; Baratta, R; D'Ambrosia, R

    1996-03-01

    To clarify the relationship between metabolic energy expenditure and fatiguability in paraplegic persons fitted with orthoses, we measured energy consumption in six thoracic paraplegic patients ambulating by means of reciprocating gait orthosis (RGO) used with and without functional electrical stimulation (FES). The data obtained from persons using both RGO and FES were adjusted to allow for the effects of fatiguability so as to obtain an approximate value for upper-body consumption. The data obtained from persons using RGO only were not adjusted, because no energy consumption occurred in the lower portion of the body. The data, expressed in kcal/kg-min and kcal/kg-m, were plotted against walking speed attained using RGO, and RGO with FES. The results were compared with those from persons fitted with long leg braces (LLB), hip guidance orthoses (HGO) and an FES walking aid (data obtained from available literature). We found that the lowest energy expenditure in kcal/kg-m across the full range of walking speeds occurred when both RGO and FES were used together, followed by RGO only, HGO, LLB, and FES only, respectively. The lowest energy expenditure in kcal/kg-min, for walking speeds, below 0-28 m/s, also occurred when both RGO and FES were used together, followed by RGO only, HGO, LLB, and FES only. The results suggest that, although the use of FES with RGO may increase oxygen uptake, it decreases energy expenditure in the upper extremities, thereby reducing patient fatigue. They also suggest that mechanical orthosis giving passive support to the hip, knee and ankle in combination with FES may provide the most efficient walking aid for paraplegic persons.

  13. Long Term Natural History Data in Ambulant Boys with Duchenne Muscular Dystrophy: 36-Month Changes

    PubMed Central

    Sormani, Maria Pia; Messina, Sonia; D′Amico, Adele; Carlesi, Adelina; Vita, Gianluca; Fanelli, Lavinia; Berardinelli, Angela; Torrente, Yvan; Lanzillotta, Valentina; Viggiano, Emanuela; D′Ambrosio, Paola; Cavallaro, Filippo; Frosini, Silvia; Barp, Andrea; Bonfiglio, Serena; Scalise, Roberta; De Sanctis, Roberto; Rolle, Enrica; Graziano, Alessandra; Magri, Francesca; Palermo, Concetta; Rossi, Francesca; Donati, Maria Alice; Sacchini, Michele; Arnoldi, Maria Teresa; Baranello, Giovanni; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Previtali, Stefano; Bruno, Claudio; Politano, Luisa; Comi, Giacomo P.; Bertini, Enrico; Mercuri, Eugenio

    2014-01-01

    The 6 minute walk test has been recently chosen as the primary outcome measure in international multicenter clinical trials in Duchenne muscular dystrophy ambulant patients. The aim of the study was to assess the spectrum of changes at 3 years in the individual measures, their correlation with steroid treatment, age and 6 minute walk test values at baseline. Ninety-six patients from 11 centers were assessed at baseline and 12, 24 and 36 months after baseline using the 6 minute walk test and the North Star Ambulatory Assessment. Three boys (3%) lost the ability to perform the 6 minute walk test within 12 months, another 13 between 12 and 24 months (14%) and 11 between 24 and 36 months (12%). The 6 minute walk test showed an average overall decline of −15.8 (SD 77.3) m at 12 months, of −58.9 (SD 125.7) m at 24 months and −104.22 (SD 146.2) m at 36 months. The changes were significantly different in the two baseline age groups and according to the baseline 6 minute walk test values (below and above 350 m) (p<0.001). The changes were also significantly different according to steroid treatment (p = 0.01). Similar findings were found for the North Star Ambulatory Assessment. These are the first 36 month longitudinal data using the 6 minute walk test and North Star Ambulatory Assessment in Duchenne muscular dystrophy. Our findings will help not only to have a better idea of the progression of the disorder but also provide reference data that can be used to compare with the results of the long term extension studies that are becoming available. PMID:25271887

  14. Long term natural history data in ambulant boys with Duchenne muscular dystrophy: 36-month changes.

    PubMed

    Pane, Marika; Mazzone, Elena Stacy; Sivo, Serena; Sormani, Maria Pia; Messina, Sonia; D'Amico, Adele; Carlesi, Adelina; Vita, Gianluca; Fanelli, Lavinia; Berardinelli, Angela; Torrente, Yvan; Lanzillotta, Valentina; Viggiano, Emanuela; D Ambrosio, Paola; Cavallaro, Filippo; Frosini, Silvia; Barp, Andrea; Bonfiglio, Serena; Scalise, Roberta; De Sanctis, Roberto; Rolle, Enrica; Graziano, Alessandra; Magri, Francesca; Palermo, Concetta; Rossi, Francesca; Donati, Maria Alice; Sacchini, Michele; Arnoldi, Maria Teresa; Baranello, Giovanni; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Previtali, Stefano; Bruno, Claudio; Politano, Luisa; Comi, Giacomo P; Bertini, Enrico; Mercuri, Eugenio

    2014-01-01

    The 6 minute walk test has been recently chosen as the primary outcome measure in international multicenter clinical trials in Duchenne muscular dystrophy ambulant patients. The aim of the study was to assess the spectrum of changes at 3 years in the individual measures, their correlation with steroid treatment, age and 6 minute walk test values at baseline. Ninety-six patients from 11 centers were assessed at baseline and 12, 24 and 36 months after baseline using the 6 minute walk test and the North Star Ambulatory Assessment. Three boys (3%) lost the ability to perform the 6 minute walk test within 12 months, another 13 between 12 and 24 months (14%) and 11 between 24 and 36 months (12%). The 6 minute walk test showed an average overall decline of -15.8 (SD 77.3) m at 12 months, of -58.9 (SD 125.7) m at 24 months and -104.22 (SD 146.2) m at 36 months. The changes were significantly different in the two baseline age groups and according to the baseline 6 minute walk test values (below and above 350 m) (p<0.001). The changes were also significantly different according to steroid treatment (p = 0.01). Similar findings were found for the North Star Ambulatory Assessment. These are the first 36 month longitudinal data using the 6 minute walk test and North Star Ambulatory Assessment in Duchenne muscular dystrophy. Our findings will help not only to have a better idea of the progression of the disorder but also provide reference data that can be used to compare with the results of the long term extension studies that are becoming available. PMID:25271887

  15. Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Implementation and Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations and Lifting of the Temporary Moratoria on Enrollment of Part B Emergency Ground Ambulance Suppliers in All Geographic Locations. Extension, implementation, and lifting of temporary moratoria.

    PubMed

    2016-08-01

    This document announces the extension of temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance suppliers and Medicare home health agencies (HHAs), subunits, and branch locations in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse. It also announces the implementation of temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance suppliers and Medicare HHAs, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey on a statewide basis. In addition, it announces the lifting of the moratoria on all Part B emergency ground ambulance suppliers. These moratoria, and the changes described in this document, also apply to the enrollment of HHAs and non-emergency ground ambulance suppliers in Medicaid and the Children's Health Insurance Program. PMID:27487581

  16. Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Implementation and Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations and Lifting of the Temporary Moratoria on Enrollment of Part B Emergency Ground Ambulance Suppliers in All Geographic Locations. Extension, implementation, and lifting of temporary moratoria.

    PubMed

    2016-08-01

    This document announces the extension of temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance suppliers and Medicare home health agencies (HHAs), subunits, and branch locations in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse. It also announces the implementation of temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance suppliers and Medicare HHAs, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey on a statewide basis. In addition, it announces the lifting of the moratoria on all Part B emergency ground ambulance suppliers. These moratoria, and the changes described in this document, also apply to the enrollment of HHAs and non-emergency ground ambulance suppliers in Medicaid and the Children's Health Insurance Program.

  17. Characterization of Artifacts Produced by Gel Displacement on Non-invasive Brain-Machine Interfaces during Ambulation.

    PubMed

    Costa, Álvaro; Salazar-Varas, Rocio; Úbeda, Andrés; Azorín, José M

    2016-01-01

    So far, Brain-Machine Interfaces (BMIs) have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals). To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training) and one movement-free condition (BMI motor imagery task) are compared to perform this study. Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD) of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions. PMID:26941601

  18. Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators.

    PubMed

    Cho, Duk Youn; Park, Si-Woon; Lee, Min Jin; Park, Dae Sung; Kim, Eun Joo

    2015-10-01

    [Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training.

  19. Characterization of Artifacts Produced by Gel Displacement on Non-invasive Brain-Machine Interfaces during Ambulation

    PubMed Central

    Costa, Álvaro; Salazar-Varas, Rocio; Úbeda, Andrés; Azorín, José M.

    2016-01-01

    So far, Brain-Machine Interfaces (BMIs) have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals). To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training) and one movement-free condition (BMI motor imagery task) are compared to perform this study. Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD) of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions. PMID:26941601

  20. Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators

    PubMed Central

    Cho, Duk Youn; Park, Si-Woon; Lee, Min Jin; Park, Dae Sung; Kim, Eun Joo

    2015-01-01

    [Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training. PMID:26644642

  1. Model application for rapid detection of the exact location when calling an ambulance using OGC Open GeoSMS Standards

    NASA Astrophysics Data System (ADS)

    Sukic, Enes; Stoimenov, Leonid

    2016-02-01

    The web has penetrated just about every sphere of human interest and using information from the web has become ubiquitous among different categories of users. Medicine has long being using the benefits of modern technologies and without them it cannot function. This paper offers a proposal of use and mutual collaboration of several modern technologies within facilitating the location and communication between persons in need of emergency medical assistance and the emergency head offices, i.e., the ambulance. The main advantage of the proposed model is the technical possibility of implementation and use of these technologies in developing countries and low implementation cost.

  2. Case Studies of Technology-aided Interventions to Promote Hand Reaching and Standing or Basic Ambulation in Persons with Multiple Disabilities.

    PubMed

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Alberti, Gloria; Campodonico, Francesca

    2016-02-01

    Motor impairments such as lack of standing and/or independent ambulation are common among persons with multiple disabilities. These two studies assessed technology-aided programs for persons with those impairments. Specifically, Study I assessed a program to teach two non-ambulatory adults to hand reach a stimulation-linked object by standing up. Study II assessed a program to teach a child and a man to ambulate while holding a rail or following a corridor wall. Standing increased from below 15% to about or over 80% of the session duration in Study I. The participants of Study II managed to complete brief ambulation trials independent of guidance. These performance achievements were discussed in relation to the technology-aided programs employed in the studies and the programs' applicability in daily contexts. PMID:27420316

  3. Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana

    PubMed Central

    Mould-Millman, Nee-Kofi; Rominski, Sarah D; Bogus, Joshua; Ginde, Adit A; Zakariah, Ahmed N; Boatemaah, Christiana A; Yancey, Arthur H; Akoriyea, Samuel Kaba; Campbell, Thomas B

    2015-01-01

    Background: Emergency medical services (EMS) systems provide professional prehospital emergency medical care and transportation to help improve outcomes from emergency conditions. Ghana’s national ambulance service has relatively low public utilization in comparison with the large burden of acute disease. Methods: A survey instrument was developed using Pechansky and Thomas’s model of access covering 5 dimensions of availability, accessibility, accommodation, affordability, and acceptability. The instrument was used in a cross-sectional survey in 2013 in Accra, Ghana; eligible participants were those 18 years and older who spoke English, French, or Twi. Although the analysis was mainly descriptive, logistic regression was used to identify factors associated with reported intention to call for an ambulance in the case of a medical emergency. Results: 468 participants completed surveys, with a response rate of 78.4%. Few (4.5%) respondents had ever used an ambulance in prior emergency situations. A substantial proportion (43.8%) knew about the public access medical emergency telephone number, but of those only 37.1% knew it was a toll-free call. Most (54.7%) respondents believed EMTs offered high-quality care, but 78.0% believed taxis were faster than ambulances and 69.2% thought the number of ambulances in Accra insufficient. Many (23.4%) thought using ambulances to transport corpses would be appropriate. In two hypothetical emergency scenarios, respondents most commonly reported taxis as the preferred transportation (63.6% if a family member were burned in a house fire, 64.7% if a pedestrian were struck by a vehicle). About 1 in 5 respondents said they would call an ambulance in either scenario (20.7% if a family member were burned in a house fire, 23.3% if a pedestrian were struck by a vehicle) while 15.5% and 10.2%, respectively, would use any available vehicle. Those aged 18–35 years were more likely than older respondents to prefer an ambulance (odds

  4. Occupational Structures and Profiles in the Federal Republic of Germany in the Field of Environmental Protection in the Public Service Sector with Reference to Air Pollution Control. CEDEFOP Panorama. National Report.

    ERIC Educational Resources Information Center

    Nitschke, Christoph; Funderich, Kirk

    A study examined the knowledge and job skills required of persons employed in air pollution control-related occupations in Germany's public service sector. In all, 18 persons from 11 offices in 10 public institutions were interviewed. In seven cases, two people from the same institution (one performing managerial duties and the other directly…

  5. Potential Use of the Australian Satellite Communications System for School of the Air and Enhanced Educational Services. Report Prepared for the Commonwealth/State Advisory Committee on the Educational Use of Communications Technology.

    ERIC Educational Resources Information Center

    Davies, N. G.; Gillam, J. A.

    This report considers the potential for the use of the Australian Communications Satellite System (ACSS) for the Australian Schools of the Air (SOTAs) and the delivery of enhanced educational services, and develops the concept of all SOTAs operating through one transponder in a national beam. An evolutionary introduction of satellite transmission…

  6. Pre-hospital assessment by a single responder: The Swedish ambulance nurse in a new role: A pilot study.

    PubMed

    Magnusson, Carl; Källenius, Christofer; Knutsson, Susanne; Herlitz, Johan; Axelsson, Christer

    2016-05-01

    When a person with vague symptoms calls 112, the dispatchers often have difficulty prioritising the severity of the call. Their only alternative has been to send an ambulance. In Gothenburg, Sweden, a nurse-manned single responder (SR) was initiated to assess this patient group. The study aims to describe patient characteristics and assessment level made by the SR nurse among patients assessed by the dispatcher as low priority and/or vague symptoms. A consecutive journal review was conducted. During six months, 529 patients were assessed; 329 (62%) attended the emergency department (ED) or inpatient care (IC). Of these, 85 patients (26%) were assessed as high priority. Only 108 were assessed as being in need of ambulance transport. ED/IC patients were significantly older. Two hundred (38%) stayed at the scene (SS) (n = 142) or were referred to primary care (PC) (n = 58). Of the 200 SS/PC patients, 38 (19%) attended the ED within 72 hrs with residual symptoms, 20 of whom were admitted to a ward. Nine patients (4% of 200 SS/PC patients) required inpatient treatment and 11 patients stayed overnight for observation. These results suggest a relatively high level of patient safety and the usefulness of an SR among patients assessed by the dispatcher as low priority. PMID:26472522

  7. Reduction in Fatalities, Ambulance Calls, and Hospital Admissions for Road Trauma After Implementation of New Traffic Laws

    PubMed Central

    Chan, Herbert; Brasher, Penelope; Erdelyi, Shannon; Desapriya, Edi; Asbridge, Mark; Purssell, Roy; Macdonald, Scott; Schuurman, Nadine; Pike, Ian

    2014-01-01

    Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. PMID:25121822

  8. Burn Functional Outcomes - Ventilator Usage and Discharge Ambulation Status of Patients in a Burn Wound in-Patient Centre.

    PubMed

    Harmon, R L; Mian, M A H; Alam, B; Hassan, Z; Mullins, R F

    2009-12-31

    Anticipating functional outcomes of patients managed in an in-patient burn wound centre can help in advising patients and their families of prognosis as well as assist case managers in discharge planning. The records of 37 burn patients were reviewed; one patient expired and was removed from further analysis. Data were obtained regarding patient characteristics, types and locations of burns and other wounds, ventilator use, level of mobility at hospital discharge, and disposition; three patients lacked discharge ambulation status and were removed from the outcome comparison analysis. Of the 36 patients, 17 had thermal burns and nine (25%) had associated inhalation injuries. Thermal burn patients (p = 0.02), patients requiring ventilator support during their hospital stay (p = 0.04), and those with inhalation injuries (p = 0.04) were less likely to be ambulating independently or with assistance at discharge from the burn wound centre than other patients. This preliminary study suggests that patients with thermal burns and inhalation injuries and those requiring ventilator support were less likely to be ambulatory at hospital discharge. Further studies appear indicated. PMID:21991182

  9. [A statistical analysis of factors influencing standing balance, activity of daily living and ambulation in hemiplegic patients].

    PubMed

    Nogaki, H

    1992-04-01

    This study was undertaken to investigate several factors influencing standing balance, activity of daily living and ambulation in hemiplegic patients after cerebro-vascular diseases. A statistical analysis of 121 hemiplegic patients with unilateral supratentorial lesions showed that age, severity of muscle weakness of involved or uninvolved extremities, unilateral spatial neglect and the sense of toe position had influence on standing balance, activity of daily living or ambulation. The patients were divided into five groups based on the degree of unilateral spatial neglect, evaluated by their copies of two daisies who omitted more than three quarters, three quarters, half, one quarter and none of the figures were defined as the USN-4, USN-3, USN-2, USN-1 and no involvement groups, respectively. Those who belonged to the USN-2 group had significantly lower scores for activity of daily living than those who belonged to the no involvement group. In the USN-2 group, 7 of the 8 patients could not keep standing for 50 seconds, while in the no involvement group, this was the case in only 1 of the 15 patients. Activity of daily living scores or sway area during standing showed no statistically significant differences between the USN-1 and no involvement groups. These results suggested that severe or moderate unilateral spatial neglect is one of the most important factors influencing standing balance and activity of daily living. PMID:1614008

  10. Wearable seismocardiography: towards a beat-by-beat assessment of cardiac mechanics in ambulant subjects.

    PubMed

    Di Rienzo, M; Vaini, E; Castiglioni, P; Merati, G; Meriggi, P; Parati, G; Faini, A; Rizzo, F

    2013-11-01

    Seismocardiogram (SCG) is the measure of the micro-vibrations produced by the heart contraction and blood ejection into the vascular tree. Over time, a large body of evidence has been collected on the ability of SCG to reflect cardiac mechanical events such as opening and closure of mitral and aortic valves, atrial filling and point of maximal aortic blood ejection. We recently developed a smart garment, named MagIC-SCG, that allows the monitoring of SCG, electrocardiogram (ECG) and respiration out of the laboratory setting in ambulant subjects. The present pilot study illustrates the results of two different experiments performed to obtain a first evaluation on whether a dynamical assessment of indexes of cardiac mechanics can be obtained from SCG recordings obtained by MagIC-SCG. In the first experiment, we evaluated the consistency of the estimates of two indexes of cardiac contractility, the pre-ejection period, PEP, and the left ventricular ejection time, LVET. This was done in the lab, by reproducing an experimental protocol well known in literature, so that our measures derived from SCG could have been compared with PEP and LVET reference values obtained by traditional techniques. Six healthy subjects worn MagIC-SCG while assuming two different postures (supine and standing); PEP was estimated as the time interval between the Q wave in ECG and the SCG wave corresponding to the opening of aortic valve; LVET was the time interval between the SCG waves corresponding to the opening and closure of the aortic valve. The shift from supine to standing posture produced a significant increase in PEP and PEP/LVET ratio, a reduction in LVET and a concomitant rise in the LF/HF ratio in the RR interval (RRI) power spectrum. These results are in line with data available in literature thus providing a first support to the validity of our estimates. In the second experiment, we evaluated in one subject the feasibility of the beat-by-beat assessment of LVET during spontaneous

  11. Factors Associated With Incidence of "?Inappropriate"? Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children

    ERIC Educational Resources Information Center

    Poltavski, Dmitri; Muus, Kyle

    2005-01-01

    Context: Ambulance transport of pediatric trauma patients to designated trauma centers in cases of moderate and severe injury is not always performed, which has been shown to result in poor treatment outcomes. Determination of factors involved in inappropriate patient transport, especially in rural areas, remains an important avenue of research.…

  12. Factors Associated with Incidence of "Inappropriate" Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children

    ERIC Educational Resources Information Center

    Poltavski, Dmitri; Muus, Kyle

    2005-01-01

    Context: Ambulance transport of pediatric trauma patients to designated trauma centers in cases of moderate and severe injury is not always performed, which has been shown to result in poor treatment outcomes. Determination of factors involved in inappropriate patient transport, especially in rural areas, remains an important avenue of research.…

  13. Real-Time Human Ambulation, Activity, and Physiological Monitoring: Taxonomy of Issues, Techniques, Applications, Challenges and Limitations

    PubMed Central

    Khusainov, Rinat; Azzi, Djamel; Achumba, Ifeyinwa E.; Bersch, Sebastian D.

    2013-01-01

    Automated methods of real-time, unobtrusive, human ambulation, activity, and wellness monitoring and data analysis using various algorithmic techniques have been subjects of intense research. The general aim is to devise effective means of addressing the demands of assisted living, rehabilitation, and clinical observation and assessment through sensor-based monitoring. The research studies have resulted in a large amount of literature. This paper presents a holistic articulation of the research studies and offers comprehensive insights along four main axes: distribution of existing studies; monitoring device framework and sensor types; data collection, processing and analysis; and applications, limitations and challenges. The aim is to present a systematic and most complete study of literature in the area in order to identify research gaps and prioritize future research directions. PMID:24072027

  14. Phylogenetic position of Rhynchopus sp. and Diplonema ambulator as indicated by analyses of euglenozoan small subunit ribosomal DNA.

    PubMed

    Busse, I; Preisfeld, Angelika

    2002-02-01

    The taxa Rhynchopus Skuja and Diplonema Griessmann were first described as remarkable protists with euglenid affinities. Later on, the placement of Diplonema within the Euglenozoa was confirmed by molecular data. For this study two new sequences were added to the euglenozoan data set. The uncertainly placed Rhynchopus can be identified as a close relative to Diplonema by small subunit ribosomal DNA (SSU rDNA) analysis. The new sequence of Diplonema ambulator is in close relationship to two other Diplonema species. Our molecular analyses clearly support the monophyly of the diplonemids comprising Rhynchopus and Diplonema. Yet the topology at the base of the euglenozoan tree remains unresolved, and especially the monophyly of the euglenids is arguable. SSU rDNA sequence analyses suggest that significantly different GC contents, high mutational saturation in the euglenids, and different evolutionary rates in the euglenozoan clades make it difficult to identify any sister group to the diplonemids.

  15. Upper Limb Strength and Function Changes during a One-Year Follow-Up in Non-Ambulant Patients with Duchenne Muscular Dystrophy: An Observational Multicenter Trial

    PubMed Central

    Seferian, Andreea Mihaela; Moraux, Amélie; Annoussamy, Mélanie; Canal, Aurélie; Decostre, Valérie; Diebate, Oumar; Le Moing, Anne-Gaëlle; Gidaro, Teresa; Deconinck, Nicolas; Van Parys, Frauke; Vereecke, Wendy; Wittevrongel, Sylvia; Mayer, Michèle; Maincent, Kim; Desguerre, Isabelle; Thémar-Noël, Christine; Cuisset, Jean-Marie; Tiffreau, Vincent; Denis, Severine; Jousten, Virginie; Quijano-Roy, Susana; Voit, Thomas; Hogrel, Jean-Yves; Servais, Laurent

    2015-01-01

    Introduction Upper limb evaluation of patients with Duchenne Muscular Dystrophy is crucially important to evaluations of efficacy of new treatments in non-ambulant patients. In patients who have lost ambulation, there are few validated and informative outcome measures. In addition, longitudinal data demonstrating sensitivity to clinical evolution of outcome measures over short-term periods are lacking. Patients and Methods We report here the results of a one-year multicenter study using specifically designed tools to assess grip, pinch strength, and hand function in wheelchair-bound patients. Our study assessed 53 non-ambulant patients with Duchenne muscular dystrophy aged 17.1 ± 4.8 years (range: 9 – 28.1 years). The average Brooke functional score of these patients was 4.6 ± 1.1. The average forced vital capacity was 44.5% predicted and 19 patients used non-invasive ventilation. Patients were assessed at baseline, 6 months, and one year using the Motor Function Measure and innovative devices (namely the MyoSet composed of MyoGrip, MyoPinch, and MoviPlate). Results Our study confirmed preliminary data previously reported regarding feasibility of use and of reliability of the MyoSet and the correlation at baseline between distal strength and clinical outcomes such as FVC, Brooke score, age, and duration since loss of ambulation. A significant correlation was observed between the distal upper limb strength and clinical variables. The sensitive dynamometers (MyoGrip and MyoPinch) and MoviPlate captured a 12-month change in non-ambulant Duchenne muscular dystrophy patients of all ages. Trial Registration ClinicalTrials.gov NCT00993161 NCT00993161 PMID:25643053

  16. Effect evaluation of a heated ambulance mattress-prototype on body temperatures and thermal comfort - an experimental study

    PubMed Central

    2014-01-01

    Background Exposure to cold temperatures is, often, a neglected problem in prehospital care. One of the leading influences of the overall sensation of cold discomfort is the cooling of the back. The aim of this study was to evaluate the effect of a heated ambulance mattress-prototype on body temperatures and thermal comfort in an experimental study. Method Data were collected during four days in November, 2011 inside and outside of a cold chamber. All participants (n = 23) participated in two trials each. In one trial, they were lying on a stretcher with a supplied heated mattress and in the other trial without a heated mattress. Outcomes were back temperature, finger temperature, core body temperature, Cold Discomfort Scale (CDS), four statements from the state-trait anxiety – inventory (STAI), and short notes of their experiences of the two mattresses. Data were analysed both quantitatively and qualitatively. A repeated measure design was used to evaluate the effect of the two mattresses. Results A statistical difference between the regular mattress and the heated mattress was found in the back temperature. In the heated mattress trial, the statement “I am tense” was fewer whereas the statements “I feel comfortable”, “I am relaxed” and “I feel content” were higher in the heated mattress trial. The qualitative analyses of the short notes showed that the heated mattress, when compared to the unheated mattress, was experienced as warm, comfortable, providing security and was easier to relax on. Conclusions Heat supply from underneath the body results in increased comfort and may prevent hypothermia which is important for injured and sick patients in ambulance care. PMID:25103366

  17. Effects of a novel cholinergic M1 agonist, AF102B, on ambulation and water drinking behavior in rats.

    PubMed

    Togashi, H; Matsumoto, M; Yoshioka, M; Saito, Y; Saito, H

    1991-01-01

    Effects of a novel M1 agonist, AF102B (cis-2-methylspiro(1,3-oxathiolane-5,3')quinuclidine HCl), on ambulation and water drinking behavior were examined using an Ambulo-Drinkometer. AF64A-treated rats, an animal model for senile dementia of the Alzheimer type (SDAT), and non-treated control rats were used. AF102B was administered orally via tap water at a concentration of 0.01% and 0.1% for an experimental therapeutic dose and a supramaximal dose, respectively. Four-week administration of 0.01% AF102B did not affect either ambulatory activity or water drinking activity in non-treated rats. Successive 0.1% AF102B administration for 4 weeks produced a significant decrease in drinking activity as compared with non-treated control rats. In AF64A-treated rats, AF102B did not change the cholinotoxin AF64A-induced high activity in ambulation. However, a decrease in water drinking activity was observed after 0.1% AF102B administration, as in non-treated rats. These results suggest that therapeutic dose of AF102B do not produce any changes in the spontaneous moter activity and water drinking behavior in normal rats or the animal model for SDAT. Several investigators reported that AF102B (FSK-508; cis-2-methylspiro (1,3-oxathiolane-5,3') quinuclidine HCl) had the property of a relatively specific muscarinic agonist of the M1-type This novel M1 agonist, AF102B, also exerted and ameliorating effect on experimental amnesia; in a T-maze, radial-arm maze task and passive avoidance tasks. AF102B improves the cognitive impairment in various animal models for memory disorders including senile dementia of the Alzheimer type (SDAT). Based on these observations, AF102B has been proposed for the treatment of SDAT.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Executive summary: Benefit-cost evaluation of an intra-regional air service in the Bay Area and a technology assessment of transportation system investments. [regional planning for the San Francisco Bay area of California

    NASA Technical Reports Server (NTRS)

    Haefner, L. E.

    1978-01-01

    The benefits and costs that would result from an intra-regional air service operation in the San Francisco Bay area were determined by utilizing an iterative statistical decision model to evaluate combinations of commuter airport sites and surface transportation facilities in conjunction with service by a given commuter aircraft type in light of area regional growth alternatives and peak and off-peak regional travel patterns. The model evaluates such transportation option with respect to criteria of airline profitability, public acceptance, and public and private non-user costs. In so doing, it incorporates information on modal split, peak and off-peak use of the air commuter fleet, terminal and airport costs, development costs and uses of land in proximity to the airport sites, regional population shifts, and induced zonal shifts in travel demand. The model is multimodal in its analytic capability, and performs exhaustive sensitivity analysis.

  19. Air Cargo Marketing Development

    NASA Technical Reports Server (NTRS)

    Kersey, J. W.

    1972-01-01

    The factors involved in developing a market for air cargo services are discussed. A comparison is made between the passenger traffic problems and those of cargo traffic. Emphasis is placed on distribution analyses which isolates total distribution cost, including logistical costs such as transportation, inventory, materials handling, packaging, and processing. Specific examples of methods for reducing air cargo costs are presented.

  20. Course Guide and Course Coordinator Orientation Program. Basic Training Program for Emergency Medical Technician. Ambulance.

    ERIC Educational Resources Information Center

    Dunlap and Associates, Inc., Darien, CT.

    To assist the States in implementing Federal standards for emergency medical services (under the Highway Safety Act of 1966), this guide has been prepared to aid in organizing, conducting, and standardizing a basic training course for emergency medical technicians (EMT's). Part I is a guide for a course designed to develop or upgrade the skill…

  1. Salud/Servicios Personales. Libro del Profesor. (Health/Personal Services. Teacher's Guide). B2. CHOICE (Challenging Options in Career Education).

    ERIC Educational Resources Information Center

    Mid-Hudson Migrant Education Center, New Paltz, NY.

    Written in Spanish, the guide comprises the first grade unit of a career education curriculum developed for migrant students. The guide covers 12 health and personal service occupations--blacksmith, television repairer, hairdresser/barber, day care worker, waitress, gas station attendant, family doctor, ambulance driver/attendant, dietician,…

  2. Air Pollution

    MedlinePlus

    Air pollution is a mixture of solid particles and gases in the air. Car emissions, chemicals from factories, ... Ozone, a gas, is a major part of air pollution in cities. When ozone forms air pollution, it's ...

  3. Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study

    PubMed Central

    Turner, J; O'Cathain, A; Knowles, E; Nicholl, J

    2013-01-01

    Objectives To measure the impact of the urgent care telephone service NHS 111 on the emergency and urgent care system. Design Controlled before and after study using routine data. Setting Four pilot sites and three control sites covering a total population of 3.6 million in England, UK. Participants and data Routine data on 36 months of use of emergency ambulance service calls and incidents, emergency department attendances, urgent care contacts (general practice (GP) out of hours, walk in and urgent care centres) and calls to the telephone triage service NHS direct. Intervention NHS 111, a new 24 h 7 day a week telephone service for non-emergency health problems, operated by trained non-clinical call handlers with clinical support from nurse advisors, using NHS Pathways software to triage calls to different services and home care. Main outcomes Changes in use of emergency and urgent care services. Results NHS 111 triaged 277 163 calls in the first year of operation for a population of 1.8 million. There was no change overall in emergency ambulance calls, emergency department attendances or urgent care use. There was a 19.3% reduction in calls to NHS Direct (95% CI −24.6% to −14.0%) and a 2.9% increase in emergency ambulance incidents (95% CI 1.0% to 4.8%). There was an increase in activity overall in the emergency and urgent care system in each site ranging 4.7–12%/month and this remained when assuming that NHS 111 will eventually take all NHS Direct and GP out of hours calls. Conclusions In its first year of operation in four pilot sites NHS 111 did not deliver the expected system benefits of reducing calls to the 999 ambulance service or shifting patients to urgent rather than emergency care. There is potential that this type of service increases overall demand for urgent care. PMID:24231457

  4. Skylab IMSS checklist application study for emergency medical care. [emergency medical care operations involving the use and operation of the portable ambulance module

    NASA Technical Reports Server (NTRS)

    Carl, J. G.; Furukawa, S.

    1975-01-01

    A manual is presented that provides basic technical documentation to support the operation and utilization of the Portable Ambulance Module (PAM) in the field. The PAM is designed to be used for emergency resuscitation and victim monitoring. The functions of all the controls, displays, and stowed equipment of the unit are defined. Supportive medical and physiological data in those areas directly related to the uses of the PAM unit are presented.

  5. Effects of a Static Bicycling Programme on the Functional Ability of Young People with Cerebral Palsy Who Are Non-Ambulant

    ERIC Educational Resources Information Center

    Williams, Heather; Pountney, Teresa

    2007-01-01

    This study investigated the effects of exercise on the motor function of 11 young people (10 females, one male; age range 11-15y; mean age 12y 7mo [SD 1y 4mo]) with cerebral palsy (CP) who were non-ambulant (Gross Motor Function Classification System Levels IV or V), using an adapted static bicycle. Three participants had dyskinetic quadriplegia,…

  6. Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: A pilot study

    PubMed Central

    Zeilig, Gabi; Weingarden, Harold; Zwecker, Manuel; Dudkiewicz, Israel; Bloch, Ayala; Esquenazi, Alberto

    2012-01-01

    Objectives The objective of the study was to evaluate the safety and tolerance of use of the ReWalk™ exoskeleton ambulation system in people with spinal cord injury. Measures of functional ambulation were also assessed and correlated to neurological spinal cord level, age, and duration since injury. Study design Case series observational study. Setting A national spinal cord injury centre. Methods Six volunteer participants were recruited from the follow-up outpatient clinic. Safety was assessed with regard to falls, status of the skin, status of the spine and joints, blood pressure, pulse, and electrocardiography (ECG). Pain and fatigue were graded by the participants using a visual analogue scale pre- and post-training. Participants completed a 10-statement questionnaire regarding safety, comfort, and secondary medical effects. After being able to walk 100 m, timed up and go, distance walked in 6 minutes and 10-m timed walk were measured. Results There were no adverse safety events. Use of the system was generally well tolerated, with no increase in pain and a moderate level of fatigue after use. Individuals with lower level of spinal cord injury performed walking more efficiently. Conclusion Volunteer participants were able to ambulate with the ReWalk™ for a distance of 100 m, with no adverse effects during the course of an average of 13–14 training sessions. The participants were generally positive regarding the use of the system. PMID:22333043

  7. [Diameter decrement of abdominal aorta and redistribution of systemic blood flow in non-ambulant Duchenne muscular dystrophy patients].

    PubMed

    Shinoe, T; Kawai, M

    1996-10-01

    Cardiomyopathy is a major life-threatening complication in Duchenne muscular dystrophy (DMD). Cardiac output is always low in advanced stage patients. Impaired muscles presumably require extremely low circulation, while blood flow to brain and internal organs is probably maintained. Therefore, the redistribution of systemic circulation must be another important factor which determines whether or not the cardiomyopathy results in fatal heart failure. Although great efforts have been focused on the cardiac function, this problem has seldom attracted attentions. Assuming that diameter of blood vessels reflects blood flow, we measured the diameter of abdominal aorta on CT at four levels: 1) beginning of the abdominal aorta, 2) before and 3) after the branching of renal arteries, 4) before bifurcation of the common iliac arteries. Six bed-ridden DMD patients were compared with 10 ambulant patients suffering from other neurological and non-neurological diseases. We obtained following results. First, the diameter of abdominal aorta is significantly smaller in DMD patients. Second, the decrement is most prominent between before and after the branching of the renal arteries. These results clearly showed predilection of renointestinal circulation at the sacrifice of lower extremities. This narrowing of distal aorta was also observed in Kugelberg-Welander disease and understood as a sequelae of longstanding abolition of lower extremity functions. PMID:8997143

  8. An art therapy intervention for cancer patients in the ambulant aftercare - results from a non-randomised controlled study.

    PubMed

    Geue, K; Richter, R; Buttstädt, M; Brähler, E; Singer, S

    2013-05-01

    Art therapy in psycho-oncology is gaining increasing importance, but systematic evaluations of its effects are rare. The aim of this study is to investigate the effects of an art therapy intervention for cancer patients in ambulant aftercare on psychological distress and coping. The intervention consisted of 22 sessions. At three points of measurement (t1: before intervention, t2: following intervention, t3: 6 months after t2), participants responded to questionnaires (Freiburg Questionnaire on Coping with Illness, Perceived Adjustment to Chronic Illness Scale, Hospital Anxiety and Depression Scale). A group of haemato-oncological patients served as the comparison group (CG). Pre-post comparisons and analyses of variance were applied for statistical analysis. Relevant confounders were controlled. Fifty-four patients (intervention group, IG) with various cancer diagnoses completed the intervention. One hundred and twenty-nine data sets were available for the CG. Analyses of variance included group membership (IG vs. CG) and the following factors: gender, other psychosocial help and major life events. None of these variables was a predictor for changes in depression, anxiety and coping. Therefore, we could not prove intervention effects over time. Our results contradict those of preliminary studies and raise important questions. Further work on evaluating art therapy is necessary to explore which intervention concepts in which setting at which treatment stage show significant effects. Therefore, controlling for relevant confounders is needed.

  9. Pilot Field Test: The Ability to Ambulate After Landing as Assessed with Seat Egress, Walk, and Obstacle Test

    NASA Technical Reports Server (NTRS)

    Fisher, E. A.; Fomina, E. V.; Reschke, M. F.; Cerisano, J. M.; Kofman, I. S.; Gadd, N. E.; Phillips, T. R.; Lee, S. M. C.; Laurie, S. S.; Stenger, M. B.; Bloomberg, J. J.; Mulavara, A. P.; Kozlovskaya, I. B.; Tomilovskaya, E. S.

    2016-01-01

    Astronauts experience alterations in multiple physiological systems due to exposure to the microgravity conditions of space flight. These changes lead to disruption in the ability to ambulate and perform functional tasks during the initial reintroduction to a gravitational environment. Figure 1 shows a schematic representation of the components involved in postflight ataxia. Full functional recovery has not been sufficiently investigated for long-duration crewmembers. The joint U.S./Russian Pilot Field Test (PFT) experiment (a pre-cursor to Field Test (FT)) was developed to address this gap in knowledge. The PFT was conducted on crewmembers traveling on Soyuz expeditions 34S - 41S and was comprised of several tasks designed to study the recovery of sensorimotor abilities of crewmembers during the first 24 hours after landing and for several days thereafter. Closing this gap will allow us to characterize the ability of crewmembers to perform critical mission tasks that they will be expected to perform after an unassisted landing following 6 to 12 months in microgravity. The Seat Egress, Walk and Obstacle (SEWO) Test will be discussed in this poster.

  10. Degree of ambulation and factors associated with the median distance moved per day in Alzheimer's disease patients.

    PubMed

    Nishikata, Shiori; Yamakawa, Miyae; Shigenobu, Kazue; Suto, Shunji; Makimoto, Kiyoko

    2013-09-01

    The Integrated Circuit tag monitoring system became available to measure wandering in terms of the distance moved by dementia patients. The purposes of the study were to describe degree of ambulation in patients with Alzheimer's disease (AD) and to examine factors associated with the distance moved. AD patients were recruited at a dementia care unit in Asakayama Hospital, Osaka, Japan. The monitoring system generated the distance moved per day. Demographic and clinical data were abstracted from medical records. Mini-Mental State Examination was used to measure cognitive function. A multiple linear regression was used to predict the distance moved per day. The research was approved by the ethics committee of the university and the hospital, and written informed consent was obtained from the patients' proxies. Majority of the AD subjects monitored had moderate to advance stage of dementia. Patients' age and cognitive function were predictors of the median distance moved/day, and these two variables explained almost half of the variance. Older age and lower cognitive function were associated with reduced median distance moved per day in AD patients.

  11. Advanced glycation end-products in the peritoneal fluid and in the peritoneal membrane of continuous ambulant peritoneal dialysis patients.

    PubMed

    Mahiout, A; Ehlerding, G; Brunkhorst, R

    1996-01-01

    In patients on continuous ambulant peritoneal dialysis (CAPD) treatment, the peritoneal membrane is continuously exposed to the high glucose concentration contained in the dialysate. This may lead to the local generation of advanced glycation end-products (AGEs). To test this hypothesis we evaluated the plasma and dialysate AGE concentrations in five CAPD patients. The dialysate was measured after a 1 h and after a 12 h dwell time. Additionally, in two patients an immunohistochemical investigation of the peritoneal membrane for AGE was performed. For the determination of AGE an ELISA using a polyclonal antibody against AGE bovine serum albumin was used; the immunohistochemical staining was performed using the streptavidin-biotin complex method. We found only low concentrations of AGE in the dialysate after a 1 h dwell time; after 12 h, however, the dialysate AGE was even greater than the plasma concentration. In both peritoneal specimens we found positive staining for AGE in the interstitium of the mesothelial layer. The dialysate AGE contained a high proportion of high-molecular-weight AGE proteins and low-molecular-weight AGE was found to be in the same concentration range as the total serum AGE. We conclude that there is local generation of AGE in the peritoneal membrane and a 'washing out' of AGE from the peritoneal membrane during longer dwell times. We speculate that the accumulation of AGE might lead to some of the functional and morphological alterations observed after long-term CAPD.

  12. Reviving Freedom House. How the storied ambulance company has been reborn.

    PubMed

    Corry, Megan; Keyes, Casey; Page, David

    2013-03-01

    Freedom House is our national EMS legacy. It was a revolutionary idea born out of the convergence of political forces. It's our EMS history, but it isn't found in our textbooks. Today we labor over the need to build workforce diversity, create community paramedicine and increase physician interaction during paramedic training. Freedom House had all of those things, yet we have collectively forgotten. Freedom House isn't about being the first. It's about believing in the power of each individual to achieve success. It's about building a system of clinical excellence and responsibility to the public. The original Freedom House paramedics became known for their advanced medical care, but to those they treated, they were known for their compassion and commitment to public service.

  13. Medical services for outdoor rock music festivals.

    PubMed Central

    Chapman, K. R.; Carmichael, F. J.; Goode, J. E.

    1982-01-01

    This paper describes the medical services provided at an outdoor rock music festival near Toronto and reviews similar services at other outdoor concerts as reported in the literature. Between 0.5% and 1.5% of concertgoers were reported to have used medical services, proportions that may be useful in planning for future festivals. Most of the medical problems encountered were minor, although life-threatening problems occasionally occurred. Alcohol and drug abuse were common but led to major medical problems in only small proportions of patients. Guidelines for planning are suggested that include recommendations about facilities, supplies and equipment, transportation and communications, staffing and procedures. The need for liaison with the concert promoters, the police, ambulance officials and local hospital personnel is noted, and the use of the nonmedical ancillary staff is encouraged. PMID:7074491

  14. Audiology Services Manual.

    ERIC Educational Resources Information Center

    Gallaudet Coll., Washington, DC. Pre-College Programs.

    The manual describes audiology services offered at the Model Secondary School for the Deaf (MSSD). Components are listed for diagnostic services, instructional services, program development, training, and publications. Testing and reporting procedures for MSSD students are outlined. Testing includes pure-tone air conduction testing, tympanometry,…

  15. Study of low density air transportation concepts

    NASA Technical Reports Server (NTRS)

    Webb, H. M.

    1972-01-01

    Low density air transport refers to air service to sparsely populated regions. There are two major objectives. The first is to examine those characteristics of sparsely populated areas which pertain to air transportation. This involves determination of geographical, commercial and population trends, as well as those traveler characteristics which affect the viability of air transport in the region. The second objective is to analyze the technical, economic and operational characteristics of low density air service. Two representative, but diverse arenas, West Virginia and Arizona, were selected for analysis: The results indicate that Arizona can support air service under certain assumptions whereas West Virginia cannot.

  16. Establishing a successful pre-hospital emergency service in a developing country: experience from Rescue 1122 service in Pakistan.

    PubMed

    Waseem, Hunniya; Naseer, Rizwan; Razzak, Junaid Abdul

    2011-06-01

    As in many other developing countries, emergency medical services, especially pre-hospital emergency care, has long been neglected in Pakistan. Consequently, patients are brought to the emergency departments by relatives or bystanders in private cars, taxis or any other readily available mode of transportation. Ambulances, where they exist, have barely a stretcher and arrangements for oxygen supply. Modern emergency services are considered too costly for many countries. A model of pre-hospital emergency services, called Rescue 1122 and established in Punjab province of Pakistan, is presented. The system is supported by government funding and provides a quality service. The article describes the process of establishment of the service, the organisational structure, the scope of services and the role it is currently playing in the healthcare of the region it serves.

  17. Articulated, Performance-Based Instruction Objectives Guide for Air Conditioning, Refrigeration, and Heating (Environmental Control System Installer/Servicer). Edition I.

    ERIC Educational Resources Information Center

    Henderson, William Edward, Jr., Ed.

    This articulation guide contains 17 units of instruction for the first year of a two-year vocational program designed to prepare the high school graduate to install, maintain, and repair various types of residential and commercial heating, air conditioning, and refrigeration equipment. The units are to introduce the student to fundamental theories…

  18. The 1998 Guide to the Evaluation of Educational Experiences in the Armed Services. 3: Air Force, Coast Guard, Department of Defense, Marine Corps.

    ERIC Educational Resources Information Center

    American Council on Education, Washington, DC.

    This guide is the standard reference work for recognizing learning acquired by military personnel for conversion to academic credit in degree work at colleges and universities. This volume contains recommendations for formal courses offered by the Air Force, the Coast Guard, the Marine Corps, and the Department of Defense in 1990 and later years.…

  19. Air Abrasion

    MedlinePlus

    ... delivered directly to your desktop! more... What Is Air Abrasion? Article Chapters What Is Air Abrasion? What Happens? The Pros and Cons Will I Feel Anything? Is Air Abrasion for Everyone? print full article print this ...

  20. Characterizing the effect of summer temperature on heatstroke-related emergency ambulance dispatches in the Kanto area of Japan

    NASA Astrophysics Data System (ADS)

    Ng, Chris Fook Sheng; Ueda, Kayo; Ono, Masaji; Nitta, Hiroshi; Takami, Akinori

    2014-07-01

    Despite rising concern on the impact of heat on human health, the risk of high summer temperature on heatstroke-related emergency dispatches is not well understood in Japan. A time-series study was conducted to examine the association between apparent temperature and daily heatstroke-related ambulance dispatches (HSAD) within the Kanto area of Japan. A total of 12,907 HSAD occurring from 2000 to 2009 in five major cities—Saitama, Chiba, Tokyo, Kawasaki, and Yokohama—were analyzed. Generalized additive models and zero-inflated Poisson regressions were used to estimate the effects of daily maximum three-hour apparent temperature (AT) on dispatch frequency from May to September, with adjustment for seasonality, long-term trend, weekends, and public holidays. Linear and non-linear exposure effects were considered. Effects on days when AT first exceeded its summer median were also investigated. City-specific estimates were combined using random effects meta-analyses. Exposure-response relationship was found to be fairly linear. Significant risk increase began from 21 °C with a combined relative risk (RR) of 1.22 (95 % confidence interval, 1.03-1.44), increasing to 1.49 (1.42-1.57) at peak AT. When linear exposure was assumed, combined RR was 1.43 (1.37-1.50) per degree Celsius increment. Overall association was significant the first few times when median AT was initially exceeded in a particular warm season. More than two-thirds of these initial hot days were in June, implying the harmful effect of initial warming as the season changed. Risk increase that began early at the fairly mild perceived temperature implies the need for early precaution.

  1. A cross-sectional study of Victorian mobile intensive care ambulance paramedics knowledge of the Valsalva manoeuvre

    PubMed Central

    2009-01-01

    Background The Valsalva Manoeuvre (VM) is a primary measure for terminating haemodynamically stable supraventricular tachycardia (SVT) in the emergency care setting. The clinical use and termination success of the VM in the prehospital setting has not been investigated to date. The objective of this study was to determine Melbourne Mobile Intensive Care Ambulance (MICA) Paramedic knowledge of the VM, and to compare this understanding with an evidence-based model of VM performance. Methods A cross-sectional study in the form of a face-to-face interview was used to determine Melbourne MICA Paramedic understanding of VM instruction between January and February, 2008. The results were then compared with an evidence-based model of VM performance to ascertain compliance with the three criteria of position, pressure and duration. Ethics approval was granted. Results There were 28 participants (60.9%) who elected a form of supine posturing, some 23 participants (50%) selected the syringe method of pressure generation, with 16 participants (34.8%) selecting the "as long as you can" option for duration. On comparison, one out of 46 MICA Paramedics correctly identified the three evidence-based criteria. Conclusions The formal education of Melbourne's MICA Paramedics would benefit from the introduction of an evidence based model of VM performance, which would impact positively on patient care and may improve reversion success in the prehospital setting. The results of this study also demonstrate that an opportunity exists to promote the evidence-based VM criteria across the primary emergency care field. PMID:20003461

  2. Pre-hospital Utility of Rapid Stroke evaluation Using In-ambulance Telemedicine (PURSUIT): A Pilot Feasibility Study

    PubMed Central

    Wu, Tzu-Ching; Nguyen, Claude; Ankrom, Christy; Yang, Julian; Persse, David; Vahidy, Farhaan; Grotta, James C.; Savitz, Sean I.

    2014-01-01

    Background and Purpose : Pre-hospital evaluation using telemedicine (TM) may accelerate acute stroke treatment with tissue plasminogen activator (t-PA). We explored the feasibility and reliability of using TM in the field and ambulance to help evaluate acute stroke patients. Methods : Ten unique, scripted stroke scenarios, each conducted four times, were portrayed by trained actors retrieved and transported by Houston Fire Department emergency medical technicians (EMT) to our stroke center. The vascular neurologists (VN) performed remote assessments in real-time, obtaining clinical data points and NIH Stroke-Scale (NIHSS) using the In-Touch RP-Xpress TM device. Each scripted scenario was recorded for a subsequent evaluation by a second blinded VN. Study feasibility was defined by the ability to conduct 80% of the sessions without major technological limitations. Reliability of video interpretation was defined by a 90% concordance between the data derived during the real-time sessions and the scripted scenarios. Results In 34/40 (85%) scenarios, the teleconsultation was conducted without major technical complication. The absolute agreement for intra-class-correlation (ICC) was 0.997 (95% CI: 0.992-0.999) for the NIHSS obtained during the real-time sessions and 0.993 (95% CI: 0.975-0.999) for the recorded sessions. Inter-rater agreement using κ-statistics showed that for live-raters, 10/15 items on the NIHSS showed excellent agreement, and 5/15 showed moderate agreement. Matching of real-time assessments occurred for 88% (30/34) of NIHSS scores by ±2 points, and 96% of the clinical information. Conclusions Mobile TM is reliable and feasible in assessing actors simulating acute stroke in the pre-hospital setting. PMID:24938842

  3. Development of an implanted intramuscular EMG-triggered FES system for ambulation after incomplete spinal cord injury.

    PubMed

    Dutta, Anirban; Kobetic, Rudi; Triolo, Ronald

    2009-01-01

    Ambulation after spinal cord injury is possible with the aid of neuroprosthesis employing functional electrical stimulation (FES). Individuals with incomplete spinal cord injury (iSCI) retain partial volitional control of muscles below the level of injury, necessitating careful integration of FES with intact voluntary motor function for efficient walking. In this study, the intramuscular electromyogram (iEMG) was used to detect the intent to step and trigger FES-assisted walking in a volunteer with iSCI via an implanted neuroprosthesis consisting of two channels of bipolar iEMG signal acquisition and 12 independent channels of stimulation. The detection was performed with two types of classifiers- a threshold-based classifier that compared the running mean of the iEMG with a discrimination threshold to generate the trigger and a pattern recognition classifier that compared the time-history of the iEMG with a specified template of activity to generate the trigger whenever the cross-correlation coefficient exceeded a discrimination threshold. The pattern recognition classifier generally outperformed the threshold-based classifier, particularly with respect to minimizing False Positive triggers. The overall True Positive rates for the threshold-based classifier were 61.6% and 87.2% for the right and left steps with overall False Positive rates of 38.4% and 33.3%. The overall True Positive rates for the left and right step with the pattern recognition classifier were 57.2% and 93.3% and the overall False Positive rates were 11.9% and 24.4%. The subject showed no preference for either the threshold or pattern recognition-based classifier as determined by the Usability Rating Scale (URS) score collected after each trial and both the classifiers were perceived as moderately easy to use.

  4. Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence on postoperative ambulation and pulmonary function.

    PubMed

    Rawal, N; Sjöstrand, U; Christoffersson, E; Dahlström, B; Arvill, A; Rydman, H

    1984-06-01

    In a randomized double-blind study of thirty grossly obese patients undergoing gastroplasty for weight reduction, the effects of intramuscular and epidural morphine were compared as regards analgesia, ambulation, gastrointestinal motility, early and late pulmonary function, duration of hospitalization, and occurrence of deep vein thrombosis in the postoperative period. The patients were operated on under thoracic epidural block combined with light endotracheal anesthesia. A six-grade scale was devised to quantify postoperative mobilization. A radioactive isotope method using 99mTc -plasmin was employed to detect postoperative deep vein thrombosis. For 14 hr after the first analgesic injection, respiratory frequency was noted every 15 min and arterial blood gases were measured hourly. Peak expiratory flow was recorded daily until the patient was discharged from hospital. Spirometry was performed the day before and the day after surgery. Plasma concentrations of morphine were measured after both intramuscular and epidural administration. Both intramuscular and epidural morphine gave effective analgesia, but the average dose of intramuscular morphine was up to seven times greater than that required by the epidural route. A larger number of patients receiving epidural morphine postoperatively were able to sit, stand, or walk unassisted within 6, 12, and 24 hr, respectively. Being alert and more mobile as a result of superior postoperative analgesia from epidural morphine, patients in this group benefited more from vigorous physiotherapy routine, which resulted in fewer pulmonary complications. Furthermore, earlier postoperative recovery of peak expiratory flow and bowel function presumably contributed to a significantly shorter hospitalization in patients receiving epidural morphine. There was no evidence of prolonged respiratory depression in this high-risk category of patients. The 99mTc -plasmin tests revealed no significant difference between the two groups.

  5. 19 CFR 122.165 - Air cabotage.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... provided for in 14 CFR 121.153, and those aircraft used exclusively in the service of any government. (b... 19 Customs Duties 1 2013-04-01 2013-04-01 false Air cabotage. 122.165 Section 122.165 Customs... AIR COMMERCE REGULATIONS Penalties § 122.165 Air cabotage. (a) The air cabotage law (49 U.S.C....

  6. 19 CFR 122.165 - Air cabotage.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... provided for in 14 CFR 121.153, and those aircraft used exclusively in the service of any government. (b... 19 Customs Duties 1 2014-04-01 2014-04-01 false Air cabotage. 122.165 Section 122.165 Customs... AIR COMMERCE REGULATIONS Penalties § 122.165 Air cabotage. (a) The air cabotage law (49 U.S.C....

  7. 19 CFR 122.165 - Air cabotage.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... provided for in 14 CFR 121.153, and those aircraft used exclusively in the service of any government. (b... 19 Customs Duties 1 2011-04-01 2011-04-01 false Air cabotage. 122.165 Section 122.165 Customs... AIR COMMERCE REGULATIONS Penalties § 122.165 Air cabotage. (a) The air cabotage law (49 U.S.C....

  8. 19 CFR 122.165 - Air cabotage.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... provided for in 14 CFR 121.153, and those aircraft used exclusively in the service of any government. (b... 19 Customs Duties 1 2012-04-01 2012-04-01 false Air cabotage. 122.165 Section 122.165 Customs... AIR COMMERCE REGULATIONS Penalties § 122.165 Air cabotage. (a) The air cabotage law (49 U.S.C....

  9. 19 CFR 122.165 - Air cabotage.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... provided for in 14 CFR 121.153, and those aircraft used exclusively in the service of any government. (b... 19 Customs Duties 1 2010-04-01 2010-04-01 false Air cabotage. 122.165 Section 122.165 Customs... AIR COMMERCE REGULATIONS Penalties § 122.165 Air cabotage. (a) The air cabotage law (49 U.S.C....

  10. Design objectives - Air transportation

    NASA Technical Reports Server (NTRS)

    Beheim, M. A.

    1974-01-01

    The mainline of air transportation is expected to continue to be based on the medium to long haul turbine powered subsonic aircraft. With greater emphasis on energy conservation, there will be considerable interest in making additional progress in propulsion system efficiency. Continued improvement in turbofan engines is expected to occur, but there may be a less conventional approach in the background. Opportunities for expanding short haul air services will certainly materialize. The outlook for supersonic air transport is less clear because of complex political and economic factors.

  11. Air/Water Purification

    NASA Technical Reports Server (NTRS)

    1992-01-01

    After 18 years of research into air/water pollution at Stennis Space Center, Dr. B. C. Wolverton formed his own company, Wolverton Environmental Services, Inc., to provide technology and consultation in air and water treatment. Common houseplants are used to absorb potentially harmful materials from bathrooms and kitchens. The plants are fertilized, air is purified, and wastewater is converted to clean water. More than 100 U.S. communities have adopted Wolverton's earlier water hyacinth and artificial marsh applications. Catfish farmers are currently evaluating the artificial marsh technology as a purification system.

  12. DEMONSTRATION BULLETIN: SITE CHARACTERIZATION ANALYSIS PENETROMETER SYSTEM (SCAPS) LIF SENSOR - U.S. ARMY, NAVY, AND AIR FORCE (TRI-SERVICES)

    EPA Science Inventory

    The Tri-Services Site Characterization Analysis Penetrometer System (SCAPS) was developed by the U.S. Army (U.S. Army Corps of Engineers, Waterways Experiment Station [WES] and the Army Environmental Center [AEC]), Navy (Naval Command, Control and Ocean Surveillance Center), and ...

  13. Integrating the Technical and the Political: The Case of an Assessment of Educational Information Service Adequacy in Oregon. AIR Forum 1980 Paper.

    ERIC Educational Resources Information Center

    Kinnick, Mary K.

    Evaluation strategies used in a 1979 assessment study of information services in Oregon are described. The study was designed to assist staff and members of the Oregon Educational Coordinating Commission with a policy decision. A multi-form, multi-method and multiple audience assessment strategy was used in an effort to account for both the…

  14. Evaluating Cellular Instrumentation on Rural Handpumps to Improve Service Delivery-A Longitudinal Study in Rural Rwanda.

    PubMed

    Nagel, Corey; Beach, Jack; Iribagiza, Chantal; Thomas, Evan A

    2015-12-15

    In rural sub-Saharan Africa, where handpumps are common, 10-67% are nonfunctional at any one time, and many never get repaired. Increased reliability requires improved monitoring and responsiveness of maintenance providers. In 2014, 181 cellular enabled water pump use sensors were installed in three provinces of Rwanda. In three arms, the nominal maintenance model was compared against a "best practice" circuit rider model, and an "ambulance" service model. In only the ambulance model was the sensor data available to the implementer, and used to dispatch technicians. The study ran for seven months in 2014-2015. In the study period, the nominal maintenance group had a median time to successful repair of approximately 152 days, with a mean per-pump functionality of about 68%. In the circuit rider group, the median time to successful repair was nearly 57 days, with a per-pump functionality mean of nearly 73%. In the ambulance service group, the successful repair interval was nearly 21 days with a functionality mean of nearly 91%. An indicative cost analysis suggests that the cost per functional pump per year is approximately similar between the three models. However, the benefits of reliable water service may justify greater focus on servicing models over installation models.

  15. Emergency medical services in India: the present and future.

    PubMed

    Sharma, Mohit; Brandler, Ethan S

    2014-06-01

    India is the second most populous country in the world. Currently, India does not have a centralized body which provides guidelines for training and operation of Emergency Medical Services (EMS). Emergency Medical Services are fragmented and not accessible throughout the country. Most people do not know the number to call in case of an emergency; services such as Dial 108/102/1298 Ambulances, Centralized Accident and Trauma Service (CATS), and private ambulance models exist with wide variability in their dispatch and transport capabilities. Variability also exists in EMS education standards with the recent establishment of courses like Emergency Medical Technician-Basic/Advanced, Paramedic, Prehospital Trauma Technician, Diploma Trauma Technician, and Postgraduate Diploma in EMS. This report highlights recommendations that have been put forth to help optimize the Indian prehospital emergency care system, including regionalization of EMS, better training opportunities, budgetary provisions, and improving awareness among the general community. The importance of public and private partnerships in implementing an organized prehospital care system in India discussed in the report may be a reasonable solution for improved EMS in other developing countries.

  16. A Movement Monitor Based on Magneto-Inertial Sensors for Non-Ambulant Patients with Duchenne Muscular Dystrophy: A Pilot Study in Controlled Environment

    PubMed Central

    Moraux, Amélie; Annoussamy, Mélanie; Dorveaux, Eric; Gasnier, Erwan; Hogrel, Jean-Yves; Voit, Thomas; Vissière, David; Servais, Laurent

    2016-01-01

    Measurement of muscle strength and activity of upper limbs of non-ambulant patients with neuromuscular diseases is a major challenge. ActiMyo® is an innovative device that uses magneto-inertial sensors to record angular velocities and linear accelerations that can be used over long periods of time in the home environment. The device was designed to insure long-term stability and good signal to noise ratio, even for very weak movements. In order to determine relevant and pertinent clinical variables with potential for use as outcome measures in clinical trials or to guide therapy decisions, we performed a pilot study in non-ambulant neuromuscular patients. We report here data from seven Duchenne Muscular Dystrophy (DMD) patients (mean age 18.5 ± 5.5 years) collected in a clinical setting. Patients were assessed while wearing the device during performance of validated tasks (MoviPlate, Box and Block test and Minnesota test) and tasks mimicking daily living. The ActiMyo® sensors were placed on the wrists during all the tests. Software designed for use with the device computed several variables to qualify and quantify muscular activity in the non-ambulant subjects. Four variables representative of upper limb activity were studied: the rotation rate, the ratio of the vertical component in the overall acceleration, the hand elevation rate, and an estimate of the power of the upper limb. The correlations between clinical data and physical activity and the ActiMyo® movement parameters were analyzed. The mean of the rotation rate and mean of the elevation rate appeared promising since these variables had the best reliability scores and correlations with task scores. Parameters could be computed even in a patient with a Brooke functional score of 6. The variables chosen are good candidates as potential outcome measures in non-ambulant patients with Duchenne Muscular Dystrophy and use of the ActiMyo® is currently being explored in home environment. Trial Registration

  17. An Agent-Based Model for Analyzing Control Policies and the Dynamic Service-Time Performance of a Capacity-Constrained Air Traffic Management Facility

    NASA Technical Reports Server (NTRS)

    Conway, Sheila R.

    2006-01-01

    Simple agent-based models may be useful for investigating air traffic control strategies as a precursory screening for more costly, higher fidelity simulation. Of concern is the ability of the models to capture the essence of the system and provide insight into system behavior in a timely manner and without breaking the bank. The method is put to the test with the development of a model to address situations where capacity is overburdened and potential for propagation of the resultant delay though later flights is possible via flight dependencies. The resultant model includes primitive representations of principal air traffic system attributes, namely system capacity, demand, airline schedules and strategy, and aircraft capability. It affords a venue to explore their interdependence in a time-dependent, dynamic system simulation. The scope of the research question and the carefully-chosen modeling fidelity did allow for the development of an agent-based model in short order. The model predicted non-linear behavior given certain initial conditions and system control strategies. Additionally, a combination of the model and dimensionless techniques borrowed from fluid systems was demonstrated that can predict the system s dynamic behavior across a wide range of parametric settings.

  18. Adaptation and Promotion of Emergency Medical Service Transportation for Climate Change

    PubMed Central

    Pan, Chih-Long; Chiu, Chun-Wen; Wen, Jet-Chau

    2014-01-01

    Abstract The purpose of this study is to find a proper prehospital transportation scenario planning of an emergency medical service (EMS) system for possible burdensome casualties resulting from extreme climate events. This project focuses on one of the worst natural catastrophic events in Taiwan, the 88 Wind-caused Disasters, caused by the Typhoon Morakot; the case of the EMS transportation in the Xiaolin village is reviewed and analyzed. The sequential-conveyance method is designed to promote the efficiency of all the ambulance services related to transportation time and distance. Initially, a proposed mobile emergency medical center (MEMC) is constructed in a safe location near the area of the disaster. The ambulances are classified into 2 categories: the first-line ambulances, which reciprocate between the MEMC and the disaster area to save time and shorten the working distances and the second-line ambulances, which transfer patients in critical condition from the MEMC to the requested hospitals for further treatment. According to the results, the sequential-conveyance method is more efficient than the conventional method for EMS transportation in a mass-casualty incident (MCI). This method improves the time efficiency by 52.15% and the distance efficiency by 56.02%. This case study concentrates on Xiaolin, a mountain village, which was heavily destroyed by a devastating mudslide during the Typhoon Morakot. The sequential-conveyance method for the EMS transportation in this research is not only more advantageous but also more rational in adaptation to climate change. Therefore, the findings are also important to all the decision-making with respect to a promoted EMS transportation, especially in an MCI. PMID:25501065

  19. Adaptation and promotion of emergency medical service transportation for climate change.

    PubMed

    Pan, Chih-Long; Chiu, Chun-Wen; Wen, Jet-Chau

    2014-12-01

    The purpose of this study is to find a proper prehospital transportation scenario planning of an emergency medical service (EMS) system for possible burdensome casualties resulting from extreme climate events. This project focuses on one of the worst natural catastrophic events in Taiwan, the 88 Wind-caused Disasters, caused by the Typhoon Morakot; the case of the EMS transportation in the Xiaolin village is reviewed and analyzed. The sequential-conveyance method is designed to promote the efficiency of all the ambulance services related to transportation time and distance. Initially, a proposed mobile emergency medical center (MEMC) is constructed in a safe location near the area of the disaster. The ambulances are classified into 2 categories: the first-line ambulances, which reciprocate between the MEMC and the disaster area to save time and shorten the working distances and the second-line ambulances, which transfer patients in critical condition from the MEMC to the requested hospitals for further treatment. According to the results, the sequential-conveyance method is more efficient than the conventional method for EMS transportation in a mass-casualty incident (MCI). This method improves the time efficiency by 52.15% and the distance efficiency by 56.02%. This case study concentrates on Xiaolin, a mountain village, which was heavily destroyed by a devastating mudslide during the Typhoon Morakot. The sequential-conveyance method for the EMS transportation in this research is not only more advantageous but also more rational in adaptation to climate change. Therefore, the findings are also important to all the decision-making with respect to a promoted EMS transportation, especially in an MCI.

  20. 14 CFR 272.7 - Notice of discontinuance of service.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PROCEEDINGS) ECONOMIC REGULATIONS ESSENTIAL AIR SERVICE TO THE FREELY ASSOCIATED STATES § 272.7 Notice of... of essential air service for such place, the level of service specified in Order 80-9-63; and (2) If the Department has made a determination of essential air service for such place, that level...

  1. Pharmacokinetics and safety of single doses of drisapersen in non-ambulant subjects with Duchenne muscular dystrophy: Results of a double-blind randomized clinical trial

    PubMed Central

    Flanigan, Kevin M.; Voit, Thomas; Rosales, Xiomara Q.; Servais, Laurent; Kraus, John E.; Wardell, Claire; Morgan, Allison; Dorricott, Susie; Nakielny, Joanna; Quarcoo, Naashika; Liefaard, Lia; Drury, Tom; Campion, Giles; Wright, Padraig

    2014-01-01

    Duchenne muscular dystrophy (DMD) is a progressive, lethal neuromuscular disorder caused by the absence of dystrophin protein due to mutations of the dystrophin gene. Drisapersen is a 2′-O-methyl-phosphorothioate oligonucleotide designed to skip exon 51 in dystrophin pre-mRNA to restore the reading frame of the mRNA. This study assessed safety, tolerability, and pharmacokinetics of drisapersen after a single subcutaneous administration in non-ambulatory subjects. Eligible subjects were non-ambulant boys aged ≥9 years, in wheelchairs for ≥1 to ≤4 years, with a diagnosis of DMD resulting from a mutation correctable by drisapersen treatment. Four dose cohorts were planned (3, 6, 9 and 12 mg/kg), but study objectives were met with the 9 mg/kg dose. Less than proportional increase in exposure was demonstrated over the 3–9 mg/kg dose range, though post hoc analysis showed dose proportionality was more feasible over the 3–6 mg/kg range. Single doses of drisapersen at 3 and 6 mg/kg did not result in significant safety or tolerability concerns; however, at the 9 mg/kg dose, pyrexia and transient elevations in inflammatory parameters were seen. The maximum tolerated dose of 6 mg/kg drisapersen was identified for further characterization in multiple dose studies in the non-ambulant DMD population. PMID:24321374

  2. Upper limb evaluation and one-year follow up of non-ambulant patients with spinal muscular atrophy: an observational multicenter trial.

    PubMed

    Seferian, Andreea Mihaela; Moraux, Amélie; Canal, Aurélie; Decostre, Valérie; Diebate, Oumar; Le Moing, Anne Gaëlle; Gidaro, Teresa; Deconinck, Nicolas; Van Parys, Frauke; Vereecke, Wendy; Wittevrongel, Sylvia; Annoussamy, Mélanie; Mayer, Michèle; Maincent, Kim; Cuisset, Jean-Marie; Tiffreau, Vincent; Denis, Severine; Jousten, Virginie; Quijano-Roy, Susana; Voit, Thomas; Hogrel, Jean-Yves; Servais, Laurent

    2015-01-01

    Assessment of the upper limb strength in non-ambulant neuromuscular patients remains challenging. Although potential outcome measures have been reported, longitudinal data demonstrating sensitivity to clinical evolution in spinal muscular atrophy patients are critically lacking. Our study recruited 23 non-ambulant patients, 16 patients (males/females = 6/10; median age 15.4 years with a range from 10.7 to 31.1 years) with spinal muscular atrophy type II and 7 patients (males/females = 2/5; median age 19.9 years with a range from 8.3 to 29.9 years) with type III. The Brooke functional score was on median 3 with a range from 2 to 6. The average total vital capacity was 46%, and seven patients required non-invasive ventilation at night. Patients were assessed at baseline, 6 months, and 1 year using the Motor Function Measure and innovative devices MyoGrip, MyoPinch, and MoviPlate, which assess handgrip strength, key pinch strength, and hand/finger extension-flexion function, respectively. The study demonstrated the feasibility and reliability of these measures for all patients, and sensitivity to negative changes after the age of 14 years. The younger patients showed an increase of the distal force in the follow-up period. The distal force measurements and function were correlated to different functional scales. These data represent an important step in the process of validating these devices as potential outcome measures for future clinical trials.

  3. A seamless ubiquitous emergency medical service for crisis situations.

    PubMed

    Lin, Bor-Shing

    2016-04-01

    In crisis situations, a seamless ubiquitous communication is necessary to provide emergency medical service to save people's lives. An excellent prehospital emergency medicine provides immediate medical care to increase the survival rate of patients. On their way to the hospital, ambulance personnel must transmit real-time and uninterrupted patient information to the hospital to apprise the physician of the situation and provide options to the ambulance personnel. In emergency and crisis situations, many communication channels can be unserviceable because of damage to equipment or loss of power. Thus, data transmission over wireless communication to achieve uninterrupted network services is a major obstacle. This study proposes a mobile middleware for cognitive radio (CR) for improving the wireless communication link. CRs can sense their operating environment and optimize the spectrum usage so that the mobile middleware can integrate the existing wireless communication systems with a seamless communication service in heterogeneous network environments. Eventually, the proposed seamless mobile communication middleware was ported into an embedded system, which is compatible with the actual network environment without the need for changing the original system architecture. PMID:26796352

  4. A seamless ubiquitous emergency medical service for crisis situations.

    PubMed

    Lin, Bor-Shing

    2016-04-01

    In crisis situations, a seamless ubiquitous communication is necessary to provide emergency medical service to save people's lives. An excellent prehospital emergency medicine provides immediate medical care to increase the survival rate of patients. On their way to the hospital, ambulance personnel must transmit real-time and uninterrupted patient information to the hospital to apprise the physician of the situation and provide options to the ambulance personnel. In emergency and crisis situations, many communication channels can be unserviceable because of damage to equipment or loss of power. Thus, data transmission over wireless communication to achieve uninterrupted network services is a major obstacle. This study proposes a mobile middleware for cognitive radio (CR) for improving the wireless communication link. CRs can sense their operating environment and optimize the spectrum usage so that the mobile middleware can integrate the existing wireless communication systems with a seamless communication service in heterogeneous network environments. Eventually, the proposed seamless mobile communication middleware was ported into an embedded system, which is compatible with the actual network environment without the need for changing the original system architecture.

  5. Air Pollution.

    ERIC Educational Resources Information Center

    Gilpin, Alan

    A summary of one of our most pressing environmental problems, air pollution, is offered in this book by the Director of Air Pollution Control for the Queensland (Australia) State Government. Discussion of the subject is not restricted to Queensland or Australian problems and policies, however, but includes analysis of air pollution the world over.…

  6. 78 FR 50138 - Applications for Certificates of Public Convenience and Necessity and Foreign Air Carrier Permits

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-16

    ... PanAir requesting a foreign air carrier permit to operate charter air transportation of property..., whether or not it constitutes part of a continuous operation that includes service to Panama. PanAir...

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

    PubMed Central

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

    2014-01-01

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

  8. Medicare, Medicaid, and Children's Health Insurance Programs: announcement of the extended temporary moratoria on enrollment of ambulance suppliers and home health agencies in designated geographic locations. Extension of temporary moratoria.

    PubMed

    2014-08-01

    This document announces the extension of temporary moratoria on the enrollment of new ambulance suppliers and home health agencies (HHAs) in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse.

  9. An optimal solution for enhancing ambulance safety: implementing a driver performance feedback and monitoring device in ground emergency medical service vehicles.

    PubMed

    Levick, Nadine R; Swanson, Jon

    2005-01-01

    A prospective study was conducted to determine if emergency vehicle driver risk behavior could be improved with an onboard computer-monitoring device, with real time auditory feedback. Data were collected over 18 months from 36 vehicles in a metropolitan EMS group, with >250 drivers. In >1.9 million recorded miles, performance improved from a baseline low of 0.018 miles between penalty counts to a high of 15.8 miles between counts. Seatbelt violations dropped from 13,500 to 4. There was a 20% saving in vehicle maintenance costs within 6 months. This technology demonstrated sustained cost savings in regards to vehicle maintenance as well as minimal retraining of drivers.

  10. Your Health Abroad

    MedlinePlus

    ... an Air Ambulance/Medical Evacuation Company Check Your Health Insurance – Are You Covered Abroad? Before you go abroad, learn what medical services your health insurance will cover overseas. If your health insurance policy ...

  11. 32 CFR 1602.17 - Military service.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Military service. 1602.17 Section 1602.17 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.17 Military service. The term military service includes service in the Army, the Navy, the Air...

  12. 32 CFR 1602.17 - Military service.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Military service. 1602.17 Section 1602.17 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.17 Military service. The term military service includes service in the Army, the Navy, the Air...

  13. 32 CFR 1602.17 - Military service.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Military service. 1602.17 Section 1602.17 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.17 Military service. The term military service includes service in the Army, the Navy, the Air...

  14. 32 CFR 1602.17 - Military service.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Military service. 1602.17 Section 1602.17 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.17 Military service. The term military service includes service in the Army, the Navy, the Air...

  15. 32 CFR 1602.17 - Military service.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Military service. 1602.17 Section 1602.17 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.17 Military service. The term military service includes service in the Army, the Navy, the Air...

  16. Apprentice Food Service Specialist (AFSC 62230).

    ERIC Educational Resources Information Center

    Air Univ., Gunter AFS, Ala. Extension Course Inst.

    This two-volume student text is designed for use by Air Force personnel enrolled in a self-study extension course for apprentice food service specialists. Covered in the first volume are fundamentals of food preparation and service (careers in food service, food service sanitation, principles of food preparation and service, and baking…

  17. 47 CFR 22.859 - Incumbent commercial aviation air-ground systems.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 2 2014-10-01 2014-10-01 false Incumbent commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.859 Incumbent commercial aviation air-ground systems. This section contains rules...

  18. 47 CFR 22.859 - Incumbent commercial aviation air-ground systems.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Incumbent commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.859 Incumbent commercial aviation air-ground systems. This section contains rules...

  19. 47 CFR 22.859 - Incumbent commercial aviation air-ground systems.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 2 2012-10-01 2012-10-01 false Incumbent commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.859 Incumbent commercial aviation air-ground systems. This section contains rules...

  20. 47 CFR 22.857 - Channel plan for commercial aviation air-ground systems.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Channel plan for commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.857 Channel plan for commercial aviation air-ground systems. The 849-851 MHz and 894-896...

  1. 47 CFR 22.859 - Incumbent commercial aviation air-ground systems.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Incumbent commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.859 Incumbent commercial aviation air-ground systems. This section contains rules...

  2. 47 CFR 22.857 - Channel plan for commercial aviation air-ground systems.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Channel plan for commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.857 Channel plan for commercial aviation air-ground systems. The 849-851 MHz and 894-896...

  3. 47 CFR 22.857 - Channel plan for commercial aviation air-ground systems.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 2 2012-10-01 2012-10-01 false Channel plan for commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.857 Channel plan for commercial aviation air-ground systems. The 849-851 MHz and 894-896...

  4. 47 CFR 22.857 - Channel plan for commercial aviation air-ground systems.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 2 2014-10-01 2014-10-01 false Channel plan for commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.857 Channel plan for commercial aviation air-ground systems. The 849-851 MHz and 894-896...

  5. 47 CFR 22.859 - Incumbent commercial aviation air-ground systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 2 2011-10-01 2011-10-01 false Incumbent commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.859 Incumbent commercial aviation air-ground systems. This section contains rules...

  6. 47 CFR 22.857 - Channel plan for commercial aviation air-ground systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 2 2011-10-01 2011-10-01 false Channel plan for commercial aviation air-ground... CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.857 Channel plan for commercial aviation air-ground systems. The 849-851 MHz and 894-896...

  7. Immediate Return to Ambulation and Improved Functional Capacity for Rehabilitation in Complex Regional Pain Syndrome following Early Implantation of a Spinal Cord Stimulation System.

    PubMed

    Goff, Brandon Jesse; Naber, Jeremy Wingseng; McCallin, John Patrick; Lopez, Edward Michael; Guthmiller, Kevin Brant; Lautenschlager, Karl Alan; Lai, Tristan Toll; Hommer, Dean Harry; Marin, Gonzalez Raul

    2014-01-01

    Complex regional pain syndrome (CRPS) is a neuropathic pain condition that is characterized by vasomotor, sensory, sudomotor, and motor symptoms. Spinal cord stimulation (SCS) has been successfully utilized for the treatment of pain refractory to conventional therapies. We present a case of a previously highly functioning 54-year-old female who developed a rarely reported case of idiopathic CRPS of the right ankle which spontaneously occurred four months after an uncomplicated anterior cervical disc fusion. This condition resulted in severe pain and functional impairment that was unresponsive to pharmacological management. The patient's rehabilitation was severely stymied by her excruciating pain. However, with the initiation of spinal cord stimulation, her pain was adequately controlled allowing for progression to full unassisted ambulation, advancing functional capacity, and improving quality of life. This case report supports the concept that rapid progression to neuromodulation, rather than delays that occur due to attempts at serial sympathetic blocks, may better control symptoms leading allowing for a more meaningful recovery.

  8. Effects of Ambulant Myofeedback Training and Ergonomic Counselling in Female Computer Workers with Work-Related Neck-Shoulder Complaints: A Randomized Controlled Trial

    PubMed Central

    Sandsjö, Leif; Vollenbroek-Hutten, Miriam M. R.; Larsman, Pernilla; Kadefors, Roland; Hermens, Hermie J.

    2007-01-01

    Objective: To investigate the effects of ambulant myofeedback training including ergonomic counselling (Mfb) and ergonomic counselling alone (EC), on work-related neck-shoulder pain and disability. Methods: Seventy-nine female computer workers reporting neck-shoulder complaints were randomly assigned to Mfb or EC and received four weeks of intervention. Pain intensity in neck, shoulders, and upper back, and pain disability, were measured at baseline, immediately after intervention, and at three and six months follow-up. Results: Pain intensity and disability had significantly decreased immediately after four weeks Mfb or EC, and the effects remained at follow up. No differences were observed between the Mfb and EC group for outcome and subjects in both intervention groups showed comparable chances for improvement in pain intensity and disability. Conclusions: Pain intensity and disability significantly reduced after both interventions and this effect remained at follow-up. No differences were observed between the two intervention groups. PMID:17260162

  9. Upper Limb Evaluation and One-Year Follow Up of Non-Ambulant Patients with Spinal Muscular Atrophy: An Observational Multicenter Trial

    PubMed Central

    Canal, Aurélie; Decostre, Valérie; Diebate, Oumar; Le Moing, Anne Gaëlle; Gidaro, Teresa; Deconinck, Nicolas; Van Parys, Frauke; Vereecke, Wendy; Wittevrongel, Sylvia; Annoussamy, Mélanie; Mayer, Michèle; Maincent, Kim; Cuisset, Jean-Marie; Tiffreau, Vincent; Denis, Severine; Jousten, Virginie; Quijano-Roy, Susana; Voit, Thomas; Hogrel, Jean-Yves; Servais, Laurent

    2015-01-01

    Assessment of the upper limb strength in non-ambulant neuromuscular patients remains challenging. Although potential outcome measures have been reported, longitudinal data demonstrating sensitivity to clinical evolution in spinal muscular atrophy patients are critically lacking. Our study recruited 23 non-ambulant patients, 16 patients (males/females = 6/10; median age 15.4 years with a range from 10.7 to 31.1 years) with spinal muscular atrophy type II and 7 patients (males/females = 2/5; median age 19.9 years with a range from 8.3 to 29.9 years) with type III. The Brooke functional score was on median 3 with a range from 2 to 6. The average total vital capacity was 46%, and seven patients required non-invasive ventilation at night. Patients were assessed at baseline, 6 months, and 1 year using the Motor Function Measure and innovative devices MyoGrip, MyoPinch, and MoviPlate, which assess handgrip strength, key pinch strength, and hand/finger extension-flexion function, respectively. The study demonstrated the feasibility and reliability of these measures for all patients, and sensitivity to negative changes after the age of 14 years. The younger patients showed an increase of the distal force in the follow-up period. The distal force measurements and function were correlated to different functional scales. These data represent an important step in the process of validating these devices as potential outcome measures for future clinical trials. Trial Registration ClinicalTrials.gov NCT00993161 PMID:25861036

  10. America's Service Academies, Your Service Academies

    ERIC Educational Resources Information Center

    Born, Dana H.; Phillips, Andrew T.; Trainor, Timothy E.

    2012-01-01

    The United States Air Force Academy, United States Naval Academy, and United States Military Academy are America's three largest service academies. They are "the" primary undergraduate institutions and commissioning sources that educate and develop the officers who are expected to lead this nation's armed forces. They are special places that have…

  11. Air Pollution.

    ERIC Educational Resources Information Center

    Fox, Donald L.

    1989-01-01

    Materials related to air pollution are reviewed for the period January 1987, to October 1988. The topics are pollution monitoring, air pollution, and environmental chemistry. The organization consists of two major analytical divisions: (1) gaseous methods; and (2) aerosol and particulate methods. (MVL)

  12. Air Pollution.

    EPA Science Inventory

    Air quality is affected by many types of pollutants that are emitted from various sources, including stationary and mobile. These sources release both criteria and hazardous air pollutants, which cause health effects, ecological harm, and material damage. They are generally categ...

  13. Engine bleed air reduction in DC-10

    NASA Technical Reports Server (NTRS)

    Newman, W. H.; Viele, M. R.

    1980-01-01

    An 0.8 percent fuel savings was achieved by a reduction in engine bleed air through the use of cabin air recirculation. The recirculation system was evaluated in revenue service on a DC-10. The cabin remained comfortable with reductions in cabin fresh air (engine bleed air) as much as 50 percent. Flight test verified the predicted fuel saving of 0.8 percent.

  14. 14 CFR 272.8 - Obligation to continue service.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PROCEEDINGS) ECONOMIC REGULATIONS ESSENTIAL AIR SERVICE TO THE FREELY ASSOCIATED STATES § 272.8 Obligation to... eligible Freely Associated State place below the level of essential air service to such place, whether or not the Department has previously determined the level of essential air service to such place,...

  15. 40 CFR 61.242-8 - Standards: Pressure relief services in liquid service and connectors.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 9 2013-07-01 2013-07-01 false Standards: Pressure relief services in... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR...: Pressure relief services in liquid service and connectors. (a) If evidence of a potential leak is found...

  16. 40 CFR 61.242-8 - Standards: Pressure relief services in liquid service and connectors.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 9 2014-07-01 2014-07-01 false Standards: Pressure relief services in... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR...: Pressure relief services in liquid service and connectors. (a) If evidence of a potential leak is found...

  17. 40 CFR 61.242-8 - Standards: Pressure relief services in liquid service and connectors.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 8 2011-07-01 2011-07-01 false Standards: Pressure relief services in... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR...: Pressure relief services in liquid service and connectors. (a) If evidence of a potential leak is found...

  18. 40 CFR 61.242-8 - Standards: Pressure relief services in liquid service and connectors.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 8 2010-07-01 2010-07-01 false Standards: Pressure relief services in... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR...: Pressure relief services in liquid service and connectors. (a) If evidence of a potential leak is found...

  19. 40 CFR 61.242-8 - Standards: Pressure relief services in liquid service and connectors.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 9 2012-07-01 2012-07-01 false Standards: Pressure relief services in... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR...: Pressure relief services in liquid service and connectors. (a) If evidence of a potential leak is found...

  20. Air Pollution

    MedlinePlus

    ... tobacco smoke. How is air pollution linked to climate change? While climate change is a global process, it ... ozone levels are also a concern. Impacts of Climate Change on Human Health in the United States: A ...