Hunter-Killer Teams: Attacking Enemy Safe Havens

DTIC Science & Technology

2010-01-01

previous practitioners through the venue of lessons learned passed on generationally. U.S. Army operations against the Southwest Indians, the Texas...much had been learned by the Office of Strategic Services (OSS) conducting guerrilla warfare activities. Prior to the Vietnam War, it was the...type formations throughout U.S. history to derive the advantages and disadvantages of their use, to capture key lessons learned about their

Remembering Pearl Harbor: The USS Arizona Memorial. Teaching with Historic Places.

ERIC Educational Resources Information Center

Vierra, John, Jr.

This lesson describes and discusses the submerged remains of the battleship USS Arizona which rests on the silt of Pearl Harbor (Hawaii), just as it had settled on December 7, 1941, the day Japan attacked the U.S. fleet and began the Pacific battles of World War II. The lesson is based on the National Register of Historic Places registration file,…

Breakthrough attacks in patients with hereditary angioedema receiving long-term prophylaxis are responsive to icatibant: findings from the Icatibant Outcome Survey.

PubMed

Aberer, Werner; Maurer, Marcus; Bouillet, Laurence; Zanichelli, Andrea; Caballero, Teresa; Longhurst, Hilary J; Perrin, Amandine; Andresen, Irmgard

2017-01-01

Patients with hereditary angioedema (HAE) due to C1-inhibitor deficiency (C1-INH-HAE) experience recurrent attacks of cutaneous or submucosal edema that may be frequent and severe; prophylactic treatments can be prescribed to prevent attacks. However, despite the use of long-term prophylaxis (LTP), breakthrough attacks are known to occur. We used data from the Icatibant Outcome Survey (IOS) to evaluate the characteristics of breakthrough attacks and the effectiveness of icatibant as a treatment option. Data on LTP use, attacks, and treatments were recorded. Attack characteristics, treatment characteristics, and outcomes (time to treatment, time to resolution, and duration of attack) were compared for attacks that occurred with versus without LTP. Data on 3228 icatibant-treated attacks from 448 patients with C1-INH-HAE were analyzed; 30.1% of attacks occurred while patients were using LTP. Attack rate, attack severity, and the distribution of attack sites were similar across all types of LTP used, and were comparable to the results found in patients who did not receive LTP. Attacks were successfully treated with icatibant; 82.5% of all breakthrough attacks were treated with a single icatibant injection without C1-INH rescue medication. Treatment outcomes were comparable for breakthrough attacks across all LTP types, and for attacks without LTP. Patients who use LTP should be aware that breakthrough attacks can occur, and such attacks can be severe. Thus, patients with C1-INH-HAE using LTP should have emergency treatment readily available. Data from IOS show that icatibant is effective for the treatment of breakthrough attacks. Trial Registration NCT01034969.

Walter Reed Army Medical Center's mental health response to the Pentagon attack.

PubMed

Cozza, Stephen J; Huleatt, William J; James, Larry C

2002-09-01

The September 11 terrorist attack on the Pentagon captured the attention and concern of America as well as the world. Given the extent of devastation, and the number of deaths at the Pentagon, it was believed that the uniformed mental health services would serve a pivotal role in the recovery and relief efforts. This article provides a synopsis of the complex and multidisciplinary mental health services provided by Walter Reed Army Medical Center in the wake of the September 11 attack on the Pentagon. This article offers an overview of the functions and roles of mental health team members, describes a constellation of services rendered, and describes how missions differed inside and outside of the Pentagon. Additionally, the authors provide the reader with how services were provided at the Family Assistance Center to family members of those killed during the attack. Liaison with civilian medical, mental health, and relief agencies and facilities will be discussed as well. The mental health response was an intensive and complicated experience and has yielded many lesson learned. To this end, the authors will provide the reader with an understanding of how the lessons learned during this mission may assist mental health commanders and leaders in planning and responding to similar deployments in the future.

Implications of the World Trade Center attack for the public health and health care infrastructures.

PubMed

Klitzman, Susan; Freudenberg, Nicholas

2003-03-01

The September 11, 2001, attack on the World Trade Center had profound effects on the well-being of New York City. The authors describe and assess the strengths and weaknesses of the city's response to the public health, environmental/ occupational health, and mental health dimensions of the attack in the first 6 months after the event. They also examine the impact on the city's health care and social service system. The authors suggest lessons that can inform the development of a post-September 11th agenda for strengthening urban health infrastructures.

Sony’s Nightmare before Christmas: The 2014 North Korean Cyber Attack on Sony and Lessons for US Government Actions in Cyberspace

DTIC Science & Technology

2018-02-01

4,  2014), http://www.businessinsider.com/ experts-the-sony-hack-looks-a-lot-like-previous-attacks-on- south-korea-2014-12. 39 Kim Zetter, “Logic Bomb ...Set Off South Korea Cyberattack,” Wired (March 21, 2013), https://www.wired.com/2013/03/logic- bomb -south-korea-attack/. 40 Brian Krebs, “The Case...Agency (March  21,  2013), http://english.yonhapnews.co.kr/ national/2013/03/21/55/0302000000AEN20130321003552315F. HTML. 47 Kim Zetter, “Logic Bomb

Implications of the World Trade Center Attack for the Public Health and Health Care Infrastructures

PubMed Central

Klitzman, Susan; Freudenberg, Nicholas

2003-01-01

The September 11, 2001, attack on the World Trade Center had profound effects on the well-being of New York City. The authors describe and assess the strengths and weaknesses of the city’s response to the public health, environmental/ occupational health, and mental health dimensions of the attack in the first 6 months after the event. They also examine the impact on the city’s health care and social service system. The authors suggest lessons that can inform the development of a post–September 11th agenda for strengthening urban health infrastructures. PMID:12604481

Remote damage control during the attacks on Paris: Lessons learned by the Paris Fire Brigade and evolutions in the rescue system.

PubMed

Lesaffre, Xavier; Tourtier, Jean-Pierre; Violin, Yann; Frattini, Benoit; Rivet, Catherine; Stibbe, Olivier; Faure, Florian; Godefroy, Anne; Gallet, Jean-Claude; Ausset, Sylvain

2017-06-01

On November 13, 2015, in 40 minutes, Paris suffered four suicide bombers attacks; shootings at three different restaurant terraces; and an attack on the Bataclan concert hall, resulting in 130 dead and 495 wounded. How did the Parisian rescue system respond and how did it evolve since?We proved we could deploy quickly wide prehospital and hospital resources and teams' equipment and preparedness is being further developed. To secure a swifter initial response, we need a better integration of the operators of the rescue chain with a simpler and more robust organization as well as improved communications channels. We must continue to anticipate and prepare for possible future attacks.

Air Base Attacks and Defensive Counters: Historical Lessons and Future Challenges

DTIC Science & Technology

2015-01-01

I. Reid, Murray Scot Tanner, and Barry Wilson, A Question of Balance: Political Context and Military Aspects of the China–Taiwan Dispute, Santa...this case, Ramstein AB, Germany) placed fighter shelters on loops in woods . Although the shelters are clearly visible from directly overhead in...this image, placing them in woods would have made target acquisition and attack more difficult for Warsaw Pact fighters. That is because, in the 1970s

Building Population Resilience to Terror Attacks: Unlearned Lessons from Military and Civilian Experience

DTIC Science & Technology

2006-11-01

disaster. Recent work by Anthony Mawson highlights the marked disparity between how people are presumed to behave during disasters and their actual...recklessly flee to safety, there is little evidence to support this belief. Building Population Resilience to Terror Attacks . . . 9 Mawson finds that... Mawson goes on to outline four corollaries to these mistaken assumptions that reflect research on human behavior in times of crisis or disaster

Operation Desert Shield Lessons Learned

DTIC Science & Technology

1991-01-01

MRE, T and B rations) issued in Army Mess Halls. (2) Peelable fruits, i.e., oranges and bananas , apples, and pears after being peeled and washed...every day, they cannot get a good seal on their protective masks and are likely to become casualties in the event of a chemical attack. LESSON...liquid mustard agent is imminent. (2) Find clean areas to get relief from wearing rubber gloves and boots before softening of the hands and feet

The Icatibant Outcome Survey: treatment of laryngeal angioedema attacks

PubMed Central

Aberer, Werner; Bouillet, Laurence; Caballero, Teresa; Maurer, Marcus; Fabien, Vincent; Zanichelli, Andrea

2016-01-01

Objective To characterize the management and outcomes of life-threatening laryngeal attacks of hereditary angioedema (HAE) treated with icatibant in the observational Icatibant Outcome Survey (NCT01034969) registry. Methods This retrospective analysis was based on data from patients with HAE type I/II who received healthcare professional-administered or self-administered icatibant to treat laryngeal attacks between September 2008 and May 2013. Results Twenty centers in seven countries contributed data. Overall, 42 patients with HAE experienced 67 icatibant-treated laryngeal attacks. Icatibant was self-administered for 62.3% of attacks (healthcare professional-administered, 37.7%). One icatibant injection was used for 87.9% of attacks, with rescue or concomitant medication used for 9.0%. The median time to treatment was 2.0 h (n=31 attacks) and the median time to resolution was 6.0 h (n=35 attacks). Conclusions This analysis describes successful use of icatibant for the treatment of laryngeal HAE attacks in a real-world setting. PMID:27116379

When a Parent Has MS: A Teenager's Guide

MedlinePlus

... synonymous with attack, relapse, flare-up or worsening. Money Strains There’s no question that MS can put ... on a family. There may not be enough money for extras like music lessons or sports, new ...

X-31 post-stall envelope expansion and tactical utility testing

NASA Technical Reports Server (NTRS)

Canter, Dave

1994-01-01

Technical and nontechnical lessons learned from the X-31 aircraft program are described in this viewgraph presentation. The tactical utility of high angle of attack flight and thrust vector control is discussed.

Leadership in Crisis: Service Chiefs in the Post-Vietnam World

DTIC Science & Technology

2012-06-01

the Korean War offered numerous lessons for the Army and USAF based on the effectiveness of interdiction and the need to coordinate with the ground ...roles and missions.100 Attack capability in this discussion is a platform’s ability to attack targets on the ground . Both USAF and Army leaders had...States Government; Record Group 11; National Archives , 7 August 1964). AU/SAASS/MILLS/AY12 72 of war.8 Soon after Johnson signed the resolution

Attacking obesity: lessons from smoking.

PubMed

Garson, Arthur; Engelhard, Carolyn L

2007-04-24

For the first time since the Civil War, American life expectancy is projected to decrease, owing to the diseases associated with obesity such as diabetes, ultimately causing cardiovascular death. In the past 30 years, the prevalence of obesity among U.S. adults has doubled, as has the incidence of type 2 diabetes. Enough data. The Surgeon General should attack obesity the same way as smoking in 1964, with: 1) Advisory Council creation of public statements; 2) warning labels and menu information in all restaurants; 3) legislation for tax incentives for industry to promote worksite health; and 4) consideration of taxation of fatty food; the cigarette tax is now 42%. It is abundantly clear that in short order, obesity will kill more people than smoking. The time has come for the country to get serious about obesity and take lessons from our nation's campaign to reduce smoking. As patient advocates, scientists, and medical professionals, cardiologists should appropriately take the lead.

Planning the bioterrorism response supply chain: learn and live.

PubMed

Brandeau, Margaret L; Hutton, David W; Owens, Douglas K; Bravata, Dena M

2007-01-01

Responses to bioterrorism require rapid procurement and distribution of medical and pharmaceutical supplies, trained personnel, and information. Thus, they present significant logistical challenges. On the basis of a review of the manufacturing and service supply chain literature, the authors identified five supply chain strategies that can potentially increase the speed of response to a bioterrorism attack, reduce inventories, and save money: effective supply chain network design; effective inventory management; postponement of product customization and modularization of component parts; coordination of supply chain stakeholders and appropriate use of incentives; and effective information management. The authors describe how concepts learned from published evaluations of manufacturing and service supply chains, as well as lessons learned from responses to natural disasters, naturally occurring outbreaks, and the 2001 US anthrax attacks, can be applied to design, evaluate, and improve the bioterrorism response supply chain. Such lessons could also be applied to the response supply chains for disease outbreaks and natural and manmade disasters.

Brigade Combat Team the World’s Police: Understanding the United States Army Brigade Combat Team’s role in Developing Foreign Police

DTIC Science & Technology

2014-06-13

September 2013, fifteen gunmen associated with the terrorist group Al- Shabaab conducted an attack in the Westgate Shopping Mall in Nairobi, Kenya. The... theory , current U.S. Army doctrine, and the lessons learned from the police development efforts in Iraq, a foreign police development model is...civilian police enablers and an understanding of police theory and the lessons learned from previous police reform efforts. 15. SUBJECT TERMS

The enduring mental health impact of the September 11th terrorist attacks: challenges and lessons learned.

PubMed

Ozbay, Fatih; Auf der Heyde, Tanja; Reissman, Dori; Sharma, Vansh

2013-09-01

The authors review the existing literature on the mental health impact of the September 11th attacks and the implications for disaster mental health clinicians and policy makers. The authors discuss the demographic characteristics of those affected and the state of mental health needs and existing mental health delivery services; the nature of the disaster and primary impacts on lives, infrastructure, and socioeconomic factors; the acute aftermath in the days and weeks after the attacks; the persistent mental health impact and evolution of services of the postacute aftermath; and the implications for future disaster mental health practitioners and policy makers. Copyright © 2013 Elsevier Inc. All rights reserved.

Disaster Preparedness and Response: Applied Exposure Science

EPA Science Inventory

In 2007, the ISEA, predecessor to ISES, held a special roundtable to discuss lessons learned for exposure science during and following environmental disasters, especially the 9/11 attacks and Hurricane Katrina. Since then, environmental agencies have been involved in responses to...

Comparison of X-31 Flight and Ground-Based Yawing Moment Asymmetries at High Angles of Attack

NASA Technical Reports Server (NTRS)

Cobleigh, Brent R.; Croom, Mark A.

2001-01-01

Significant yawing moment asymmetries were encountered during the high-angle-of-attack envelope expansion of the two X-31 aircraft. These asymmetries caused position saturations of the thrust-vectoring vanes and trailing-edge flaps during some stability-axis rolling maneuvers at high angles of attack. The two test aircraft had different asymmetry characteristics, and ship two has asymmetries that vary as a function of Reynolds number. Several aerodynamic modifications have been made to the X-31 forebody with the goal of minimizing the asymmetry. These modifications include adding transition strips on the forebody and noseboom, using two different length strakes, and increasing nose bluntness. Ultimately, a combination of forebody strakes, nose blunting, and noseboom transition strips reduced the yawing moment asymmetry enough to fully expand the high-angle-of-attack envelope. Analysis of the X-31 flight data is reviewed and compared to wind-tunnel and water-tunnel measurements. Several lessons learned are outlined regarding high-angle-of-attack configuration design and ground testing.

Hereditary Angioedema Attacks Resolve Faster and Are Shorter after Early Icatibant Treatment

PubMed Central

Maurer, Marcus; Kaplan, Allen; Investigators, on behalf of I. O. S.

2013-01-01

Background Attacks of hereditary angioedema (HAE) are unpredictable and, if affecting the upper airway, can be lethal. Icatibant is used for physician- or patient self-administered symptomatic treatment of HAE attacks in adults. Its mode of action includes disruption of the bradykinin pathway via blockade of the bradykinin B2 receptor. Early treatment is believed to shorten attack duration and prevent severe outcomes; however, evidence to support these benefits is lacking. Objective To examine the impact of timing of icatibant administration on the duration and resolution of HAE type I and II attacks. Methods The Icatibant Outcome Survey is an international, prospective, observational study for patients treated with icatibant. Data on timings and outcomes of icatibant treatment for HAE attacks were collected between July 2009–February 2012. A mixed-model of repeated measures was performed for 426 attacks in 136 HAE type I and II patients. Results Attack duration was significantly shorter in patients treated <1 hour of attack onset compared with those treated ≥1 hour (6.1 hours versus 16.8 hours [p<0.001]). Similar significant effects were observed for <2 hours versus ≥2 hours (7.2 hours versus 20.2 hours [p<0.001]) and <5 hours versus ≥5 hours (8.0 hours versus 23.5 hours [p<0.001]). Treatment within 1 hour of attack onset also significantly reduced time to attack resolution (5.8 hours versus 8.8 hours [p<0.05]). Self-administrators were more likely to treat early and experience shorter attacks than those treated by a healthcare professional. Conclusion Early blockade of the bradykinin B2 receptor with icatibant, particularly within the first hour of attack onset, significantly reduced attack duration and time to attack resolution. PMID:23390491

Theoretical perspectives on public communication preparedness for terrorist attacks.

PubMed

Wray, Ricardo J; Kreuter, Matthew W; Jacobsen, Heather; Clements, Bruce; Evans, R Gregory

2004-01-01

The experience of federal health authorities in responding to the mailed anthrax attacks in the Fall of 2001 sheds light on the challenges of public information dissemination in emergencies. Lessons learned from the Fall of 2001 have guided more recent efforts related to crisis communication and preparedness goals. This article applies theories and evidence from the field of communication to provide an orientation to how public health communication can best contribute to the preparedness effort. This theoretical orientation provides a framework to systematically assess current recommendations for preparedness communication.

How to Improve the ROK and U.S. Military Alliance Against North Korea’s Threats to Cyberspace: Lessons From NATO’s Defense Cooperation

DTIC Science & Technology

2017-12-01

For instance, when Unit 121 created a supercomputer for decryption and encryption efforts by combining imported high -end qualified computers, Kim...developed and undeveloped countries, but the cyber-attacks by North Korea can double the effect by inflaming psychological fears when combined with other...lessons that the ROK and U.S. alliance can glean from NATO’s cyber cooperation. To maintain the balance of power with the ROK, North Korea has

The Lessons of Mumbai

DTIC Science & Technology

2009-01-01

Airport attack in which three members of the Japanese Red Army opened fire and threw hand grenades at arriving passengers. Barricade and hostage...Albless Hospital, near the CST. 22:50 Gunfire at the Metro Theatre (Metro Cinema Junction). 23:00 Explosion in a taxi in Vile Parle in north

French Ministry of Health's response to Paris attacks of 13 November 2015.

PubMed

Philippe, Jean-Marc; Brahic, Olivier; Carli, Pierre; Tourtier, Jean-Pierre; Riou, Bruno; Vallet, Benoit

2016-04-01

On Friday November 13th at 9:20 pm, three kamikaze bombs went off around the Stade de France a stadium in Saint-Denis just outside Paris, 4 different shootings took place and bombings in Paris and hundreds of people were held hostage in a theater.This multi-site terrorist attack was the first of this magnitude in France. Drawing the lessons of these attacks and those which occurred in other countries from a health perspective is essential to continuously adapt and improve the French response to possible future attacks. Several issues would need to be further explored: Management of uncertainties: When to trigger the plans: after the 1st attack, the 2nd? When do attacks end and when to release mobilized resources? Management of victims: How to ensure that all victims are secured or taken care of? How to provide assistance when attacks are ongoing? Management of teams: Proper follow-up of persons involved in the response: health professionals, police and firemen, emergency call centers but also civil servants within administration that contributed to the response. Communication: Reactivity of all is a key element to secure appropriate resource is mobilized for the response. All actors have to be able to communicate quickly in a secured way.

Beyond Iraq: The Lessons of a Hard Place

DTIC Science & Technology

2007-07-01

Hegemony or Survival, widely read since Venezuelan President Huga Chavez called attention to it in his UN General Assembly speech in the fall of 2006, Noam ... Chomsky makes a sport of attacking the 2002 National Security Strategy upon which the 2004 NMS is based. 39. 2006 National Security Strategy

Safety and Security: Lessons Learned from 9/11.

ERIC Educational Resources Information Center

Schmitz, William J.

2002-01-01

Discusses issues faced by the Borough of Manhattan Community College following the September 11th terrorist attacks: the expense of recovery and budgeting for it, developing an emergency preparedness plan, the characteristics of emergency management and disaster recovery plans, technology and its role in emergency management, being prepared for…

Analysis of characteristics associated with reinjection of icatibant: Results from the icatibant outcome survey.

PubMed

Longhurst, Hilary J; Aberer, Werner; Bouillet, Laurence; Caballero, Teresa; Fabien, Vincent; Zanichelli, Andrea; Maurer, Marcus

2015-01-01

Phase 3 icatibant trials showed that most hereditary angioedema (HAE) (C1 inhibitor deficiency) acute attacks were treated successfully with one injection of icatibant, a selective bradykinin B2 receptor antagonist. We conducted a post hoc analysis of icatibant reinjection for HAE type I and II attacks in a real-world setting by using data from the Icatibant Outcome Survey, an ongoing observational study that monitors the safety and effectiveness of icatibant treatment. Descriptive retrospective analyses of icatibant reinjection were performed on Icatibant Outcome Survey data (February 2008 to December 2012). New attacks were defined as the onset of new symptoms after full resolution of the previous attack. Potential associations between the patient and attack characteristics and reinjection were explored by using logistic regression analysis. Icatibant was administered for 652 attacks in 170 patients with HAE type I or II. Most attacks (89.1%) were treated with a single icatibant injection. For attacks that required two or three injections, the second injection was given a median of 11.0 hours after the first injection, with 90.4% of second injections administered ≥6 hours after the first injection. Time to resolution and attack duration were significantly longer for two or three injections versus one icatibant injection (p < 0.0001 and p < 0.05, respectively). Multivariate logistic regression analysis identified sex, attack severity, and laryngeal attacks as significantly correlated with reinjection (all p ≤ 0.05). These factors did not remain predictors for reinjection when two outlier patients with distinct patterns of icatibant use were excluded. In this real-world setting, most HAE attacks resolved with one icatibant injection. There was no distinct profile for patients or attacks that required reinjection when outliers with substantially different patterns of use were excluded. Because new attacks were not distinguished from the recurrence of symptoms, reinjection rates may be slightly higher than shown here. Clinical trial identifier: NCT01034969.

Public health foundations and the tobacco industry: lessons from Minnesota

PubMed Central

Ibrahim, J; Tsoukalas, T; Glantz, S

2004-01-01

Objective: To investigate whether private foundations can be created in a way that will insulate them from attacks by the tobacco industry, using the Minnesota Partnership for Action Against Tobacco (MPAAT) as a case study. Design: Information was collected from internal tobacco industry documents, court documents, newspapers, and interviews with health advocates and elected officials. Results: The creation of MPAAT as an independent foundation did not insulate it from attacks by tobacco industry allies. During 2001–2002, MPAAT was repeatedly attacked by Attorney General Mike Hatch and major media, using standard tobacco industry rhetoric. This strategy of attack and demands for information were reminiscent of previous attacks on Minnesota's Plan for Nonsmoking and Health and the American Stop Smoking Intervention Study (ASSIST). MPAAT was ultimately forced to restructure its programme to abandon effective community norm change interventions around smoke-free policies and replace them with less effective individual cessation interventions. Neither MPAAT nor other health advocates mounted an effective public response to these attacks, instead relying on the insider strategy of responding in court. Conclusion: It is not possible to avoid attacks by the tobacco industry or its political allies. Like programmes administered by government agencies, tobacco control foundations must be prepared for these attacks, including a proactive plan to educate the public about the principles of community based tobacco control. Public health advocates also need to be willing to take prompt action to defend these programmes and hold public officials who attack tobacco control programmes accountable for their actions. PMID:15333877

How to learn and develop from both good and bad lessons- the 2011Tohoku tsunami case -

NASA Astrophysics Data System (ADS)

Sugimoto, Megumi; Okazumi, Toshio

2013-04-01

The 2011 Tohoku tsunami revealed Japan has repeated same mistakes in a long tsunami disaster history. After the disaster Japanese remember many old lessons and materials: an oral traditional evacuation method 'Tsunami TENDENKO' which is individual independent quick evacuation, a tsunami historical memorial stone "Don't construct houses below this stone to seaside" in Aneyoshi town Iwate prefecture, Namiwake-shrine naming from the story of protect people from tsunami in Sendai city, and so on. Tohoku area has created various tsunami historical cultures to descendent. Tohoku area had not had a tsunami disaster for 50 years after the 1960 Chilean tsunami. The 2010 Chilean tsunami damaged little fish industry. People gradually lost tsunami disaster awareness. At just the bad time the magnitude (M) 9 scale earthquake attacked Tohoku. It was for our generations an inexperienced scale disaster. People did not make use of the ancestor's lessons to survive. The 2004 Sumatra tsunami attacked just before 7 years ago. The magnitude scale is almost same as M 9 scale. Why didn't Tohoku people and Japanese tsunami experts make use of the lessons? Japanese has a character outside Japan. This lesson shows it is difficult for human being to learn from other countries. As for Three mile island accident case in US, it was same for Japan. To addition to this, there are similar types of living lessons among different hazards. For examples, nuclear power plantations problem occurred both the 2012 Hurricane Sandy in US and the 2011 Tohoku tsunami. Both local people were not informed about the troubles though Oyster creek nuclear power station case in US did not proceed seriously all. Tsunami and Hurricane are different hazard. Each exparts stick to their last. 1. It is difficult for human being to transfer living lessons through next generation over decades. 2. It is difficult for human being to forecast inexperienced events. 3. It is usually underestimated the danger because human being have a tendency to judge based on own experience. 4. It is difficult for human being to make use of lessons from different countries because human being would not like to think own self suffer victim for a self-preservation mind. 5. It is usual for experts not to pay attention to other fields even if similar case occurs in different fields. We started collecting 18 hazards of such historical living lessons all over the world before the 2011 Tohoku tsunami. We adapted to this project collecting lessons from Tohoku tsunami and will publish for small children in developing countries in March 2013. This will be translated in at least 10 languages. This disaster lessons guide books are free. We will introduce some lessons in the presentations. We believe education is one of useful countermeasures to prevent from repeating same mistakes and transfer directly living lessons to new generations.

A benchmark system to optimize our defense against an attack on the US food supply using the Risk Reduction Effectiveness and Capabilities Assessment Program.

PubMed

Hodoh, Ofia; Dallas, Cham E; Williams, Paul; Jaine, Andrew M; Harris, Curt

2015-01-01

A predictive system was developed and tested in a series of exercises with the objective of evaluating the preparedness and effectiveness of the multiagency response to food terrorism attacks. A computerized simulation model, Risk Reduction Effectiveness and Capabilities Assessment Program (RRECAP), was developed to identify the key factors that influence the outcomes of an attack and quantify the relative reduction of such outcomes caused by each factor. The model was evaluated in a set of Tabletop and Full-Scale Exercises that simulate biological and chemical attacks on the food system. More than 300 participants representing more than 60 federal, state, local, and private sector agencies and organizations. The exercises showed that agencies could use RRECAP to identify and prioritize their advance preparation to mitigate such attacks with minimal expense. RRECAP also demonstrated the relative utility and limitations of the ability of medical resources to treat patients if responders do not recognize and mitigate the attack rapidly, and the exercise results showed that proper advance preparation would reduce these deficiencies. Using computer simulation prediction of the medical outcomes of food supply attacks to identify optimal remediation activities and quantify the benefits of various measures provides a significant tool to agencies in both the public and private sector as they seek to prepare for such an attack.

Lesson of the month 2: The limitations of steroid therapy in bradykinin-mediated angioedema attacks.

PubMed

Ismail, Sharif; Cheng, Leo; Grigoriadou, Sofia; Laffan, James; Menon, Manoj

2015-02-01

Acute angioedema attacks are conventionally treated with antihistamines and steroids, in line with a presumed mechanism of disease involving overwhelming mast-cell degranulation. This approach overlooks a small but important minority of cases in which attacks are bradykinin driven and exhibit poor responsiveness to steroid or anti-histamine therapy. These patients may have a family history of angioedema (hereditary angioedema), or a past medical history including B-cell lymphoproliferative disorders or autoimmune disease (acquired angioedema). Rather than steroid therapy, they respond to administration of a bradykinin inhibitor, or more commonly, a C1 esterase inhibitor substitute, to control acute symptoms and reduce the probability of invasive airway insertion. In the long-term, they require C1 esterase inhibitor sparing therapy and a treat-the-cause approach to reduce the risk of recurrent attacks. We present here a case of a middle-aged woman who presented with recurrent angioedema of initially uncertain aetiology. © 2015 Royal College of Physicians.

Effectiveness of icatibant for treatment of hereditary angioedema attacks is not affected by body weight: findings from the Icatibant Outcome Survey, a cohort observational study.

PubMed

Caballero, Teresa; Zanichelli, Andrea; Aberer, Werner; Maurer, Marcus; Longhurst, Hilary J; Bouillet, Laurence; Andresen, Irmgard

2018-01-01

Icatibant is a bradykinin B2-receptor antagonist used for the treatment of hereditary angioedema attacks resulting from C1-inhibitor deficiency. Treatment is not adjusted by body weight however the impact of body mass index (BMI) on the effectiveness of icatibant is not documented in the literature. We examined disease characteristics and icatibant treatment effectiveness in patients stratified by BMI in the Icatibant Outcome Survey, an ongoing, international, observational study monitoring the real-world safety and effectiveness of icatibant. Attack and treatment characteristics as well as outcomes following treatment with icatibant were compared among patients with underweight, normal, overweight, and obese BMI. Data from 2697 icatibant-treated attacks in 342 patients (3.5, 44.7, 34.8, and 17.0% patients of underweight, normal, overweight, and obese BMI, respectively) were analyzed. There was no significant difference in the frequency and severity of attacks across BMI groups, although obese patients tended to have more attacks of high severity. There was no impact of BMI on the frequency of laryngeal attacks, but patients with normal BMI had fewer cutaneous attacks and more abdominal attacks. Most attacks (71.9-83.8%) were treated with a single icatibant injection without the need for rescue with plasma-derived C1-inhibitor (pdC1-INH), regardless of BMI. Patients with obese BMI used pdC1-INH as rescue treatment more often (P < 0.0001; P = 0.0232 excluding 2 outliers) and treated attacks earlier than patients with normal BMI (P = 0.007). Furthermore, time to resolution and duration of attack were shorter for patients with high BMI (P < 0.001 for overweight and P < 0.05 for obese versus normal). Overall, icatibant was comparatively effective in treating attacks in patients across all BMI groups. Trial registration NCT01034969.

The Transformation of Russian Military Doctrine: Lessons Learned from Kosovo and Chechnya

DTIC Science & Technology

2000-07-01

operations. However, due to the failures of Russian military reform from 1992–1997 and the chronic underfunding of Russian defense from 1997–1999 (in...since NATO’s attack. A serious reassessment of Russian military reform became essential. Once again conventional forces would need to be ready for the

Fort McHenry National Monument and Historic Shrine. Teacher's Guide.

ERIC Educational Resources Information Center

Rogers, Jim

This teacher's guide explores Fort McHenry and the British attack on Baltimore Harbor (Maryland) in 1814. The guide contains 11 lessons: (1) "Where in the World Is Baltimore?" (no handout-use classroom resources); (2) "Why Baltimore?" (Handout-Why Baltimore?); (3) "Now Where Do We Place the Fort?" (Handout-Map of…

The Future of Raiding: Lessons in Raiding Tactics from the Indian Wars and Law Enforcement

DTIC Science & Technology

2009-06-01

the national government, but continued through the 1840s. Only when raiders affected the rich southern states of Durango , Zacatecas, and San Luis...bondage in native camps.”67 In September 1843, a Comanche raiding party attacked a ranch in the northern Mexican territory of Durango . The

Lessons from X-Ray Astronomy Applied to HST

NASA Astrophysics Data System (ADS)

Schreier, Ethan J.; Doxsey, Rodger

2000-09-01

Riccardo Giacconi, probably more than any other single individual, established x-ray astronomy as an essential sub-discipline of astronomy. Its incorporation into the mainstream of astronomy was substantially completed with the Einstein Observatory which, with its imaging capabilities and its Guest Observer program, invited non-x-ray astronomers to use the facility. It was therefore perhaps fitting that when optical astronomy moved into space, with the Hubble Space Telescope, it called on Riccardo to oversee the transition. He brought with him lessons about building and operating space observatories, experience working with NASA on large science projects, a business-like approach to attacking tasks, and his unique vision and abilities. Among the guiding principles he brought to HST were: involvement of a strong scientific research staff in all aspects of the program; establishment of a vital, active research environment; attention to "science system engineering" and applying a rational scientific approach to problems; creation of an atmosphere of "ruthless intellectual honesty" and maintenance of the highest regard for process. These formed the basis both for attacking the problems of HST, and for building an Institute to do so.

The effects of stress, anxiety, and outdoor temperature on the frequency and severity of Raynaud's attacks: the Raynaud's Treatment Study.

PubMed

Brown, K M; Middaugh, S J; Haythornthwaite, J A; Bielory, L

2001-04-01

It was expected that stress and anxiety would be related to Raynaud's phenomenon (RP) attack characteristics when mild outdoor temperatures produced partial or no digital vasoconstriction. Hypotheses were that in warmer temperature categories, compared to those below 40 degrees F, higher stress or anxiety would be associated with more frequent, severe, and painful attacks. The Raynaud's Treatment Study recruited 313 participants with primary RP. Outcomes were attack rate, severity, and pain. Predictors were average daily outdoor temperature, stress, anxiety, age, gender, and a stress-by-temperature or an anxiety-by-temperature interaction. Outcomes were tested separately in multiple linear regression models. Stress and anxiety were tested in separate models. Stress was not a significant predictor of RP attack characteristics. Higher anxiety was related to more frequent attacks above 60 degrees F. It was also related to greater attack severity at all temperatures, and to greater pain above 60 degrees F and between 40 degrees and 49.9 degrees F.

Clinical outcomes and predictive factors related to good outcomes in plasma exchange in severe attack of NMOSD and long extensive transverse myelitis: Case series and review of the literature.

PubMed

Aungsumart, Saharat; Apiwattanakul, Metha

2017-04-01

To investigate the predictive factors associated with good outcomes of plasma exchange in severe attacks through neuromyelitis optica spectrum disorder (NMOSD) and long extensive transverse myelitis (LETM). In addition, to review the literature of predictive factors associated with the good outcomes of plasma exchange in central nervous system inflammatory demyelinating diseases (CNS IDDs). Retrospective study in 27 episodes of severe acute attacks myelitis and optic neuritis in 24 patients, including 20 patients with NMOSD seropositive, 1 patient with NMOSD seronegative and 3 patients with LETM. Plasma exchange was performed, reflecting poor responses to high-dose intravenous methylprednisolone (IVMP) therapy. The outcomes of the present study were the functional outcome improvements at 6 months after plasma exchange. The predictive factors of good outcomes after plasma exchange were determined in this cohort, and additional factors reported in the literature were reviewed. Plasma exchange was performed in 16 spinal cord attacks and 11 attacks of optic neuritis. Twenty patients were female (83%). The median age of the patients at the time of plasma exchange was 41 years old. The median disease duration was 0.6 years. The AQP4-IgG status was positive in 20 patients (83%). Plasma exchange following IVMP therapy led to a significant improvement in 81% of the cases after 6 months of follow up. A baseline Expanded Disability Status Scale (EDSS) score ≤6 before the attack was associated with significant improvement at 6 months (p=0.02, OR 58.33, 95%CI 1.92-1770). In addition, we reviewed the evidence for factors associated with good outcomes of plasma exchange in CNS IDDs, classified according to pre-plasma exchange, post-plasma exchange, and radiological features. Plasma exchange following IVMP therapy is effective as a treatment for patients experiencing a severe attack of NMOSD or LETM. The factors associated with good outcomes after plasma exchange in CNS IDDs are reviewed in the literature. We classified 3 different aspects, including pre-plasma exchange factors, based on minimal disability at baseline, preserved reflexes, early initiation, and short disease duration; post plasma exchange factors, including early improvement or lower disability at last follow up; and radiographic factors, for which the presence of active gadolinium lesions and the absence of spinal cord atrophy seem to be good outcomes for plasmapheresis. Copyright © 2017. Published by Elsevier B.V.

The Oklahoma bombing. Lessons learned.

PubMed

Anteau, C M; Williams, L A

1997-06-01

The Oklahoma City bombing experience in April of 1995 provided a unique opportunity to test the effectiveness of an existing disaster plan. The critical care nurses at Columbia Presbyterian Hospital learned valuable lessons about managing intense activity, equipment and supplies, staffing resources, and visitor issues. The degree to which the bombing affected the emotional state of personnel was unanticipated, and leaders learned that critical stress management interventions should be included in every emergency preparedness plan. Additionally, recommendations include using runners for communication; assigning specific roles (supplies, staffing, triage); keeping additional staff in reserve for shift relief; ensuring ample hospital staff members are available to coordinate visitors and media; and setting up record systems to preserve continuity. The unique lessons learned as a result of this terrorist attack can be used by other critical care nurses to understand and refine disaster plans.

Risk Communication Strategies: Lessons Learned from Previous Disasters with a Focus on the Fukushima Radiation Accident.

PubMed

Svendsen, Erik R; Yamaguchi, Ichiro; Tsuda, Toshihide; Guimaraes, Jean Remy Davee; Tondel, Martin

2016-12-01

It has been difficult to both mitigate the health consequences and effectively provide health risk information to the public affected by the Fukushima radiological disaster. Often, there are contrasting public health ethics within these activities which complicate risk communication. Although no risk communication strategy is perfect in such disasters, the ethical principles of risk communication provide good practical guidance. These discussions will be made in the context of similar lessons learned after radiation exposures in Goiania, Brazil, in 1987; the Chernobyl nuclear power plant accident, Ukraine, in 1986; and the attack at the World Trade Center, New York, USA, in 2001. Neither of the two strategies is perfect nor fatally flawed. Yet, this discussion and lessons from prior events should assist decision makers with navigating difficult risk communication strategies in similar environmental health disasters.

Mass casualty response in the 2008 Mumbai terrorist attacks.

PubMed

Roy, Nobhojit; Kapil, Vikas; Subbarao, Italo; Ashkenazi, Isaac

2011-12-01

The November 26-29, 2008, terrorist attacks on Mumbai were unique in its international media attention, multiple strategies of attack, and the disproportionate national fear they triggered. Everyone was a target: random members of the general population, iconic targets, and foreigners alike were under attack by the terrorists. A retrospective, descriptive study of the distribution of terror victims to various city hospitals, critical radius, surge capacity, and the nature of specialized medical interventions was gathered through police, legal reports, and interviews with key informants. Among the 172 killed and 304 injured people, about four-fifths were men (average age, 33 years) and 12% were foreign nationals. The case-fatality ratio for this event was 2.75:1, and the mortality rate among those who were critically injured was 12%. A total of 38.5% of patients arriving at the hospitals required major surgical intervention. Emergency surgical operations were mainly orthopedic (external fixation for compound fractures) and general surgical interventions (abdominal explorations for penetrating bullet/shrapnel injuries). The use of heavy-duty automatic weapons, explosives, hostages, and arson in these terrorist attacks alerts us to new challenges to medical counterterrorism response. The need for building central medical control for a coordinated response and for strengthening public hospital capacity are lessons learned for future attacks. These particular terrorist attacks had global consequences, in terms of increased security checks and alerts for and fears of further similar "Mumbai-style" attacks. The resilience of the citizens of Mumbai is a critical measure of the long-term effects of terror attacks.

Lessons learned from modern military surgery.

PubMed

Beekley, Alec C; Starnes, Benjamin W; Sebesta, James A

2007-02-01

The era of global terrorism and asymmetric warfare heralded by the September 11, 2001 attacks on the United States have blurred the traditional lines between civilian and military trauma. The lessons learned by physicians in the theaters of war, particularly regarding the response to mass casualties, blast and fragmentation injuries, and resuscitation of casualties in austere environments, likely resonate strongly with civilian trauma surgeons in the current era. The evolution of a streamlined trauma system in the theaters of operations, the introduction of an in-theater institution review board process, and dedicated personnel to collect combat casualty data have resulted in improved data capture and realtime, on-the-scene research.

Lessons Learned from MG George Crook’s Apache Campaigns with Applicability for the Current Global War on Terror

DTIC Science & Technology

2003-04-07

in Saudi Arabian internal politics. Islamism has other modern roots as well. In 1928 Hassan al- Banna formed the Islamic Brotherhood in Egypt.13...Soon afterward the Kandahar raid, the Northern Alliance / 5th SFG attacks increased the pace of peeling apart the opposition forces from each other

Lessons Sifted from Tragedy at Columbine

ERIC Educational Resources Information Center

Viadero, Debra

2009-01-01

A decade after Eric D. Harris and Dylan B. Klebold fatally gunned down 13 people and wounded 23 others at Columbine High School, researchers are still sifting for answers to questions raised by the elaborate and notorious attack. Books and studies being published to coincide with the 10th anniversary of the April 20, 1999, massacre at the…

Experiences from coordinating research after the 2011 terrorist attacks in Norway

PubMed Central

Refsdal, Nils O.

2014-01-01

This brief report presents some of the lessons learned from coordinating research in which people directly affected by terrorist attacks in Norway in 2011 are taking part. After the terrorist attacks, it was decided to establish a national coordinating function in order to protect those who were affected when they participate in research. By gathering key stakeholders, it is possible to avoid duplication of research through practical measures such as information sharing, facilitating cooperation, and working toward sharing of data. In addition, a coordinating function provides a platform for working to increase the impact of the research among practitioners and policy makers, and inform the general public. The conclusions are that coordination should be interdisciplinary, that it is important to plan for the sharing and reuse of data, and that both the research community and the research infrastructure should take steps to improve preparedness when disaster inevitably strikes again. PMID:25018857

Physical Activity in Physical Education: Are Longer Lessons Better?

PubMed Central

Smith, Nicole J.; Monnat, Shannon M.; Lounsbery, Monica A.F.

2015-01-01

BACKGROUND The purpose of this study was to compare physical activity (PA) outcomes in a sample of high school physical education (PE) lessons from schools that adopted traditional versus modified block schedule formats. METHODS We used the System for Observing Fitness Instruction Time (SOFIT) to conduct observations of 168 high school (HS) PE lessons delivered by 22 PE teachers in 4 schools. We used t-tests and multilevel models were used to explore variability in moderate PA and vigorous PA. RESULTS PA outcomes were significantly different between modified block and traditional schools. Students who attended traditional schools engaged in more vigorous PA in PE lessons. Modified block lessons lost more scheduled lesson time due to poor transition to and from the locker room. PA outcomes were positively associated with fitness and teacher promotion of PA and negatively associated with lost time, class size, management, and knowledge. CONCLUSIONS Though PE proponents widely advocate for more PE minutes, this study showed that greater time scheduled in PE does not necessarily result in more student accrual of MVPA minutes. PMID:25611935

Improving the redistribution of the security lessons in healthcare: An evaluation of the Generic Security Template.

PubMed

He, Ying; Johnson, Chris

2015-11-01

The recurrence of past security breaches in healthcare showed that lessons had not been effectively learned across different healthcare organisations. Recent studies have identified the need to improve learning from incidents and to share security knowledge to prevent future attacks. Generic Security Templates (GSTs) have been proposed to facilitate this knowledge transfer. The objective of this paper is to evaluate whether potential users in healthcare organisations can exploit the GST technique to share lessons learned from security incidents. We conducted a series of case studies to evaluate GSTs. In particular, we used a GST for a security incident in the US Veterans' Affairs Administration to explore whether security lessons could be applied in a very different Chinese healthcare organisation. The results showed that Chinese security professional accepted the use of GSTs and that cyber security lessons could be transferred to a Chinese healthcare organisation using this approach. The users also identified the weaknesses and strengths of GSTs, providing suggestions for future improvements. Generic Security Templates can be used to redistribute lessons learned from security incidents. Sharing cyber security lessons helps organisations consider their own practices and assess whether applicable security standards address concerns raised in previous breaches in other countries. The experience gained from this study provides the basis for future work in conducting similar studies in other healthcare organisations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The anatomy of a shark attack: a case report and review of the literature.

PubMed

Caldicott, D G; Mahajani, R; Kuhn, M

2001-07-01

Shark attacks are rare but are associated with a high morbidity and significant mortality. We report the case of a patient's survival from a shark attack and their subsequent emergency medical and surgical management. Using data from the International Shark Attack File, we review the worldwide distribution and incidence of shark attack. A review of the world literature examines the features which make shark attacks unique pathological processes. We offer suggestions for strategies of management of shark attack, and techniques for avoiding adverse outcomes in human encounters with these endangered creatures.

The Initial Response to the Boston Marathon Bombing

PubMed Central

Gates, Jonathan D.; Arabian, Sandra; Biddinger, Paul; Blansfield, Joe; Burke, Peter; Chung, Sarita; Fischer, Jonathan; Friedman, Franklin; Gervasini, Alice; Goralnick, Eric; Gupta, Alok; Larentzakis, Andreas; McMahon, Maria; Mella, Juan; Michaud, Yvonne; Mooney, David; Rabinovici, Reuven; Sweet, Darlene; Ulrich, Andrew; Velmahos, George; Weber, Cheryl; Yaffe, Michael B.

2017-01-01

Objective We discuss the strengths of the medical response to the Boston Marathon bombings that led to the excellent outcomes. Potential shortcomings were recognized, and lessons learned will provide a foundation for further improvements applicable to all institutions. Background Multiple casualty incidents from natural or man-made incidents remain a constant global threat. Adequate preparation and the appropriate alignment of resources with immediate needs remain the key to optimal outcomes. Methods A collaborative effort among Boston’s trauma centers (2 level I adult, 3 combined level I adult/pediatric, 1 freestanding level I pediatric) examined the details and outcomes of the initial response. Each center entered its respective data into a central database (REDCap), and the data were analyzed to determine various prehospital and early in-hospital clinical and logistical parameters that collectively define the citywide medical response to the terrorist attack. Results A total of 281 people were injured, and 127 patients received care at the participating trauma centers on that day. There were 3 (1%) immediate fatalities at the scene and no in-hospital mortality. A majority of the patients admitted (66.6%) suffered lower extremity soft tissue and bony injuries, and 31 had evidence for exsanguinating hemorrhage, with field tourniquets in place in 26 patients. Of the 75 patients admitted, 54 underwent urgent surgical intervention and 12 (22%) underwent amputation of a lower extremity. Conclusions Adequate preparation, rapid logistical response, short transport times, immediate access to operating rooms, methodical multidisciplinary care delivery, and good fortune contributed to excellent outcomes. PMID:25386862

Nonepileptic attack disorder among married women.

PubMed

Dhanaraj, M; Rangaraj, R; Arulmozhi, T; Vengatesan, A

2005-06-01

To study the clinical features, precipitating stressful life events and prognosis of nonepileptic attack disorder (NEAD) among married women. Prospective cohort study with 1-year follow-up. A tertiary care teaching hospital. Of the 1020 patients with epilepsy referred to the epilepsy clinic during 2002-2003, 30 were married women with NEAD. The diagnostic criteria for NEAD included normal EEG during ictal and post-ictal phase of the generalized 'attack.' The data collected included clinical characteristics, semiology of the attacks, precipitating stressful events, and co-morbid psychiatric disorders. The control group included 30 age-matched married women with generalized tonic-clonic seizures. The long-term outcome and factors influencing the outcomes were analyzed. The mean duration of illness was 18 months, and the pattern of the attack was 'fall and lying still' in 53% and 'fall with generalized motor movements' in 47%. The frequency was one or more per week in 57% and occasionally in 43%. The important stressful events were matrimonial discord following illegal relationship of the husband with another woman (chi2 = 9.02, P = 0.003) and constant quarrel with other family members (chi2 = 5.19, P = 0.02). The prevalence of sexual abuse was low (7%). Co-morbid psychiatric disorder was observed in 70%. At the end of 1 year, 39% were free from the attack. Resolution of the stressful life events (chi2 = 4.52, P = 0.03) and lower frequency of attack at the time of reporting (chi2 = 3.88, P = 0.05) correlated with good outcomes. Among patients with NEAD in India, the major precipitating factors were matrimonial discord following illegal relationship of the husband with another woman and constant quarrel with other family members and not sexual abuse. Women with low frequency of attack at the time of reporting and the remission of the stressful events had better outcomes.

The World Trade Center Attack: Lessons for all aspects of health care

PubMed Central

Tamber, Pritpal S; Vincent, Jean-Louis

2001-01-01

The attack on the World Trade Center had the potential to overwhelm New York's health services. Sadly, however, the predicted thousands of treatable patients failed to materialize. Horror and sadness has now been replaced by anger, fear, and the determination to be better prepared next time. This determination not only exists in politics but also in health care, and as with all attempts to enforce change there needs to be a period of collecting opinions and data. This article introduces nine reviews in Critical Care offering varied health care perspectives of the events of 11 September 2001 from people who were there and from experts in disaster management. PMID:11737910

The effects of extinction-aroused attention on context conditioning.

PubMed

Nelson, James Byron; Fabiano, Andrew M; Lamoureux, Jeffrey A

2018-04-01

Two experiments assessed the effects of extinguishing a conditioned cue on subsequent context conditioning. Each experiment used a different video-game method where sensors predicted attacking spaceships and participants responded to the sensor in a way that prepared them for the upcoming attack. In Experiment 1 extinction of a cue which signaled a spaceship-attack outcome facilitated subsequent learning when the attack occurred unsignaled. In Experiment 2 extinction of a cue facilitated subsequent learning, regardless of whether the spaceship outcome was the same or different as used in the earlier training. In neither experiment did the extinction context become inhibitory. Results are discussed in terms of current associative theories of attention and conditioning. © 2018 Nelson et al.; Published by Cold Spring Harbor Laboratory Press.

Managing mild casualties in mass-casualty incidents: lessons learned from an aborted terrorist attack.

PubMed

Bloch, Yuval H; Leiba, Adi; Veaacnin, Nurit; Paizer, Yohanan; Schwartz, Dagan; Kraskas, Ahuva; Weiss, Gali; Goldberg, Avishay; Bar-Dayan, Yaron

2007-01-01

Mildly injured and "worried well" patients can have profound effects on the management of a mass-casualty incident. The objective of this study is to describe the characteristics and lessons learned from an event that occurred on 28 August 2005 near the central bus station in Beer-Sheva, Israel. The unique profile of injuries allows for the examination of the medical and operational aspects of the management of mild casualties. Data were collected during and after the event, using patient records and formal debriefings. They were processed focusing on the characteristics of patient complaints, medical response, and the dynamics of admission. A total of 64 patients presented to the local emergency department, including two critical casualties. The remaining 62 patients were mildly injured or suffered from stress. Patient presentation to the emergency department was bi-phasic; during the first two hours following the attack (i.e., early phase), the rate of arrival was high (one patient every three minutes), and anxiety was the most frequent chief complaint. During the second phase, the rate of arrival was lower (one patient every 27 minutes), and the typical chief complaint was somatic. Additionally, tinnitus and complaints related to minor trauma also were recorded frequently. Psychiatric consultation was obtained for 58 (91%) of the patients. Social services were involved in the care of 47 of the patients (73%). Otolaryngology and surgery consultations were obtained for 45% and 44%, respectively. The need for some medical specialties (e.g., surgery and orthopedics) mainly was during the first phase, whereas others, mainly psychiatry and otolaryngology, were needed during both phases. Only 13 patients (20%) needed a consultation from internal medicine. Following a terrorist attack, a large number of mildly injured victims and those experiencing stress are to be expected, without a direct relation to the effectiveness of the attack. Mildly injured patients tend to appear in two phases. In the first phase, the rate of admission is expected to be higher. Due to the high incidence of anxiety and other stress-related phenomena, many mildly injured patients will require psychiatric evaluation. In the case of a bombing attack, many of the victims must be evaluated by an otolaryngologist.

Implementing and Integrating Effective Teaching Strategies Including Features of Lesson Study in an Elementary Science Methods Course

ERIC Educational Resources Information Center

Carrier, Sarah J.

2011-01-01

Teacher preparation programs have been under attack by policy makers in the last decade, and teacher educators are constantly striving to improve their programs. Yet, there are several research-based practices that have been shown to be effective for developing teachers. In this article, the author summarizes a study in one science methods course…

Age-related monoclonal gammapathies: clinical lessons from the aging C57BL mouse.

PubMed

Radl, J

1990-07-01

In this article the long-held notion that benign monoclonal gammapathy (BMG) is a premalignant stage in the development of multiple myeloma (MM) is attacked. Jiri Radl argues that clinical and experimental observations indicate that they are separate entities which may be distinguished in the laboratory and which should be managed in radically different ways.

Teaching for Tolerance and Understanding during the Japanese Internment: Lessons for Educators Today

ERIC Educational Resources Information Center

Banks, Cherry A. McGee

2007-01-01

Following the Japanese attack on the US naval base at Pearl Harbor on December 7, 1941, the nation was thrown into a state of fear and hysteria. On February 19, 1942, President Roosevelt issued Executive Order No. 9066 which resulted in more than 120,000 persons of Japanese ancestry being either interned in relocation centers, drafted, or…

Enduring Lessons of Justice from the World War II Japanese American Internment

ERIC Educational Resources Information Center

Gallavan, Nancy P.; Roberts, Teresa A.

2005-01-01

In 1942, less than four months after Japan's attack on Pearl Harbor and the subsequent United States entry into World War II , nearly 120,000 persons of Japanese ancestry living along the west coast of the United States were ordered to evacuate their homes and sent to internment camps. The evacuees, separated from their extended families, former…

Effects of Learner Cognitive Styles and Metacognitive Tools on Information Acquisition Paths and Learning in Hyperspace Environments.

ERIC Educational Resources Information Center

Hsu, T. Ella; And Others

This study was designed to investigate the effects of the presence or absence of metacognitive skill tools available in hyperspace environments on field independent and field dependent learners. Learners were engaged in problem solving in an information-rich hyperspace based on a lesson on the attack on Pearl Harbor. Forty undergraduates were…

Is the long-term prognosis of transient ischemic attack or minor ischemic stroke affected by the occurrence of nonfocal symptoms?

PubMed

Compter, Annette; van der Worp, H Bart; van Gijn, Jan; Kappelle, L Jaap; Koudstaal, Peter J; Algra, Ale

2014-05-01

In patients with a transient ischemic attack or ischemic stroke, nonfocal neurological symptoms, such as confusion and nonrotatory dizziness, may be associated with a higher risk of vascular events. We assessed the relationship between nonfocal symptoms and the long-term risk of vascular events or death in patients with a transient ischemic attack or minor ischemic stroke. We related initial symptoms with outcome events in 2409 patients with a transient ischemic attack (n=723) or minor ischemic stroke (n=1686), included in the Life Long After Cerebral ischemia cohort. All patients underwent a standardized interview on the occurrence of focal and nonfocal neurological symptoms during the qualifying event. The primary outcome was the composite of any stroke, myocardial infarction, or vascular death. Secondary outcomes were all-cause death, vascular death, cardiac death, myocardial infarction, and stroke. Hazard ratios were calculated with Cox regression. Focal symptoms were accompanied by nonfocal symptoms in 739 (31%) patients. During a mean follow-up of 10.1 years, the primary outcome occurred in 1313 (55%) patients. There was no difference in the risk of the primary outcome between patients with both focal and nonfocal symptoms and patients with focal symptoms alone (adjusted hazard ratio, 0.97; 95% confidence interval, 0.86-1.09; P=0.60). The risk of each of the secondary outcomes was also similar in both groups. About one third of the patients with a transient ischemic attack or minor ischemic stroke has both focal and nonfocal neurological symptoms. Nonfocal symptoms are not associated with an increased long-term risk of vascular events or death. This trial was not registered because enrollment began before July 1, 2005.

The psychological and psychiatric effects of terrorism: lessons from London.

PubMed

Rubin, G James; Wessely, Simon

2013-09-01

The 7 July 2005 bombings in London caused heightened levels of distress among some in the general community. This distress was most notable in Muslims and members of ethnic minority groups. These effects were transient for most. An estimated 30% of those who were more affected by the attacks, including victims and witnesses, developed psychiatric disorders as a result. An outreach program was set up to screen those who were exposed to potentially traumatic events and to offer them evidence-based treatment. This article discusses what lessons might be learned from studies of the general community and the screen-and-treat approach. Copyright © 2013 Elsevier Inc. All rights reserved.

Agent Based Study of Surprise Attacks:. Roles of Surveillance, Prompt Reaction and Intelligence

NASA Astrophysics Data System (ADS)

Shanahan, Linda; Sen, Surajit

Defending a confined territory from a surprise attack is seldom possible. We use molecular dynamics and statistical physics inspired agent-based simulations to explore the evolution and outcome of such attacks. The study suggests robust emergent behavior, which emphasizes the importance of accurate surveillance, automated and powerful attack response, building layout, and sheds light on the role of communication restrictions in defending such territories.

An Overview of Controls and Flying Qualities Technology on the F/A-18 High Alpha Research Vehicle

NASA Technical Reports Server (NTRS)

Pahle, Joseph W.; Wichman, Keith D.; Foster, John V.; Bundick, W. Thomas

1996-01-01

The NASA F/A-18 High Alpha Research Vehicle (HARV) has been the flight test bed of a focused technology effort to significantly increase maneuvering capability at high angles of attack. Development and flight test of control law design methodologies, handling qualities metrics, performance guidelines, and flight evaluation maneuvers are described. The HARV has been modified to include two research control effectors, thrust vectoring, and actuated forebody strakes in order to provide increased control power at high angles of attack. A research flight control system has been used to provide a flexible, easily modified capability for high-angle-of-attack research controls. Different control law design techniques have been implemented and flight-tested, including eigenstructure assignment, variable gain output feedback, pseudo controls, and model-following. Extensive piloted simulation has been used to develop nonlinear performance guide-lines and handling qualities criteria for high angles of attack. This paper reviews the development and evaluation of technologies useful for high-angle-of-attack control. Design, development, and flight test of the research flight control system, control laws, flying qualities specifications, and flight test maneuvers are described. Flight test results are used to illustrate some of the lessons learned during flight test and handling qualities evaluations.

A cluster-randomized controlled trial of strategies to increase adolescents' physical activity and motivation during physical education lessons: the Motivating Active Learning in Physical Education (MALP) trial.

PubMed

Rosenkranz, Richard R; Lubans, David R; Peralta, Louisa R; Bennie, Andrew; Sanders, Taren; Lonsdale, Chris

2012-10-01

The physical activity (PA) levels of many children and adolescents in Australia are currently insufficient to promote health benefits. Physical education (PE) programs aim to promote PA and reach nearly all school-aged children, but PA levels within PE lessons are often low. PE teachers may influence children's motivation to be physically active in PE lessons, but little is known about teacher strategies that effectively motivate children to participate in PA, and few intervention studies have examined motivational strategies in PE. The purpose of this study was to compare the effect of three motivational strategies, each based on Self-Determination Theory (SDT), on PA levels, and their hypothesized antecedents, during year 8 PE lessons. This study employed a cluster-randomized controlled trial design. Following a familiarization session, PA levels and hypothesized PA antecedents were measured during a baseline lesson and a post-intervention or control lesson. Teachers (n = 16) and their classes from five secondary schools in Sydney, Australia were randomly assigned into four blocks and instructed to provide one of four 20-min lesson teaching strategy conditions: (1) explaining the relevance of activities; (2) providing choice from PA options selected by the teacher; (3) providing equipment and free choice of activities; or (4) usual practice. The primary outcomes were lesson time spent in moderate-to-vigorous PA, and motivation towards the lesson. Secondary outcomes were perceptions of teacher behavior, psychological needs satisfaction, and lesson time spent in sedentary behavior. PA and sedentary behavior were measured during baseline and post-intervention lessons with waist-mounted Actigraph GT3X accelerometers. Teacher behavior, psychological needs satisfaction, and motivation were assessed via questionnaires at the end of each lesson. Linear mixed-model analyses will be run on all outcomes, with students nested within teachers as a random effect. Study findings will inform the development of effective SDT-based teaching strategy interventions to enhance students' psychological needs satisfaction, motivation, and PA levels. More effective teaching strategies may be identified that are capable of improving adolescents' PA levels, and thereby provide beneficial population health outcomes. This trial is registered with Current Controlled Trials and is traceable as ISRCTN07038258.

A cluster-randomized controlled trial of strategies to increase adolescents’ physical activity and motivation during physical education lessons: the Motivating Active Learning in Physical Education (MALP) trial

PubMed Central

2012-01-01

Background The physical activity (PA) levels of many children and adolescents in Australia are currently insufficient to promote health benefits. Physical education (PE) programs aim to promote PA and reach nearly all school-aged children, but PA levels within PE lessons are often low. PE teachers may influence children’s motivation to be physically active in PE lessons, but little is known about teacher strategies that effectively motivate children to participate in PA, and few intervention studies have examined motivational strategies in PE. The purpose of this study was to compare the effect of three motivational strategies, each based on Self-Determination Theory (SDT), on PA levels, and their hypothesized antecedents, during year 8 PE lessons. Methods/design This study employed a cluster-randomized controlled trial design. Following a familiarization session, PA levels and hypothesized PA antecedents were measured during a baseline lesson and a post-intervention or control lesson. Teachers (n = 16) and their classes from five secondary schools in Sydney, Australia were randomly assigned into four blocks and instructed to provide one of four 20-min lesson teaching strategy conditions: (1) explaining the relevance of activities; (2) providing choice from PA options selected by the teacher; (3) providing equipment and free choice of activities; or (4) usual practice. The primary outcomes were lesson time spent in moderate-to-vigorous PA, and motivation towards the lesson. Secondary outcomes were perceptions of teacher behavior, psychological needs satisfaction, and lesson time spent in sedentary behavior. PA and sedentary behavior were measured during baseline and post-intervention lessons with waist-mounted Actigraph GT3X accelerometers. Teacher behavior, psychological needs satisfaction, and motivation were assessed via questionnaires at the end of each lesson. Linear mixed-model analyses will be run on all outcomes, with students nested within teachers as a random effect. Discussion Study findings will inform the development of effective SDT-based teaching strategy interventions to enhance students’ psychological needs satisfaction, motivation, and PA levels. More effective teaching strategies may be identified that are capable of improving adolescents’ PA levels, and thereby provide beneficial population health outcomes. Trial registration This trial is registered with Current Controlled Trials and is traceable as ISRCTN07038258. PMID:23025261

Writing Learning Outcomes for English Language Lessons in Multilingual Schools

ERIC Educational Resources Information Center

Jones, Sally Ann

2016-01-01

This article proposes a pedagogic innovation in teacher education by articulating a method for writing learning outcomes for English language lessons in multilingual school contexts. The argument for this approach is founded on curriculum studies; however, the practice also draws specifically on applied psycholinguistic and sociolinguistic…

Replacement Attack: A New Zero Text Watermarking Attack

NASA Astrophysics Data System (ADS)

Bashardoost, Morteza; Mohd Rahim, Mohd Shafry; Saba, Tanzila; Rehman, Amjad

2017-03-01

The main objective of zero watermarking methods that are suggested for the authentication of textual properties is to increase the fragility of produced watermarks against tampering attacks. On the other hand, zero watermarking attacks intend to alter the contents of document without changing the watermark. In this paper, the Replacement attack is proposed, which focuses on maintaining the location of the words in the document. The proposed text watermarking attack is specifically effective on watermarking approaches that exploit words' transition in the document. The evaluation outcomes prove that tested word-based method are unable to detect the existence of replacement attack in the document. Moreover, the comparison results show that the size of Replacement attack is estimated less accurate than other common types of zero text watermarking attacks.

Cognitive-Behavior Therapy for Vietnamese Refugees with PTSD and Comorbid Panic Attacks

ERIC Educational Resources Information Center

Hinton, Devon E.; Safren, Steven A.; Pollack, Mark H.; Tran, Minh

2006-01-01

For Vietnamese refugees, we describe (a) how headache- and orthostasis-focused panic attacks are generated, (b) a culturally sensitive treatment for PTSD with comorbid headache- and orthostasis-focused panic attacks, and (c) the outcome of a treatment series. In a multiple-baseline, across-subjects design (N = 3), all patients demonstrated…

Summary and results of the joint WMD-DAC/Alameda County bioterrorism response plan exercise.

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

Manley, Dawn Kataoka; Lipkin, Joel; West, Todd H.

2003-11-01

On June 12,2003, the Alameda County Public Health Department and Sandia National Laboratories/CA jointly conducted an exercise that used a Weapons of Mass Destruction-Decision Analysis Center (WMD-DAC) bioterrorism attack simulation to test the effectiveness of the county's emergency response plan. The exercise was driven by an assumed release (in the vicinity of the Berkeley Marina), and subsequent spread, of a small quantity of aerosolized, weapons-grade anthrax spores. The simulation used several key WMD-DAC capabilities, namely: (1) integration with an atmospheric dispersion model to calculate expected dose levels in the affected areas, (2) a individual-tracking capability for both infected and non-infectedmore » persons as they made decisions, sought treatment, and received prophylaxis drugs, and (3) a user interface that allows exercise participants to affect the scenario evolution and outcome. The analysis of the county's response plan included documenting and reviewing the decisions made by participants during the exercise. Twenty-six local and regional officials representing the health care system, emergency medical services and law enforcement were involved in responding to the simulated attack. The results of this joint effort include lessons learned both by the Alameda County officials regarding implementation of their bioterrorism response plan and by the Sandia representatives about conducting exercises of this type. These observations are reviewed in this report, and they form a basis for providing a better understanding of group/individual decision processes and for identifying effective communication options among decision makers.« less

Nuclear Lessons for Cyber Security

DTIC Science & Technology

2011-01-01

major kinetic violence. In the physical world, governments have a near monopoly on large - scale use of force, the defender has an intimate knowledge of...with this transformative technology. Until now, the issue of cyber security has largely been the domain of computer experts and specialists. When the...with increasing economic returns to scale and political practices that make jurisdictional control difficult. Attacks from the informational realm

Adolescents' Mental Health Outcomes According to Different Types of Exposure to Ongoing Terror Attacks

ERIC Educational Resources Information Center

Braun-Lewensohn, Orna; Celestin-Westreich, Smadar; Celestin, Leon-Patrice; Verte, Dominique; Ponjaert-Kristoffersen, Ingrid

2009-01-01

This study investigates the impact of several types of exposure to terror attacks on adolescents' psychological outcomes in the context of ongoing terror. A total of 913 adolescents (51 girls) aged 12 to 18 years (12-13.6 = 33%; 13.7-15.6 = 38%; 15.7-18 = 28%) took part in the study. Detailed data were collected concerning objective, subjective…

Peritraumatic panic attacks and health outcomes two years after psychological trauma: implications for intervention and research.

PubMed

Boscarino, Joseph A; Adams, Richard E

2009-05-15

Several studies have suggested that experiencing a peritraumatic panic attack (PPA) during a traumatic event predicts future mental health status. Some investigators have suggested that this finding has psychotherapeutic significance. We assessed the hypothesis that PPA was not related to longer-term health status after event exposure, once background confounders were controlled. In our study we assessed exposure to the World Trade Center disaster (WTCD) and other negative life events, demographic factors, social support, self-esteem, and panic attack onset in predicting health outcome among 1681 New York City residents 2 years after the attack. Initial bivariate results indicated that a PPA was related to a number of adverse outcomes 2 years after the WTCD, including posttraumatic stress disorder, depression, poor physical health, anxiety, binge drinking, and mental health treatment seeking. However, when multivariate (MV) models were estimated adjusting for potential confounders, most of these associations were either non-significant or substantially reduced. Contrary to previous predictions, these MV models revealed that recent negative life events and current self-esteem at follow-up were the best predictors of health outcomes, not PPA. Although post-trauma interventions may target individuals who experienced PPA after traumatic exposures, reducing the long-term health consequences following such exposures based on PPA alone may be problematic. Modifications of psychopathology constructs based on the reported correlation between PPA and post-trauma outcomes may be premature.

Safe Schooling: Always at the Ready

ERIC Educational Resources Information Center

Moore, Brian N.

2012-01-01

Those who spent time in the classroom recognize the need to formulate well-designed lesson plans before they can provide a first-rate education. A lesson plan provides guidance on what they will be teaching, the tools they will need to teach a lesson, and their expectations for the outcomes of the lesson--what kids will learn. The same is true for…

Development and content validity testing of a patient-reported outcomes questionnaire for the assessment of hereditary angioedema in observational studies.

PubMed

Bonner, Nicola; Abetz-Webb, Linda; Renault, Lydie; Caballero, Teresa; Longhurst, Hilary; Maurer, Marcus; Christiansen, Sandra; Zuraw, Bruce

2015-07-01

Hereditary Angioedema (HAE), a rare genetic disease, manifests as intermittent, painful attacks of angioedema. Attacks vary in frequency and severity and include skin, abdominal and life-threatening laryngeal swellings. This study aimed to develop a patient reported outcome (PRO) tool for the assessment of HAE attacks, including their management and impact on patients' lives, for use in clinical studies, or by physicians in general practice. The results of open-ended face to face concept elicitation interviews with HAE patients in Argentina (n = 10) and the US (n = 33) were used to develop the first draft questionnaire of the HAE patient reported outcomes questionnaire (HAE PRO). Subsequently, in-depth cognitive debriefing interviews were performed with HAE patients in the UK (n = 10), Brazil (n = 10), Germany (n = 11) and France (n = 12). Following input from eight multinational clinical experts further cognitive interviews were conducted in the US (n = 12) and Germany (n = 12). Patients who experienced abdominal, cutaneous or laryngeal attacks of varying severity levels were included in all rounds of interviews. Across the rounds of interviews patients discussed their HAE attack symptoms, impacts and treatments. Cognitive debriefing interviews explored patient understanding and relevance of questionnaire items. All interviews were conducted face to face following a pre-defined semi-structured interview guide in the patient's native language. Patients reported a variety of HAE symptoms, attack triggers, warning signs, attack impacts and treatment options which were used to develop the HAE PRO. The HAE PRO was revised and refined following input from patients and clinical experts. The final 18-item HAE PRO provides an assessment of the HAE attack experience including symptoms, impacts, treatment requirements, healthcare resource use and loss of productivity caused by HAE attacks. Patient and expert input has contributed to the development of a content valid questionnaire that assesses concepts important to HAE patients globally. HAE patients across cultures consider the HAE PRO a relevant and appropriate assessment of HAE attacks and treatment.

Economic burden of gouty arthritis attacks for employees with frequent and infrequent attacks.

PubMed

Lynch, Wendy; Chan, Wing; Kleinman, Nathan; Andrews, L M; Yadao, Anthony M

2013-04-01

The objective of this study was to compare episode-related and annual costs and work absence days for employees with <3 versus ≥ 3 annual gout attacks. Human Capital Management Services data (2009-2010) from adult employees with gout (International Classification of Diseases, Ninth Revision code 274.x) and ≥ 12 months of medical and pharmacy benefits were studied. Outcomes of interest included medical and drug costs, number of emergency department and urgent care visits, number of inpatient days, short- and long-term disability, sick leave, workers' compensation costs, and work absence days. An algorithm based on diagnosis code and antigout medication use identified acute gout treatment episodes. Multivariate analysis compared annual and pre-episode vs. during-episode outcomes for employees with ≥ 3 vs. <3 gout annual attacks. Of 3361 employees with gout, 76 had ≥ 3 attacks; these employees had higher short-term disability costs ($1663 vs. $643, P=0.06) and days (11.68 versus 4.61, P<0.05), more emergency room visits (0.55 vs. 0.23, P<0.0001), and urgent care visits (0.07 vs. 0.04, P<0.01), and lower pharmacy costs ($1677 vs. $1108, P<0.0001) than those with <3 attacks. Medical costs both before ($203 higher) and during attacks ($136 higher) were significantly higher for those with ≥ 3 attacks than for those with <3 attacks. Additionally, a quadratic increasing relationship was found between number of attacks and cost. Frequency of acute gout attacks (≥ 3 episodes per year) among employees with gout was associated with greater short-term disability cost, absence days, and emergency department and urgent care visits, and trends toward higher overall costs.

An avatar based education application to improve patients' knowledge of and response to heart attack symptoms: a pragmatic randomized controlled trial protocol.

PubMed

Tongpeth, Jintana; Du, Huiyun; Clark, Robyn

2018-06-19

To evaluate the effectiveness of an interactive, avatar based education application to improve knowledge of and response to heart attack symptoms in people who are at risk of a heart attack. Poor knowledge of heart attack symptoms is recognised as a significant barrier to timely medical treatment. Numerous studies have demonstrated that technology can assist in patient education to improve knowledge and self-care. A single-center, non-blinded, two parallel groups, pragmatic randomized controlled trial. Seventy patients will be recruited from the coronary care unit of a public hospital. Eligible participants will be randomised to either the usual care or the intervention group (usual care plus avatar-based heart attack education app). The primary outcome of this study is knowledge. Secondary outcomes include response to heart attack symptoms, health service use and satisfaction. Study participants will be followed-up for six months. This study will evaluate the avatar based education app as a method to deliver vital information to patients. Participants' knowledge of and response to heart attack symptoms, as well as their health service use, will be assessed to evaluate the intervention effectiveness. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Space occupation near the basket shapes collective behaviours in youth basketball.

PubMed

Esteves, Pedro T; Silva, Pedro; Vilar, Luís; Travassos, Bruno; Duarte, Ricardo; Arede, Jorge; Sampaio, Jaime

2016-08-01

This study aimed to analyse how youth basketball players explored numerical overloads during shot attempts by measuring their space occupation across specific court areas. Four process-tracing variables measured how the number of attackers (NA), number of defenders (ND), interpersonal distance between attacker and the closest defender (ID) and distance between attacker and the basket (DBkt) impacted on the performance outcome (converted shot; missed shot; ball possession lost). Ten competitive games involving 13 U14 teams were video recorded and players' displacements were digitised. The associations between performance outcomes and the process-tracing measures were assessed using standardised mean differences and a cross-correlation function. A multinomial logistic regression was used to calculate the odds ratio (OR) for each of the three possible outcomes. Results revealed that when shot attempts occurred at larger ID and at smaller DBkt, the possibilities to obtain a converted shot increased. The numerical overload of defenders near the scoring target was predominantly associated with offensive success. Also, the possibility of attackers to lead the spatial relation of movements with the defenders, near the scoring target, appeared as a prominent strategy to succeed. In sum, basketball teams that exhibit potential to adapt their collective behaviours to local changes in the environment might be closer to achieving successful outcomes.

Differences in mental health outcomes by acculturation status following a major urban disaster.

PubMed

Adams, Richard E; Boscarino, Joseph A

2013-01-01

A number of studies have assessed the association between acculturation and psychological outcomes following a traumatic event. Some suggest that low acculturation is associated with poorer health outcomes, while others show no differences or that low acculturation is associated with better outcomes. One year after the terrorist attacks on the World Trade Center, we surveyed a multi-ethnic population of New York City adults (N= 2,368). We assessed posttraumatic stress disorder (PTSD), major depression, panic attack, anxiety symptoms, and general physical and mental health status. We classified study respondents into "low," "moderate," or "high" acculturation, based on survey responses. Bivariate results indicated that low acculturation individuals were more likely to experience negative life events, have low social support, and less likely to have pre-disaster mental health disorders. Those in the low acculturation group were also more likely to experience post-disaster perievent panic attacks, have higher anxiety, and have poorer mental health status. However, using logistic regression to control for confounding, and adjusting for multiple comparisons, we found that none of these outcomes were associated with acculturation status. Thus, our study suggests that acculturation was not associated with mental health outcomes following a major traumatic event.

A Mixed Methods Comparison of Teachers' Lunar Modeling Lesson Implementation and Student Learning Outcomes

ERIC Educational Resources Information Center

Lamar, Mary F.; Wilhelm, Jennifer Anne; Cole, Merryn

2018-01-01

The authors compare three teachers' adaptations and implementation of a lunar modeling lesson to explain marked differences in student learning outcomes on a spatial-scientific lunar assessment. They used a modified version of the Practices of Science Observation Protocol (P-SOP; Forbes, Biggers, & Zangori, 2013) to identify ways in which…

Labeling of Medication and Placebo Alters the Outcome of Episodic Migraine Attacks

PubMed Central

Kam-Hansen, Slavenka; Jakubowski, Moshe; Kelley, John M.; Kirsch, Irving; Hoaglin, David C.; Kaptchuk, Ted J.; Burstein, Rami

2014-01-01

Information provided to patients is thought to influence placebo and drug effects. We investigated the potential relationship between treatment labeling and its outcome in a prospective, within-subjects, repeated measures study of episodic migraine. A cohort of 66 participants documented 7 separate migraine attack: one untreated attack, followed by six attacks that were randomly assigned for either rizatriptan (10 mg Maxalt) or placebo treatments, each of which labeled once as ‘Maxalt’, once as ‘Placebo’, and once as ‘Maxalt or Placebo’ (459 documented attacks). Data were analyzed using generalized linear mixed model statistics. While Maxalt was generally superior to placebo, the placebo effect, and to a lesser extent Maxalt efficacy, increased monotonically with treatment labeling as follows: ‘Placebo’ label < ‘Maxalt or placebo’ label ≤ ‘Maxalt’ label. Efficacy of Maxalt mislabeled as placebo was not significantly different from the efficacy of placebo mislabeled as Maxalt. The placebo effect was significant under each labeling condition relative to no treatment, amounting in magnitude to >50% of Maxalt effect under the corresponding labeling condition. Thus, incremental “positive” information yielded incremental efficacy of placebo and medication during migraine attacks. PMID:24401940

Planning guidance for emergency response to a hypothetical nuclear attack on Riyadh, Saudi Arabia

NASA Astrophysics Data System (ADS)

Shubayr, Nasser Ali M.

The threat of nuclear attack will remain imminent in an ever-advancing society. Saudi Arabia is not immune to this threat. This dissertation establishes planning guidance for response to a nuclear attack on Riyadh, the capital of Saudi Arabia, based on a hypothetical scenario of a nuclear detonation. A case scenario of a one-megaton thermonuclear bomb detonated at ground level over Riyadh is used to support the thesis. Previous nuclear tests and the Hiroshima and Nagasaki bombings have been used to present possible effects on Riyadh. US planning guidance and lessons learned from the Chernobyl and Fukushima nuclear plants accidents have been used to develop the emergency response guidance. The planning guidance outlines a rapid response to the nuclear detonation. Four damage zones have been identified; severe damage zone, moderate damage zone, light damage zone and dangerous fallout zone. Actions that are recommended, and those that should be avoided, have been determined for each zone. Shelter/ evacuation evaluation for blast-affected and fallout-affected areas is the basis for the recommendation that shelter in place is the best decision for the first hours to days after the attack. Guidelines for medical care response and population monitoring and decontamination are included to reduce the early and long-term effects of the attack. Recommendations to the Saudi Arabian authorities have been made to facilitate suitable preparedness and response for such an event.

Biology Teachers Designing Context-Based Lessons for Their Classroom Practice--The Importance of Rules-of-Thumb

ERIC Educational Resources Information Center

Wieringa, Nienke; Janssen, Fred J. J. M.; Van Driel, Jan H.

2011-01-01

In science education in the Netherlands new, context-based, curricula are being developed. As in any innovation, the outcome will largely depend on the teachers who design and implement lessons. Central to the study presented here is the idea that teachers, when designing lessons, use rules-of-thumb: notions of what a lesson should look like if…

V/STOL concepts in the United States: Past, present, and future

NASA Technical Reports Server (NTRS)

Nelms, W. P.; Anderson, S. B.

1984-01-01

Nonhelicopter types of V/STOL aircraft developed in the United States are reviewed, and some lessons learned from a selected number of concepts are highlighted. The AV-8B, which was developed by modifications to the British Harrier is the only current concept examined. Configurations proposed for the future subsonic, multimissing aircraft and the future supersonic fighter/attack aircraft are described. Emphasis is on these supersonic concepts.

Protecting Emergency Responders: Lessons Learned from Terrorist Attacks

DTIC Science & Technology

2002-03-05

Contact lenses tended to dry out when worn with respirators for long periods. Wet shoes and socks caused blisters.1 Trades panel members believed...the confusion and compounds the safety and rescue responsibilities of firefighters and other responders who are in the command structure. In the...enter eyes and to irritate them. Heavy labor in hot weather, which caused de- hydration and dry eyes, apparently compounded this problem at the sites

Predicting Resource Needs for Multiple and Mass Casualty Events in Combat: Lessons Learned From Combat Support Hospital Experience in Operation Iraqi Freedom

DTIC Science & Technology

2009-04-01

from rocket attack near a forward operating base (Photo courtesy of Tommy A. Brown). Predicting Resource Needs for Mass Casualty in Combat Volume 66...combat support hospital. J Trauma 2008; 64(2 suppl):S79–S85. 19. Wedmore I, McManus JG, Pusateri AE, et al. A special report on the chitosan -based

Studying Acute Coronary Syndrome Through the World Wide Web: Experiences and Lessons

PubMed Central

2017-01-01

This study details my viewpoint on the experiences, lessons, and assessments of conducting a national study on care-seeking behavior for heart attack in the United States utilizing the World Wide Web. The Yale Heart Study (YHS) was funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH). Grounded on two prior studies, the YHS combined a Web-based interview survey instrument; ads placed on the Internet; flyers and posters in public libraries, senior centers, and rehabilitation centers; information on chat rooms; a viral marketing strategy; and print ads to attract potential participants to share their heart attack experiences. Along the way, the grant was transferred from Ohio State University (OSU) to Yale University, and significant administrative, information technology, and personnel challenges ensued that materially delayed the study’s execution. Overall, the use of the Internet to collect data on care-seeking behavior is very time consuming and emergent. The cost of using the Web was approximately 31% less expensive than that of face-to-face interviews. However, the quality of the data may have suffered because of the absence of some data compared with interviewing participants. Yet the representativeness of the 1154 usable surveys appears good, with the exception of a dearth of African American participants. PMID:29030328

Cyber / Physical Security Vulnerability Assessment Integration

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

MacDonald, Douglas G.; Simpkins, Bret E.

Abstract Both physical protection and cyber security domains offer solutions for the discovery of vulnerabilities through the use of various assessment processes and software tools. Each vulnerability assessment (VA) methodology provides the ability to identify and categorize vulnerabilities, and quantifies the risks within their own areas of expertise. Neither approach fully represents the true potential security risk to a site and/or a facility, nor comprehensively assesses the overall security posture. The technical approach to solving this problem was to identify methodologies and processes that blend the physical and cyber security assessments, and develop tools to accurately quantify the unaccounted formore » risk. SMEs from both the physical and the cyber security domains developed the blending methodologies, and cross trained each other on the various aspects of the physical and cyber security assessment processes. A local critical infrastructure entity volunteered to host a proof of concept physical/cyber security assessment, and the lessons learned have been leveraged by this effort. The four potential modes of attack an adversary can use in approaching a target are; Physical Only Attack, Cyber Only Attack, Physical Enabled Cyber Attack, and the Cyber Enabled Physical Attack. The Physical Only and the Cyber Only pathway analysis are two of the most widely analyzed attack modes. The pathway from an off-site location to the desired target location is dissected to ensure adversarial activity can be detected and neutralized by the protection strategy, prior to completion of a predefined task. This methodology typically explores a one way attack from the public space (or common area) inward towards the target. The Physical Enabled Cyber Attack and the Cyber Enabled Physical Attack are much more intricate. Both scenarios involve beginning in one domain to affect change in the other, then backing outward to take advantage of the reduced system effectiveness, before penetrating further into the defenses. The proper identification and assessment of the overlapping areas (and interaction between these areas) in the VA process is necessary to accurately assess the true risk.« less

Interpersonal coordination tendencies shape 1-vs-1 sub-phase performance outcomes in youth soccer.

PubMed

Duarte, Ricardo; Araújo, Duarte; Davids, Keith; Travassos, Bruno; Gazimba, Vítor; Sampaio, Jaime

2012-05-01

This study investigated the influence of interpersonal coordination tendencies on performance outcomes of 1-vs-1 sub-phases in youth soccer. Eight male developing soccer players (age: 11.8 ± 0.4 years; training experience: 3.6 ± 1.1 years) performed an in situ simulation of a 1-vs-1 sub-phase of soccer. Data from 82 trials were obtained with motion-analysis techniques, and relative phase used to measure the space-time coordination tendencies of attacker-defender dyads. Approximate entropy (ApEn) was then used to quantify the unpredictability of interpersonal interactions over trials. Results revealed how different modes of interpersonal coordination emerging from attacker-defender dyads influenced the 1-vs-1 performance outcomes. High levels of space-time synchronisation (47%) and unpredictability in interpersonal coordination processes (ApEn: 0.91 ± 0.34) were identified as key features of an attacking player's success. A lead-lag relation attributed to a defending player (34% around -30° values) and a more predictable coordination mode (ApEn: 0.65 ± 0.27, P < 0.001), demonstrated the coordination tendencies underlying the success of defending players in 1-vs-1 sub-phases. These findings revealed how the mutual influence of each player on the behaviour of dyadic systems shaped emergent performance outcomes. More specifically, the findings showed that attacking players should be constrained to exploit the space-time synchrony with defenders in an unpredictable and creative way, while defenders should be encouraged to adopt postures and behaviours that actively constrain the attacker's actions.

Sport Education as a Curriculum Approach to Student Learning of Invasion Games: Effects on Game Performance and Game Involvement

PubMed Central

Farias, Cláudio; Valério, Carla; Mesquita, Isabel

2018-01-01

The teaching and learning of games and sport-based activities has historically been the dominant form of the physical education curricula. With an interest in providing to students meaningful and culturally situated sporting experiences, Sport Education is probably the most implemented and researched pedagogical model worldwide. However, although there is considerable evidence that the model as a curriculum approach can benefit the development of social goals and healthy sport behaviors, not a single study as to date examined students’ game-play development beyond participation in single and isolated teaching units. Therefore, the purpose of this study was to examine students’ development of Game Performance and Game Involvement during participation in three consecutive Sport Education seasons of invasion games. The participants were an experienced physical education teacher and one seventh-grade class totaling 26 students (10 girls and 16 boys). Using the Game Performance Assessment Instrument (Oslin et al., 1998), pre-test to post-tests measures of students’ Game Performance and Game Involvement were collected during their participation in basketball (20 lessons), handball (16 lessons), and football (18 lessons) units. Inter-group differences and pre-test to post-test improvements within each season were analyzed through 2 (time) x group (sport) repeated measures ANOVA tests. There were found significant pre-test to post-test improvements in Game Performance and Game Involvement in the second (handball) and third (football) seasons, but not in the first season (basketball). Students’ Game Performance and Involvement scores of handball and football were significantly higher than their scores while playing basketball. The opportunity for an extended engagement in game-play activities and prolonged membership of students in the same teams throughout three consecutive seasons of Sport Education were key to the outcomes found. The specific configurations of the game forms played by students either inhibited or enabled their game-play development. Key points The effect of time fostered by the extended participation of students in consecutive seasons of the model was paramount to promote effective gains in Game Performance and Game Involvement. Specific modifications imposed on the game, such as asymmetric attack-defense game configurations had a positive effect on the development of the learning outcomes. The persistent membership that was extended across sequential units of invasion games helped players build more sophisticated game-play routines and problem-solving. PMID:29535578

A non-equivalent group pilot trial of a school-based physical activity and fitness intervention for 10-11 year old english children: born to move.

PubMed

Fairclough, Stuart J; McGrane, Bronagh; Sanders, George; Taylor, Sarah; Owen, Michael; Curry, Whitney

2016-08-24

PE lessons are the formal opportunity in schools for promotion of physical activity and fitness. This study aimed to evaluate the effectiveness of a pilot PE intervention on physical activity, fitness, and psychosocial outcomes. Participants were 139 children aged 10-11 years from four schools. For six weeks children in two schools received a twice-weekly pilot 'Born to Move' (BTM) physical activity (PA) and fitness intervention alongside one regular PE lesson. Children in the two comparison (COM) schools received their regular twice weekly PE lessons. Outcomes were lesson time and whole-day light (LPA), moderate (MPA), vigorous (VPA), and MVPA, and sedentary time, muscular fitness, cardiorespiratory fitness (CRF), and lesson-specific perceived exertion, enjoyment, and perceived competence. Outcomes were assessed at baseline (T0), midway through the intervention (T1), and at the end (T2) using ANOVAs and ANCOVAs. Intervention fidelity was measured using child and teacher surveys at T2 and analysed using Chi-square tests. The BTM group engaged in moderate PA for significantly more lesson time (29.4 %) than the COM group (25.8 %; p = .009, d = .53). The amount of moderate-to-vigorous PA (MVPA) during the T1 BTM lesson contributed 14.0 % to total MVPA, which was significantly more than the COM group's T1 PE lesson (11.4 %; p < .001, d = .47). The BTM group were significantly more active during the whole-day (p < .05) and the school-day (p < .01). In both groups push-up test performance increased (p < .001) and CRF test performance decreased (p < .01). Perceived exertion, enjoyment, and perceived competence increased in both groups (p < .05), but the BTM group rated their enjoyment of the T1 BTM lesson higher than the COM group rated their PE lesson (p = .02, d = .56). The children's and teachers' responses to the intervention indicated that the delivery aims of enjoyment, engagement, inclusivity, and challenge were satisfied. The BTM pilot programme has potential to positively impact on physical activity, fitness, and psychosocial outcomes. Further, BTM was enjoyed by the children, and valued by the teachers. This study can inform the design of a modified larger-scale cluster RCT evaluation.

Panic attacks and panic disorder in a population-based sample of active Canadian military personnel.

PubMed

Kinley, D Jolene; Walker, John R; Mackenzie, Corey S; Sareen, Jitender

2011-01-01

The factors contributing to psychiatric problems among military personnel, particularly for panic, are unclear. The objective of this study was to examine the prevalence and correlates of panic disorder and panic attacks in the Canadian military. Statistics Canada and the Department of National Defense conducted the Canadian Community Health Survey-Canadian Forces Supplement in 2002 (May to December) with a representative sample of active Canadian military personnel (aged 16-54 years; N = 8,441; response rate, 81.5%). Comparisons were made between respondents with no past-year panic attacks, panic attacks without panic disorder, and panic disorder on measures of DSM-IV mental disorders, as well as validated measures of disability, distress, suicidal ideation, perceived need for mental health treatment, and mental health service use. Lifetime exposure to combat operations, witnessing of atrocities, and deployments were also assessed. Panic disorder and panic attacks were common in the military population, with past-year prevalence estimates of 1.8% and 7.0%, respectively. Both panic disorder and panic attacks were associated with increased odds of all mental disorders assessed, suicidal ideation, 2-week disability, and distress. Perceived need for mental health treatment and service use were common in individuals with panic attacks and panic disorder (perceived need: 46.3% for panic attacks, 89.6% for panic disorder; service use: 32.5% for panic attacks, 74.5% for panic disorder). Panic attacks and panic disorder in the military are associated with outcomes that could be detrimental to well-being and work performance, and early detection of panic in this population could help reduce these negative outcomes. © Copyright 2011 Physicians Postgraduate Press, Inc.

Issues in Violent Risk Assessment: Lessons Learned and Future Directions

ERIC Educational Resources Information Center

Kroner, Daryl G.

2005-01-01

Realizing that the assessment of dangerousness with a yes/no format as a poor form of violent risk assessment has been the most important lesson learned about violence in the last 20 years. Further examining (a) what outcome and (b) how the indicators of the outcome should be measured has resulted in better violent risk assessment. The most…

Predicting the effect of climate change on wildfire behavior and initial attack success

Treesearch

Jeremy S. Fried; J. Keith Gilless; William J. Riley; Tadashi J. Moody; Clara Simon de Blas; Katharine Hayhoe; Max Mortiz; Scott Stephens; Margaret Torn

2008-01-01

This study focused on how climate change-induced effects on weather will translate into changes in wildland fire severity and outcomes in California, particularly on the effectiveness of initial attack at limiting the number of fires that escape initial attack. The results indicate that subtle shifts in fire behavior of the sort that might be induced by the climate...

Posttraumatic Stress Disorder Following the September 11, 2001, Terrorist Attacks: A Review of the Literature among Highly Exposed Populations

ERIC Educational Resources Information Center

Neria, Yuval; Digrande, Laura; Adams, Ben G.

2011-01-01

The September 11, 2001 (9/11), terrorist attacks were unprecedented in their magnitude and aftermath. In the wake of the attacks, researchers reported a wide range of mental and physical health outcomes, with posttraumatic stress disorder (PTSD) the one most commonly studied. In this review, we aim to assess the evidence about PTSD among highly…

A code inspection process for security reviews

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

Garzoglio, Gabriele; /Fermilab

2009-05-01

In recent years, it has become more and more evident that software threat communities are taking an increasing interest in Grid infrastructures. To mitigate the security risk associated with the increased numbers of attacks, the Grid software development community needs to scale up effort to reduce software vulnerabilities. This can be achieved by introducing security review processes as a standard project management practice. The Grid Facilities Department of the Fermilab Computing Division has developed a code inspection process, tailored to reviewing security properties of software. The goal of the process is to identify technical risks associated with an application andmore » their impact. This is achieved by focusing on the business needs of the application (what it does and protects), on understanding threats and exploit communities (what an exploiter gains), and on uncovering potential vulnerabilities (what defects can be exploited). The desired outcome of the process is an improvement of the quality of the software artifact and an enhanced understanding of possible mitigation strategies for residual risks. This paper describes the inspection process and lessons learned on applying it to Grid middleware.« less

A code inspection process for security reviews

NASA Astrophysics Data System (ADS)

Garzoglio, Gabriele

2010-04-01

In recent years, it has become more and more evident that software threat communities are taking an increasing interest in Grid infrastructures. To mitigate the security risk associated with the increased numbers of attacks, the Grid software development community needs to scale up effort to reduce software vulnerabilities. This can be achieved by introducing security review processes as a standard project management practice. The Grid Facilities Department of the Fermilab Computing Division has developed a code inspection process, tailored to reviewing security properties of software. The goal of the process is to identify technical risks associated with an application and their impact. This is achieved by focusing on the business needs of the application (what it does and protects), on understanding threats and exploit communities (what an exploiter gains), and on uncovering potential vulnerabilities (what defects can be exploited). The desired outcome of the process is an improvement of the quality of the software artifact and an enhanced understanding of possible mitigation strategies for residual risks. This paper describes the inspection process and lessons learned on applying it to Grid middleware.

Challenge Activities for the Physical Education Classroom: Affective Learning Outcomes

ERIC Educational Resources Information Center

McKenzie, Emily; Symonds, Matthew L.; Fink, Kevin; Tapps, Tyler

2017-01-01

The purpose of this article is to share three challenge-based lesson plans that can be implemented by physical educators in their classroom. Each of the lesson examples addresses the three learning domains: psychomotor, cognitive and affective. Additionally, each lesson is aligned with SHAPE America's National Standards for K-12 Physical…

Companion Guides for Lesson Planning: A Planning Template and the Lesson Plan Pro Forma

ERIC Educational Resources Information Center

Pang, May

2016-01-01

Jason Anderson's proposal, in "ELT Journal" (2015), for an affordance-based approach to lesson planning raises important issues in teacher education. However, his arguments against the role of planned outcomes in favour of an affordance-based focus using learning opportunities as units of planning fail to acknowledge the complexities…

The Measurement of Psychological Constructs in Peace Education.

ERIC Educational Resources Information Center

Christie, Daniel J.

Peace education research typically is designed to evaluate the effects of a single lesson or a group of lessons (unit) on some attitudinal or learning outcomes. The current research was designed to evaluate a set of procedures for identifying a mix of peace education lessons that desirably impact on students. Three curriculum consultants were…

Lessons learned from cross-border medical response to the terrorist bombings in Tabba and Ras-el-Satan, Egypt, on 07 October 2004.

PubMed

Leiba, Adi; Blumenfeld, Amir; Hourvitz, Ariel; Weiss, Gali; Peres, Michal; Laor, Dani; Schwartz, Dagan; Arad, Jacob; Goldberg, Avishay; Levi, Yeheskel; Bar-Dayan, Yaron

2005-01-01

Large-scale, terrorist attacks can happen in peripheral areas, which are located close to a country's borders and far from its main medical facilities and involve multi-national casualties and responders. The objective of this study was to analyze the terrorist suicide bombings that occurred on 07 October 2004, near the Israeli-Egyptian border, as representative of such a complex scenario. Data from formal debriefings after the event were processed in order to learn about victim outcomes, resource utilization, critical events, and time course of the emergency response. A total of 185 injured survivors were repatriated: four were severely wounded, 13 were moderately injured, and 168 were mildly injured. Thirty-eight people died. A forward medical team landed at the border town's airport, which provided reinforcement in the field and in the local hospital. Israeli and Egyptian search and rescue teams collaborated at the destruction site. One-hundred sixty-eight injured patients arrived at the small border hospital that rapidly organized itself for the mass-casualty incident, operating as an evacuation "staging hospital". Twenty-three casualties secondarily were distributed to two major trauma centers in the south and the center of Israel, respectively, either by ambulance or by helicopter. Large-scale, terrorist attacks at a peripheral border zone can be handled by international collaboration, reinforcement of medical teams at the site itself and at the peripheral neighboring hospital, rapid rearrangement of an "evacuation hospital", and efficient transport to trauma centers by ambulances, helicopters, and other aircraft.

From the Andes to the Hindu Kush: Columbian Airpower Lessons for Afghanistan

DTIC Science & Technology

2010-05-20

includes both rotary and fixed wing assets to conduct a variety of air operations. The ANAAC build plan includes fifty-four Mi-17. Twenty of these are to...Win. Dulles: Potomac Books, Inc., 2007. Renner , Stephen L., Major. A Modest Proposal for Air Attack Combat Aviation Advisors. School of Advanced Air ...by Major William J Maher United States Air Force School of Advanced Military Studies United States Army Command and General

The Interagency Process and America’s Second Front in the Global War on Terrorism

DTIC Science & Technology

2003-04-01

Environmental Factors Channel Interagency Dynamics”, NS Coursebook , AY 2003, Air Command and Staff College, Maxwell AFB, AL, p. 117. 4 Strategy Course, Lesson...Study of Airpower.” AP Coursebook , 2002, 2 3 History, USSOCOM, 15th Anniversary Edition, 16 April 2002, p. 83 4 Profile: Philippines, U.S...our infrastructure, both physical and information networks, from attack from terrorist groups that have already demonstrated their technical savvy

Money in the Bank. Lessons Learned from Past Counterinsurgency (COIN) Operations

DTIC Science & Technology

2007-01-01

to work among their own people, which helped draw recruits from established social networks, exploited their familiarity with the villagers and the...in U.S. military support. Local indigenous forces were used to attack the VCI because they were familiar with the terrain and the inhabitants of the...cultivate human intelligence (HUMINT) through a cache of local assets and agents. Direct familiarity with the villagers can help soldiers detect the

The Ho Chi Minh Campaign: Operational Art in the Fall of Saigon

DTIC Science & Technology

2014-05-22

the proper blend of tactical units to support strategic success. Soviet military thinking viewed depth as vital to operational art, enabled by the...Politburo learned a valuable lesson from the limited offensive. They underestimated the effectiveness of U.S. airpower, resulting in an under...of 1974, the NVA launched its first major attack focused at the Tam KY, the provincial capital of Quang Tin. The purpose of 31Anthony James Joes

The World Trade Center Attack: Lessons for disaster management

PubMed Central

Simon, Ronald; Teperman, Sheldon

2001-01-01

As the largest, and one of the most eclectic, urban center in the United States, New York City felt the need to develop an Office of Emergency Management to coordinate communications and direct resources in the event of a mass disaster. Practice drills were then carried out to assess and improve disaster preparedness. The day of 11 September 2001 began with the unimaginable. As events unfolded, previous plans based on drills were found not to address the unique issues faced and new plans rapidly evolved out of necessity. Heroic actions were commonplace. Much can be learned from the events of 11 September 2001. Natural and unnatural disasters will happen again, so it is critical that these lessons be learned. Proper preparation will undoubtedly save lives and resources. PMID:11737917

Scripted and Unscripted Science Lessons for Children with Autism and Intellectual Disability.

PubMed

Knight, Victoria F; Collins, Belva; Spriggs, Amy D; Sartini, Emily; MacDonald, Margaret Janey

2018-02-27

Both scripted lessons and unscripted task analyzed lessons have been used effectively to teach science content to students with intellectual disability and autism spectrum disorder. This study evaluated the efficacy, efficiency, and teacher preference of scripted and unscripted task analyzed lesson plans from an elementary science curriculum designed for students with intellectual disability and autism spectrum disorder by evaluating both lesson formats for (a) student outcomes on a science comprehension assessment, (b) sessions to criterion, and (c) average duration of lessons. Findings propose both lesson types were equally effective, but unscripted task analyzed versions may be more efficient and were preferred by teachers to scripted lessons. Implications, limitations, and suggestions for future research are also discussed.

Decision and Game Theory for Security

NASA Astrophysics Data System (ADS)

Alpcan, Tansu; Buttyán, Levente; Baras, John S.

Attack--defense trees are used to describe security weaknesses of a system and possible countermeasures. In this paper, the connection between attack--defense trees and game theory is made explicit. We show that attack--defense trees and binary zero-sum two-player extensive form games have equivalent expressive power when considering satisfiability, in the sense that they can be converted into each other while preserving their outcome and their internal structure.

Tampering detection system using quantum-mechanical systems

DOEpatents

Humble, Travis S [Knoxville, TN; Bennink, Ryan S [Knoxville, TN; Grice, Warren P [Oak Ridge, TN

2011-12-13

The use of quantum-mechanically entangled photons for monitoring the integrity of a physical border or a communication link is described. The no-cloning principle of quantum information science is used as protection against an intruder's ability to spoof a sensor receiver using a `classical` intercept-resend attack. Correlated measurement outcomes from polarization-entangled photons are used to protect against quantum intercept-resend attacks, i.e., attacks using quantum teleportation.

Risk-based decision making for staggered bioterrorist attacks : resource allocation and risk reduction in "reload" scenarios.

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

Lemaster, Michelle Nicole; Gay, David M.; Ehlen, Mark Andrew

2009-10-01

Staggered bioterrorist attacks with aerosolized pathogens on population centers present a formidable challenge to resource allocation and response planning. The response and planning will commence immediately after the detection of the first attack and with no or little information of the second attack. In this report, we outline a method by which resource allocation may be performed. It involves probabilistic reconstruction of the bioterrorist attack from partial observations of the outbreak, followed by an optimization-under-uncertainty approach to perform resource allocations. We consider both single-site and time-staggered multi-site attacks (i.e., a reload scenario) under conditions when resources (personnel and equipment whichmore » are difficult to gather and transport) are insufficient. Both communicable (plague) and non-communicable diseases (anthrax) are addressed, and we also consider cases when the data, the time-series of people reporting with symptoms, are confounded with a reporting delay. We demonstrate how our approach develops allocations profiles that have the potential to reduce the probability of an extremely adverse outcome in exchange for a more certain, but less adverse outcome. We explore the effect of placing limits on daily allocations. Further, since our method is data-driven, the resource allocation progressively improves as more data becomes available.« less

Reconstruction of improvised explosive device blast loading to personnel in the open

NASA Astrophysics Data System (ADS)

Wiri, Suthee; Needham, Charles

2016-05-01

Significant advances in reconstructing attacks by improvised explosive devices (IEDs) and other blast events are reported. A high-fidelity three-dimensional computational fluid dynamics tool, called Second-order Hydrodynamic Automatic Mesh Refinement Code, was used for the analysis. Computer-aided design models for subjects or vehicles in the scene accurately represent geometries of objects in the blast field. A wide range of scenario types and blast exposure levels were reconstructed including free field blast, enclosed space of vehicle cabin, IED attack on a vehicle, buried charges, recoilless rifle operation, rocket-propelled grenade attack and missile attack with single subject or multiple subject exposure to pressure levels from ˜ 27.6 kPa (˜ 4 psi) to greater than 690 kPa (>100 psi). To create a full 3D pressure time-resolved reconstruction of a blast event for injury and blast exposure analysis, a combination of intelligence data and Blast Gauge data can be used to reconstruct an actual in-theatre blast event. The methodology to reconstruct an event and the "lessons learned" from multiple reconstructions in open space are presented. The analysis uses records of blast pressure at discrete points, and the output is a spatial and temporal blast load distribution for all personnel involved.

Lessons Learned in Over a Decade of Technical Support for U.S. Nuclear Cyber Security Programmes

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

Glantz, Clifford S.; Landine, Guy P.; Craig, Philip A.

Pacific Northwest National Laboratory’s (PNNL) nuclear cyber security team has been providing technical support to the U.S. Nuclear Regulatory Commission (NRC) since 2002. This team has provided cyber security technical experties in conducting cyber security inspections, developing of regulatory rules and guidance, reviewing facility cyber security plans, developing inspection guidance, and developing and teaching NRC inspectors how to conduct cyber security assessments. The extensive experience the PNNL team has gathered has allowed them to compile a lenghty list of recommendations on how to improve cyber security programs and conduct assessments. A selected set of recommendations are presented, including the needmore » to: integrate an array of defenisve strategies into a facility’s cyber security program, coordinate physical and cyber security activities, train phycial security forces to resist a cyber-enabled physical attack, improve estimates of the consequences of a cyber attack, properly resource cyber security assessments, appropropriately account for insider threats, routinely monitor security devices for potential attacks, supplement compliance-based requirements with risk-based decision making, and introduce the concept of resilience into cyber security programs.« less

An Analysis of Strategies for Teaching Standards-Based Lesson Plan Alignment to Preservice Teachers

ERIC Educational Resources Information Center

Drost, Bryan R.; Levine, Anita C.

2015-01-01

Research consistently shows that well-aligned lesson plans lead to better student learning outcomes. The development of these plans challenges both preservice teachers and the teacher educators who instruct them. This exploratory study examined strategies for teaching lesson plan alignment utilized by 87 teacher educators in the United States.…

Operation ANVIL/DRAGOON: The Invasion of Southern France, Offensive, Deliberate Assault, Amphibious, 15 August-1 September 1944

DTIC Science & Technology

1984-05-01

QUADRANT —where it was agreed a diversionary attack -for OVERLORD would take place in southern France. The operation, as proposed by the Americans...diversionary attack in southern France was codified by the American and British leadership at QUADRANT , the issue was again heavily debated by the "Big...the outcome at the war. Ore can ssv that the outcome ot the war in Europa was decided when operation OVERLORD was approved ior execution. The battle

Introducing the Future Now: Using Memetics and Popular Culture to Identify the Post-9/11 Homeland Security Zeitgeist

DTIC Science & Technology

2008-03-01

the case within NCIS. Law and Order: Criminal Intent Episode 30 February 27, 2007 A reporter is poisoned with Polonium - 210 and the FBI joins the... effect did the terrorist attacks on September 11, 2001 have on American culture? One outcome was the emergence of “homeland security” as a new...ABSTRACT What effect did the terrorist attacks on September 11, 2001, have on American culture? One outcome was the emergence of “homeland security” as

Security Assessment of Cyberphysical Digital Microfluidic Biochips.

PubMed

Ali, Sk Subidh; Ibrahim, Mohamed; Sinanoglu, Ozgur; Chakrabarty, Krishnendu; Karri, Ramesh

2016-01-01

A digital microfluidic biochip (DMFB) is an emerging technology that enables miniaturized analysis systems for point-of-care clinical diagnostics, DNA sequencing, and environmental monitoring. A DMFB reduces the rate of sample and reagent consumption, and automates the analysis of assays. In this paper, we provide the first assessment of the security vulnerabilities of DMFBs. We identify result-manipulation attacks on a DMFB that maliciously alter the assay outcomes. Two practical result-manipulation attacks are shown on a DMFB platform performing enzymatic glucose assay on serum. In the first attack, the attacker adjusts the concentration of the glucose sample and thereby modifies the final result. In the second attack, the attacker tampers with the calibration curve of the assay operation. We then identify denial-of-service attacks, where the attacker can disrupt the assay operation by tampering either with the droplet-routing algorithm or with the actuation sequence. We demonstrate these attacks using a digital microfluidic synthesis simulator. The results show that the attacks are easy to implement and hard to detect. Therefore, this work highlights the need for effective protections against malicious modifications in DMFBs.

Improving Weight Loss Outcomes of Community Interventions by Incorporating Behavioral Strategies

PubMed Central

Crane, Melissa M.; Thomas, J. Graham; Kumar, Rajiv; Weinberg, Brad

2010-01-01

Objectives. We examined whether adding behavioral weight loss strategies could improve the outcomes of a community weight loss campaign. Methods. Shape Up RI is a 12-week, online, team-based program for health improvement in Rhode Island. In study 1, we randomly assigned participants to the standard Shape Up RI program or to the program plus video lessons on weight loss. In study 2, we randomly assigned participants to the standard program or to the program plus video lessons; daily self-monitoring of weight, eating, and exercise; and computer-generated feedback. Results. Adding video lessons alone (study 1) did not result in significantly improved weight loss (2.0 ±2.8 kg vs 1.4 ±2.9 kg; P = .15). However, when the video lessons were supplemented with self-monitoring and feedback (study 2), the average weight loss more than doubled (3.5 ±3.8 kg vs 1.4 ±2.7 kg; P < .01), and the proportion of individuals achieving a weight loss of 5% or more tripled (40.5% vs 13.2%; P < .01). Participants in study 2 submitted self-monitoring records on 78% of days, and adherence was significantly related to outcome. Conclusions. Adding behavioral strategies to community campaigns may improve weight loss outcomes with minimal additional cost. PMID:20966375

Lift-fan aircraft: Lessons learned-the pilot's perspective

NASA Technical Reports Server (NTRS)

Gerdes, Ronald M.

1993-01-01

This paper is written from an engineering test pilot's point of view. Its purpose is to present lift-fan 'lessons learned' from the perspective of first-hand experience accumulated during the period 1962 through 1988 while flight testing vertical/short take-off and landing (V/STOL) experimental aircraft and evaluating piloted engineering simulations of promising V/STOL concepts. Specifically, the scope of the discussions to follow is primarily based upon a critical review of the writer's personal accounts of 30 hours of XV-5A/B and 2 hours of X-14A flight testing as well as a limited simulator evaluation of the Grumman Design 755 lift-fan aircraft. Opinions of other test pilots who flew these aircraft and the aircraft simulator are also included and supplement the writer's comments. Furthermore, the lessons learned are presented from the perspective of the writer's flying experience: 10,000 hours in 100 fixed- and rotary-wing aircraft including 330 hours in 5 experimental V/STOL research aircraft. The paper is organized to present to the reader a clear picture of lift-fan lessons learned from three distinct points of view in order to facilitate application of the lesson principles to future designs. Lessons learned are first discussed with respect to case histories of specific flight and simulator investigations. These principles are then organized and restated with respect to four selected design criteria categories in Appendix I. Lastly, Appendix Il is a discussion of the design of a hypothetical supersonic short take-off vertical landing (STOVL) fighter/attack aircraft.

Investigating the Aftermath of Terror: Fundamental Outcomes, Methodological Choices, and Future Directions.

PubMed

Gradus, Jaimie L; Marx, Brian P; Sloan, Denise M

2016-06-01

Acts of terrorism are becoming increasingly common throughout the world. These events represent a significant public health concern given the associated health consequences. Although it is clear that terrorist attacks have mental and physical health sequelae, the exact nature and prevalence of these consequences are unclear. Epidemiological research can play an important role in better understanding the mental and physical impact of terrorist attacks. In this editorial, we highlight recent epidemiological research on these terrorism-related health outcomes. We also provide suggestions for how future studies can build on the existing literature and describe ways in which epidemiological methods can be harnessed to extend the current literature. Lastly, we offer recommendations on how to best prepare communities for the aftermath of terrorist attacks, highlighting secondary intervention and prevention strategies. Overall, multilevel strategies are needed to adequately cope with the growing rise of terrorist acts, and these strategies will have to be reassessed as the nature of terrorist attacks changes.

How Belfius Bank's response to the terrorist attacks in Brussels helped embed business continuity in the company culture.

PubMed

Jappens, Ludo

2017-01-01

Until 2015, major terrorist incidents in Belgium were considered a 'black swan'. However, the suicide attacks in Paris on 13th November, 2015 provided a wake-up call. Investigations revealed that the raid was prepared in Belgium by jihadists who grew up in Brussels and was coordinated by Belgian ISIS fighters in Syria. In an instant, it became clear that terror had been embedded in Belgian society and could erupt at any moment. At Belfius Bank Belgium, the subsequent months were a rollercoaster ride of terrorist-related events. Business activities were strongly affected, as the company's head office is located in the centre of Brussels. This paper focuses on the way Belfius responded to the events and how the lessons learned have helped to improve its business continuity and crisis management capability.

Deterrence from Cold War to Long War: Lessons from Six Decades of RAND Research

DTIC Science & Technology

2008-01-01

highly credible intention. Declaring an intention to retaliate for an attack on U.S. territory was no threat in Schelling’s formulation ; it was a...unconditional commitments are not rational . We shall say 14 Deterrence—From Cold War to Long War that they represent a non- rational element in...this method is impractical. Another strategy that Schelling discussed was embracing non- rationality and simply giving the impression that U.S

Blended-Wing-Body Low-Speed Flight Dynamics: Summary of Ground Tests and Sample Results

NASA Technical Reports Server (NTRS)

Vicroy, Dan D.

2009-01-01

A series of low-speed wind tunnel tests of a Blended-Wing-Body tri-jet configuration to evaluate the low-speed static and dynamic stability and control characteristics over the full envelope of angle of attack and sideslip are summarized. These data were collected for use in simulation studies of the edge-of-the-envelope and potential out-of-control flight characteristics. Some selected results with lessons learned are presented.

Logistical Support for the Heavy-Light Mix,

DTIC Science & Technology

1988-01-20

determination to learn from history. While the physical ability to support this force is marginal, the logistical procedures, concepts of support, and a...others. £ They emphasized arni-or and mechanized in 4 antry which could keep pace with the tanks. 2 -- t. - - - - *i . h -I. -o, ., . i. . -. rJIPT...Army received a costly review of the combined arms lessons learned during WW II. In June. 1950, the North Korean Army launched an all-out attack into

3-D Soviet Style: A Presentation on Lessons Learned from the Soviet Experience in Afghanistan

DTIC Science & Technology

2007-10-01

communication and to the efforts the Soviets made in building Afghan security forces. It includes information on the theory and practice of Soviet...state-building; lines of communication are a critical vulnerability to insurgent attacks; successive battlefield victories do not guarantee strategic...rouge en ce qui concerne la sécurisation de ses voies de communication . Un accent particulier est également mis sur les efforts soviétiques visant à

Al Sahawa - The Awakening. Volume V: Al Anbar Province, Area of Operations Raleigh, Fallujah

DTIC Science & Technology

2016-08-01

Arabic. 2 The Corridor defines a 70-mile stretch of communities along the Euphrates from Hadithah to Hit. 3 Fallujah was operationally important to...analysis and lessons, many of which are transferrable to current and future conflicts. The ultimate product is a multimedia instructional package to...stretch of communities along the Euphrates from Hadithah to Hit. 22 Fallujah was operationally important to the insurgents as a launching pad for attacks

Examining the Statistical Rigor of Test and Evaluation Results in the Live, Virtual and Constructive Environment

DTIC Science & Technology

2011-06-01

Committee Meeting. 23 June 2008. Bjorkman, Eileen A. and Frank B. Gray . “Testing in a Joint Environment 2004-2008: Findings, Conclusions and...the LVC joint test environment to evaluate system performance and joint mission effectiveness (Bjorkman and Gray 2009a). The LVC battlespace...attack (Bjorkman and Gray 2009b). Figure 3 - JTEM Methodology (Bjorkman 2008) A key INTEGRAL FIRE lesson learned was realizing the need for each

Seizing the Lodgment: Forcible Entry Lessons from Panama and the Falklands

DTIC Science & Technology

2016-05-10

combat power long before the initiation of hostilities. The Army began deployment of additional troops in early 1989 as part of Operation Nimrod ...Dancer, an effort to bolster existing US forces in Panama in response to instability. As part of Nimrod Dancer, the Army deployed an additional brigade...90 1) Task Force Atlantic. 7th Infantry Division elements stationed in Panama as part of Operation Nimrod Dancer. Attacked H-hour targets north of

Studying Acute Coronary Syndrome Through the World Wide Web: Experiences and Lessons.

PubMed

Alonzo, Angelo A

2017-10-13

This study details my viewpoint on the experiences, lessons, and assessments of conducting a national study on care-seeking behavior for heart attack in the United States utilizing the World Wide Web. The Yale Heart Study (YHS) was funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH). Grounded on two prior studies, the YHS combined a Web-based interview survey instrument; ads placed on the Internet; flyers and posters in public libraries, senior centers, and rehabilitation centers; information on chat rooms; a viral marketing strategy; and print ads to attract potential participants to share their heart attack experiences. Along the way, the grant was transferred from Ohio State University (OSU) to Yale University, and significant administrative, information technology, and personnel challenges ensued that materially delayed the study's execution. Overall, the use of the Internet to collect data on care-seeking behavior is very time consuming and emergent. The cost of using the Web was approximately 31% less expensive than that of face-to-face interviews. However, the quality of the data may have suffered because of the absence of some data compared with interviewing participants. Yet the representativeness of the 1154 usable surveys appears good, with the exception of a dearth of African American participants. ©Angelo A Alonzo. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 13.10.2017.

The Alberta Stroke Prevention in TIAs and mild strokes (ASPIRE) intervention: rationale and design for evaluating the implementation of a province-wide TIA triaging system.

PubMed

Jeerakathil, Thomas; Shuaib, Ashfaq; Majumdar, Sumit R; Demchuk, Andrew M; Butcher, Kenneth S; Watson, Tim J; Dean, Naeem; Gordon, Deb; Edmond, Cathy; Coutts, Shelagh B

2014-10-01

Stroke risk after transient ischaemic attack is high and, it is a challenge worldwide to provide urgent assessment and preventive services to entire populations. To determine whether a province-wide transient ischaemic attack Triaging algorithm and transient ischaemic attack hotline (the Alberta Stroke Prevention in transient ischaemic attacks and mild strokes intervention) can reduce the rate of stroke recurrence following transient ischaemic attack across the population of Alberta, Canada (population 3·7 million, 90-day rate of post-stroke transient ischaemic attack currently 9·5%). It also seeks to improve upon current transient ischaemic attack triaging rules by incorporating time from symptom onset as a predictive variable. The transient ischaemic attack algorithm and hotline were developed with a broad consensus of clinicians, patients, policy-makers, and researchers and based on local adaptation of the work of others and research and insights developed within the province. Because neither patient-level nor region-level randomization was possible, we conducted a quasi-experimental design examining changes in the post-transient ischaemic attack rate of stroke recurrence before and after the 15-month implementation period using an interrupted time-series regression analysis. The design controls for changes in case-mix, co-interventions, and secular trends. A prospective transient ischaemic attack cohort will also be concurrently created with telephone follow-up at seven-days and 90 days as well as passive follow-up over the longer term using linkages to provincial healthcare administrative databases. The primary outcome measure is the change in recurrence rate of stroke following transient ischaemic attack at seven-days and 90 days, comparing a period of two-years before vs. two-years after the intervention is implemented. All cases of recurrent stroke will be validated. Secondary outcomes include functional status, hospitalizations, morbidity, and mortality. We are undertaking a rigorous evaluation of a population-based approach to improving quality of transient ischaemic attack care. Whether positive or negative, our work should provide important insights for all potential stakeholders. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

Alkaptonuria: An example of a "fundamental disease"--A rare disease with important lessons for more common disorders.

PubMed

Gallagher, James A; Dillon, Jane P; Sireau, Nicolas; Timmis, Oliver; Ranganath, Lakshminarayan R

2016-04-01

"Fundamental diseases" is a term introduced by the charity Findacure to describe rare genetic disorders that are gateways to understanding common conditions and human physiology. The concept that rare diseases have important lessons for biomedical science has been recognised by some of the great figures in the history of medical research, including Harvey, Bateson and Garrod. Here we describe some of the recently discovered lessons from the study of the iconic genetic disease alkaptonuria (AKU), which have shed new light on understanding the pathogenesis of osteoarthritis. In AKU, ochronotic pigment is deposited in cartilage when collagen fibrils become susceptible to attack by homogentisic acid (HGA). When HGA binds to collagen, cartilage matrix becomes stiffened, resulting in the aberrant transmission of loading to underlying subchondral bone. Aberrant loading leads to the formation of pathophysiological structures including trabecular excrescences and high density mineralised protrusions (HDMPs). These structures initially identified in AKU have subsequently been found in more common osteoarthritis and appear to play a role in joint destruction in both diseases. Copyright © 2016 Elsevier Ltd. All rights reserved.

Psychosocial predictors of resilience after the September 11, 2001 terrorist attacks.

PubMed

Butler, Lisa D; Koopman, Cheryl; Azarow, Jay; Blasey, Christine M; Magdalene, Juliette C; DiMiceli, Sue; Seagraves, David A; Hastings, T Andrew; Chen, Xin-Hua; Garlan, Robert W; Kraemer, Helena C; Spiegel, David

2009-04-01

The terrorist attacks of September 11, 2001 inflicted distress beyond those directly exposed, thereby providing an opportunity to examine the contributions of a range of factors (cognitive, emotional, social support, coping) to psychological resilience for those indirectly exposed. In an Internet convenience sample of 1281, indices of resilience (higher well-being, lower distress) at baseline (2.5-12 weeks post-attack) were each associated with less emotional suppression, denial and self-blame, and fewer negative worldview changes. After controlling for initial outcomes, baseline negative worldview changes and aspects of social support and coping all remained significant predictors of 6-month outcomes, with worldview changes bearing the strongest relationship to each. These findings highlight the role of emotional, coping, social support, and particularly, cognitive variables in adjustment after terrorism.

Lessons from mosquitoes' painless piercing.

PubMed

Gurera, Dev; Bhushan, Bharat; Kumar, Navin

2018-05-18

Arthropods are the largest group of the living organisms. They attack other organisms by biting, stinging, or piercing and sucking. Among various medically important arthropods, which feed on living hosts, mosquitoes' piercing spread viruses which have been reported to cause the highest number of deaths annually. The primary cause of the deaths is malaria, which is spread by infected mosquitoes' piercing. This study aims at elucidating lessons from mosquitoes' painless piercing. Mosquitoes pierce using their fascicle, which is a bundle of coherently functioning six stylets. Based on experiments and available literature, it is presented that mosquitoes painlessly pierce using a combination of the numbing, the fascicle's serrated design, the vibratory actuation, and the graded and frequency-dependent mechanical properties of the labrum. Based on this understanding, a mosquito-inspired microneedle design has also been proposed. Copyright © 2018 Elsevier Ltd. All rights reserved.

Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood.

PubMed

Hamil-Luker, Jenifer; O'Rand, Angela M

2007-02-01

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.

Ticagrelor in Acute Stroke or Transient Ischemic Attack in Asian Patients: From the SOCRATES Trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes).

PubMed

Wang, Yongjun; Minematsu, Kazuo; Wong, Ka Sing Lawrence; Amarenco, Pierre; Albers, Gregory W; Denison, Hans; Easton, J Donald; Evans, Scott R; Held, Peter; Jonasson, Jenny; Molina, Carlos A; Johnston, S Claiborne

2017-01-01

In the SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes), ticagrelor was not superior to aspirin. Because of differences in patient demographics and stroke disease pattern in Asia, outcomes of ticagrelor versus aspirin were assessed among Asian patients in a prespecified exploratory analysis. Baseline demographics, treatment effects, and safety of ticagrelor and aspirin were assessed among Asian patients. Differences in outcomes between groups were assessed using Cox proportional hazard model. A total of 3858 (29.2%) SOCRATES participants were recruited in Asia. Among the Asian patients, the primary end point event occurred in 186 (9.6%) of the 1933 patients treated with ticagrelor, versus 224 (11.6%) of the 1925 patients treated with aspirin (hazard ratio, 0.81; 95% confidence interval, 0.67-0.99). The exploratory P value for treatment-by-region interaction was 0.27. The primary end point event rate in the Asian subgroup was numerically higher than that in the non-Asian group (10.6% versus 5.7%; nominal P<0.01). Among the Asian patients, the rate of PLATO (Platelet Inhibition and Patient Outcomes)-defined major bleeding was similar in the ticagrelor group and the aspirin group (0.6% versus 0.8%; hazard ratio, 0.76; 95% confidence interval, 0.36-1.61). The event rates were numerically higher in the Asian patients. Among the Asian patients with acute stroke or transient ischemic attacks, there was a trend toward a lower hazard ratio in reducing risk of the primary end point of stroke, myocardial infarction, or death in the ticagrelor group. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720. © 2016 American Heart Association, Inc.

Pedagogical Techniques and Student Outcomes in Applied Instrumental Lessons Taught by Experienced and Pre-Service American Music Teachers

ERIC Educational Resources Information Center

Henninger, Jacqueline C.; Flowers, Patricia J.; Councill, Kimberly H.

2006-01-01

The purpose of the study was to examine the effect of teacher experience on student progress and performance quality in an introductory applied lesson. Nine experienced teachers and 15 pre-service teachers taught an adult beginner to play "Mary Had a Little Lamb" on a wind instrument. The lessons were videotaped for subsequent analysis of teaching…

Doomed to Repeat It How the United States Air Force Can Apply History via Counterinsurgency Lessons Learned to Meet Anti-Access/Area Denial Challenges

DTIC Science & Technology

2012-08-01

technology used in the COIN fight are not readily transferable to conflicts against enemies using A2/AD tactics, such as heavy electromagnetic attack...particularly when matched against a technology advanced enemy. Technologies unsuitable for an opposed electromagnetic spectrum are unsurvivable...increased numbers of weapons systems such as the MQ-1, MQ-9, and MC-12. Additionally, open-ended deployments of ISR assets such as the RC-135 RIVET

Marine Corps Center for Lessons Learned. Volume 8, Issue 11, November 2012

DTIC Science & Technology

2012-11-01

place throughout the month of July 2012 and involved 25,000 personnel from twenty-two nations and more than 40 ships and 200 aircraft. Marine Corps...from July to September 2012. Many of the principal commanders and key staff personnel who participated in the exercise were interviewed by MCCLL...01 January - 31 July 2012 (MCCLL) 2. 1st Battalion, 8th Marines (1/8) OEF 12.1 After Action Report (AAR) 3. Marine Attack Squadron 211 (VMA-211

Victory From Above. Air Power Theory and the Conduct of Operations Desert Shield and Desert Storm

DTIC Science & Technology

1994-06-01

Or Why Did We Do It That Way?’ in Air Power. CollectedffEsay on Doctrine ed. Andrew Vallance (London: Her Askleatys Stationery Office, 1990), 17-30...York: National Strategy Information Center, 1983); Richard K Bette, Surprise Attack: Lessons for Defense Planning (Washington, D.C.: Brookings...Chart MI.H.3; Cordesman, 570. 21. Richard Mackenxie, "A Conversation with Chuck Homer,’ Air Force Magazine, June 1991, 57-58; Blackwell, 85-86. 22

Interleukin-5 Inhibitors for Severe Asthma: Rationale and Future Outlook.

PubMed

Shrimanker, Rahul; Pavord, Ian D

2017-04-01

In this review, we outline the pathophysiology of severe asthma and discuss the role of anti-interleukin (IL)-5 inhibitors for the treatment of asthma. Anti-IL-5 treatments have shown efficacy in reducing the rate of severe asthma attacks in eosinophilic asthma. We review the history of the development of these agents, lessons learnt about severe asthma along the way and key clinical trials supporting efficacy of the three anti-IL-5 treatments that are clinically available or undergoing clinical trials in asthma.

Psychological Effects of U.S. Air Operations in Four Wars, 1941 - 1991. Lessons for the Commanders.

DTIC Science & Technology

1995-01-01

enemy leaders are likely to attach high value to their retention of power and personal survival. To create negotiating leverage from these...and drive civilian workers away from their war- production jobs . Attacks on strategic targets have also been designed to induce other external...finished the job ." See Will p. A21; William Drozdiak, "Armed Dissent in Baghdad, Saddam ReBaans His Washington PqstMay 2, 1991, p. A29; Alan Cowell

Psychological Effects of U.S. Air Operations in Four Wars, 1941-1991. Lessons for U.S. Commanders,

DTIC Science & Technology

1996-01-01

attach high value to their retention of power and personal survival. To create negotiating leverage from these fundamental enemy inter- ests, a...Objectives 7 to demoralize and drive civilian workers away from their war- production jobs . Attacks on strategic targets have also been designed to...Iraqi put it, the U.S. forces "should have come to Baghdad and finished the job ." See Williams (1991), p. A21; William Drozdiak, "Armed Dissent in

Transforming to Effects-Based Operations: Lessons from the United Kingdom Experience

DTIC Science & Technology

2008-01-01

acquisition of the Airborne Stand-off Radar ( ASTOR ) ground surveillance system which links into the American Joint Surveillance and Attack Radar System...Pumas and the navy’s Sea King HC4s are very old and struggling to cope with the climates in which they are now operating. SECTION 4 The ongoing...Vol. 80, No. 1, pp. 49-62. 21. Tom King , House of Commons Parliamentary Debates, Statement on Defence “Options for Change,” July 25, 1990, session

Air Superiority and Airfield Attack - Lessons from History.

DTIC Science & Technology

1984-05-15

escaped the port of Dunkirk and the Luftwaffe had failed miserably to fulfill Giring’s unwarranted boast, "My.Luftwaffe will do it alone.",25 In the forty...AMIENS + CHERBOURG LE HARV" le11 0+ + Figure 2. Combat environment. 35 a single-engine fighter with a flashing fuel-warning light or oil streaming...Brussels-Evere (c) Brussels-Grimbergen (d) Brussels-Melsbrock (e) Antwerp-Durne (f) St. Trond (g) Le Culot (h) Asch (2) Holland (a) Eindhoven, and

The Icatibant Outcome Survey: experience of hereditary angioedema management from six European countries.

PubMed

Caballero, T; Aberer, W; Longhurst, H J; Maurer, M; Zanichelli, A; Perrin, A; Bouillet, L; Andresen, I

2017-07-01

Hereditary angioedema (HAE) due to C1-inhibitor deficiency (C1-INH-HAE) is a rare, potentially fatal, bradykinin-mediated disease. Icatibant is a bradykinin B2 receptor antagonist originally approved in 2008 in the European Union and 2011 in the United States as an acute therapy option for HAE attacks in adults. To compare demographics, disease characteristics and treatment outcomes of icatibant-treated HAE attacks in patients with C1-INH-HAE enrolled in the Icatibant Outcome Survey across six European countries: Austria, France, Germany, Italy, Spain and the UK. The Icatibant Outcome Survey [IOS; Shire, Zug, Switzerland (NCT01034969)] is an international observational study monitoring the safety and effectiveness of icatibant. Descriptive, retrospective analyses compared IOS country data derived during July 2009-April 2015. Overall, 481 patients with C1-INH-HAE provided demographic data. A significant difference across countries in age at onset (P = 0.003) and baseline attack frequency (P < 0.001) was found although no significant differences were found with respect to gender (majority female; P = 0.109), age at diagnosis (P = 0.182) or delay in diagnosis (P = 0.059). Icatibant was used to treat 1893 attacks in 325 patients with majority self-administration in all countries. Overall, significant differences (all P < 0.001) were found across countries in time to treatment [median 1.8 h; median range: 0.0 (Germany-Austria) to 4.4 (France) h], time to resolution [median 6.5 h; median range: 3 (Germany-Austria) to 12 (France) h] and attack duration [median 10.5 h; median range: 3.1 (Germany-Austria) to 18.5 (France) h]. These data form the first European cross-country comparison of disease characteristics and icatibant use in patients with C1-INH-HAE who are enrolled in IOS. International variation in icatibant practice and treatment outcomes across the six European countries assessed highlight the need to further investigate the range of country-specific parameters driving regional variations in icatibant use. © 2017 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.

Network Robustness: the whole story

NASA Astrophysics Data System (ADS)

Longjas, A.; Tejedor, A.; Zaliapin, I. V.; Ambroj, S.; Foufoula-Georgiou, E.

2014-12-01

A multitude of actual processes operating on hydrological networks may exhibit binary outcomes such as clean streams in a river network that may become contaminated. These binary outcomes can be modeled by node removal processes (attacks) acting in a network. Network robustness against attacks has been widely studied in fields as diverse as the Internet, power grids and human societies. However, the current definition of robustness is only accounting for the connectivity of the nodes unaffected by the attack. Here, we put forward the idea that the connectivity of the affected nodes can play a crucial role in proper evaluation of the overall network robustness and its future recovery from the attack. Specifically, we propose a dual perspective approach wherein at any instant in the network evolution under attack, two distinct networks are defined: (i) the Active Network (AN) composed of the unaffected nodes and (ii) the Idle Network (IN) composed of the affected nodes. The proposed robustness metric considers both the efficiency of destroying the AN and the efficiency of building-up the IN. This approach is motivated by concrete applied problems, since, for example, if we study the dynamics of contamination in river systems, it is necessary to know both the connectivity of the healthy and contaminated parts of the river to assess its ecological functionality. We show that trade-offs between the efficiency of the Active and Idle network dynamics give rise to surprising crossovers and re-ranking of different attack strategies, pointing to significant implications for decision making.

Panic attack history and anxiety sensitivity in relation to cognitive-based smoking processes among treatment-seeking daily smokers.

PubMed

Johnson, Kirsten A; Farris, Samantha G; Schmidt, Norman B; Smits, Jasper A J; Zvolensky, Michael J

2013-01-01

Empirical research has found that panic attacks are related to increased risk of more severe nicotine withdrawal and poor cessation outcome. Anxiety sensitivity (AS; fear of anxiety and related sensations) has similarly been found to be related to an increased risk of acute nicotine withdrawal and poorer cessation outcome. However, research has yet to examine the relative contributions of panic attacks and AS in terms of cognitive-based smoking processes (e.g., negative reinforcement smoking expectancies, addictive and negative affect-based reduction smoking motives, barriers to cessation, problem symptoms experienced while quitting). Participants (n = 242; 57.4% male; M (age) = 38.1) were daily smokers recruited as a part of a larger randomized control trial for smoking cessation. It was hypothesized that both panic attacks and AS would uniquely and independently predict the studied cognitive-based smoking processes. As hypothesized, AS was uniquely and positively associated with all smoking processes after controlling for average number of cigarettes smoked per day, current Axis I diagnosis, and participant sex. However, panic attack history was only significantly related to problem symptoms experienced while quitting smoking. Although past research has demonstrated significant associations between panic attacks and certain aspects of cigarette smoking (e.g., severity of nicotine withdrawal; lower abstinence rates, and negative affect reduction motives), the present findings suggest that AS may be more relevant to understanding beliefs about and motives for smoking behavior as well as perceptions of cessation-related difficulties.

Baseline heartbeat perception accuracy and short-term outcome of brief cognitive-behaviour therapy for panic disorder with agoraphobia.

PubMed

Masdrakis, Vasilios G; Legaki, Emilia-Maria; Vaidakis, Nikolaos; Ploumpidis, Dimitrios; Soldatos, Constantin R; Papageorgiou, Charalambos; Papadimitriou, George N; Oulis, Panagiotis

2015-07-01

Increased heartbeat perception accuracy (HBP-accuracy) may contribute to the pathogenesis of Panic Disorder (PD) without or with Agoraphobia (PDA). Extant research suggests that HBP-accuracy is a rather stable individual characteristic, moreover predictive of worse long-term outcome in PD/PDA patients. However, it remains still unexplored whether HBP-accuracy adversely affects patients' short-term outcome after structured cognitive behaviour therapy (CBT) for PD/PDA. To explore the potential association between HBP-accuracy and the short-term outcome of a structured brief-CBT for the acute treatment of PDA. We assessed baseline HBP-accuracy using the "mental tracking" paradigm in 25 consecutive medication-free, CBT-naive PDA patients. Patients then underwent a structured, protocol-based, 8-session CBT by the same therapist. Outcome measures included the number of panic attacks during the past week, the Agoraphobic Cognitions Questionnaire (ACQ), and the Mobility Inventory-Alone subscale (MI-alone). No association emerged between baseline HBP-accuracy and posttreatment changes concerning number of panic attacks. Moreover, higher baseline HBP-accuracy was associated with significantly larger reductions in the scores of the ACQ and the MI-alone scales. Our results suggest that in PDA patients undergoing structured brief-CBT for the acute treatment of their symptoms, higher baseline HBP-accuracy is not associated with worse short-term outcome concerning panic attacks. Furthermore, higher baseline HBP-accuracy may be associated with enhanced therapeutic gains in agoraphobic cognitions and behaviours.

Fetal sex modifies effects of prenatal stress exposure and adverse birth outcomes.

PubMed

Wainstock, Tamar; Shoham-Vardi, Ilana; Glasser, Saralee; Anteby, Eyal; Lerner-Geva, Liat

2015-01-01

Prenatal maternal stress is associated with pregnancy complications, poor fetal development and poor birth outcomes. Fetal sex has also been shown to affect the course of pregnancy and its outcomes. The aim of this study was to evaluate whether fetal sex modifies the association between continuous exposure to life-threatening rocket attack alarms and adverse pregnancy outcomes. A retrospective cohort study was conducted in which the exposed group was comprised of 1846 women exposed to rocket-attack alarms before and during pregnancy. The unexposed group, with similar sociodemographic characteristics, delivered during the same period of time at the same medical center, but resided out of rocket-attack range. Multivariable models for each gender separately, controlling for possible confounders, evaluated the risk associated with exposure for preterm births (PTB), low birthweight (LBW), small for gestational age and small head circumference (HC). In both univariable and multivariable analyses exposure status was a significant risk factor in female fetuses only: PTB (adj. OR = 1.43; 1.04-1.96), LBW (adj. OR = 1.41; 1.02-1.95) and HC < 31 cm (adj. OR = 1.78; 1.11-2.88). In addition, regarding all adverse outcomes, the male-to-female ratio was higher in the exposed group than in the unexposed group. The findings support the hypothesis that male and female fetuses respond differentially to chronic maternal stress.

Psychologists and detainee interrogations: key decisions, opportunities lost, and lessons learned.

PubMed

Pope, Kenneth S

2011-01-01

After the 9-11 terrorist attacks, U.S. psychologists faced hard choices about what roles, if any, were appropriate for psychologists in the detainee interrogations conducted in settings such as the Bagram Airbase, the Abu Ghraib Prison, and the Guantanamo Bay Detention Camps. The American Psychological Association (APA) sparked intense controversy with its policies and public statements. This article reviews APA decisions, documents, and public statements in this area, in the context of major criticisms and responses to those criticisms. The review focuses on key issues: how the APA created and reported policies in the areas of ethics and national security; transparency; psychologists' professional identities; psychologists' qualifications; ethical-legal conflicts; policies opposing torture; interpretations of avoiding harm; and effective interrogations. It suggests lessons learned, missed opportunities, and questions in need of a fresh approach. © 2011 by Annual Reviews. All rights reserved

Adjustment Among Area Youth After the Boston Marathon Bombing and Subsequent Manhunt

PubMed Central

Dantowitz, Annie; Chou, Tommy; Edson, Aubrey L.; Elkins, R. Meredith; Kerns, Caroline; Brown, Bonnie; Green, Jennifer Greif

2014-01-01

BACKGROUND: The majority of research on terrorism-exposed youth has examined large-scale terrorism with mass casualties. Limited research has examined children’s reactions to terrorism of the scope of the Boston Marathon bombing. Furthermore, the extraordinary postattack interagency manhunt and shelter-in-place warning made for a truly unprecedented experience in its own right for families. Understanding the psychological adjustment of Boston-area youth in the aftermath of these events is critical for informing clinical efforts. METHODS: Survey of Boston-area parents/caretakers (N = 460) reporting on their child’s experiences during the attack week, as well as psychosocial functioning in the first 6 attack months. RESULTS: There was heterogeneity across youth in attack- and manhunt-related experiences and clinical outcomes. The proportion of youth with likely attack/manhunt-related posttraumatic stress disorder (PTSD) was roughly 6 times higher among Boston Marathon–attending youth than nonattending youth. Attack and manhunt experiences each uniquely predicted 9% of PTSD symptom variance, with manhunt exposures more robustly associated than attack-related exposures with a range of psychosocial outcomes, including emotional symptoms, conduct problems, hyperactivity/inattention, and peer problems. One-fifth of youth watched >3 hours of televised coverage on the attack day, which was linked to PTSD symptoms, conduct problems, and total difficulties. Prosocial behavior and positive peer functioning buffered the impact of exposure. CONCLUSIONS: Clinical efforts must maintain a broadened focus beyond simply youth present at the blasts and must also include youth highly exposed to the intense interagency pursuit and manhunt. Continued research is needed to understand the adjustment of youth after mass traumas and large-scale manhunts in residential communities. PMID:24918223

Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA.

PubMed

Smith, Wade S; Lev, Michael H; English, Joey D; Camargo, Erica C; Chou, Maggie; Johnston, S Claiborne; Gonzalez, Gilberto; Schaefer, Pamela W; Dillon, William P; Koroshetz, Walter J; Furie, Karen L

2009-12-01

Acute ischemic stroke due to large vessel occlusion (LVO)-vertebral, basilar, carotid terminus, middle and anterior cerebral arteries-likely portends a worse prognosis than stroke unassociated with LVO. Because little prospective angiographic data have been reported on a cohort of unselected patients with stroke and with transient ischemic attack, the clinical impact of LVO has been difficult to quantify. The Screening Technology and Outcome Project in Stroke Study is a prospective imaging-based study of stroke outcomes performed at 2 academic medical centers. Patients with suspected acute stroke who presented within 24 hours of symptom onset and who underwent multimodality CT/CT angiography were approached for consent for collection of clinical data and 6-month assessment of outcome. Demographic and clinical variables and 6-month modified Rankin Scale scores were collected and combined with blinded interpretation of the CT angiography data. The OR of each variable, including occlusion of intracranial vascular segment in predicting good outcome and 6-month mortality, was calculated using univariate and multivariate logistic regression. Over a 33-month period, 735 patients with suspected stroke were enrolled. Of these, 578 were adjudicated as stroke and 97 as transient ischemic attack. Among patients with stroke, 267 (46%) had LVO accounting for the stroke and 13 (13%) of patients with transient ischemic attack had LVO accounting for transient ischemic attack symptoms. LVO predicted 6-month mortality (OR, 4.5; 95% CI, 2.7 to 7.3; P<0.001). Six-month good outcome (modified Rankin Scale score

`Question Moments': A Rolling Programme of Question Opportunities in Classroom Science

NASA Astrophysics Data System (ADS)

Pedrosa-de-Jesus, Helena; Leite, Sara; Watts, Mike

2016-06-01

This naturalistic study integrates specific `question moments' into lesson plans to increase pupils' classroom interactions. A range of tools explored students' ideas by providing students with opportunities to ask and write questions. Their oral and written outcomes provide data on individual and group misunderstandings. Changes to the schedule of lessons were introduced to explore these questions and address disparities. Flexible lesson planning over 14 lessons across a 4-week period of high school chemistry accommodated students' contributions and increased student participation, promoted inquiring and individualised teaching, with each teaching strategy feeding forward into the next.

One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack: Korean Multicenter Stroke Registry Analysis.

PubMed

Park, Hong-Kyun; Kim, Beom Joon; Han, Moon-Ku; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae-Kwan; Kim, Dae-Hyun; Nah, Hyun-Wook; Park, Tai Hwan; Park, Sang-Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun-Sik; Cho, Yong-Jin; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi-Sun; Kim, Joon-Tae; Choi, Kang-Ho; Kim, Dong-Eog; Ryu, Wi-Sun; Choi, Jay Chol; Johansson, Saga; Lee, Su Jin; Lee, Won Hee; Lee, Ji Sung; Lee, Juneyoung; Bae, Hee-Joon

2017-11-01

Patients with minor ischemic stroke or transient ischemic attack are at high risk of recurrent stroke and vascular events, which are potentially disabling or fatal. This study aimed to evaluate contemporary subsequent vascular event risk after minor ischemic stroke or transient ischemic attack in Korea. Patients with minor ischemic stroke or high-risk transient ischemic attack admitted within 7 days of symptom onset were identified from a Korean multicenter stroke registry database. We estimated 3-month and 1-year event rates of the primary outcome (composite of stroke recurrence, myocardial infarction, or all-cause death), stroke recurrence, a major vascular event (composite of stroke recurrence, myocardial infarction, or vascular death), and all-cause death and explored differences in clinical characteristics and event rates according to antithrombotic strategies at discharge. Of 9506 patients enrolled in this study, 93.8% underwent angiographic assessment and 72.7% underwent cardiac evaluations; 25.1% had symptomatic stenosis or occlusion of intracranial arteries. At discharge, 95.2% of patients received antithrombotics (antiplatelet polytherapy, 37.1%; anticoagulation, 15.3%) and 86.2% received statins. The 3-month cumulative event rate was 5.9% for the primary outcome, 4.3% for stroke recurrence, 4.6% for a major vascular event, and 2.0% for all-cause death. Corresponding values at 1 year were 9.3%, 6.1%, 6.7%, and 4.1%, respectively. Patients receiving nonaspirin antithrombotic strategies or no antithrombotic agent had higher baseline risk profiles and at least 1.5× higher event rates for clinical event outcomes than those with aspirin monotherapy. Contemporary secondary stroke prevention strategies based on thorough diagnostic evaluation may contribute to the low subsequent vascular event rates observed in real-world clinical practice in Korea. © 2017 American Heart Association, Inc.

Robust allocation of a defensive budget considering an attacker's private information.

PubMed

Nikoofal, Mohammad E; Zhuang, Jun

2012-05-01

Attackers' private information is one of the main issues in defensive resource allocation games in homeland security. The outcome of a defense resource allocation decision critically depends on the accuracy of estimations about the attacker's attributes. However, terrorists' goals may be unknown to the defender, necessitating robust decisions by the defender. This article develops a robust-optimization game-theoretical model for identifying optimal defense resource allocation strategies for a rational defender facing a strategic attacker while the attacker's valuation of targets, being the most critical attribute of the attacker, is unknown but belongs to bounded distribution-free intervals. To our best knowledge, no previous research has applied robust optimization in homeland security resource allocation when uncertainty is defined in bounded distribution-free intervals. The key features of our model include (1) modeling uncertainty in attackers' attributes, where uncertainty is characterized by bounded intervals; (2) finding the robust-optimization equilibrium for the defender using concepts dealing with budget of uncertainty and price of robustness; and (3) applying the proposed model to real data. © 2011 Society for Risk Analysis.

Conceptual model of acid attacks based on survivor's experiences: Lessons from a qualitative exploration.

PubMed

Sabzi Khoshnami, Mohammad; Mohammadi, Elham; Addelyan Rasi, Hamideh; Khankeh, Hamid Reza; Arshi, Maliheh

2017-05-01

Acid attack, a worldwide phenomenon, has been increasing in recent years. In addition to severe injuries to the face and body, such violence leads to psychological and social problems that affect the survivors' quality of life. The present study provides a more in-depth understanding of this phenomenon and explores the nature and dimensions of acid attacks based on survivors' experiences. A grounded theory study using semi-structured, recorded interviews and applying purposeful theoretical sampling was conducted with 12 acid attack survivors in Iran. Data were analysed using constant comparison in open, axial and selective coding stages. A conceptual model was developed to explain the relationships among the main categories extracted through the grounded theory study. Physical and psychological wounds emerged as a core category. Traditional context and extreme beauty value in society acted as the context of the physical and psychological wounds experienced. Living with a drug abuser with behavioural disorders and lack of problem-solving skills in interpersonal conflict were found to be causal conditions. Action strategies to deal with this experience were found to be composed of individual, interpersonal and structural levels. Education, percentage and place of burning acted as intervening conditions that influenced survivors' strategies. Finally, adverse consequences of social deprivation and feeling helpless and hindered were found to have an important impact. Acid attack lead to physical and psychological wounds in survivors. This is a multi-dimensional phenomenon involving illness, disability, and victimization, and requires a wide range of strategies at different levels. The conceptual model derived through this study can serve as a good basis for intervention programs. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Outercourse: Exploring Nonpenetrative Forms of Pleasurable Safer Sex

ERIC Educational Resources Information Center

Bakaroudis, Maria

2014-01-01

Best practices in comprehensive sexuality education call for rights-based, factual lessons that provide healthy options and are sensitive to the varied contextual factors affecting participants. Further, lessons are to better balance positive and negative outcomes of sexual expression that reflect the sexual realities of (young) men and women.…

Reconstructing Economics in Light of the 2007-? Financial Crisis

ERIC Educational Resources Information Center

Friedman, Benjamin M.

2010-01-01

The lessons learned from the recent financial crisis should significantly reshape the economics profession's thinking, including, importantly, what we teach our students. Five such lessons are that we live in a monetary economy and therefore aggregate demand and policies that affect aggregate demand are determinants of real economic outcomes; that…

Courtside: Lesson Lost?

ERIC Educational Resources Information Center

Zirkel, Perry A.

2004-01-01

In this month's Courtside, the author will stray somewhat from his usual format of describing a single case. Instead, he will be presenting the details of two separate cases, both of which involve similar circumstances, rely on similar legal arguments, and have similar outcomes. Most important, both appear to carry the same lesson. The lessons…

A Tale of 2 Units: Lessons in Changing the Care Delivery Model.

PubMed

Wharton, Glenda; Berger, Jill; Williams, Tracy

2016-04-01

In response to patient care quality and satisfaction concerns, a hospital determined the need to change the care delivery model on some inpatient units. Two pilot units adopted 2 different models of care. The authors describe the change project, successful outcomes, and lessons learned.

Physical Activity in Physical Education: Are Longer Lessons Better?

ERIC Educational Resources Information Center

Smith, Nicole J.; Monnat, Shannon M.; Lounsbery, Monica A. F.

2015-01-01

Background: The purpose of this study was to compare physical activity (PA) outcomes in a sample of high school (HS) physical education (PE) lessons from schools that adopted "traditional" versus "modified block" schedule formats. Methods: We used the System for Observing Fitness Instruction Time (SOFIT) to conduct observations…

Providing Culturally Responsive Teaching in Field-Based and Student Teaching Experiences: A Case Study

ERIC Educational Resources Information Center

Kea, Cathy D.; Trent, Stanley C.

2013-01-01

This mixed design study chronicles the yearlong outcomes of 27 undergraduate preservice teacher candidates' ability to design and deliver culturally responsive lesson plans during field-based experience lesson observations and student teaching settings after receiving instruction in a special education methods course. While components of…

Using Patient Reported Outcomes and PROMIS in Research and Clinical Applications: Experiences from the PCORI Pilot Projects

PubMed Central

Bingham, Clifton O.; Bartlett, Susan J.; Merkel, Peter A.; Mielenz, Thelma J.; Pilkonis, Paul A.; Edmundson, Lauren; Moore, Emily; Sabharwal, Rajeev K.

2016-01-01

Purpose The field of patient-centered outcomes research (PCOR) continues to develop. Patient-reported outcomes, and in particular, the Patient-Reported Outcomes Measurement Information System (PROMIS) contribute complementary data to clinician-derived outcomes traditionally used in health decision-making. However, there has been little work to understand how PROMIS measures may inform or be integrated into PCOR or clinical applications. Methods Lead investigators from four pilot projects funded by the Patient-Centered Outcomes Research Institute (PCORI) collaborated to discuss lessons learned about the use of PROMIS in PCOR studies via virtual and in-person meetings. In addition, a qualitative data collection tool was used to assess the pilot projects’ experiences. Results Lessons learned from the pilot projects centered on practical elements of research design, such as choosing the right outcomes to study, considering the advantages and limitations of the PROMIS short forms and computer adaptive technology versions, planning ahead for a feasible data collection process, maintaining the focus on patients by ensuring that the research is truly patient-centered, and helping patients and providers make the most of PROMIS in care. Conclusions The PCORI Pilot Projects demonstrated that PROMIS can be successfully used to conduct research that will help patients make decisions about their care. Interest in PCOR continues to grow and the lessons learned from these projects about the use of PROMIS will be helpful to investigators. Given the numerous benefits of PROMIS, implementing this tool in research and care will hopefully lead to significant progress in measuring health outcomes that are meaningful and relevant to all stakeholders. PMID:26914103

Using patient-reported outcomes and PROMIS in research and clinical applications: experiences from the PCORI pilot projects.

PubMed

Bingham, Clifton O; Bartlett, Susan J; Merkel, Peter A; Mielenz, Thelma J; Pilkonis, Paul A; Edmundson, Lauren; Moore, Emily; Sabharwal, Rajeev K

2016-08-01

The field of patient-centered outcomes research (PCOR) continues to develop. Patient-reported outcomes and, in particular the Patient-Reported Outcomes Measurement Information System (PROMIS) contribute complementary data to clinician-derived outcomes traditionally used in health decision-making. However, there has been little work to understand how PROMIS measures may inform or be integrated into PCOR or clinical applications. Lead investigators from four pilot projects funded by the Patient-Centered Outcomes Research Institute (PCORI) collaborated to discuss lessons learned about the use of PROMIS in PCOR studies via virtual and in-person meetings. In addition, a qualitative data collection tool was used to assess the pilot projects' experiences. Lessons learned from the pilot projects centered on practical elements of research design, such as choosing the right outcomes to study, considering the advantages and limitations of the PROMIS short forms and computer adaptive technology versions, planning ahead for a feasible data collection process, maintaining the focus on patients by ensuring that the research is truly patient-centered, and helping patients and providers make the most of PROMIS in care. The PCORI pilot projects demonstrated that PROMIS can be successfully used to conduct research that will help patients make decisions about their care. Interest in PCOR continues to grow and the lessons learned from these projects about the use of PROMIS will be helpful to investigators. Given the numerous benefits of PROMIS, implementing this tool in research and care will hopefully lead to significant progress in measuring health outcomes that are meaningful and relevant to all stakeholders.

Public Figure Attacks in the United States, 1995-2015.

PubMed

Meloy, J Reid; Amman, Molly

2016-09-01

An archival descriptive study of public figure attackers in the United States between 1995 and 2015 was undertaken. Fifty-six incidents were identified, primarily through exhaustive internet searches, composed of 58 attackers and 58 victims. A code book was developed which focused upon victims, offenders, pre-attack behaviors including direct threats, attack characteristics, post-offense and other outcomes, motivations and psychological abstracts. The average interrater agreement for coding of bivariate variables was 0.835 (intraclass correlation coefficient). The three most likely victim categories were politicians, judges, and athletes. Attackers were males, many with a psychiatric disorder, most were grandiose, and most had both a violent and nonviolent criminal history. The known motivations for the attacks were often angry and personal, the most common being dissatisfaction with a judicial or other governmental process (23%). In only one case was the primary motivation to achieve notoriety. Lethality risk during an attack was 55%. Collateral injury or death occurred in 29% of the incidents. Only 5% communicated a direct threat to the target beforehand. The term "publicly intimate figure" is introduced to describe the sociocultural blurring of public and private lives among the targets, and its possible role in some attackers' perceptions and motivations. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Lesson Study as Professional Development within Secondary Physics Teacher Professional Learning Communities

NASA Astrophysics Data System (ADS)

Collins, Tonya Monique Nicki

Two Professional Learning Communities of physics teachers from different high schools voluntarily participated in Lesson Study as a means of professional development. The five teacher-participants and one participant-researcher partook of two Lesson Study cycles, each of which focused on student physics misconceptions. The Lesson Study resulted in two topics of physics: projectiles and gravitation. The researcher aimed to determine what happens to secondary physics teachers who undergo Lesson Study through this phenomenological case study. Specifically, (1) What is the process of Lesson Study with secondary physics teachers? and (2) What are the teacher-reported outcomes of Lesson Study with secondary physics teachers? Overall, Lesson Study provided an avenue for secondary physics teachers to conduct inquiry on their students in an attempt to better understand student thinking and learning. As a result, teachers collaborated to learn how to better meet the needs of their students and self-reported growth in many areas of teaching and teacher knowledge. The study resulted in twelve hypotheses to be tested in later research centering on idealizing the process of Lesson Study and maximizing secondary physics teacher growth.

Lessons from America? Commercialization and growth of private medicine in Britain.

PubMed

Rayner, G

1987-01-01

This article examines the transition of the private medical sector in Britain from a mere appendage to the National Health Service to a significant business sector involving multinational enterprise. The author argues that private medicine continues to be in a state of flux because its degree of independence is limited by its links to the dominant public sector, particularly with regard to staffing, and is still vulnerable to attacks from the opposition parties. Private medicine, despite rapid growth in the late 1970s, is beset by mounting costs and intense competition.

A Ticking Time Bomb: Counterterrorism Lessons From the U.S. Government’s Failure to Prevent the Fort Hood Attack

DTIC Science & Technology

2011-02-03

passed them to a second JTTF for an inquiry. However, the ensuing inqu iry fai led to identi fy the totality of Hasan’s communications and to inform...The memorandum included the content of Hasan’ s initial [REDACTED] communications and requested an inqu iry into Hasan. The request was not a...REDACTED]. He did not, however, forma ll y request that the Washington JlTF conduct a more thorough investigation of Hasan including interviews of his

Experimental design affects social behavior outcomes in adult zebrafish developmentally exposed to lead.

PubMed

Weber, Daniel N; Ghorai, Jugal K

2013-09-01

Lead (Pb(2+)) affects neuronal and endocrine systems that influence social interactions. By providing potential hiding locations, spatial heterogeneity may affect Pb(2+)-induced behavioral outcomes. Therefore, a test chamber was designed into which a refuge could be inserted. The refuge allowed test subjects to escape from the mirror image that stimulated agonistic interactions. Behaviors with a mirror were compared with baseline activity patterns without a mirror. Adult (12-month old) male and female zebrafish, exposed to Pb(2+) (0-10 μM) as embryos (2-24 hours post fertilization), were tested individually for 5 min in each chamber design within 2 h of feeding. Behaviors were evaluated for % time in mirror zone, distance traveled (=activity level), and attacks on the mirror image. When there was no refuge, significant concentration-dependent increases occurred in male % time in mirror zone, activity level, and number of attacks. Increases in these variables were less pronounced in females. When there was a refuge, there were significant differences for males only in activity level and attacks at the higher developmental exposure concentrations; % time in mirror zone followed a similar pattern and level as without refuge. Females displayed Pb(2+)-induced behavioral changes only for attacks on mirror. Since the presence of refuges that is, environmental enrichment, reduced Pb(2+)-induced agonistic behavior in both sexes, experimental spatial design can be considered an important factor when interpreting behavioral outcomes.

The efficacy and safety of alprazolam versus other benzodiazepines in the treatment of panic disorder.

PubMed

Moylan, Steven; Staples, John; Ward, Stephanie Alison; Rogerson, Jan; Stein, Dan J; Berk, Michael

2011-10-01

We performed a meta-analysis of all single- or double-blind, randomized controlled trials comparing alprazolam to another benzodiazepine in the treatment of adult patients meeting the Diagnostic and Statistical Manual of Mental Disorders, Third or Fourth Edition, criteria for panic disorder or agoraphobia with panic attacks. Eight studies met inclusion criteria, describing a total of at least 631 randomized patients. In the pooled results, there were no significant differences in efficacy between alprazolam and the comparator benzodiazepines on any of the prespecified outcomes: improvement in mean panic attack frequency (between-arm weighted mean difference of 0.6 panic attacks per week; 95% confidence interval [CI], -0.3 to 1.6), improvement in Hamilton Anxiety Rating Scale score (weighted mean difference of 0.8 points; 95% CI, -0.5 to 2.1), and proportion of patients free of panic attacks at the final evaluation (pooled relative risk, 1.1; 95% CI, 0.9-1.4). Statistical heterogeneity on prespecified outcomes was not eliminated by stratification on baseline anxiety level. The available evidence fails to demonstrate alprazolam as superior to other benzodiazepines for the treatment of panic disorder.

Mental and physical health consequences of the September 11, 2001 (9/11) attacks in primary care: a longitudinal study.

PubMed

Neria, Yuval; Wickramaratne, Priya; Olfson, Mark; Gameroff, Marc J; Pilowsky, Daniel J; Lantigua, Rafael; Shea, Steven; Weissman, Myrna M

2013-02-01

The magnitude of the September 11, 2001 (9/11) attacks was without precedent in the United States, but long-term longitudinal research on its health consequences for primary care patients is limited. We assessed the prevalence and exposure-related determinants of mental disorders, functioning, general medical conditions, and service utilization, 1 and 4 years after the 9/11 attacks, in an urban primary care cohort (N = 444) in Manhattan. Although the prevalence of posttraumatic stress disorder (PTSD) and levels of functional impairment declined over time, a substantial increase in suicidal ideation and missed work was observed. Most medical outcomes and service utilization indicators demonstrated a short-term increase after the 9/11 attacks (mean change of +20.3%), followed by a minor decrease in the subsequent year (mean change of -3.2%). Loss of a close person was associated with the highest risk for poor mental health and functional status over time. These findings highlight the importance of longitudinal assessments of mental, functional, and medical outcomes in urban populations exposed to mass trauma and terrorism. Copyright © 2013 International Society for Traumatic Stress Studies.

A Model of Biological Attacks on a Realistic Population

NASA Astrophysics Data System (ADS)

Carley, Kathleen M.; Fridsma, Douglas; Casman, Elizabeth; Altman, Neal; Chen, Li-Chiou; Kaminsky, Boris; Nave, Demian; Yahja, Alex

The capability to assess the impacts of large-scale biological attacks and the efficacy of containment policies is critical and requires knowledge-intensive reasoning about social response and disease transmission within a complex social system. There is a close linkage among social networks, transportation networks, disease spread, and early detection. Spatial dimensions related to public gathering places such as hospitals, nursing homes, and restaurants, can play a major role in epidemics [Klovdahl et. al. 2001]. Like natural epidemics, bioterrorist attacks unfold within spatially defined, complex social systems, and the societal and networked response can have profound effects on their outcome. This paper focuses on bioterrorist attacks, but the model has been applied to emergent and familiar diseases as well.

Attributing heart attack and stroke to "Old Age": Implications for subsequent health outcomes among older adults.

PubMed

Stewart, Tara L; Chipperfield, Judith G; Perry, Raymond P; Hamm, Jeremy M

2016-01-01

This study assessed the extent to which older adults attribute a recent heart attack/stroke to "old age," and examined consequences for subsequent lifestyle behavior and health-care service utilization. Community-dwelling adults (N = 57, ages 73-98 years) were interviewed about their heart attack/stroke, and an objective health registry provided data on health-care utilization over a 3-year period. Endorsement of "old age" as a cause of heart attack/stroke negatively predicted lifestyle behavior change, and positively predicted frequency of physician visits and likelihood of hospitalization over the subsequent 3 years. Findings suggest the importance of considering "old age" attributions in the context of cardiovascular health events. © The Author(s) 2014.

Timing of prophylactic surgery in prevention of diverticulitis recurrence: a cost-effectiveness analysis.

PubMed

Richards, Robert J; Hammitt, James K

2002-09-01

Although surgery is recommended after two or more attacks of uncomplicated diverticulitis, the optimal timing for surgery in terms of cost-effectiveness is unknown. A Markov model was used to compare the costs and outcomes of performing surgery after one, two, or three uncomplicated attacks in 60-year-old hypothetical cohorts. Transition state probabilities were assigned values using published data and expert opinion. Costs were estimated from Medicare reimbursement rates. Surgery after the third attack is cost saving, yielding more years of life and quality adjusted life years at a lower cost than the other two strategies. The results were not sensitive to many of the variables tested in the model or to changes made in the discount rate (0-5%). In conclusion, performing prophylactic resection after the third attack of diverticulitis is cost saving in comparison to resection performed after the first or second attacks and remains cost-effective during sensitivity analysis.

Attack tolerance of correlated time-varying social networks with well-defined communities

NASA Astrophysics Data System (ADS)

Sur, Souvik; Ganguly, Niloy; Mukherjee, Animesh

2015-02-01

In this paper, we investigate the efficiency and the robustness of information transmission for real-world social networks, modeled as time-varying instances, under targeted attack in shorter time spans. We observe that these quantities are markedly higher than that of the randomized versions of the considered networks. An important factor that drives this efficiency or robustness is the presence of short-time correlations across the network instances which we quantify by a novel metric the-edge emergence factor, denoted as ξ. We find that standard targeted attacks are not effective in collapsing this network structure. Remarkably, if the hourly community structures of the temporal network instances are attacked with the largest size community attacked first, the second largest next and so on, the network soon collapses. This behavior, we show is an outcome of the fact that the edge emergence factor bears a strong positive correlation with the size ordered community structures.

Heart attack risk perception biases among hypertension patients: the role of educational level and worry.

PubMed

Peterson, Laurel M; Helweg-Larsen, Marie; Volpp, Kevin G; Kimmel, Stephen E

2012-01-01

Risk biases such as comparative optimism (thinking one is better off than similar others) and risk inaccuracy (misestimating one's risk compared to one's calculated risk) for health outcomes are common. Little research has investigated racial or socioeconomic differences in these risk biases. Results from a survey of individuals with poorly controlled hypertension (N=813) indicated that participants showed (1) comparative optimism for heart attack risk by underestimating their heart attack risk compared to similar others, and (2) risk inaccuracy by overestimating their heart attack risk compared to their calculated heart attack risk. More highly educated participants were more comparatively optimistic because they rated their personal risk as lower; education was not related to risk inaccuracy. Neither race nor the federal poverty level was related to risk biases. Worry partially mediated the relationship between education and personal risk. Results are discussed as they relate to the existing literature on risk perception.

An Interview with Joe McMann: Lessons Learned from Fifty Years of Observing Hardware and Human Behavior

NASA Technical Reports Server (NTRS)

McMann, Joe

2011-01-01

Pica Kahn conducted "An Interview with Joe McMann: Lessons Learned in Human and Hardware Behavior" on August 16, 2011. With more than 40 years of experience in the aerospace industry, McMann has gained a wealth of knowledge. This presentation focused on lessons learned in human and hardware behavior. During his many years in the industry, McMann observed that the hardware development process was intertwined with human influences, which impacted the outcome of the product.

Lessons learned after three years of legalized, recreational marijuana: The Colorado experience.

PubMed

Ghosh, Tista S; Vigil, Daniel I; Maffey, Ali; Tolliver, Rickey; Van Dyke, Mike; Kattari, Leonardo; Krug, Heather; Reed, Jack K; Wolk, Larry

2017-11-01

In November 2012 Colorado voters approved legalized recreational marijuana. On January 1, 2014 Colorado became the first state to allow legal sales of non-medical marijuana for adults over the age of 21. Since that time, the state has been monitoring potential impacts on population health. In this paper we present lessons learned in the first three years following legal sales of recreational marijuana. These lessons pertain to health behaviors and health outcomes, as well as to health policy issues. Our intent is to share these lessons with other states as they face the prospect of recreational marijuana legalization. Copyright © 2017 Elsevier Inc. All rights reserved.

Methodological, Theoretical, Infrastructural, and Design Issues in Conducting Good Outcome Studies

ERIC Educational Resources Information Center

Kelly, Michael P.; Moore, Tessa A.

2011-01-01

This article outlines a set of methodological, theoretical, and other issues relating to the conduct of good outcome studies. The article begins by considering the contribution of evidence-based medicine to the methodology of outcome research. The lessons which can be applied in outcome studies in nonmedical settings are described. The article…

Comparative tolerability of treatments for acute migraine: A network meta-analysis.

PubMed

Thorlund, Kristian; Toor, Kabirraaj; Wu, Ping; Chan, Keith; Druyts, Eric; Ramos, Elodie; Bhambri, Rahul; Donnet, Anne; Stark, Richard; Goadsby, Peter J

2017-09-01

Introduction Migraine headache is a neurological disorder whose attacks are associated with nausea, vomiting, photophobia and phonophobia. Treatments for migraine aim to either prevent attacks before they have started or relieve attacks (abort) after onset of symptoms and range from complementary therapies to pharmacological interventions. A number of treatment-related adverse events such as somnolence, fatigue, and chest discomfort have previously been reported in association with triptans. The comparative tolerability of available agents for the abortive treatment of migraine attacks has not yet been systematically reviewed and quantified. Methods We performed a systematic literature review and Bayesian network meta-analysis for comparative tolerability of treatments for migraine. The literature search targeted all randomized controlled trials evaluating oral abortive treatments for acute migraine over a range of available doses in adults. The primary outcomes of interest were any adverse event, treatment-related adverse events, and serious adverse events. Secondary outcomes were fatigue, dizziness, chest discomfort, somnolence, nausea, and vomiting. Results Our search yielded 141 trials covering 15 distinct treatments. Of the triptans, sumatriptan, eletriptan, rizatriptan, zolmitriptan, and the combination treatment of sumatriptan and naproxen were associated with a statistically significant increase in odds of any adverse event or a treatment-related adverse event occurring compared with placebo. Of the non-triptans, only acetaminophen was associated with a statistically significant increase in odds of an adverse event occurring when compared with placebo. Overall, triptans were not associated with increased odds of serious adverse events occurring and the same was the case for non-triptans. For the secondary outcomes, with the exception of vomiting, all triptans except for almotriptan and frovatriptan were significantly associated with increased risk for all outcomes. Almotriptan was significantly associated with an increased risk of vomiting, whereas all other triptans yielded non-significant lower odds compared with placebo. Generally, the non-triptans were not associated with decreased tolerability for the secondary outcomes. Discussion In summary, triptans were associated with higher odds of any adverse event or a treatment-related adverse event occurring when compared to placebo and non-triptans. Non-significant results for non-triptans indicate that these treatments are comparable with one another and placebo regarding tolerability outcomes.

Outcomes and lessons learned from evaluating TRICARE's disease management programs.

PubMed

Dall, Timothy M; Askarinam Wagner, Rachel C; Zhang, Yiduo; Yang, Wenya; Arday, David R; Gantt, Cynthia J

2010-06-01

To share outcomes and lessons learned from an evaluation of disease management (DM) programs for asthma, congestive heart failure (CHF), and diabetes for TRICARE patients. Multiyear evaluation of participants in voluntary, opt-out DM programs. Patient-centered programs, administered by 3 regional contractors, provide phone-based consultations with a care manager, educational materials, and newsletters. The study sample consisted of 23,793 asthma, 4092 CHF, and 29,604 diabetes patients with at least 6 months' tenure in the program. Medical claims were analyzed to quantify program effect on healthcare utilization, medical costs, and clinical outcomes. Multivariate regression analysis with an historical control group was used to predict patient outcomes in the absence of DM. The difference between actual and predicted DM patient outcomes was attributed to the program. A patient survey collected data on program satisfaction and perceived usefulness of program information and services. Modest improvements in patient outcomes included reduced inpatient days and medical costs, and (with few exceptions) increased percentages of patients receiving appropriate medications and tests. Annual per patient reductions in medical costs were $453, $371, and $783 for asthma, CHF, and diabetes program participants, respectively. The estimated return on investment was $1.26 per $1.00 spent on DM services. Findings suggest that the DM programs more than pay for themselves, in addition to improving patient health and quality of life. Lessons learned in program design, implementation, effectiveness, and evaluation may benefit employers contemplating DM, DM providers, and evaluators of DM programs.

The Teachers' Action, 1984-1986: Learning Lessons from History

ERIC Educational Resources Information Center

Rieser, Richard

2016-01-01

Thirty years ago teachers in the NUT and NASUWT were involved in a protracted industrial dispute. The outcome of the dispute had huge implications for education policy in the years that followed (most obviously the introduction of the 1987 Education Bill), and has important lessons for teacher unionism today. The author offers a personal…

Effects of Detailed Illustrations on Science Learning: An Eye-Tracking Study

ERIC Educational Resources Information Center

Lin, Yu Ying; Holmqvist, Kenneth; Miyoshi, Kiyofumi; Ashida, Hiroshi

2017-01-01

The eye-tracking method was used to assess the influence of detailed, colorful illustrations on reading behaviors and learning outcomes. Based on participants' subjective ratings in a pre-study, we selected eight one-page human anatomy lessons. In the main study, participants learned these eight human anatomy lessons; four were accompanied by…

Why Higher Education: Lessons Learned in a Learner-Centered College

ERIC Educational Resources Information Center

Shugart, Sanford C.

2016-01-01

Based on a decade of consistently improving student outcomes at Valencia College, first winner of the Aspen Prize for Excellence in Community Colleges, five lessons for connecting student and institutional purpose are described. These include: a focus on what students really experience, understanding the college as a bridge and not a destination,…

Affordance, Learning Opportunities, and the Lesson Plan Pro Forma

ERIC Educational Resources Information Center

Anderson, Jason

2015-01-01

This article argues that the most commonly used lesson plan pro formas in language teacher education are inappropriately premised on an outcomes-based approach to teaching, one that is in conflict with what we know about how languages are learnt and how experienced teachers teach. It proposes an alternative, affordance-based approach to lesson…

Gender Inequality in Biology Classes in China and Its Effects on Students' Short-Term Outcomes

NASA Astrophysics Data System (ADS)

Liu, Ning; Neuhaus, Birgit

2014-07-01

This study investigated gender inequality in biology lessons and analysed the effects of the observed inequality on students' short-term knowledge achievement, situational interest and students' evaluation of teaching (SET). Twenty-two biology teachers and 803 7th-grade students from rural and urban classrooms in China participated in the study. Each teacher was videotaped for 1 lesson on the topic blood and circulatory system. Before and after the lessons, the students completed tests and questionnaires. Chi-square analysis was conducted to compare the boys' and girls' participation rates of answering teachers' questions in the lessons. The findings revealed that in the urban classrooms the boys had a significantly higher rate of participation than did the girls, and hence also a higher situational interest. However, no such gender inequity was found among the rural students. The study also revealed that urban students answered more complicated questions compared with the rural students in general. The findings of this study suggest that the teachers should try to balance boys' and girls' participation and involve more students in answering questions in their lessons. The study also raises questions about long-term effects of students' participation in answering teachers' questions on their outcomes-knowledge achievement, situational interest and SET.

Pediatric multiple sclerosis: Clinical features and outcome.

PubMed

Waldman, Amy; Ness, Jayne; Pohl, Daniela; Simone, Isabella Laura; Anlar, Banu; Amato, Maria Pia; Ghezzi, Angelo

2016-08-30

Multiple sclerosis (MS) in children manifests with a relapsing-remitting MS (RRMS) disease course. Acute relapses consist of new neurologic deficits persisting greater than 24 hours, in the absence of intercurrent illness, and occur with a higher frequency early in the disease as compared to adult-onset RRMS. Most pediatric patients with MS recover well from these early relapses, and cumulative physical disability is rare in the first 10 years of disease. Brainstem attacks, poor recovery from a single attack, and a higher frequency of attacks portend a greater likelihood of future disability. Although prospective pediatric-onset MS cohorts have been established in recent years, there remains very limited prospective data detailing the longer-term clinical outcome of pediatric-onset MS into adulthood. Whether the advent of MS therapies, and the largely off-label access to such therapies in pediatric MS, has improved prognosis is unknown. MS onset during the key formative academic years, concurrent with active cognitive maturation, is an important determinant of long-term outcome, and is discussed in detail in another article in this supplement. Finally, increasing recognition of pediatric MS worldwide, recent launch of phase III trials for new agents in the pediatric MS population, and the clear imperative to more fully appreciate health-related quality of life in pediatric MS through adulthood highlight the need for standardized, validated, and robust outcome measures. © 2016 American Academy of Neurology.

Reynolds Number Effects at High Angles of Attack

NASA Technical Reports Server (NTRS)

Fisher, David F.; Cobleigh, Brent R.; Banks, Daniel W.; Hall, Robert M.; Wahls, Richard A.

1998-01-01

Lessons learned from comparisons between ground-based tests and flight measurements for the high-angle-of-attack programs on the F-18 High Alpha Research Vehicle (HARV), the X-29 forward-swept wing aircraft, and the X-31 enhanced fighter maneuverability aircraft are presented. On all three vehicles, Reynolds number effects were evident on the forebodies at high angles of attack. The correlation between flight and wind tunnel forebody pressure distributions for the F-18 HARV were improved by using twin longitudinal grit strips on the forebody of the wind-tunnel model. Pressure distributions obtained on the X-29 wind-tunnel model at flight Reynolds numbers showed excellent correlation with the flight data up to alpha = 50 deg. Above (alpha = 50 deg. the pressure distributions for both flight and wind tunnel became asymmetric and showed poorer agreement, possibly because of the different surface finish of the model and aircraft. The detrimental effect of a very sharp nose apex was demonstrated on the X-31 aircraft. Grit strips on the forebody of the X-31 reduced the randomness but increased the magnitude of the asymmetry. Nose strakes were required to reduce the forebody yawing moment asymmetries and the grit strips on the flight test noseboom improved the aircraft handling qualities.

Preparing Houston: lessons learned, future directions

NASA Astrophysics Data System (ADS)

Madjid, Mohammad; Mirhaji, Parsa; Lillibridge, Scott R.; Casscells, S. W.

2003-09-01

On September 11, 2001, Al Qaeda terrorists committed a savage act against humanity when they used domestic jetliners to crash into buildings in New York City and Washington, DC, killing thousands of people. In October 2001, coming on the heels of this savagery was another act of barbarity, this time using anthrax, not jetliners, to take innocent lives. Each incident demonstrates the vulnerability of an open society, and Americans are left to wonder how such acts can be prevented. Now, Al Qaeda operatives are reportedly regrouping, recruiting, and changing their tactics to distribute money and messages to operatives around the world. Many experts believe that terrorist attacks are inevitable. No city is immune from attack, and no city is fully prepared to handle the residual impact of a potentially ravaging biological or chemical attack. A survey conducted by the Cable News Network (CNN) in January 2002, studied 30 major US cities, ranking them based on 6 statistical indices of vulnerability. Thirteen cities were deemed better prepared than Houston, 10 were in a similar state of preparedness, and only 6 were less prepared than Houston. Here, we discuss the measures which have taken place in Houston to make it a safer place and which plans are needed for future. Houston experience can be used as a model to develop similar plans for other cities nation-wide.

Panic attacks and possession by djinns: lessons from ethnopsychiatry.

PubMed

Bragazzi, Nicola Luigi; Del Puente, Giovanni

2012-01-01

This clinical case report shows how important it is for a psychiatrist to have a knowledge of the cultural and religious context of the patient, in order to understand fully his or her complaints. Culture and religion, in fact, are not neutral, but convey symbols, meanings, and myths that should be properly explored to shed light on the patient's inner world. Patient D was a 19-year-old Muslim Italo-Tunisian girl, who consulted a psychiatrist for anxiety and panic attacks, and reported being possessed by djinns (ie, "evil creatures", as described in the Qur'an). A culturally informed interview was carried out, together with administration of psychometric scales, including the Symptom Checklist-90 Revised and Psychological Measure of Islamic Religiousness. Based on her scores and the results of this multidimensional assessment, patient D was treated with transcultural psychotherapy and fluoxetine. After a year of follow-up, she reported no further episodes of panic disorder. For proper assessment and treatment, a combined anthropological, sociological, and psychopathological approach was necessary.

Panic attacks and possession by djinns: lessons from ethnopsychiatry

PubMed Central

Bragazzi, Nicola Luigi; Del Puente, Giovanni

2012-01-01

This clinical case report shows how important it is for a psychiatrist to have a knowledge of the cultural and religious context of the patient, in order to understand fully his or her complaints. Culture and religion, in fact, are not neutral, but convey symbols, meanings, and myths that should be properly explored to shed light on the patient’s inner world. Patient D was a 19-year-old Muslim Italo-Tunisian girl, who consulted a psychiatrist for anxiety and panic attacks, and reported being possessed by djinns (ie, “evil creatures”, as described in the Qur’an). A culturally informed interview was carried out, together with administration of psychometric scales, including the Symptom Checklist-90 Revised and Psychological Measure of Islamic Religiousness. Based on her scores and the results of this multidimensional assessment, patient D was treated with transcultural psychotherapy and fluoxetine. After a year of follow-up, she reported no further episodes of panic disorder. For proper assessment and treatment, a combined anthropological, sociological, and psychopathological approach was necessary. PMID:23293545

75 FR 79011 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-17

..., criminal justice and services outcomes, as well as lessons learned to inform future efforts. [[Page 79012... outcomes of interest and subpopulations of focus: homelessness, housing, treatment history, readiness to...

Event-related household discussions following the Boston Marathon bombing and associated posttraumatic stress among area youth

PubMed Central

Carpenter, Aubrey L.; Elkins, R. Meredith; Kerns, Caroline; Chou, Tommy; Green, Jennifer Greif; Comer, Jonathan S.

2017-01-01

Objective Despite research documenting the scope of disaster-related posttraumatic stress (PTS) in youth, less is known about how family processes immediately post-disaster might associate with child outcomes. The 2013 Boston Marathon bombing affords a unique opportunity to assess links between immediate family discussions about community trauma and child mental health outcomes. Method The present study examined associations between attack-related household discussions and child PTS among Boston-area youth ages four to nineteen following the Marathon bombing (N=460). Caregivers completed surveys two to six months post-attack about immediate household discussions about the events, child exposure to potentially traumatic attack-related experiences, and child PTS. Results During the Marathon bombing and manhunt, there was considerable heterogeneity in household discussions across area families, and several discussion items were differentially predictive of variability in children’s PTS. Specifically, after controlling for children’s direct exposure to the potentially traumatic attack/manhunt events, children showed lower PTS when it was their caregivers who informed them about the attack and manhunt, and when their caregivers expressed confidence in their safety and discussed their own feelings about the manhunt with their child. Children showed higher PTS when their caregivers did not discuss the events in front of them, asked others to avoid discussing the events in front of them, and expressed concern at the time that their child might not be safe. Child age and traumatic attack/manhunt exposure moderated several links between household discussions and child PTS. Conclusions Findings underscore the importance of family communication and caregiver modeling during times of community threat and uncertainty. PMID:26538213

Awareness of heart attack and stroke symptoms among Hispanic male adults living in the United States.

PubMed

Lutfiyya, May Nawal; Bardales, Ricardo; Bales, Robert; Aguero, Carlos; Brady, Shelly; Tobar, Adriana; McGrath, Cynthia; Zaiser, Julia; Lipsky, Martin S

2010-10-01

There is evidence that Hispanic men are a high risk group for treatment delay for both heart attack and stroke. More targeted research is needed to elucidate this specific population's knowledge of warning signs for these acute events. This study sought to describe within-group disparities in Hispanic men's knowledge of heart attack and stroke symptomology. Multivariate techniques were used to analyze a multi-year Behavioral Risk Factor Surveillance Heart and Stroke module database. The data were cross-sectional and focused on health risk factors and behaviors. The research participants were U.S. male Hispanic adults aged 18-99. The main outcome measure for the study was heart attack and stroke symptom knowledge score. Multivariate logistic regression analysis yielded that Hispanic men aged >or=18 years who earned low scores on the composite heart attack and stroke knowledge questions (range 0-8 points) were more likely to: have less than a high school education, have deferred medical care because of cost, not have an identified health care provider, and be uninsured. There were significant within-group differences. Targeting educational efforts toward older (>or=55 years) Hispanic men with less than high school education, those who do not have an identified health care provider or health insurance, and who defer health care because of cost could be ways to improve the outcome of acute vascular events among the U.S. Hispanic adult male population.

Avatar Web-Based Self-Report Survey System Technology for Public Health Research: Technical Outcome Results and Lessons Learned.

PubMed

Savel, Craig; Mierzwa, Stan; Gorbach, Pamina M; Souidi, Samir; Lally, Michelle; Zimet, Gregory; Interventions, Aids

2016-01-01

This paper reports on a specific Web-based self-report data collection system that was developed for a public health research study in the United States. Our focus is on technical outcome results and lessons learned that may be useful to other projects requiring such a solution. The system was accessible from any device that had a browser that supported HTML5. Report findings include: which hardware devices, Web browsers, and operating systems were used; the rate of survey completion; and key considerations for employing Web-based surveys in a clinical trial setting.

Case Management of Dengue: Lessons Learned

PubMed Central

Kalayanarooj, Siripen; Srikiatkhachorn, Anon

2017-01-01

Abstract The global burden of dengue and its geographic distribution have increased over the past several decades. The introduction of dengue in new areas has often been accompanied by high case-fatality rates. Drawing on the experience in managing dengue cases at the Queen Sirikit National Institute of Child Health in Bangkok, Thailand, this article provides the authors’ perspectives on key clinical lessons to improve dengue-related outcomes. Parallels between this clinical experience and outcomes reported in randomized controlled trials, results of efforts to disseminate practice recommendations, and suggestions for areas for further research are also discussed. PMID:28403440

Lessons from trial-based cost-effectiveness analyses of mental health interventions: why uncertainty about the outcome, estimate and willingness to pay matters.

PubMed

Hoch, Jeffrey S; Dewa, Carolyn S

2007-01-01

The principal aim of this article is to share lessons learned by the authors while conducting economic evaluations, using clinical trial data, of mental health interventions. These lessons are quite general and have clear relevance for pharmacoeconomic studies. In addition, we explore how net benefit regression can be used to enhance consideration of key issues when conducting an economic evaluation based on clinical trial data. The first study we discuss found that cost-effectiveness results varied markedly based on the choice of both the patient outcome and the willingness to pay for more of that outcome. The importance of willingness to pay was also highlighted in the results from the second study. Even with a set willingness-to-pay value, most of the time the probability that the new treatment was cost effective was not 100%. In the third study, the cost effectiveness of the new treatment varied by patient characteristics. These observations have important implications for pharmacoeconomic studies. Namely, analysts must carefully consider choice of patient outcome, willingness to pay, patient heterogeneity and the statistical uncertainty inherent in the data. Net benefit regression is a useful technique for exploring these crucial issues when undertaking an economic evaluation using patient-level data on both costs and effects.

Rationale and study protocol of the EASY Minds (Encouraging Activity to Stimulate Young Minds) program: cluster randomized controlled trial of a primary school-based physical activity integration program for mathematics.

PubMed

Riley, Nicholas; Lubans, David R; Holmes, Kathryn; Morgan, Philip J

2014-08-08

Novel strategies are required to increase school-based physical activity levels of children. Integrating physical activity in mathematics lessons may lead to improvements in students' physical activity levels as well as enjoyment, engagement and learning. The primary aim of this study is to evaluate the impact of a curriculum-based physical activity integration program known as EASY Minds (Encouraging Activity to Stimulate Young Minds) on children's daily school time physical activity levels. Secondary aims include exploring the impact of EASY Minds on their engagement and 'on task' behaviour in mathematics. Grade 5/6 classes from eight public schools in New South Wales, Australia will be randomly allocated to intervention (n = 4) or control (n = 4) groups. Teachers from the intervention group will receive one day of professional development, a resource pack and asked to adapt their lessons to embed movement-based learning in their daily mathematics program in at least three lessons per week over a six week period. Intervention support will be provided via a weekly email and three lesson observations. The primary outcomes will be children's physical activity levels (accelerometry) across both the school day and during mathematics lessons (moderate-to-vigorous physical activity and sedentary time). Children's 'on-task' behaviour, enjoyment of mathematics and mathematics attainment will be assessed as secondary outcomes. A detailed process evaluation will be undertaken. EASY Minds is an innovative intervention that has the potential to improve key physical and academic outcomes for primary school aged children and help guide policy and practice regarding the teaching of mathematics. Australian and New Zealand Clinical Trials Register ACTRN12613000637741 13/05/2013.

Implementing Assessment in an Outcome-Based Marketing Curriculum

ERIC Educational Resources Information Center

Borin, Norm; Metcalf, Lynn E.; Tietje, Brian C.

2008-01-01

This article describes the development and implementation of assessment in a new outcome-based marketing curriculum that was developed using a zero-based approach. Outcomes for the marketing curriculum were specified at the program, department, course, and lesson levels. Direct embedded assessments as well as indirect assessment methods were used…

Successful Community Nutrition Programming: Lessons from Kenya, Tanzania, and Uganda.

ERIC Educational Resources Information Center

Iannotti, Lora; Gillespie, Stuart

This report on the key findings from a series of assessments of successful community nutrition programming conducted in Kenya, Tanzania, and Uganda between 1999 and 2000. The aim of the assessments was to identify key lessons learned from the successful processes and outcomes in these programs. The report is divided into eight chapters: (1)…

Mobile Learning vs. Traditional Classroom Lessons: A Comparative Study

ERIC Educational Resources Information Center

Furió, D.; Juan, M.-C.; Seguí, I.; Vivó, R.

2015-01-01

Different methods can be used for learning, and they can be compared in several aspects, especially those related to learning outcomes. In this paper, we present a study in order to compare the learning effectiveness and satisfaction of children using an iPhone game for learning the water cycle vs. the traditional classroom lesson. The iPhone game…

Seed Aid for Food Security? Some Lessons from Zimbabwe's Agricultural Recovery Programme

ERIC Educational Resources Information Center

Foti, Richard; Muringai, Violet; Mavunganidze, Zira

2007-01-01

Does agricultural input aid always lead to favourable food security outcomes? This paper describes Zimbabwe's agricultural recovery program for the 2003/2004 farming season and draws some lessons that can be used in the designing and implementation of future programs. Input aid was found to be most beneficial if it is packaged together with other…

Efficacy of a Community-Based Physical Activity Program KM2H2 for Stroke and Heart Attack Prevention among Senior Hypertensive Patients: A Cluster Randomized Controlled Phase-II Trial

PubMed Central

Gong, Jie; Chen, Xinguang; Li, Sijian

2015-01-01

Objective To evaluate the efficacy of the program Keep Moving toward Healthy Heart and Healthy Brain (KM2H2) in encouraging physical activities for the prevention of heart attack and stroke among hypertensive patients enrolled in the Community-Based Hypertension Control Program (CBHCP). Design Cluster randomized controlled trial with three waves of longitudinal assessments at baseline, 3 and 6 months post intervention. Setting Community-based and patient-centered self-care for behavioral intervention in urban settings of China. Participants A total of 450 participants diagnosed with hypertension from 12 community health centers in Wuhan, China were recruited, and were randomly assigned by center to receive either KM2H2 plus standard CBHCP care (6 centers and 232 patients) or the standard care only (6 centers and 218 patients). Intervention KM2H2 is a behavioral intervention guided by the Transtheoretical Model, the Model of Personalized Medicine and Social Capital Theory. It consists of six intervention sessions and two booster sessions engineered in a progressive manner. The purpose is to motivate and maintain physical activities for the prevention of heart attack and stroke. Outcome Measures Heart attack and stroke (clinically diagnosed, primary outcome), blood pressure (measured, secondary outcome), and physical activity (self-report, tertiary outcome) were assessed at the individual level during the baseline, 3- and 6-month post-intervention. Results Relative to the standard care, receiving KM2H2 was associated with significant reductions in the incidence of heart attack (3.60% vs. 7.03%, p < .05) and stroke (5.11% vs. 9.90%, p<0.05), and moderate reduction in blood pressure (-3.72mmHg in DBP and -2.92 mmHg in DBP) at 6-month post-intervention; and significant increases in physical activity at 3- (d = 0.53, 95% CI: 0.21, 0.85) and 6-month (d = 0.45, 95% CI: 0.04, 0.85) post-intervention, respectively. Conclusion The program KM2H2 is efficacious to reduce the risk of heart attack and stroke among senior patients who are on anti-hypertensive medication. Findings of this study provide solid data supporting a formal phase-III trial to establish the effectiveness of KM2H2 for use in community settings for prevention. Trial Registration ISRCTN Register ISRCTN12608966 PMID:26426421

Comparing acquired angioedema with hereditary angioedema (types I/II): findings from the Icatibant Outcome Survey.

PubMed

Longhurst, H J; Zanichelli, A; Caballero, T; Bouillet, L; Aberer, W; Maurer, M; Fain, O; Fabien, V; Andresen, I

2017-04-01

Icatibant is used to treat acute hereditary angioedema with C1 inhibitor deficiency types I/II (C1-INH-HAE types I/II) and has shown promise in angioedema due to acquired C1 inhibitor deficiency (C1-INH-AAE). Data from the Icatibant Outcome Survey (IOS) were analysed to evaluate the effectiveness of icatibant in the treatment of patients with C1-INH-AAE and compare disease characteristics with those with C1-INH-HAE types I/II. Key medical history (including prior occurrence of attacks) was recorded upon IOS enrolment. Thereafter, data were recorded retrospectively at approximately 6-month intervals during patient follow-up visits. In the icatibant-treated population, 16 patients with C1-INH-AAE had 287 attacks and 415 patients with C1-INH-HAE types I/II had 2245 attacks. Patients with C1-INH-AAE versus C1-INH-HAE types I/II were more often male (69 versus 42%; P = 0·035) and had a significantly later mean (95% confidence interval) age of symptom onset [57·9 (51·33-64·53) versus 14·0 (12·70-15·26) years]. Time from symptom onset to diagnosis was significantly shorter in patients with C1-INH-AAE versus C1-INH-HAE types I/II (mean 12·3 months versus 118·1 months; P = 0·006). Patients with C1-INH-AAE showed a trend for higher occurrence of attacks involving the face (35 versus 21% of attacks; P = 0·064). Overall, angioedema attacks were more severe in patients with C1-INH-HAE types I/II versus C1-INH-AAE (61 versus 40% of attacks were classified as severe to very severe; P < 0·001). Median total attack duration was 5·0 h and 9·0 h for patients with C1-INH-AAE versus C1-INH-HAE types I/II, respectively. © 2016 British Society for Immunology.

Comparing acquired angioedema with hereditary angioedema (types I/II): findings from the Icatibant Outcome Survey

PubMed Central

Zanichelli, A.; Caballero, T.; Bouillet, L.; Aberer, W.; Maurer, M.; Fain, O.; Fabien, V.; Andresen, I.

2017-01-01

Summary Icatibant is used to treat acute hereditary angioedema with C1 inhibitor deficiency types I/II (C1‐INH‐HAE types I/II) and has shown promise in angioedema due to acquired C1 inhibitor deficiency (C1‐INH‐AAE). Data from the Icatibant Outcome Survey (IOS) were analysed to evaluate the effectiveness of icatibant in the treatment of patients with C1‐INH‐AAE and compare disease characteristics with those with C1‐INH‐HAE types I/II. Key medical history (including prior occurrence of attacks) was recorded upon IOS enrolment. Thereafter, data were recorded retrospectively at approximately 6‐month intervals during patient follow‐up visits. In the icatibant‐treated population, 16 patients with C1‐INH‐AAE had 287 attacks and 415 patients with C1‐INH‐HAE types I/II had 2245 attacks. Patients with C1‐INH‐AAE versus C1‐INH‐HAE types I/II were more often male (69 versus 42%; P = 0·035) and had a significantly later mean (95% confidence interval) age of symptom onset [57·9 (51·33–64·53) versus 14·0 (12·70–15·26) years]. Time from symptom onset to diagnosis was significantly shorter in patients with C1‐INH‐AAE versus C1‐INH‐HAE types I/II (mean 12·3 months versus 118·1 months; P = 0·006). Patients with C1‐INH‐AAE showed a trend for higher occurrence of attacks involving the face (35 versus 21% of attacks; P = 0·064). Overall, angioedema attacks were more severe in patients with C1‐INH‐HAE types I/II versus C1‐INH‐AAE (61 versus 40% of attacks were classified as severe to very severe; P < 0·001). Median total attack duration was 5·0 h and 9·0 h for patients with C1‐INH‐AAE versus C1‐INH‐HAE types I/II, respectively. PMID:27936514

Adolescent pregnancy and parenting: controversies of the past and lessons for the future.

PubMed

Klerman, L V

1993-11-01

Recent research findings suggest that old ways of looking at adolescent sexuality, pregnancy, and parenting should be revised and that new approaches to service programs should be developed. This paper presents some new facts by examining the validity of nine beliefs about adolescent pregnancy: that nothing can reduce the rate of adolescent pregnancy; that pregnant adolescents experience poor pregnancy outcomes; that adolescent mothers do not complete their high school education; that pregnant adolescents have large families; that adolescent mothers remain on welfare for long periods; that pregnancy in adolescence is a mistake and, given a chance to overcome the immediate problems associated with it, young mothers can go on to lead normal lives; that welfare causes adolescent pregnancy and parenting; that adolescent mothers are poor parents; and that service programs can have a significant impact on adolescent pregnancy and parenting. Although programs aimed at the prevention and amelioration of the problems experienced by pregnant adolescents, young mothers, and their children and families have shown some success, relatively few are sufficiently powerful to bring about major changes--and even these are infrequently replicated because of high costs. Further progress in this area depends not only on new and expanded programs, but also on attacking the problem of poverty, which is an underlying cause of early sexual activity and childbearing.

Shark attack: review of 86 consecutive cases.

PubMed

Woolgar, J D; Cliff, G; Nair, R; Hafez, H; Robbs, J V

2001-05-01

On average there are approximately 50 confirmed shark attacks worldwide annually. Despite their rarity, such incidents often generate much public and media attention. The injuries of 86 consecutive victims of shark attack were reviewed from 1980 to 1999. Clinical data retrieved from the South African Shark Attack Files, maintained by the Natal Sharks Board, were retrospectively analyzed to determine the nature, treatment, and outcome of injuries. The majority of victims (n = 68 [81%]) had relatively minor injuries that required simple primary suture. Those patients (n = 16 [19%]) with more extensive limb lacerations longer than 20 cm or with soft-tissue loss of more than one myofascial compartment were associated with higher morbidity and limb loss. In 8 of the 10 fatalities, death occurred as a result of exsanguinating hemorrhage from a limb vascular injury. Victims of shark attack usually sustain only minor injuries. In more serious cases, particularly if associated with a major vascular injury, hemorrhage control and early resuscitation are of utmost importance during the initial management if these patients are to survive.

How Can the U.S. Military Avoid Another 9/15?: An Analysis of the Inability of U.S. Military Leaders to Provide an Adequate Strategy for Responding to the 9/11 Attacks

DTIC Science & Technology

2007-12-01

Deputy Chief of Staff for Operations and Plans, Department of the Army (DSCOPS, DA). d. Conduct programs which bear directly on the Army in the field...response recommendation were all products of an educational system that focused on a Direct Approach. In his work, Learning to Eat Soup with a...79 Duggan, p 169. 80 John Nagl, Learning to Eat Soup with a Knife: Counterinsurgency Lessons from Malaya and Vietnam, Chicago: University of

Associations Between Fish Consumption and Contaminant Biomarkers With Cardiovascular Conditions Among Older Male Anglers in Wisconsin.

PubMed

Raymond, Michelle R; Christensen, Krista Y; Thompson, Brooke A; Anderson, Henry A

2016-07-01

The aim of this study was to determine fish consumption habits and contaminant exposures associated with adverse cardiovascular outcomes among older male anglers. One hundred fifty-four men aged 50 years and older living and fishing in Wisconsin completed a detailed survey and provided hair and blood samples. Associations between fish consumption and body burdens of several contaminants, with self-reported cardiovascular outcomes, were evaluated. Consuming fish species with higher methyl mercury content was positively associated with odds of angina, coronary heart disease (CHD), or heart attack, while consuming fattier species was negatively associated with high blood pressure or high cholesterol. Total mercury in blood was associated with 27% higher odds of heart attack, and certain classes of polychlorinated biphenyls were positively associated with CHD. Total mercury exposures may affect cardiovascular outcomes. Educational interventions promoting consumption of fish low in methyl mercury among older male anglers are needed.

The impact of teachers’ modifications of an evidenced-based HIV prevention intervention on program outcomes

PubMed Central

Wang, Bo; Stanton, Bonita; Lunn, Sonja; Rolle, Glenda; Poitier, Maxwell; Adderley, Richard; Li, Xiaoming; Koci, Veronica; Deveaux, Lynette

2015-01-01

The degree to which evidence-based program outcomes are affected by modifications is a significant concern in the implementation of interventions. The ongoing national implementation of an evidence-based HIV prevention program targeting grade six students in The Bahamas [Focus on Youth in The Caribbean (FOYC)] offers an opportunity to explore factors associated with teachers’ modification of FOYC lessons and to examine the impact of types and degrees of modifications on student outcomes. Data were collected in 2012 from 155 teachers and 3646 students in 77 government elementary schools. Results indicate that teachers taught 16 of 30 core activities, 24.5 of 46 total activities and 4.7 of 8 sessions. Over one-half of the teachers made modifications to FOYC core activities; one-fourth of the teachers modified 25% or more core activities that they taught (heavily modified FOYC). Omitting core activities was the most common content modification, followed by lengthening FOYC lessons with reading, writing assignments or role-play games, shortening core activities or adding educational videos. Mixed-effects modeling revealed that omitting core activities had negative impacts on all four student outcomes. Shortening core activities and adding videos into lessons had negative impacts on HIV/AIDS knowledge and/or intention to use condom protection. Heavy modifications (>1/4 core activities) were associated with diminished program effectiveness. Heavy modifications and omitting or shortening core activities were negatively related to teachers’ level of implementation. We conclude that poorer student outcomes were associated with heavy modifications. PMID:26297497

The Impact of Teachers' Modifications of an Evidenced-Based HIV Prevention Intervention on Program Outcomes.

PubMed

Wang, Bo; Stanton, Bonita; Lunn, Sonja; Rolle, Glenda; Poitier, Maxwell; Adderley, Richard; Li, Xiaoming; Koci, Veronica; Deveaux, Lynette

2016-01-01

The degree to which evidence-based program outcomes are affected by modifications is a significant concern in the implementation of interventions. The ongoing national implementation of an evidence-based HIV prevention program targeting grade 6 students in The Bahamas [Focus on Youth in The Caribbean (FOYC)] offers an opportunity to explore factors associated with teachers' modification of FOYC lessons and to examine the impact of types and degrees of modifications on student outcomes. Data were collected in 2012 from 155 teachers and 3646 students in 77 government elementary schools. Results indicate that teachers taught 16 of 30 core activities, 24.5 of 46 total activities and 4.7 of 8 sessions. Over one-half of the teachers made modifications to FOYC core activities; one-fourth of the teachers modified 25 % or more core activities that they taught (heavily modified FOYC). Omitting core activities was the most common content modification, followed by lengthening FOYC lessons with reading, writing assignments or role-play games, and shortening core activities or adding educational videos. Mixed-effects modeling revealed that omitting core activities had negative impacts on all four student outcomes. Shortening core activities and adding videos into lessons had negative impacts on HIV/AIDS knowledge and/or intention to use condom protection. Heavy modifications (>1/4 core activities) were associated with diminished program effectiveness. Heavy modifications and omitting or shortening core activities were negatively related to teachers' level of implementation. We conclude that poorer student outcomes were associated with heavy modifications.

Computationally predicted Adverse Outcome Pathway networks for liver-related diseases using publicly available data sources: Case studies and lessons learned

EPA Science Inventory

The Adverse Outcome Pathway (AOP) framework summarizes key information about mechanistic events leading to an adverse health or ecological outcome. In recent years computationally predicted AOPs (cpAOP) making use of publicly available data have been proposed as a means of accele...

Outcome Assessment of a Management Program Using a Portfolio Approach: Lessons Learned

ERIC Educational Resources Information Center

Drost, Donald; Hanson, Lee; Molstady, Clark; Peake, Lloyd; Newman, Eric

2008-01-01

Over the past two decades the interest and use of student portfolios for assessing student learning outcomes has grown considerably. This paper presents an overview of the portfolio approach to outcome assessment adopted by the Department of Management at California State University, San Bernardino and discusses major issues encountered over six…

Lessons that Last: Former Youth Organizers' Reflections on What and How They Learned

ERIC Educational Resources Information Center

Conner, Jerusha

2014-01-01

This study examines the learning outcomes and learning environment of a youth organizing program that has been effective in promoting individual as well as social change. Drawing on interviews with 25 former youth organizers from the program, this study explores the lessons that stay with them as they transition to young adulthood and the factors…

Academies: It's Time to Learn the Lessons. NFER Thinks: What the Evidence Tells Us

ERIC Educational Resources Information Center

Worth, Jack

2015-01-01

Academies are now a part of the English school landscape. Future policy should focus on learning the lessons from the growth of academy schools. In this "NFER Thinks," the author presents the case that any future expansion in the number of academies should be motivated by a clear vision of the long-term outcomes for learners that…

Performance-Based Education Project: A Component of the Institutional Outcomes Model. Course Prototype. U.S. History 121 (HIS121).

ERIC Educational Resources Information Center

John Wood Community Coll., Quincy, IL.

This document is an assessment of a performance-based education project that involved a United States history course, offered at a community college. Thirty-two student performance objectives are outlined and lesson plans designed to achieve each objective are presented. Each lesson plan consists of an instructional topic, prerequisites, interest…

The Supporting Healthy Marriage Evaluation: Early Lessons from the Implementation of a Relationship and Marriage Skills Program for Low-Income Married Couples

ERIC Educational Resources Information Center

Gaubert, Jennifer Miller; Knox, Virginia; Alderson, Desiree Principe; Dalton, Christopher; Fletcher, Kate; McCormick, Meghan

2010-01-01

This report presents early implementation and operational lessons from the Supporting Healthy Marriage (SHM) evaluation. Funded by the Administration for Children and Families, SHM uses a rigorous research design to test the effectiveness of a new approach to improving outcomes for low-income children: strengthening the marriages and relationships…

No Second Chance to Make a First Impression: The "Thin-Slice" Effect on Instructor Ratings and Learning Outcomes in Higher Education

ERIC Educational Resources Information Center

Samudra, Preeti G.; Min, Inah; Cortina, Kai S.; Miller, Kevin F.

2016-01-01

Prior research has found strong and persistent effects of instructor first impressions on student evaluations. Because these studies look at real classroom lessons, this finding fits two different interpretations: (1) first impressions may color student experience of instruction regardless of lesson quality, or (2) first impressions may provide…

Video-Enhanced Lesson Observation as a Source of Multiple Modes of Data for School Leadership: A Videographic Approach

ERIC Educational Resources Information Center

Hidson, Elizabeth

2018-01-01

A growing body of literature recognizes the affordances of video in education, especially in relation to lesson observation and reflection as part of teachers' initial teacher education and continuing professional development. Minimal attention has been paid to the outcomes of video-enhanced observation as a source of multiple modes of data for…

First External Evaluations of Quality Assurance Agencies--Lessons Learned. ENQA Workshop Report 10

ERIC Educational Resources Information Center

Costes, Nathalie; Curvale, Bruno; Kraft, Michael G.; Llavori, Rafael; Malan, Thierry; Szanto, Tibor

2010-01-01

This report is a product of an ENQA (European Association for Quality Assurance in Higher Education) seminar on the first external evaluations of quality assurance agencies, held in Paris in July 2008. The seminar took stock of the achieved reviews of agencies to learn lessons from these first outcomes and, hence, provided a platform for…

Effective Lesson Planning: Field Trips in the Science Curriculum

NASA Astrophysics Data System (ADS)

Rieger, C. R.

2010-10-01

Science field trips can positively impact and motivate students. However, if a field trip is not executed properly, with appropriate preparation and follow-up reinforcement, it can result in a loss of valuable educational time and promote misconceptions in the students. This study was undertaken to determine if a classroom lesson before an out-of-the-classroom activity would affect learner gain more or less than a lesson after the activity. The study was based on the immersive theater movie ``Earth's Wild Ride'' coupled with a teacher-led Power Point lesson. The participants in the study were students in a sixth grade physical science class. The order of lessons showed no detectable effect on final learner outcomes. Based on pre- and post-testing, improvement in mean learning gain came from the teacher-led lesson independent of the movie. The visit to the immersive theater, however, had significant positive effects that did not show up in the quantitative results of the testing.

Predicting Suicide Attacks: Integrating Spatial, Temporal, and Social Features of Terrorist Attack Targets

DTIC Science & Technology

2013-01-01

used in health and criminol- ogy to predict outcomes (Browning, Cagney, and Wen, 2003; Samp- son, Morenoff, and Gannon -Rowley, 2002 ). For each...Bernard, H . Russell , and Gery W. Ryan, Analyzing Qualitative Data: Systematic Approaches, Thousand Oaks, Calif.: Sage, 2010. Berrebi, Claude, “Evidence...PERSON a. REPORT unclassified b . ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18

The effects of estimation of censoring, truncation, transformation and partial data vectors

NASA Technical Reports Server (NTRS)

Hartley, H. O.; Smith, W. B.

1972-01-01

The purpose of this research was to attack statistical problems concerning the estimation of distributions for purposes of predicting and measuring assembly performance as it appears in biological and physical situations. Various statistical procedures were proposed to attack problems of this sort, that is, to produce the statistical distributions of the outcomes of biological and physical situations which, employ characteristics measured on constituent parts. The techniques are described.

Avatar Web-Based Self-Report Survey System Technology for Public Health Research: Technical Outcome Results and Lessons Learned

PubMed Central

Savel, Craig; Mierzwa, Stan; Gorbach, Pamina M.; Souidi, Samir; Lally, Michelle; Zimet, Gregory; Interventions, AIDS

2016-01-01

This paper reports on a specific Web-based self-report data collection system that was developed for a public health research study in the United States. Our focus is on technical outcome results and lessons learned that may be useful to other projects requiring such a solution. The system was accessible from any device that had a browser that supported HTML5. Report findings include: which hardware devices, Web browsers, and operating systems were used; the rate of survey completion; and key considerations for employing Web-based surveys in a clinical trial setting. PMID:28149445

Do burns increase the severity of terror injuries?

PubMed

Peleg, Kobi; Liran, Alon; Tessone, Ariel; Givon, Adi; Orenstein, Arie; Haik, Josef

2008-01-01

The use of explosives and suicide bombings has become more frequent since October 2000. This change in the nature of terror attacks has marked a new era in the Israeli-Palestinian conflict. We previously reported that the incidence of thermal injuries has since risen. However, the rise in the incidence of burns among victims of terror was proportionate to the rise in the incidence of burns among all trauma victims. This paper presents data from the Israeli National Trauma Registry during the years 1997--2003, to compare the severity of injuries and outcome (mortality rates) in terror victims with and without burn injuries. We also compare the severity of injuries and outcome (mortality rates) for patients with terror-attack related burns to non terror-attack related burns during the same period. Data was obtained from the Israeli National Trauma Registry for all patients admitted to 8 to 10 hospitals in Israel between 1997 and 2003. We analyzed and compared demographic and clinical characteristics of 219 terror-related burn patients (terror/burn), 2228 terror patients with no associated burns (Terror/no-burn) and 6546 non terror related burn patients (burn/no-terror). Severity of injuries was measured using the injury severity score, and burn severity by total body surface percentage indices. Admission rates to Intensive Care Units (ICU) and total length of hospitalization were also used to measure severity of injuries. In-hospital mortality rates were used to indicate outcome. Of burn/terror patients, 87.2% suffered other accompanying injuries, compared with 10.4% of burn/no-terror patients. Of burn/terror patients, 49.8% were admitted to ICU compared with only 11.9% of burn/no-terror patients and 23.8% of no-burn/terror patients. Mean length of hospital stay was 18.5 days for the terror/burn group compared with 11.1 days for the burn/no-terror group and 9.5 days for the terror/no-burn group. Burn/terror patients had a significantly higher injury severity score compared with the other groups. In-hospital mortality rate for the burn/no-terror group was 3.4%. The burn/terror group had a mortality rate of 6.4% which was similar to the no-burn/terror group (6.6%). Terror-attack injuries with accompanying burns have a more complex presentation, are of higher severity, and are associated with increased length of hospital stay and a higher ICU admissions rate, compared with terror-attack injuries without burns and non terror-attack related burns. However, mortality rates in terror-attack injuries are not affected by burns.

Panic Attacks and Smoking Cessation among Cancer Patients Receiving Smoking Cessation Treatment

PubMed Central

Farris, Samantha G.; Robinson, Jason D.; Zvolensky, Michael J.; Hogan, Julianna; Rabius, Vance; Cinciripini, Paul M.; Karam-Hage, Maher; Blalock, Janice A.

2018-01-01

Objective Little is known about factors associated with smoking cessation in cancer patients. This study examined the impact of panic attacks on smoking abstinence likelihood among cancer patients receiving tobacco cessation treatment. Method The relationship of panic attacks to 7-day point-prevalence abstinence at mid-treatment, end of treatment, and 6-month post-end of treatment were examined among cancer patients (N = 2,255 patients; 50.1% female; Mage = 54.9, SD = 11.0) who received counseling and pharmacotherapy for smoking cessation. Panic attack history indexed by two questions from the Patient Health Questionnaire (PHQ). Post-prevalence abstinence was assessed via the Timeline Follow-Back. Results Cancer patients with a history of panic attacks, (n = 493, 21.9%) relative to those without, were less likely to be abstinent at mid-treatment (OR = 0.79, CI95% = 0.64–0.98) and end of treatment (OR = 0.72, CI95% = 0.58–0.89). After adjusting for significant covariates, panic attack history remained predictive of decreased abstinence likelihood at end of treatment (OR = 0.78, CI95% = 0.62–0.99). Conclusions Panic attacks may be related to poorer cessation outcome during smoking treatment among cancer patients, and may be usefully assessed and targeted for intervention. PMID:27235990

Panic attacks and smoking cessation among cancer patients receiving smoking cessation treatment.

PubMed

Farris, Samantha G; Robinson, Jason D; Zvolensky, Michael J; Hogan, Julianna; Rabius, Vance; Cinciripini, Paul M; Karam-Hage, Maher; Blalock, Janice A

2016-10-01

Little is known about factors associated with smoking cessation in cancer patients. This study examined the impact of panic attacks on smoking abstinence likelihood among cancer patients receiving tobacco cessation treatment. The relationship of panic attacks to 7-day point-prevalence abstinence at mid-treatment, end of treatment, and 6-month post-end of treatment were examined among cancer patients (N=2255 patients; 50.1% female; Mage=54.9, SD=11.0) who received counseling and pharmacotherapy for smoking cessation. Panic attack history indexed by two questions from the Patient Health Questionnaire (PHQ). Point-prevalence abstinence was assessed via the Timeline Follow-Back. Cancer patients with a history of panic attacks, (n=493, 21.9%) relative to those without, were less likely to be abstinent at mid-treatment (OR=0.79, CI95%=0.64-0.98) and end of treatment (OR=0.72, CI95%=0.58-0.89). After adjusting for significant covariates, panic attack history remained predictive of decreased abstinence likelihood at end of treatment (OR =0.78, CI95%=0.62-0.99). Panic attacks may be related to poorer cessation outcome during smoking treatment among cancer patients, and may be usefully assessed and targeted for intervention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Signaling aggression.

PubMed

van Staaden, Moira J; Searcy, William A; Hanlon, Roger T

2011-01-01

From psychological and sociological standpoints, aggression is regarded as intentional behavior aimed at inflicting pain and manifested by hostility and attacking behaviors. In contrast, biologists define aggression as behavior associated with attack or escalation toward attack, omitting any stipulation about intentions and goals. Certain animal signals are strongly associated with escalation toward attack and have the same function as physical attack in intimidating opponents and winning contests, and ethologists therefore consider them an integral part of aggressive behavior. Aggressive signals have been molded by evolution to make them ever more effective in mediating interactions between the contestants. Early theoretical analyses of aggressive signaling suggested that signals could never be honest about fighting ability or aggressive intentions because weak individuals would exaggerate such signals whenever they were effective in influencing the behavior of opponents. More recent game theory models, however, demonstrate that given the right costs and constraints, aggressive signals are both reliable about strength and intentions and effective in influencing contest outcomes. Here, we review the role of signaling in lieu of physical violence, considering threat displays from an ethological perspective as an adaptive outcome of evolutionary selection pressures. Fighting prowess is conveyed by performance signals whose production is constrained by physical ability and thus limited to just some individuals, whereas aggressive intent is encoded in strategic signals that all signalers are able to produce. We illustrate recent advances in the study of aggressive signaling with case studies of charismatic taxa that employ a range of sensory modalities, viz. visual and chemical signaling in cephalopod behavior, and indicators of aggressive intent in the territorial calls of songbirds. Copyright © 2011 Elsevier Inc. All rights reserved.

Epidemiology of international terrorism involving fatal outcomes in developed countries (1994-2003).

PubMed

Wilson, Nick; Thomson, George

2005-01-01

We aimed to describe the public health burden and epidemiology of international terrorism (i.e. involving foreign nationals) with fatal outcomes in developed countries. Data was abstracted from a United States Department of State database for 21 'established market economy' countries and 18 'former socialist economies of Europe' for 1994-2003. To put the findings in a wider context, comparisons were made with WHO data on all homicides for each country. A total of 32 international terrorist attacks causing fatalities were identified over the 10-year period. These resulted in 3299 deaths, giving a crude annual mortality rate of 0.3 per million population. The mortality burden attributable to international terrorism in these countries was 208 times less than that attributable to other homicide. Even for the country with the highest mortality burden from international terrorism (the United States), this ratio was 60. There was no statistically significant trend in the number of attacks over time, but the attack severity (in terms of deaths per attack) was higher in the latter part of the 10-year period. A number of limitations with this data set were identified. If a more rigorous definition of 'international terrorism' was used, then this would substantially reduce the total number of such attacks defined in this way. In conclusion, there is a need for better quality data and improved classification systems for describing international terrorism. Nevertheless, the available data indicates that the mortality burden from international terrorism in developed countries is small compared to that from other homicide.

Public knowledge of heart attack symptoms in Beijing residents.

PubMed

Zhang, Qing-Tan; Hu, Da-Yi; Yang, Jin-Gang; Zhang, Shou-Yan; Zhang, Xin-Quan; Liu, Shu-Shan

2007-09-20

Definitive treatment for heart attack is early reperfusion with either angioplasty or thrombolytic therapy, and the benefit is strictly time-dependent. Patient outcomes are improved with either therapy when initiated as soon as possible. Recognition of heart attack symptoms is logically tied to taking action to receive prompt emergency care. Inadequate knowledge of heart attack symptoms may prolong delay. The purpose of this study was to document knowledge about heart attack symptoms in Beijing residents and to identify the characteristics associated with increased knowledge of heart attack. A structured survey was conducted in 18 communities in Beijing from March 1 through June 10 in 2006. Addresses and participants were selected randomly following a stratification. The survey was designed to collect knowledge of heart attack symptoms from sampled adults in each community. A total of 4627 respondents completed the questionnaires correctly, and 50.29% of them were female. Totally 64.15% of the respondents reported chest pain or discomfort (common symptoms) as a symptom of heart attack; 75.38% reported at least one of the following eight symptoms as a symptom of heart attack: back pain, shortness of breath, arm pain or numbness, nausea or vomiting, neck, jaw or shoulder pain, epigastric pain, sweating, weakness (less common symptoms); 20.36% correctly reported four or more heart attack symptoms, only 7.4% knew all the correct heart attack symptoms, and 28.94% knew about reperfusion therapy for heart attack; 31.7% reported to call 120 or 999 while having a heart attack themselves; however 89.6% reported to call 120 or 999 when someone else is suffering from a heart attack. Very old persons and those with health insurance coverage, high education level, high household income, longer living in Beijing and previous experience with heart disease had greater knowledge of heart attack symptoms. Public knowledge of common heart attack symptoms as well as less common heart attack symptoms is deficient in Beijing residents. But their knowledge of calling emergency medical services when someone is having a heart attack is relatively adequate. Public health efforts are needed to increase the recognition of the major heart attack symptoms in both the general public and groups at high risk for an acute cardiac event, especially in socioeconomically disadvantaged subgroups, including persons with low education level, low household income, and no health insurance coverage.

Landmark lecture on cardiology: the quest for the ultimate team in health care - what we can learn from musicians about leadership, innovation, and teambuilding?

PubMed

Penny, Daniel J

2017-12-01

The importance of teamwork is being increasingly recognised in healthcare. Nonetheless, it is equally recognised that teamwork is difficult. In this article, I explore whether we can learn lessons from musicians, orchestras, and conductors as we build our teams. The evolution of the role of the conductor provides useful lessons on leadership and the evolving role of the members of the orchestra on how team members can contribute to a shared outcome. The uncertainty of jazz provides useful lessons for innovation in an increasingly turbulent healthcare environment.

Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health community

PubMed Central

Wright, J; Harrison, S; McGeorge, M; Patterson, C; Russell, I; Russell, D; Small, N; Taylor, M; Walsh, M; Warren, E; Young, J

2006-01-01

Problem Rapid referral and management of patients with transient ischaemic attacks is a key component in the national strategy for stroke prevention. However, patients with transient ischaemic attacks are poorly identified and undertreated. Design and setting Before and after evaluation of quality improvement programme with controlled comparison in three primary care trusts reflecting diverse populations and organisational structures in an urban district in the North of England. Key measures for improvement The proportion of patients receiving antiplatelet drugs and safe driving advice on referral to a speciality clinic, and the numbers of referrals, adjusted for age, to the specialist clinic before and after the improvement programme. Strategies for change Interviews with patient and professionals to identify gaps and barriers to good practice; development of evidence based guidelines for the management of patients with transient ischaemic attacks; interactive multidisciplinary workshops for each primary care trust with feedback of individual audit results of referral practice; outreach visits to teams who were unable to attend the workshops; referral templates and desktop summaries to provide reminders of the guidelines to clinicians; incorporation of standards into professional contracts. Effects of change A significant improvement occurred in identification and referral of patients with transient ischaemic attacks to specialist clinics, with a 41% increase in referrals from trained practices compared with control practices. There were also significant improvements in the early treatment and safety advice provided to patients before referral. Lessons learnt A strategic approach to effective quality improvement across a diverse health community is feasible and achievable. Careful planning with patient and professional involvement to develop a tailored and multifaceted quality improvement programme to implement evidence based practice can work in very different primary care settings. Key components of the effectiveness of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication, and use of established networks and opinion leaders. PMID:16456203

Efficacy of a Community-Based Physical Activity Program KM2H2 for Stroke and Heart Attack Prevention among Senior Hypertensive Patients: A Cluster Randomized Controlled Phase-II Trial.

PubMed

Gong, Jie; Chen, Xinguang; Li, Sijian

2015-01-01

To evaluate the efficacy of the program Keep Moving toward Healthy Heart and Healthy Brain (KM2H2) in encouraging physical activities for the prevention of heart attack and stroke among hypertensive patients enrolled in the Community-Based Hypertension Control Program (CBHCP). Cluster randomized controlled trial with three waves of longitudinal assessments at baseline, 3 and 6 months post intervention. Community-based and patient-centered self-care for behavioral intervention in urban settings of China. A total of 450 participants diagnosed with hypertension from 12 community health centers in Wuhan, China were recruited, and were randomly assigned by center to receive either KM2H2 plus standard CBHCP care (6 centers and 232 patients) or the standard care only (6 centers and 218 patients). KM2H2 is a behavioral intervention guided by the Transtheoretical Model, the Model of Personalized Medicine and Social Capital Theory. It consists of six intervention sessions and two booster sessions engineered in a progressive manner. The purpose is to motivate and maintain physical activities for the prevention of heart attack and stroke. Heart attack and stroke (clinically diagnosed, primary outcome), blood pressure (measured, secondary outcome), and physical activity (self-report, tertiary outcome) were assessed at the individual level during the baseline, 3- and 6-month post-intervention. Relative to the standard care, receiving KM2H2 was associated with significant reductions in the incidence of heart attack (3.60% vs. 7.03%, p < .05) and stroke (5.11% vs. 9.90%, p<0.05), and moderate reduction in blood pressure (-3.72 mmHg in DBP and -2.92 mmHg in DBP) at 6-month post-intervention; and significant increases in physical activity at 3- (d = 0.53, 95% CI: 0.21, 0.85) and 6-month (d = 0.45, 95% CI: 0.04, 0.85) post-intervention, respectively. The program KM2H2 is efficacious to reduce the risk of heart attack and stroke among senior patients who are on anti-hypertensive medication. Findings of this study provide solid data supporting a formal phase-III trial to establish the effectiveness of KM2H2 for use in community settings for prevention. ISRCTN Register ISRCTN12608966.

Socio-professional handicap and accidental risk in patients with hypersomnias of central origin.

PubMed

Bayon, Virginie; Léger, Damien; Philip, Pierre

2009-12-01

Narcolepsy and idiopathic hypersomnia profoundly affect quality of life, education and work. Young patients are very handicapped by unexpected sleep episodes during lessons. Professionals frequently complain about sleepiness at work. Motor discomfort (i.e., cataplectic attacks) surprisingly is less handicapping in narcoleptics than sleepiness but only a few studies clearly assess the problem. Quality of life is also largely impaired in its physical and emotional dimensions. Sleepiness is the major factor explaining a decrease of quality of life and unexpectedly cataplectic attacks have little impact on patients. Another potential problem for these patients is the risk of accidents at work or when driving. Narcoleptic and hypersomniac patients have a higher risk of accidents than apneic or insomniac subjects. But, confounding factors such as duration of driving, number of cataplectic attacks or even objective level of alertness are not always entered in the analytic models mainly because of small samples of patients. Unlike in apneic patients, the effect of treatment on accidental risk has not been studied in narcoleptics or in hypersomniacs. Epidemiological data are needed to improve knowledge concerning these areas. Clinical trials assessing the impact of treatment on driving and work are also urgently needed. Finally, medical treatment does not seem to be completely efficient and physicians should pay more attention to the education, work, life and social environment of their patients.

"Evita Una Muerte, Esta en Tus Manos" Program: Bystander First Aid Training for Terrorist Attacks.

PubMed

Pajuelo Castro, J J; Meneses Pardo, J C; Salinas Casado, P L; Hernandez Martin, P; Montilla Canet, R; Del Campo Cuesta, J L; Incera Bustio, G; Martin Ayuso, D

The latest terrorist attacks in Europe and in the rest of the world, and the military experience in the most recent conflicts leave us with several lessons learned. The most important is that the fate of the wounded rests in the hands of the one who applies the first dressing, because the victims usually die within the first 10 minutes, before professional care providers or police personnel arrive at the scene. A second lesson is that the primary cause of preventable death in these types of incidents involving explosives and firearms is massive hemorraghe. There is a need to develop a training oriented to citizens so they can identify and use available resources to avoid preventable deaths that occur in this kind of incidents, especially massive hemorrhage. A 7-hour training intervention program was developed and conducted between January and May 2017. Data were collected from participants' answers on a multiple-choice test before and after undertaking the training. Improved mean score for at least 75% of a group's members on the posttraining test was considered reflective of adequate knowledge. A total of 173 participants (n = 74 men [42.8%]; n = 99 women [57.2%]) attended the training. They were classified into three groups: a group of citizens/ first responders with no prior health training, a group of health professionals, and a group of nursing students. Significant differences (ρ < .05) between mean pre- and post-training test scores occurred in each of the three groups. There was a clear improvement in the knowledge of the students after the training when pre- and post-training test scores were compared within the three groups. The greatest improvement was seen in the citizens/first responders group. 2017.

Strategic aspects of cyberattack, attribution, and blame.

PubMed

Edwards, Benjamin; Furnas, Alexander; Forrest, Stephanie; Axelrod, Robert

2017-03-14

Cyber conflict is now a common and potentially dangerous occurrence. The target typically faces a strategic choice based on its ability to attribute the attack to a specific perpetrator and whether it has a viable punishment at its disposal. We present a game-theoretic model, in which the best strategic choice for the victim depends on the vulnerability of the attacker, the knowledge level of the victim, payoffs for different outcomes, and the beliefs of each player about their opponent. The resulting blame game allows analysis of four policy-relevant questions: the conditions under which peace (i.e., no attacks) is stable, when attacks should be tolerated, the consequences of asymmetric technical attribution capabilities, and when a mischievous third party or an accident can undermine peace. Numerous historical examples illustrate how the theory applies to cases of cyber or kinetic conflict involving the United States, Russia, China, Japan, North Korea, Estonia, Israel, Iran, and Syria.

Strategic aspects of cyberattack, attribution, and blame

PubMed Central

Edwards, Benjamin; Furnas, Alexander; Forrest, Stephanie

2017-01-01

Cyber conflict is now a common and potentially dangerous occurrence. The target typically faces a strategic choice based on its ability to attribute the attack to a specific perpetrator and whether it has a viable punishment at its disposal. We present a game-theoretic model, in which the best strategic choice for the victim depends on the vulnerability of the attacker, the knowledge level of the victim, payoffs for different outcomes, and the beliefs of each player about their opponent. The resulting blame game allows analysis of four policy-relevant questions: the conditions under which peace (i.e., no attacks) is stable, when attacks should be tolerated, the consequences of asymmetric technical attribution capabilities, and when a mischievous third party or an accident can undermine peace. Numerous historical examples illustrate how the theory applies to cases of cyber or kinetic conflict involving the United States, Russia, China, Japan, North Korea, Estonia, Israel, Iran, and Syria. PMID:28242700

Panic attack symptoms differentiate patients with epilepsy from those with psychogenic nonepileptic spells (PNES).

PubMed

Hendrickson, Rick; Popescu, Alexandra; Dixit, Ronak; Ghearing, Gena; Bagic, Anto

2014-08-01

Psychogenic nonepileptic spells (PNES) are frequently challenging to differentiate from epileptic seizures. The experience of panic attack symptoms during an event may assist in distinguishing PNES from seizures secondary to epilepsy. A retrospective analysis of 354 patients diagnosed with PNES (N=224) or with epilepsy (N=130) investigated the thirteen Diagnostic and Statistical Manual-IV-Text Revision panic attack criteria endorsed by the two groups. We found a statistically higher mean number of symptoms reported by patients with PNES compared with those with epilepsy. In addition, the majority of the panic attack symptoms including heart palpitations, sweating, shortness of breath, choking feeling, chest discomfort, dizziness/unsteadiness, derealization or depersonalization, fear of dying, paresthesias, and chills or hot flashes were significantly more frequent in those with PNES. As patients with PNES frequently have poor clinical outcomes, treatment addressing the anxiety symptomatology may be beneficial. Copyright © 2014 Elsevier Inc. All rights reserved.

How Schools Are Using Action Research on Practical Work, New Technologies and Research and Development to Improve Student Outcomes

ERIC Educational Resources Information Center

Davenport, Carol

2013-01-01

Three methods from different schools illustrate how the cyclic process of action research can be used to develop teaching skills. The importance of learning from successful and unsuccessful lessons or parts of lessons is emphasised as the basis for development and improvement. This process can be carried out on an individual basis but development…

Building Bridges between Technology and Content Literacy in Special Education: Lessons Learned from Special Educators' Use of Integrated Technology and Perceived Benefits for Students

ERIC Educational Resources Information Center

Ciampa, Katia

2017-01-01

This single-site case study describes the outcomes and lessons learned from the implementation of a technology professional development initiative aimed at helping three special education teachers from an urban elementary school learn how to infuse technology in their content literacy instruction. Three types of qualitative data were collected:…

Promoting Social and Emotional Learning Outcomes in Physical Education: Insights from a School-Based Research Project in Singapore

ERIC Educational Resources Information Center

Ang, Swee Chong; Penney, Dawn

2013-01-01

Competition is an integral aspect of many physical education lessons, and one of the central characteristics of units and lessons adopting the Sport Education model. Pedagogy has a key, yet under-researched, role to play in supporting students to develop social and emotional skills that will enable them to cope with situations in which they…

Study of Health Outcomes in School Children: Key Challenges and Lessons Learned from the Framingham Schools' Natural History of Nevi Study

ERIC Educational Resources Information Center

Geller, Alan C.; Oliveria, Susan A.; Bishop, Marilyn; Buckminster, Marcia; Brooks, Katie R.; Halpern, Allan C.

2007-01-01

Background: We describe the planning, recruitment, key challenges, and lessons learned in the development of a study of the evolution of nevi (moles) among children in a school setting. Methods: This population-based study of digital photography and dermoscopy of the child's back (overview, close-up, and dermoscopic images) and genetic specimens…

Thinking Science Australia: A Short History of How Thirty Science Lessons Transform Learning and Teaching

ERIC Educational Resources Information Center

Smith, Tim

2016-01-01

Originally called Cognitive Acceleration through Science Education, Thinking Science is a program of 30 lessons, usually delivered in Years 7 and 8, that has been shown to improve learner outcomes in science, maths and English. Over recent years, it has grown in popularity in Australia and was the subject of an ARC-funded research project at the…

Education through Fiction: Acquiring Opinion-Forming Skills in the Context of Genomics

ERIC Educational Resources Information Center

Knippels, Marie-Christine P. J.; Severiens, Sabine E.; Klop, Tanja

2009-01-01

The present study examined the outcomes of a newly designed four-lesson science module on opinion-forming in the context of genomics in upper secondary education. The lesson plan aims to foster 16-year-old students' opinion-forming skills in the context of genomics and to test the effect of the use of fiction in the module. The basic hypothesis…

The Purposeful Classroom: How to Structure Lessons with Learning Goals in Mind

ERIC Educational Resources Information Center

Frey, Nancy; Fisher, Douglas

2011-01-01

One of the best ways to make sure the spirit of accountability is reflected in your teaching practice is to make sure everything you do in the classroom relates to a specific learning outcome. ASCD best-selling authors Doug Fisher and Nancy Frey explain exactly how to do that and take you through all the steps of making sure every lesson plan has…

Nightfall and the Cloud: Examining the Future of Unmanned Combat Aerial Vehicles and Remotely Piloted Aircraft

DTIC Science & Technology

2015-10-01

likely outcomes and make decisions; however, that is a fundamentally different dy- namic than a true learning process. Preprogrammed assumptions and design ...ISR, targeting, forward air control, laser designation , weapons delivery, battle damage assessment ISR, targeting acquisition, and attack...KTAS 400 KTAS Weapons Payload N/A N/A 2 Hellfire missiles 4 Hellfire missiles 14 Hellfire or 4 Hellfire and 2x GBU -12 or 2 Joint Direct Attack

Children's Mental Health in the Context of Terrorist Attacks, Ongoing Threats, and Possibilities of Future Terrorism.

PubMed

Comer, Jonathan S; Bry, Laura J; Poznanski, Bridget; Golik, Alejandra M

2016-09-01

Over the past two decades, the field has witnessed tremendous advances in our understanding of terrorism and its impacts on affected youth. It is now well established that a significant proportion of exposed youth show elevated PTSD symptoms in the months following a terrorist attack. In more recent years, research has expanded beyond confirming our understanding of the association between direct terrorism exposure and child PTSD symptoms by elucidating (a) links between terrorism exposure and non-PTSD clinical outcomes (e.g., externalizing problems, substance use), (b) individual differences associated with divergent patterns of risk and resilience, (c) the clinical correlates of media-based contact with terrorism, (d) clinical outcomes associated with exposure to recurrent terrorist attacks, and (e) exposure to extended contexts of uncertainty and the possibilities of future terrorism. Researchers studying the effects of terrorism and political violence on youth have increasingly examined a much broader range of regions in the world, affording needed opportunities to consider the generalizability of prior findings to youth living in different political contexts, in less developed regions of the world, and/or in regions with different rates of recurrent terrorism. In order to understand and, in turn, best meet the clinical needs of the majority of terrorism-affected youth across the globe, more targeted research on exposed youth is needed in developing regions of the world and regions enduring more recurrent terrorist attacks.

WILD PIG ATTACKS ON HUMANS

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

Mayer, J.

Attacks on humans by wild pigs (Sus scrofa) have been documented since ancient times. However, studies characterizing these incidents are lacking. In an effort to better understand this phenomenon, information was collected from 412 wild pig attacks on humans. Similar to studies of large predator attacks on humans, data came from a variety of sources. The various attacks compiled occurred in seven zoogeographic realms. Most attacks occurred within the species native range, and specifically in rural areas. The occurrence was highest during the winter months and daylight hours. Most happened under non-hunting circumstances and appeared to be unprovoked. Wounded animalsmore » were the chief cause of these attacks in hunting situations. The animals involved were typically solitary, male and large in size. The fate of the wild pigs involved in these attacks varied depending upon the circumstances, however, most escaped uninjured. Most human victims were adult males traveling on foot and alone. The most frequent outcome for these victims was physical contact/mauling. The severity of resulting injuries ranged from minor to fatal. Most of the mauled victims had injuries to only one part of their bodies, with legs/feet being the most frequent body part injured. Injuries were primarily in the form of lacerations and punctures. Fatalities were typically due to blood loss. In some cases, serious infections or toxemia resulted from the injuries. Other species (i.e., pets and livestock) were also accompanying some of the humans during these attacks. The fates of these animals varied from escaping uninjured to being killed. Frequency data on both non-hunting and hunting incidents of wild pig attacks on humans at the Savannah River Site, South Carolina, showed quantitatively that such incidents are rare.« less

Contextual and Personal Predictors of Adaptive Outcomes under Terror Attack: The Case of Israeli Adolescents

ERIC Educational Resources Information Center

Zeidner, Moshe

2005-01-01

This paper explores individual differences in perceptions of political violence, strategies for coping with violence, and adaptive outcomes. Data on political violence stress, personal variables, coping strategies, and stress reactions were gathered on a sample of 227 Israeli adolescents in Haifa and Northern Israel confronted with a prolonged…

Outcomes-based Pricing Program Puts Money in Beneficiaries' Pockets.

PubMed

Silverman, Ed

2017-08-01

Harvard Pilgrim's program gives rebates to beneficiaries if Repatha doesn't help them avoid a heart attack or stroke. It's just the latest in a growing number of outcomes-based pricing agreements in which an insurer can get a discount from a drugmaker if a drug doesn't help patients as much as expected.

Hereditary angioedema with normal C1 inhibitor in a French cohort: Clinical characteristics and response to treatment with icatibant.

PubMed

Bouillet, Laurence; Boccon-Gibod, Isabelle; Launay, David; Gompel, Anne; Kanny, Gisele; Fabien, Vincent; Fain, Oliver

2017-03-01

The clinical characteristics and icatibant-treatment outcomes of patients with hereditary angioedema with normal C1 inhibitor (HAE-nC1 INH) are limited. We retrospectively analyzed data from French HAE patients enrolled in the Icatibant Outcome Survey registry (from July 2009 to September 2013) to compare disease characteristics and the effectiveness and safety of acute icatibant-treated angioedema attacks in patients with HAE-nC1 INH, HAE with C1 INH deficiency (type I), or dysfunction (type II). One center in Grenoble contributed 22 patients with HAE-nC1 INH and a family history of HAE while 15 centers across France contributed 153 patients with HAE type I and seven patients with HAE type II. Patients with HAE-nC1 INH compared to HAE type I, respectively, were more likely to be female (88.1% vs. 63.4%), older at median age of disease onset (21 years vs. 15 years), and have a greater rate of abdominal (80% vs. 61%) and laryngeal (23% vs. 14%) attacks. Icatibant was effective in both groups though the median time to resolution of attack was significantly longer in the HAE-nC1 INH group (20.0 h, 37 attacks) versus the HAE type I group (14.0 h, 67 attacks). Icatibant was self-administered for 96.1% of attacks in patients with HAE-nC1 INH and 75.8% in patients with HAE type I. No serious adverse side effects related to icatibant were reported. These data help further define the disease characteristics of HAE-nC1 INH in the French population and extend the limited data reporting the safe and effective use of icatibant in acute treatment of angioedema in French patients diagnosed with HAE-nC1 INH.

Hereditary angioedema with normal C1 inhibitor in a French cohort: Clinical characteristics and response to treatment with icatibant

PubMed Central

Boccon‐Gibod, Isabelle; Launay, David; Gompel, Anne; Kanny, Gisele; Fabien, Vincent; Fain, Oliver

2017-01-01

Abstract Introduction The clinical characteristics and icatibant‐treatment outcomes of patients with hereditary angioedema with normal C1 inhibitor (HAE‐nC1 INH) are limited. Methods We retrospectively analyzed data from French HAE patients enrolled in the Icatibant Outcome Survey registry (from July 2009 to September 2013) to compare disease characteristics and the effectiveness and safety of acute icatibant‐treated angioedema attacks in patients with HAE‐nC1 INH, HAE with C1 INH deficiency (type I), or dysfunction (type II). Results One center in Grenoble contributed 22 patients with HAE‐nC1 INH and a family history of HAE while 15 centers across France contributed 153 patients with HAE type I and seven patients with HAE type II. Patients with HAE‐nC1 INH compared to HAE type I, respectively, were more likely to be female (88.1% vs. 63.4%), older at median age of disease onset (21 years vs. 15 years), and have a greater rate of abdominal (80% vs. 61%) and laryngeal (23% vs. 14%) attacks. Icatibant was effective in both groups though the median time to resolution of attack was significantly longer in the HAE‐nC1 INH group (20.0 h, 37 attacks) versus the HAE type I group (14.0 h, 67 attacks). Icatibant was self‐administered for 96.1% of attacks in patients with HAE‐nC1 INH and 75.8% in patients with HAE type I. No serious adverse side effects related to icatibant were reported. Conclusions These data help further define the disease characteristics of HAE‐nC1 INH in the French population and extend the limited data reporting the safe and effective use of icatibant in acute treatment of angioedema in French patients diagnosed with HAE‐nC1 INH. PMID:28250922

The assessment of professional competence: building blocks for theory development.

PubMed

van der Vleuten, C P M; Schuwirth, L W T; Scheele, F; Driessen, E W; Hodges, B

2010-12-01

This article presents lessons learnt from experiences with assessment of professional competence. Based on Miller's pyramid, a distinction is made between established assessment technology for assessing 'knows', 'knowing how' and 'showing how' and more recent developments in the assessment of (clinical) performance at the 'does' level. Some general lessons are derived from research of and experiences with the established assessment technology. Here, many paradoxes are revealed and empirical outcomes are often counterintuitive. Instruments for assessing the 'does' level are classified and described, and additional general lessons for this area of performance assessment are derived. These lessons can also be read as general principles of assessment (programmes) and may provide theoretical building blocks to underpin appropriate and state-of-the-art assessment practices. Copyright © 2010 Elsevier Ltd. All rights reserved.

Does acute maternal stress in pregnancy affect infant health outcomes? Examination of a large cohort of infants born after the terrorist attacks of September 11, 2001.

PubMed

Endara, Skye M; Ryan, Margaret A K; Sevick, Carter J; Conlin, Ava Marie S; Macera, Caroline A; Smith, Tyler C

2009-07-20

Infants in utero during the terrorist attacks of September 11, 2001 may have been negatively affected by maternal stress. Studies to date have produced contradictory results. Data for this retrospective cohort study were obtained from the Department of Defense Birth and Infant Health Registry and included up to 164,743 infants born to active-duty military families. Infants were considered exposed if they were in utero on September 11, 2001, while the referent group included infants gestating in the same period in the preceding and following year (2000 and 2002). We investigated the association of this acute stress during pregnancy with the infant health outcomes of male:female sex ratio, birth defects, preterm birth, and growth deficiencies in utero and in infancy. No difference in sex ratio was observed between infants in utero in the first trimester of pregnancy on September 11, 2001 and infants in the referent population. Examination of the relationship between first-trimester exposure and birth defects also revealed no significant associations. In adjusted multivariable models, neither preterm birth nor growth deficiencies were significantly associated with the maternal exposure to the stress of September 11 during pregnancy. The findings from this large population-based study suggest that women who were pregnant during the terrorist attacks of September 11, 2001 had no increased risk of adverse infant health outcomes.

How to use Gagne's model of instructional design in teaching psychomotor skills

PubMed Central

Rostami, Kamran; Ishaq, Sauid

2011-01-01

Gagne's model of instructional design is based on the information processing model of the mental events that occur when adults are presented with various stimuli and focuses on the learning outcomes and how to arrange specific instructional events to achieve those outcomes. Applying Gagne's nine-step model is an excellent way to ensure an effective and systematic learning program as it gives structure to the lesson plans and a holistic view to the teaching. In this paper, we have chosen a routine practical procedure that junior doctors need to learn: insertion of a peritoneal (ascitic) drain and we use Gagne's “events of instruction” to design a lesson plan for this subject. PMID:24834168

How to use Gagne's model of instructional design in teaching psychomotor skills.

PubMed

Khadjooi, Kayvan; Rostami, Kamran; Ishaq, Sauid

2011-01-01

Gagne's model of instructional design is based on the information processing model of the mental events that occur when adults are presented with various stimuli and focuses on the learning outcomes and how to arrange specific instructional events to achieve those outcomes. Applying Gagne's nine-step model is an excellent way to ensure an effective and systematic learning program as it gives structure to the lesson plans and a holistic view to the teaching. In this paper, we have chosen a routine practical procedure that junior doctors need to learn: insertion of a peritoneal (ascitic) drain and we use Gagne's "events of instruction" to design a lesson plan for this subject.

An internet-supported school physical activity intervention in low socioeconomic status communities: results from the Activity and Motivation in Physical Education (AMPED) cluster randomised controlled trial.

PubMed

Lonsdale, Chris; Lester, Aidan; Owen, Katherine B; White, Rhiannon L; Peralta, Louisa; Kirwan, Morwenna; Diallo, Thierno M O; Maeder, Anthony J; Bennie, Andrew; MacMillan, Freya; Kolt, Gregory S; Ntoumanis, Nikos; Gore, Jennifer M; Cerin, Ester; Cliff, Dylan P; Lubans, David R

2017-10-09

Quality physical education (PE) is the cornerstone of comprehensive school physical activity (PA) promotion programmes. We tested the efficacy of a teacher professional learning intervention, delivered partially via the internet, designed to maximise opportunities for students to be active during PE lessons and enhance adolescents' motivation towards PE and PA. A two-arm cluster randomised controlled trial with teachers and Grade 8 students from secondary schools in low socioeconomic areas of Western Sydney, Australia. The Activity and Motivation in Physical Education (AMPED) intervention for secondary school PE teachers included workshops, online learning, implementation tasks and mentoring sessions. The primary outcome was the proportion of PE lesson time that students spent in moderate-to-vigorous physical activity (MVPA), measured by accelerometers at baseline, postintervention (7-8 months after baseline) and maintenance (14-15 months). Secondary outcomes included observed PE teachers' behaviour during lessons, students' leisure-time PA and students' motivation. Students (n=1421) from 14 schools completed baseline assessments and were included in linear mixed model analyses. The intervention had positive effects on students' MVPA during lessons. At postintervention, the adjusted mean difference in the proportion of lesson time spent in MVPA was 5.58% (p<0.001, approximately 4 min/lesson). During the maintenance phase, this effect was 2.64% (p<0.001, approximately 2 min/lesson). The intervention had positive effects on teachers' behaviour, but did not impact students' motivation. AMPED produced modest improvements in MVPA and compares favourably with previous interventions delivered exclusively face-to-face. Online teacher training could help facilitate widespread dissemination of professional learning interventions. ACTRN12614000184673. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Lessons learned from the Syrian sarin attack: evaluation of a clinical syndrome through social media.

PubMed

Rosman, Yossi; Eisenkraft, Arik; Milk, Nadav; Shiyovich, Arthur; Ophir, Nimrod; Shrot, Shai; Kreiss, Yitshak; Kassirer, Michael

2014-05-06

On the night of 21 August 2013, sarin was dispersed in the eastern outskirts of Damascus, killing 1400 civilians and severely affecting thousands more. This article aims to delineate the clinical presentation and management of a mass casualty event caused by a nerve agent as shown in the social media. Authors searched YouTube for videos uploaded of this attack and identified 210 videos. Of these, 67 met inclusion criteria and were evaluated in the final analysis.These videos displayed 130 casualties; 119 (91.5%) of which were defined as moderately injured or worse. The most common clinical signs were dyspnea (53.0%), diaphoresis (48.5%), and loss of consciousness (40.7%). Important findings included a severe shortage of supporting measures and lack of antidotal autoinjectors. Decontamination, documented in 25% of the videos, was done in an inefficient manner. Protective gear was not noticed, except for sporadic use of latex gloves and surgical masks.This is believed to be the first time that social media was used to evaluate clinical data and management protocols to better prepare against future possible events.

Consequence-driven cyber-informed engineering (CCE)

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

Freeman, Sarah G.; St Michel, Curtis; Smith, Robert

The Idaho National Lab (INL) is leading a high-impact, national security-level initiative to reprioritize the way the nation looks at high-consequence risk within the industrial control systems (ICS) environment of the country’s most critical infrastructure and other national assets. The Consequence-driven Cyber-informed Engineering (CCE) effort provides both private and public organizations with the steps required to examine their own environments for high-impact events/risks; identify implementation of key devices and components that facilitate that risk; illuminate specific, plausible cyber attack paths to manipulate these devices; and develop concrete mitigations, protections, and tripwires to address the high-consequence risk. The ultimate goal ofmore » the CCE effort is to help organizations take the steps necessary to thwart cyber attacks from even top-tier, highly resourced adversaries that would result in a catastrophic physical effect. CCE participants are encouraged to work collaboratively with each other and with key U.S. Government (USG) contributors to establish a coalition, maximizing the positive effect of lessons-learned and further contributing to the protection of critical infrastructure and other national assets.« less

Receipt of outpatient cardiac rehabilitation among heart attack survivors--United States, 2005.

PubMed

2008-02-01

Each year, approximately 865,000 persons in the United States have a myocardial infarction (i.e., heart attack). In 2007, direct and indirect costs of heart disease were estimated at approximately $277.1 billion. Cardiac rehabilitation, an essential component of recovery care after a heart attack, focuses on cardiovascular risk reduction, promoting healthy behaviors, reducing death and disability, and promoting an active lifestyle for heart attack survivors. Current guidelines from the American Heart Association (AHA) and the American Association of Cardiovascular and Pulmonary Rehabilitation emphasize the importance of cardiac rehabilitation, which reduces morbidity and mortality, improves clinical outcomes, enhances psychological recovery, and decreases the risk for secondary cardiac events. To estimate the prevalence of receipt of outpatient cardiac rehabilitation among heart attack survivors in 21 states and the District of Columbia (DC), data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) were assessed. The results of that assessment indicated that 34.7% of BRFSS respondents who had experienced a heart attack participated in outpatient cardiac rehabilitation. Outpatient cardiac rehabilitation for eligible patients after a heart attack is an essential component of care that should be incorporated into treatment plans. Increasing the number of persons who participate in cardiac rehabilitation services also can reduce health-care costs for recurrent events and reduce the burden on families and caregivers of patients with serious sequelae.

Acute gouty arthritis complicated with acute ST elevation myocardial infarction is independently associated with short- and long-term adverse non-fatal cardiac events.

PubMed

Liu, Kuan-Liang; Lee, Hsin-Fu; Chou, Shing-Hsien; Lin, Yen-Chen; Lin, Chia-Pin; Wang, Chun-Li; Chang, Chi-Jen; Hsu, Lung-An

2014-01-01

Large epidemiologic studies have associated gouty arthritis with the risk of coronary heart disease. However, there has been a lack of information regarding the outcomes for patients who have gout attacks during hospitalization for acute myocardial infarction. We reviewed the data of 444 consecutive patients who were admitted to our hospital between 2005 and 2008 due to acute ST elevation myocardial infarction (STEMI). The clinical outcomes were compared between patients with gout attack and those without. Of the 444, 48 patients with acute STEMI developed acute gouty arthritis during hospitalization. The multivariate analysis identified prior history of gout and estimated glomerular filtration rate as independent risk factors of gout attack for patients with acute STEMI (odds ratio (OR) 21.02, 95 % CI 2.96-149.26, p = 0.002; OR 0.92, 95 % CI 0.86-0.99, p = 0.035, respectively). The in-hospital mortality and duration of hospital stay did not differ significantly between the gouty group and the non-gouty group (controls). During a mean follow-up of 49 ± 28 months, all-cause mortality and stroke were similar for both groups. Multivariate Cox regression showed that gout attack was independently associated with short- and long-term adverse non-fatal cardiac events (hazard ratio (HR) 1.88, 95 % CI 1.09-3.24, p = 0.024; HR 1.82, 95 % CI 1.09-3.03, p = 0.022, respectively). Gout attack among patients hospitalized due to acute STEMI was independently associated with short-term and long-term rates of adverse non-fatal cardiac events.

Will America Fall Apart Like the Maya? Grade 7 Lesson. Schools of California Online Resources for Education (SCORE): Connecting California's Classrooms to the World.

ERIC Educational Resources Information Center

McDonald, David

If a civilization as powerful and technologically advanced during its time as the Maya could disappear, can the same tragic outcome befall the United States? In this lesson, students work in teams to research the ancient Mayan civilization, specifically the circumstances of its demise. Student teams prepare a report of their findings and recommend…

Virtual Learning Simulations in High School: Effects on Cognitive and Non-cognitive Outcomes and Implications on the Development of STEM Academic and Career Choice.

PubMed

Thisgaard, Malene; Makransky, Guido

2017-01-01

The present study compared the value of using a virtual learning simulation compared to traditional lessons on the topic of evolution, and investigated if the virtual learning simulation could serve as a catalyst for STEM academic and career development, based on social cognitive career theory. The investigation was conducted using a crossover repeated measures design based on a sample of 128 high school biology/biotech students. The results showed that the virtual learning simulation increased knowledge of evolution significantly, compared to the traditional lesson. No significant differences between the simulation and lesson were found in their ability to increase the non-cognitive measures. Both interventions increased self-efficacy significantly, and none of them had a significant effect on motivation. In addition, the results showed that the simulation increased interest in biology related tasks, but not outcome expectations. The findings suggest that virtual learning simulations are at least as efficient in enhancing learning and self-efficacy as traditional lessons, and high schools can thus use them as supplementary educational methods. In addition, the findings indicate that virtual learning simulations may be a useful tool in enhancing student's interest in and goals toward STEM related careers.

A cluster randomized controlled trial of strategies to increase adolescents' physical activity and motivation in physical education: results of the Motivating Active Learning in Physical Education (MALP) trial.

PubMed

Lonsdale, Chris; Rosenkranz, Richard R; Sanders, Taren; Peralta, Louisa R; Bennie, Andrew; Jackson, Ben; Taylor, Ian M; Lubans, David R

2013-11-01

Physical education (PE) programs aim to promote physical activity (PA) and reach most school-aged youth. However, PA levels within PE lessons are often low. In this cluster-randomized controlled trial, we examined the effects of three self-determination theory-based motivational strategies on PA and sedentary behavior, as well as their hypothesized antecedents during PE lessons. Data were collected in Sydney, Australia (October-December 2011). After baseline testing, teachers (n=16) and their classes (n=288 students; M=13.6 years, 50.4% male) were randomly assigned to one of four teaching strategy conditions: (1) explaining relevance; (2) providing choice; (3) complete free choice; or (4) usual practice. Teachers then delivered the assigned strategy. Primary outcomes were accelerometer-assessed PA and student motivation during lessons. Secondary outcomes included sedentary behavior, perceptions of teachers' support and psychological needs satisfaction. The 'free choice' intervention increased PA (p<.05). 'Providing choice' and 'free choice' interventions decreased sedentary behavior (p<.05). The interventions did not influence motivation, but students' autonomy increased during both choice-based interventions (p<.05). Promoting choice can produce short-term increases in PA and decreases in sedentary behavior, as well as increased perceived autonomy during PE lessons. © 2013.

Virtual Learning Simulations in High School: Effects on Cognitive and Non-cognitive Outcomes and Implications on the Development of STEM Academic and Career Choice

PubMed Central

Thisgaard, Malene; Makransky, Guido

2017-01-01

The present study compared the value of using a virtual learning simulation compared to traditional lessons on the topic of evolution, and investigated if the virtual learning simulation could serve as a catalyst for STEM academic and career development, based on social cognitive career theory. The investigation was conducted using a crossover repeated measures design based on a sample of 128 high school biology/biotech students. The results showed that the virtual learning simulation increased knowledge of evolution significantly, compared to the traditional lesson. No significant differences between the simulation and lesson were found in their ability to increase the non-cognitive measures. Both interventions increased self-efficacy significantly, and none of them had a significant effect on motivation. In addition, the results showed that the simulation increased interest in biology related tasks, but not outcome expectations. The findings suggest that virtual learning simulations are at least as efficient in enhancing learning and self-efficacy as traditional lessons, and high schools can thus use them as supplementary educational methods. In addition, the findings indicate that virtual learning simulations may be a useful tool in enhancing student’s interest in and goals toward STEM related careers. PMID:28611701

Quantifying Cyber-Resilience Against Resource-Exhaustion Attacks

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

Fink, Glenn A.; Griswold, Richard L.; Beech, Zachary W.

2014-07-11

Resilience in the information sciences is notoriously difficult to define much less to measure. But in mechanical engi- neering, the resilience of a substance is mathematically defined as the area under the stress vs. strain curve. We took inspiration from mechanics in an attempt to define resilience precisely for information systems. We first examine the meaning of resilience in language and engineering terms and then translate these definitions to information sciences. Then we tested our definitions of resilience for a very simple problem in networked queuing systems. We discuss lessons learned and make recommendations for using this approach in futuremore » work.« less

National Memorial Institute for the Prevention of Terrorism

NASA Astrophysics Data System (ADS)

Reimer, Dennis J.; Houghton, Brian K.; Powell, Ellen L.

2004-09-01

The National Memorial Institute for the Prevention of Terrorism (MIPT) in Oklahoma City is a living memorial to the victims, survivors, family members and rescue workers affected by the April 19, 1995 bombing of the Murrah Federal Building. The Institute conducts research into the development of technologies to counter biological, nuclear and chemical weapons of mass destruction and cyberterrorism, as well as research into the social and political causes and effects of terrorism. This paper describes MIPT funded research in areas of detection, decontamination, personal protective equipment, attack simulations, treatments, awareness, improved public communication during and after an incident, as well as lessons learned from terrorist incidents.

National Memorial Institute for the Prevention of Terrorism

NASA Astrophysics Data System (ADS)

Reimer, Dennis J.; Houghton, Brian K.; Ellis, James O., III

2003-09-01

The National Memorial Institute for the Prevention of Terrorism in Oklahoma City is a living memorial to the victims, survivors, family members and rescue workers affected by the April 19, 1995 bombing of the Murrah Federal Building. The Institute conducts research into the development of technologies to counter biological, nuclear and chemical weapons of mass destruction and cyberterrorism, as well as research into the social and political causes and effects of terrorism. This paper describes MIPT funded research in areas of detection, decontamination, personal protective equipment, attack simulations, treatments, awareness, improved public communication during and after an incident, as well as lessons learned from terrorist incidents.

Differentiating experts' anticipatory skills in beach volleyball.

PubMed

Cañal-Bruland, Rouwen; Mooren, Merel; Savelsbergh, Geert J P

2011-12-01

In this study, we examined how perceptual-motor expertise and watching experience contribute to anticipating the outcome of opponents' attacking actions in beach volleyball. To this end, we invited 8 expert beach volleyball players, 8 expert coaches, 8 expert referees, and 8 control participants with no beach volleyball experience to watch videos of attack sequences that were occluded at three different times and to predict the outcome of these situations. Results showed that expert players and coaches (who were both perceptual-motor experts) outperformed the expert referees (who were watching experts but did not have the same motor expertise) and the control group in the latest occlusion condition (i.e., at spiker-ball contact). This finding suggests that perceptual-motor expertise may contribute to successful action anticipation in beach volleyball.

Association Between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack.

PubMed

Wang, Yilong; Zhao, Xingquan; Lin, Jinxi; Li, Hao; Johnston, S Claiborne; Lin, Yi; Pan, Yuesong; Liu, Liping; Wang, David; Wang, Chunxue; Meng, Xia; Xu, Jianfeng; Wang, Yongjun

2016-07-05

Data are limited regarding the association between CYP2C19 genetic variants and clinical outcomes of patients with minor stroke or transient ischemic attack treated with clopidogrel. To estimate the association between CYP2C19 genetic variants and clinical outcomes of clopidogrel-treated patients with minor stroke or transient ischemic attack. Three CYP2C19 major alleles (*2, *3, *17) were genotyped among 2933 Chinese patients from 73 sites who were enrolled in the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) randomized trial conducted from January 2, 2010, to March 20, 2012. Patients with acute minor ischemic stroke or transient ischemic attack in the trial were randomized to treatment with clopidogrel combined with aspirin or to aspirin alone. The primary efficacy outcome was new stroke. The secondary efficacy outcome was a composite of new composite vascular events (ischemic stroke, hemorrhagic stroke, myocardial infarction, or vascular death). Bleeding was the safety outcome. Among 2933 patients, 1948 (66.4%) were men, with a mean age of 62.4 years. Overall, 1207 patients (41.2%) were noncarriers and 1726 patients (58.8%) were carriers of loss-of-function alleles (*2, *3). After day 90 follow-up, clopidogrel-aspirin reduced the rate of new stroke in the noncarriers but not in the carriers of the loss-of-function alleles (P = .02 for interaction; events among noncarriers, 41 [6.7%] with clopidogrel-aspirin vs 74 [12.4%] with aspirin; hazard ratio [HR], 0.51 [95% CI, 0.35-0.75]; events among carriers, 80 [9.4%] with clopidogrel-aspirin vs 94 [10.8%] with aspirin; HR, 0.93 [95% CI, 0.69 to 1.26]). Similar results were observed for the secondary composite efficacy outcome (noncarriers: 41 [6.7%] with clopidogrel-aspirin vs 75 [12.5%] with aspirin; HR, 0.50 [95% CI, 0.34-0.74]; carriers: 80 [9.4%] with clopidogrel-aspirin vs 95 [10.9%] with aspirin; HR, 0.92 [95% CI, 0.68-1.24]; P = .02 for interaction). The effect of treatment assignment on bleeding did not vary significantly between the carriers and the noncarriers of the loss-of-function alleles (2.3% for carriers and 2.5% for noncarriers in the clopidogrel-aspirin group vs 1.4% for carriers and 1.7% for noncarriers in the aspirin only group; P = .78 for interaction). Among patients with minor ischemic stroke or transient ischemic attack, the use of clopidogrel plus aspirin compared with aspirin alone reduced the risk of a new stroke only in the subgroup of patients who were not carriers of the CYP2C19 loss-of-function alleles. These findings support a role of CYP2C19 genotype in the efficacy of this treatment. clinicaltrials.gov Identifier: NCT00979589.

Outcome-Specific Transfer between Predictive and Instrumental Learning Is Unaffected by Extinction but Reversed by Counterconditioning in Human Participants

ERIC Educational Resources Information Center

Rosas, Juan M.; Paredes-Olay, Maria C.; Garcia-Gutierrez, Ana; Espinosa, Juan J.; Abad, Maria J. F.

2010-01-01

Three experiments were conducted to explore the effects of different interference treatments upon outcome-specific transfer from predictive learning to instrumental responding. A computer game was designed in which participants had to defend Andalusia from navy and air-force attacks. Participants learned the relationship between two instrumental…

Residential Group Care Quarterly. Volume 5, Number 2, Fall 2004

ERIC Educational Resources Information Center

Kirkwood, Scott, Ed.

2004-01-01

This issue of "Residential Group Care Quarterly" contains the following articles: (1) "Achieving Better Outcomes for Children and Families: Reducing the Use of Restraint and Seclusion" (Katherine Johnson); (2) "STAR Project Outcomes" (Nancy Campbell); (3) "The Devereux Glenholme School" (Mary Guilfoile); (4) "Lessons Learned in the Reduction of…

"Doing the Best You Can with What You Have:" Lessons Learned from Outcomes Assessment.

ERIC Educational Resources Information Center

Carter, Elizabeth W.

2002-01-01

Discusses outcomes focused assessments of library research instruction using pretests and posttests, attitude and usage surveys, and focus groups at The Citadel library. Suggests that assessment results influence library instruction content, staffing, collection development, and collaboration with other faculty and academic departments.…

Learning Lessons: An Independent Review of Indigenous Education in the Northern Territory.

ERIC Educational Resources Information Center

Northern Territory Dept. of Education, Darwin (Australia).

A review of Indigenous education was undertaken in the Northern Territory, Australia, to determine the educational views of Indigenous communities, key issues affecting educational outcomes for Indigenous children, and supportable actions to improve those outcomes. Data collection included 126 targeted interviews, 40 public meetings, 106 formal…

Sleep duration versus sleep insufficiency as predictors of cardiometabolic health outcomes.

PubMed

Altman, Nicole G; Izci-Balserak, Bilgay; Schopfer, Elizabeth; Jackson, Nicholas; Rattanaumpawan, Pinyo; Gehrman, Philip R; Patel, Nirav P; Grandner, Michael A

2012-12-01

The objective of the present study was to investigate the relationship between sleep insufficiency and sleep duration, particularly regarding negative cardiometabolic health outcomes already considered to be affected by reduced sleep time. A total of N=30,934 participants from the 2009 Behavioural Risk Factor Surveillance System (BRFSS) answered questions about their sleep duration as well as subjective feelings of sleep insufficiency. Outcomes included body mass index (BMI), obesity (BMI ≥ 30kgm(-2)) and history of hypertension, diabetes, hypercholesterolaemia, heart attack and stroke. Linear and logistic regression models examined whether cardiometabolic outcomes were associated with (1) sleep duration alone, (2) sleep insufficiency alone and (3) the combined effect of sleep duration and sleep insufficiency. Results indicated that, when examined alone, sleep duration <5h (versus 7h) was related to BMI (B=2.716, p<0.01), obesity (B=2.080, p<0.000001), diabetes (B=3.162, p<0.000001), hypertension (B=2.703, p<0.000001), hypercholesterolaemia (B=1.922, p<0.00001), heart attack (B=4.704, p<0.000001) and stroke (B=4.558, p<0.000001), and sleep insufficiency (days per week, continuous) was related to BMI (B=0.181, p<0.01), obesity (B=1.061, p<0.000001) and hypercholesterolaemia (B=1.025, p<0.01). All of these relationships remained significant after adjustment for covariates, except for diabetes and sleep duration. Also, after adjustment, a significant relationship between insufficient sleep and hypertension emerged (B=1.039, p<0.001). When evaluated together, after adjustment for covariates, significant relationships remained between sleep duration <5h (versus 7h) and BMI (B=1.266, p<0.05), obesity (B=1.389, p<0.05), hypertension (B=1.555, p<0.01), heart attack (B=2.513, p<0.01) and stroke (B=1.807, p<0.05). It should be noted that relationships between sleep duration >9h (versus 7h) were seen for heart attack (B=1.863, p<0.001) and stroke (B=1.816, p<0.01). In these models, sleep insufficiency was associated with hypercholesterolaemia (B=1.031, p<0.01) and hypertension (B=1.027, p<0.05). These analyses show that both sleep duration and insufficiency are related to cardiometabolic health outcomes, and that when evaluated together, both variables demonstrate unique effects. Copyright © 2012 Elsevier B.V. All rights reserved.

Sleep Duration versus Sleep Insufficiency as Predictors of Cardiometabolic Health Outcomes

PubMed Central

Altman, Nicole G.; Schopfer, Elizabeth; Jackson, Nicholas; Izci-Balserak, Bilgay; Rattanaumpawan, Pinyo; Gehrman, Philip R.; Patel, Nirav P.; Grandner, Michael A.

2012-01-01

Objective The objective of the present study was to investigate the relationship between sleep insufficiency and sleep duration, particularly regarding negative cardiometabolic health outcomes already considered to be affected by reduced sleep time. Methods A total of N=30,934 participants from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) answered questions about their sleep duration as well as subjective feelings of sleep insufficiency. Outcomes included body mass index (BMI), obesity (BMI≥30), and history of hypertension, diabetes, hypercholesterolemia, heart attack, and stroke. Linear and logistic regression models examined whether cardiometabolic outcomes were associated with (1) sleep duration alone, (2) sleep insufficiency alone, and (3) the combined effect of sleep duration and sleep insufficiency. Results Results indicated that, when examined alone, sleep duration <5 hours (vs 7 hours) was related to BMI (B=2.716, p<0.01), obesity (B=2.080, p<0.000001), diabetes (B=3.162, p<0.000001), hypertension (B=2.703, p<0.000001), hypercholesterolemia (B=1.922, p<0.00001), heart attack (B=4.704, p<0.000001), and stroke (B=4.558, p<0.000001), and sleep insufficiency (days per week, continuous) was related to BMI (B=0.181, p<.01), obesity (B=1.061, p<0.000001), and hypercholesterolemia (B=1.025, p<.01). All of these relationships remained significant after adjustment for covariates, except for diabetes and sleep duration. Also, after adjustment, a significant relationship between insufficient sleep and hypertension emerged (B=1.039, p<.001). When evaluated together, after adjustment for covariates, significant relationships remained between sleep duration <5 hours (vs 7 hours) and BMI (B=1.266, p<0.05), obesity (B=1.389, p<.05), hypertension (B=1.555, p<0.01), heart attack (B=2.513, p<0.01)and stroke (B=1.807, p<0.05). It should be noted that relationships between sleep duration >9 hours (vs 7 hours) were seen for heart attack (B=1.863, p<0.001) and stroke (B=1.816, p<0.01). In these models, sleep insufficiency was associated with hypercholesterolemia (B=1.031, p<0.01)and hypertension (B=1.027, p<0.05). Conclusions These analyses show that both sleep duration and insufficiency are related to cardiometabolic health outcomes, and that when evaluated together, both variables demonstrate unique effects. PMID:23141932

Comparing Asian American Women's Knowledge, Self-Efficacy, and Perceived Risk of Heart Attack to Other Racial and Ethnic Groups: The mPED Trial.

PubMed

Fukuoka, Yoshimi; Lisha, Nadra E; Vittinghoff, Eric

2017-09-01

The aim of the study was to compare knowledge and awareness of heart attacks/heart disease and perceived risk for future heart attack in Asian/Pacific Islander women, compared to other racial and ethnic groups. In this cross-sectional study, 318 women enrolled in a mobile phone-based physical activity education trial were analyzed. Heart attack knowledge, self-efficacy for recognizing and responding to heart attack symptoms, and perceived risk for a future heart attack were measured. Analyses were conducted using logistic, proportional odds, and linear regression models, depending on the outcome and adjusting for age. Pairwise differences between Asian/Pacific Islanders and the other four groups were assessed using a Bonferroni correction (p < 0.0125). Asian/Pacific Islander women had significantly lower total scores for knowledge of heart attack and self-efficacy for heart attack recognition and care seeking behavior compared to the Caucasian women (p = 0.001 and p = 0.002, respectively). However, perceived risk did not differ among the groups. Forty-six percent of the Asian American women, compared to 25% of Caucasian women, falsely believed "breast cancer is the number one cause of death for women (p = 0.002)." In addition, Asian/Pacific Islander women were less likely to report "arm pain, numbness, tingling, or radiating" as one of the heart attack symptoms compared to the Caucasian and the multiracial group (34%, 63% [p < 0.001], and 66% [p = 0.004], respectively). These findings highlight the urgent need to develop effective, tailored campaigns to close the knowledge gap between Asian/Pacific Islander women and Caucasian women.

Moving Nursing Program Portfolio Assessment From Midterm to End of Program: Lessons Learned.

PubMed

Hickey, Kari; Rossetti, Jeanette; Oldenburg, Nancy; Abendroth, Maryann; Uhlken, Connie; Musker, Kathleen; Peters, Bradley; Paramore, Patricia

Portfolio assessment promotes a culture of evidence, evaluates program outcomes, and provides an opportunity to assess the acquisition of knowledge and skills that are not easily assessed by examinations and other traditional assessment methods in nursing curricula. The portfolio program of 1 Midwestern school of nursing recently moved portfolio assessment to the end of program. The process of this change including logistics, rubric development, and lessons learned is highlighted.

Attacking 22 entries in rugby union: running demands and differences between successful and unsuccessful entries.

PubMed

Tierney, P; Tobin, D P; Blake, C; Delahunt, E

2017-12-01

Global Positioning System (GPS) technology is commonly utilized in team sports, including rugby union. It has been used to describe the average running demands of rugby union. This has afforded an enhanced understanding of the physical fitness requirements for players. However, research in team sports has suggested that training players relative to average demands may underprepare them for certain scenarios within the game. To date, no research has investigated the running demands of attacking 22 entries in rugby union. Additionally, no research has been undertaken to determine whether differences exist in the running intensity of successful and unsuccessful attacking 22 entries in rugby union. The first aim of this study was to describe the running intensity of attacking 22 entries. The second aim of this study was to investigate whether differences exist in the running intensity of successful and unsuccessful attacking 22 entries. Running intensity was measured using meters per minute (m min -1 ) for (a) total distance, (b) running distance, (c) high-speed running distance, and (d) very high-speed running distance. This study provides normative data for the running intensity of attacking 22 entries in rugby union. Forwards achieved greater high-speed running intensity in successful (3.6 m min -1 ) compared to unsuccessful (1.8 m min -1 ) attacking 22 entries. Forwards should try and achieve greater high-speed running intensity in attacking 22 entries to increase the likelihood of successful outcomes during this period of gameplay. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Use of a structured migraine diary improves patient and physician communication about migraine disability and treatment outcomes.

PubMed

Baos, V; Ester, F; Castellanos, A; Nocea, G; Caloto, M T; Gerth, W C

2005-03-01

Migraine is frequently undertreated, perhaps because impaired communication between patients and physicians underestimate the disability associated with migraine attacks. The purpose of this study was to evaluate the benefits of a structured migraine diary used during a prospective open-label study of triptan-naive patients in Spain for recording information on response to therapy for a pre-study migraine attack and three consecutive migraine attacks, the first and third treated with rizatriptan 10-mg wafer and the second with usual non-triptan therapy. Of 97 patients (83% women; mean age, 39 years) who completed the study, all reported moderate to severe pain, and two-thirds reported severe to total impairment during migraine attacks. At study end, 72% of patients reported that the migraine diary helped communication with their doctor about migraine, and 70% were more or much more satisfied than before the study with level of overall medical care provided by their doctor. Patients who reported the diary to be useful also reported higher overall satisfaction with medical care (p < 0.001). Most of the 22 physicians (91%) reported that the diary enabled them to better communicate with their patients about migraine, and all reported that it enabled them to assess differences in pain intensity and disability across patients. We conclude that a structured migraine diary can be a valuable aid for improving communication between physicians and patients regarding migraine disability and treatment outcomes.

Impact of handgun types on gun assault outcomes: a comparison of gun assaults involving semiautomatic pistols and revolvers

PubMed Central

Reedy, D; Koper, C

2003-01-01

Objective: To examine whether gun assaults committed with semiautomatic pistols are more injurious and lethal than those committed with revolvers. Setting: Jersey City, New Jersey from 1992 through 1996. Methods: Using police records on fatal and non-fatal handgun assaults, t tests and χ2 tests were employed to determine if attacks with pistols result in more shots fired than those with revolvers, leading to more gunshot victims and more severely wounded victims. Results: More shots were fired in attacks with pistols (average = 3.2 to 3.7) than in attacks with revolvers (average = 2.3 to 2.6). Although pistol use was unrelated to the probability that an incident resulted in any injury or death, it was associated with a 15% increase in the number of wounded victims in those cases in which people were shot (1.15 per pistol case, 1.0 per revolver case), implying that the total number of gunshot victims may have been 9.4% lower had pistols not been used in any attacks. Pistol use was not related to the number of wounds per gunshot victim. Conclusions: The findings provide limited evidence that recent growth in the production and use of pistols has contributed to higher levels of gunshot victimizations. However, available data did not permit an assessment of whether the associations between gun types and assault outcomes are mediated by characteristics of incidents and actors. PMID:12810743

Survival of resuscitated cardiac arrest patients with ST-elevation myocardial infarction (STEMI) conveyed directly to a Heart Attack Centre by ambulance clinicians.

PubMed

Fothergill, Rachael T; Watson, Lynne R; Virdi, Gurkamal K; Moore, Fionna P; Whitbread, Mark

2014-01-01

This study reports survival outcomes for patients resuscitated from out-of-hospital cardiac arrest (OHCA) subsequent to ST-elevation myocardial infarction (STEMI), and who were conveyed directly by ambulance clinicians to a specialist Heart Attack Centre for expert cardiology assessment, angiography and possible percutaneous coronary intervention (PCI). This is a retrospective descriptive review of data sourced from the London Ambulance Service's OHCA registry over a one-year period. We observed excellent survival rates for our cohort of patients with 66% of patients surviving to be discharged from hospital, the majority of whom were still alive after one year. Those who survived tended to be younger, to have had a witnessed arrest in a public place with an initial cardiac rhythm of VF/VT, and to have been transported to the specialist centre more quickly than those who did not. A system allowing ambulance clinicians to autonomously convey OHCA STEMI patients who achieve a return of spontaneous circulation directly to a Heart Attack Centre is highly effective and yields excellent survival outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Social media campaigns that make a difference: what can public health learn from the corporate sector and other social change marketers?

PubMed

Freeman, Becky; Potente, Sofia; Rock, Vanessa; McIver, Jacqueline

2015-03-30

A great deal of enthusiasm and interest exists in using social media for public health communications, but few research studies have examined its success in promoting and adopting protective health behaviours. To begin to understand how best to develop effective online social marketing campaigns, this paper provides a summary of success factors and key lessons learnt from selected social media campaign case studies. Case study review Methods: A selection of case studies was reviewed for lessons in campaign development, delivery and evaluation from both the corporate and public health sectors. Information about the objective of the campaign, the tactics used and the lessons learnt was extracted from each case study. Lessons learnt from across the case studies were then sorted according to themes. Lessons from the nine case studies selected were categorised into eight themes: planning, use of social media tools, community, content, personal benefits, promotion, costs and challenges. Outcome evaluation data were lacking in the case studies. Overall, the nine case studies show that social media hold promise in changing user behaviours and that social media are highly effective in recruiting participants and motivating them to take small, concrete actions. The case studies also demonstrate that there is room in social media for targeted, inexpensive, small-scale projects, as well as large, well-funded, mass-reach marketing blitzes. Social media campaign process and impact evaluation measures are readily available. Outcome evaluation models and measures are needed to better assess the effectiveness of social media campaigns in changing health behaviours.

Going beyond the lesson: Self-generating new factual knowledge in the classroom

PubMed Central

Esposito, Alena G.; Bauer, Patricia J.

2016-01-01

For children to build a knowledge base, they must integrate and extend knowledge acquired across separate episodes of new learning. Children’s performance was assessed in a task requiring them to self-generate new factual knowledge from the integration of novel facts presented through separate lessons in the classroom. Whether self-generation performance predicted academic outcomes in reading comprehension and mathematics was also examined. The 278 participating children were in grades K-3 (mean age 7.7 years; range 5.5–10.3 years). Children self-generated new factual knowledge through integration in the classroom; age-related increases were observed. Self-generation performance predicted both reading comprehension and mathematics academic outcomes, even when controlling for caregiver education. PMID:27728784

Case Management of Dengue: Lessons Learned.

PubMed

Kalayanarooj, Siripen; Rothman, Alan L; Srikiatkhachorn, Anon

2017-03-01

The global burden of dengue and its geographic distribution have increased over the past several decades. The introduction of dengue in new areas has often been accompanied by high case-fatality rates. Drawing on the experience in managing dengue cases at the Queen Sirikit National Institute of Child Health in Bangkok, Thailand, this article provides the authors' perspectives on key clinical lessons to improve dengue-related outcomes. Parallels between this clinical experience and outcomes reported in randomized controlled trials, results of efforts to disseminate practice recommendations, and suggestions for areas for further research are also discussed. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Does uninsurance affect the health outcomes of the insured? Evidence from heart attack patients in California.

PubMed

Daysal, N Meltem

2012-07-01

In this paper, I examine the impact of uninsured patients on the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999-2006). My results indicate that uninsured patients have an economically significant effect that increases the mortality rate of insured heart attack patients. I show that these results are not driven by alternative explanations, including reverse causality, patient composition effects, sample selection or unobserved trends and that they are robust to a host of specification checks. The primary channel for the observed spillover effects is increased hospital uncompensated care costs. Although data limitations constrain my capacity to check how hospitals change their provision of care to insured heart attack patients in response to reduced revenues, the evidence I have suggests a modest increase in the quantity of cardiac services without a corresponding increase in hospital staff. Copyright © 2012 Elsevier B.V. All rights reserved.

Occupational Practitioner’s Role in the Management of a Crisis: Lessons Learned from the Paris November 2015 Terrorist Attack

PubMed Central

Descatha, Alexis; Huynh Tuong, Alice; Coninx, Pierre; Baer, Michel; Loeb, Thomas; Despréaux, Thomas

2016-01-01

In massive catastrophic events, occupational health practitioners are more and more frequently involved in the management of such situations. We aim to describe the multiple aspects of the role that occupational health practitioners might play, by focusing on the recent example of the Paris terrorist attack of November 2015. During and after the Paris attack, occupational practitioners, in collaboration with emergency and security professionals, were involved in psychological care, assembling information, follow-up, return-to-work, and improving in-company safety plans. Based on this experience and other industrial disasters, we distinguish three phases: the critical phase, the post-critical phase, and the anticipation phase. In the critical phase, the occupational practitioner cares for patients before the emergency professionals take charge, initiates the psychological management, and may also play an organizational role for company health aspects. In the post-critical phase, he or she would be involved in monitoring those affected by the events and participate in preventing, to the extent possible, posttraumatic stress disorder, helping victims in the return-to-work process, and improving procedures and organizing drills. In addition to their usual work of primary prevention, occupational practitioners should endeavor to improve preparedness in the anticipation phase, by taking part in contingency planning, training in first aid, and defining immediately applicable protocols. In conclusion, recent events have highlighted the essential role of occupational health services in anticipation of a crisis, management during the crisis, and follow-up. PMID:27703965

Navigating the storm: report and recommendations from the Atlantic Storm exercise.

PubMed

Smith, Bradley T; Inglesby, Thomas V; Brimmer, Esther; Borio, Luciana; Franco, Crystal; Gronvall, Gigi Kwik; Kramer, Bradley; Maldin, Beth; Nuzzo, Jennifer B; Schuler, Ari; Stern, Scott; Henderson, Donald A; Larsen, Randall J; Hamilton, Daniel S; O'Toole, Tara

2005-01-01

Atlantic Storm was a tabletop exercise simulating a series of bioterrorism attacks on the transatlantic community. The exercise occurred on January 14, 2005, in Washington, DC, and was organized and convened by the Center for Biosecurity of UPMC, the Center for Transatlantic Relations of Johns Hopkins University, and the Transatlantic Biosecurity Network. Atlantic Storm portrayed a summit meeting of presidents, prime ministers, and other international leaders from both sides of the Atlantic Ocean in which they responded to a campaign of bioterrorist attacks in several countries. The summit principals, who were all current or former senior government leaders, were challenged to address issues such as attaining situational awareness in the wake of a bioattack, coping with scarcity of critical medical resources such as vaccine, deciding how to manage the movement of people across borders, and communicating with their publics. Atlantic Storm illustrated that much might be done in advance to minimize the illness and death, as well as the social, economic, and political disruption, that could be caused by an international epidemic, be it natural or the result of a bioterrorist attack. These lessons are especially timely given the growing concerns over the possibility of an avian influenza pandemic that would require an international response. However, international leaders cannot create the necessary response systems in the midst of a crisis. Medical, public health, and diplomatic response systems and critical medical resources (e.g., medicines and vaccines) must be in place before a bioattack occurs or a pandemic emerges.

Occupational Practitioner's Role in the Management of a Crisis: Lessons Learned from the Paris November 2015 Terrorist Attack.

PubMed

Descatha, Alexis; Huynh Tuong, Alice; Coninx, Pierre; Baer, Michel; Loeb, Thomas; Despréaux, Thomas

2016-01-01

In massive catastrophic events, occupational health practitioners are more and more frequently involved in the management of such situations. We aim to describe the multiple aspects of the role that occupational health practitioners might play, by focusing on the recent example of the Paris terrorist attack of November 2015. During and after the Paris attack, occupational practitioners, in collaboration with emergency and security professionals, were involved in psychological care, assembling information, follow-up, return-to-work, and improving in-company safety plans. Based on this experience and other industrial disasters, we distinguish three phases: the critical phase, the post-critical phase, and the anticipation phase. In the critical phase, the occupational practitioner cares for patients before the emergency professionals take charge, initiates the psychological management, and may also play an organizational role for company health aspects. In the post-critical phase, he or she would be involved in monitoring those affected by the events and participate in preventing, to the extent possible, posttraumatic stress disorder, helping victims in the return-to-work process, and improving procedures and organizing drills. In addition to their usual work of primary prevention, occupational practitioners should endeavor to improve preparedness in the anticipation phase, by taking part in contingency planning, training in first aid, and defining immediately applicable protocols. In conclusion, recent events have highlighted the essential role of occupational health services in anticipation of a crisis, management during the crisis, and follow-up.

The Effect of Keystone Individuals on Collective Outcomes Can Be Mediated through Interactions or Behavioral Persistence

PubMed Central

Pinter-Wollman, Noa; Keiser, Carl N.; Wollman, Roy; Pruitt, Jonathan N.

2017-01-01

Collective behavior emerges from interactions among group members who often vary in their behavior. The presence of just one or a few keystone individuals, such as leaders or tutors, may have a large effect on collective outcomes. These individuals can catalyze behavioral changes in other group members, thus altering group composition and collective behavior. The influence of keystone individuals on group function may lead to trade-offs between ecological situations, because the behavioral composition they facilitate may be suitable in one situation but not another. We use computer simulations to examine various mechanisms that allow keystone individuals to exert their influence on group members. We further discuss a trade-off between two potentially conflicting collective outcomes, cooperative prey attack and disease dynamics. Our simulations match empirical data from a social spider system and produce testable predictions for the causes and consequences of the influence of keystone individuals on group composition and collective outcomes. We find that a group’s behavioral composition can be impacted by the keystone individual through changes to interaction patterns or behavioral persistence over time. Group behavioral composition and the mechanisms that drive the distribution of phenotypes influence collective outcomes and lead to trade-offs between disease dynamics and cooperative prey attack. PMID:27420788

The effect of antihypertensive treatment on the incidence of stroke and cognitive decline in the elderly: a meta-analysis.

PubMed

Parsons, Christine; Murad, Mohammad Hassan; Andersen, Stuart; Mookadam, Farouk; Labonte, Helene

2016-03-01

To evaluate the effectiveness of antihypertensives in reducing neurocognitive outcomes in elderly patients. We conducted a systematic literature search of randomized trials in which hypertensive patients with a mean age ≥65 years received antihypertensive or control treatment. Outcomes were stroke, transient ischemic attack, cognitive decline and dementia. We included 14 trials for meta-analysis. Compared to placebo, antihypertensive treatment reduced the risk of stroke (RR: 0.67 [95% CI: 0.57-0.79]). Reduced risk was significant for transient ischemic attack, fatal stroke, nonfatal stroke and total stroke. There were insufficient data to compare individual agents. Antihypertensive treatment is associated with a significant reduction in stroke in elderly individuals. Reductions in dementia and cognitive decline were not significant; however, there was short follow-up. Comparative effectiveness evidence is limited.

Does acute maternal stress in pregnancy affect infant health outcomes? Examination of a large cohort of infants born after the terrorist attacks of September 11, 2001

PubMed Central

Endara, Skye M; Ryan, Margaret AK; Sevick, Carter J; Conlin, Ava Marie S; Macera, Caroline A; Smith, Tyler C

2009-01-01

Background Infants in utero during the terrorist attacks of September 11, 2001 may have been negatively affected by maternal stress. Studies to date have produced contradictory results. Methods Data for this retrospective cohort study were obtained from the Department of Defense Birth and Infant Health Registry and included up to 164,743 infants born to active-duty military families. Infants were considered exposed if they were in utero on September 11, 2001, while the referent group included infants gestating in the same period in the preceding and following year (2000 and 2002). We investigated the association of this acute stress during pregnancy with the infant health outcomes of male:female sex ratio, birth defects, preterm birth, and growth deficiencies in utero and in infancy. Results No difference in sex ratio was observed between infants in utero in the first trimester of pregnancy on September 11, 2001 and infants in the referent population. Examination of the relationship between first-trimester exposure and birth defects also revealed no significant associations. In adjusted multivariable models, neither preterm birth nor growth deficiencies were significantly associated with the maternal exposure to the stress of September 11 during pregnancy. Conclusion The findings from this large population-based study suggest that women who were pregnant during the terrorist attacks of September 11, 2001 had no increased risk of adverse infant health outcomes. PMID:19619310

Evaluating PTSD on Reproductive Outcomes: Women Deployed in Iraq and Afghanistan

DTIC Science & Technology

2009-10-01

Center attacks and its effect on pregnancy outcome . Paediatric and Perinatal Epidemiology, 2005. 19(5): p. 334-41. 6. Xiong, X., et al., Exposure ...health system. Thus, the effect of women’s military service on reproductive outcomes is a key concern. Due to the unique situation of women in the... exposure to PTSD as a consequence of deployment is one example of recent concern. A recent study found women who had deployed to Iraq/Afghanistan

Public-Private Partnerships in College Student Housing: Lessons from Three Institutions

ERIC Educational Resources Information Center

McClure, Kevin R.; Ryder, Andrew J.; DeVita, James M.

2017-01-01

Despite the increasing popularity of public-private partnerships, empirical research about the origins, models, and long-term outcomes of this approach to financing, constructing, and managing college student housing is scant. In this study, we sought to investigate the origins, models, and outcomes of public-private partnerships in college…

Effect of Active Lessons on Physical Activity, Academic, and Health Outcomes: A Systematic Review

ERIC Educational Resources Information Center

Martin, Rosemarie; Murtagh, Elaine M.

2017-01-01

Purpose: The purpose of this study was to conduct a systematic review of classroom-based physical activity interventions that integrate academic content and assess the effectiveness of the interventions on physical activity, learning, facilitators of learning, and health outcomes. Method: Six electronic databases (ERIC, PubMed, Google Scholar,…

Machine Transcription. Vocational Education Curriculum Guide. Business Education.

ERIC Educational Resources Information Center

West Virginia State Vocational Curriculum Lab., Cedar Lakes.

This curriculum guide provides the basic curriculum components required to develop lesson plans that address the learning outcomes for the area of machine transcription. It is not a complete, self-contained curriculum. Instead, the guide provides the teacher with a number of informational items related to the learning outcomes and allows him/her…

The 2005 London terror attacks: An investigation of changes in psychological wellbeing and social capital pre- and post-attacks (2003-07)-A UK panel study.

PubMed

Giordano, Giuseppe N; Lindström, Martin

2016-12-01

The London public transport suicide bombings, which occurred on 7th July 2005, were described as the worst single terrorist atrocity on British soil to date. Past acts of terrorism have been associated with deterioration in population mental health. They may also negatively impact levels of social capital, which is considered a buffer against poor mental health outcomes. By employing panel data from the British Household Panel Survey and following the same individuals (N T =9287) three times over a five-year period (2003, 2005 and 2007), the aim of this longitudinal multilevel study was to investigate: (i) the impact of terrorism on individual-level social capital (generalised trust and social participation) across the UK; and (ii) the buffering effects of social capital on psychological wellbeing (GHQ-12). By comparing 2005 and 2007 covariate values (including the two social capital proxies) against their pre-terror baseline (2003) measurements in two separate multilevel logistic regression models, we examined the immediate and longer-term effects of the 2005 attacks on our GHQ-12 outcome. Compared to baseline, generalised trust dropped from 44% to 36% immediately post-terror attacks in 2005, while local participation increased from 45.8% to 47.5%. Social capital levels started to return to baseline levels by 2007, yet both proxies maintained independent buffering effects against poor GHQ-12 scores in years 2005 and 2007. From this empirical evidence, it seems that though generalised trust levels are negatively affected by acts of terrorism, the accompanying increase in local active participation may aid in the re-establishment of societal norms and beliefs in later years. Decision makers should be aware that such atrocities may negatively impact on populations' generalised trust in the shorter-term. To safeguard against losing this buffer against poor mental health outcomes, local active participation should be encouraged.

Epidemiologic methods lessons learned from environmental public health disasters: Chernobyl, the World Trade Center, Bhopal, and Graniteville, South Carolina.

PubMed

Svendsen, Erik R; Runkle, Jennifer R; Dhara, Venkata Ramana; Lin, Shao; Naboka, Marina; Mousseau, Timothy A; Bennett, Charles

2012-08-01

Environmental public health disasters involving hazardous contaminants may have devastating effects. While much is known about their immediate devastation, far less is known about long-term impacts of these disasters. Extensive latent and chronic long-term public health effects may occur. Careful evaluation of contaminant exposures and long-term health outcomes within the constraints imposed by limited financial resources is essential. Here, we review epidemiologic methods lessons learned from conducting long-term evaluations of four environmental public health disasters involving hazardous contaminants at Chernobyl, the World Trade Center, Bhopal, and Graniteville (South Carolina, USA). We found several lessons learned which have direct implications for the on-going disaster recovery work following the Fukushima radiation disaster or for future disasters. These lessons should prove useful in understanding and mitigating latent health effects that may result from the nuclear reactor accident in Japan or future environmental public health disasters.

Enhancing mathematics teachers' quality through Lesson Study.

PubMed

Lomibao, Laila S

2016-01-01

The efficiency and effectivity of the learning experience is dependent on the teacher quality, thus, enhancing teacher's quality is vital in improving the students learning outcome. Since, the usual top-down one-shot cascading model practice for teachers' professional development in Philippines has been observed to have much information dilution, and the Southeast Asian Ministers of Education Organization demanded the need to develop mathematics teachers' quality standards through the Southeast Asia Regional Standards for Mathematics Teachers (SEARS-MT), thus, an intensive, ongoing professional development model should be provided to teachers. This study was undertaken to determine the impact of Lesson Study on Bulua National High School mathematics teachers' quality level in terms of SEARS-MT dimensions. A mixed method of quantitative-qualitative research design was employed. Results of the analysis revealed that Lesson Study effectively enhanced mathematics teachers' quality and promoted teachers professional development. Teachers positively perceived Lesson Study to be beneficial for them to become a better mathematics teacher.

Simulating cyber warfare and cyber defenses: information value considerations

NASA Astrophysics Data System (ADS)

Stytz, Martin R.; Banks, Sheila B.

2011-06-01

Simulating cyber warfare is critical to the preparation of decision-makers for the challenges posed by cyber attacks. Simulation is the only means we have to prepare decision-makers for the inevitable cyber attacks upon the information they will need for decision-making and to develop cyber warfare strategies and tactics. Currently, there is no theory regarding the strategies that should be used to achieve objectives in offensive or defensive cyber warfare, and cyber warfare occurs too rarely to use real-world experience to develop effective strategies. To simulate cyber warfare by affecting the information used for decision-making, we modify the information content of the rings that are compromised during in a decision-making context. The number of rings affected and value of the information that is altered (i.e., the closeness of the ring to the center) is determined by the expertise of the decision-maker and the learning outcome(s) for the simulation exercise. We determine which information rings are compromised using the probability that the simulated cyber defenses that protect each ring can be compromised. These probabilities are based upon prior cyber attack activity in the simulation exercise as well as similar real-world cyber attacks. To determine which information in a compromised "ring" to alter, the simulation environment maintains a record of the cyber attacks that have succeeded in the simulation environment as well as the decision-making context. These two pieces of information are used to compute an estimate of the likelihood that the cyber attack can alter, destroy, or falsify each piece of information in a compromised ring. The unpredictability of information alteration in our approach adds greater realism to the cyber event. This paper suggests a new technique that can be used for cyber warfare simulation, the ring approach for modeling context-dependent information value, and our means for considering information value when assigning cyber resources to information protection tasks. The first section of the paper introduces the cyber warfare simulation challenge and the reasons for its importance. The second section contains background information related to our research. The third section contains a discussion of the information ring technique and its use for simulating cyber attacks. The fourth section contains a summary and suggestions for research.

A cross sectional study of the relationship between the exposure of pregnant women to military attacks in 2014 in Gaza and the load of heavy metal contaminants in the hair of mothers and newborns

PubMed Central

Manduca, Paola; Diab, Safwat Y; Qouta, Samir R; Albarqouni, Nabil MA; Punamaki, Raiija-Leena

2017-01-01

Objective Metal contamination of humans in war areas has rarely been investigated. Weaponry’s heavy metals become environmentally stable war remnants and accumulate in living things. They also pose health risks in terms of prenatal intake, with potential long term risks for reproductive and children’s health. We studied the contribution of military attacks to the load of 23 metals in the hair of Palestinian women in the Gaza Strip, who were pregnant at the time of the military attacks in 2014, and their newborns. We compared the metal load in the mothers with values for adult hair from outside the war area (RHS) as the reference. We investigated heavy metals trans-passing in utero, and assessed if the heavy metal intake could derive from sources unrelated to the war. Design Cross sectional study. Participants and setting Cross sectional convenience sample of 502 mothers delivering in the Gaza Strip and their newborns. Main outcome measured Measure of the load of heavy metals in mother and newborn hair by inductively coupled plasma-mass spectrometry (ICP-MS). Comparison of metal loads with the reference RHS, between groups with different exposures to attacks and house/agriculture chemicals, and between mothers and newborns. Data for birth registry and for exposures to war and other known risk factors were obtained at interview with the mothers. Photographic documentation of damage from military attacks was obtained. Results The whole cross sectional convenience sample had a significantly higher load of heavy metals than the reference RHS. Women exposed to military attacks had a significantly higher load of heavy metals than those not exposed; the load in newborns correlated positively with the mothers’ load. No significant difference was found between users/non-users of house/agriculture chemicals. No other known confounder was identified. Conclusions High heavy metal loads in mothers, reflected in those of their newborns, were associated with exposure to military attacks, posing a risk of immediate and long term negative outcomes for pregnancy and child health. Surveillance, biomonitoring and further research are recommended. Implications for general and public health are discussed. PMID:28768639

The World Trade Center health surveillance program: results of the first 10 years and implications for prevention.

PubMed

Lucchini, R G; Crane, M A; Crowley, L; Globina, Y; Milek, D J; Boffetta, P; Landrigan, P J

2012-01-01

The terrorist attacks on the World Trade Center (WTC) of September 11, 2001 resulted in the deaths of 2,823 persons. They also generated a long-lasting burden of multiple physical and mental health illnesses among the cohort of 50,000 rescue workers who responded to the attacks and in the 400,000 residents and workers in nearby areas of New York City. A comprehensive health surveillance program was developed from the first months after the accidents and was further developed in the subsequent ears. Individual exposure and health data were stored in ad hoc databases and produced epidemiological outcomes on the various exposure-related illnesses. About 10 years of longitudinal assessment of this large cohort of WTC rescue and recovery workers, yielded data from participants in the WTC Screening, Monitoring, and Treatment Program. Police officers, firefighters, construction workers, and municipal workers were included in the cohort. Cumulative and annual incidence were estimated for various physical disorders including asthma, sinusitis, and gastroesophageal reflux disease, mental health disorders including depression, post-traumatic stress disorder [PTSD], and panic disorder. Respiratory functionality was also assessed. Exposure was characterized with qualitative parameter including working on the pile and being engulfed in the dust cloud, and quantitative parameters including the time of arrival on site and the exposure duration. Upper and lower respiratory conditions such as rhinosinusitis and asthma have been found in a significant number of people in WTC-exposed populations. A lack of appropriate respiratory protection may have contributed to these effects. Other commonly observed physical health conditions include gastro-esophageal reflux disease, obstructive sleep apnea and musculo-skeletal injuries. Many WTC-exposed individuals also suffer from mental health conditions, primarily post-traumatic stress disorder, depression, panic disorder, and substantial stress reaction. Recent studies suggest that WTC exposure may increase the risk of cancer and of mortality from cardiac disease. Ten years of systematic health surveillance after the 9/11 WTC attacks, show long lasting burden of physical and mental health problems. Continued monitoring and treatment of this population is needed for early diagnoses of initial clinical conditions that can be treated more effectively. The experience of September 11 offers also indications on how to approach the acute and delayed health effects of civilian catastrophes. Critical lessons are derived about the importance of having trained responders--medical and non-medical--in place in advance of disasters, and about the need to proceed with adequate exposure assessment in a timely manner.

Measuring outcomes for neurosurgical procedures.

PubMed

Theodosopoulos, Philip V; Ringer, Andrew J

2015-04-01

Health care evolution has led to focused attention on clinical outcomes of care. Surgical disciplines are increasingly asked to provide evidence of treatment efficacy. As the technological advances push the surgical envelope further, it becomes imperative that postoperative outcomes are studied in a prospective fashion to assess the quality of care provided. The authors present their experience from a multiyear implementation of an outcomes initiative and share lessons learned, emphasizing the important structural elements of such an endeavor. Copyright © 2015 Elsevier Inc. All rights reserved.

Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys

ClinicalTrials.gov

2018-05-02

Heart Attack; Cardiac Arrest; Congestive Heart Failure; Atrial Fibrillation; Angina; Deep Vein Thrombosis; Pulmonary Embolism; Respiratory Arrest; Respiratory Failure; Pneumonia; Gastrointestinal Bleed; Stomach Ulcer; Delirium; Stroke; Nerve Injury; Surgical Wound Infection

Influence of female sex and fertile age on neuromyelitis optica spectrum disorders.

PubMed

Borisow, Nadja; Kleiter, Ingo; Gahlen, Anna; Fischer, Katrin; Wernecke, Klaus-Dieter; Pache, Florence; Ruprecht, Klemens; Havla, Joachim; Krumbholz, Markus; Kümpfel, Tania; Aktas, Orhan; Ringelstein, Marius; Geis, Christian; Kleinschnitz, Christoph; Berthele, Achim; Hemmer, Bernhard; Angstwurm, Klemens; Weissert, Robert; Stellmann, Jan-Patrick; Schuster, Simon; Stangel, Martin; Lauda, Florian; Tumani, Hayrettin; Mayer, Christoph; Zeltner, Lena; Ziemann, Ulf; Linker, Ralf A; Schwab, Matthias; Marziniak, Martin; Then Bergh, Florian; Hofstadt-van Oy, Ulrich; Neuhaus, Oliver; Winkelmann, Alexander; Marouf, Wael; Rückriem, Lioba; Faiss, Jürgen; Wildemann, Brigitte; Paul, Friedemann; Jarius, Sven; Trebst, Corinna; Hellwig, Kerstin

2017-07-01

Gender and age at onset are important epidemiological factors influencing prevalence, clinical presentation, and treatment response in autoimmune diseases. To evaluate the impact of female sex and fertile age on aquaporin-4-antibody (AQP4-ab) status, attack localization, and response to attack treatment in patients with neuromyelitis optica (NMO) and its spectrum disorders (neuromyelitis optica spectrum disorder (NMOSD)). Female-to-male ratios, diagnosis at last visit (NMO vs NMOSD), attack localization, attack treatment, and outcome were compared according to sex and age at disease or attack onset. A total of 186 NMO/SD patients (82% female) were included. In AQP4-ab-positive patients, female predominance was most pronounced during fertile age (female-to-male ratio 23:1). Female patients were more likely to be positive for AQP4-abs (92% vs 55%; p < 0.001). Interval between onset and diagnosis of NMO/SD was longer in women than in men (mean 54 vs 27 months; p = 0.023). In women, attacks occurring ⩽40 years of age were more likely to show complete remission ( p = 0.003) and better response to high-dose intravenous steroids ( p = 0.005) compared to woman at >40 years. Our data suggest an influence of sex and age on susceptibility to AQP4-ab-positive NMO/SD. Genetic and hormonal factors might contribute to pathophysiology of NMO/SD.

Crafting usable knowledge for sustainable development.

PubMed

Clark, William C; van Kerkhoff, Lorrae; Lebel, Louis; Gallopin, Gilberto C

2016-04-26

This paper distills core lessons about how researchers (scientists, engineers, planners, etc.) interested in promoting sustainable development can increase the likelihood of producing usable knowledge. We draw the lessons from both practical experience in diverse contexts around the world and from scholarly advances in understanding the relationships between science and society. Many of these lessons will be familiar to those with experience in crafting knowledge to support action for sustainable development. However, few are included in the formal training of researchers. As a result, when scientists and engineers first venture out of the laboratory or library with the goal of linking their knowledge with action, the outcome has often been ineffectiveness and disillusionment. We therefore articulate here a core set of lessons that we believe should become part of the basic training for researchers interested in crafting usable knowledge for sustainable development. These lessons entail at least four things researchers should know, and four things they should do. The knowing lessons involve understanding the coproduction relationships through which knowledge making and decision making shape one another in social-environmental systems. We highlight the lessons that emerge from examining those coproduction relationships through the ICAP lens, viewing them from the perspectives of Innovation systems, Complex systems, Adaptive systems, and Political systems. The doing lessons involve improving the capacity of the research community to put its understanding of coproduction into practice. We highlight steps through which researchers can help build capacities for stakeholder collaboration, social learning, knowledge governance, and researcher training.

Crafting usable knowledge for sustainable development

PubMed Central

2016-01-01

This paper distills core lessons about how researchers (scientists, engineers, planners, etc.) interested in promoting sustainable development can increase the likelihood of producing usable knowledge. We draw the lessons from both practical experience in diverse contexts around the world and from scholarly advances in understanding the relationships between science and society. Many of these lessons will be familiar to those with experience in crafting knowledge to support action for sustainable development. However, few are included in the formal training of researchers. As a result, when scientists and engineers first venture out of the laboratory or library with the goal of linking their knowledge with action, the outcome has often been ineffectiveness and disillusionment. We therefore articulate here a core set of lessons that we believe should become part of the basic training for researchers interested in crafting usable knowledge for sustainable development. These lessons entail at least four things researchers should know, and four things they should do. The knowing lessons involve understanding the coproduction relationships through which knowledge making and decision making shape one another in social–environmental systems. We highlight the lessons that emerge from examining those coproduction relationships through the ICAP lens, viewing them from the perspectives of Innovation systems, Complex systems, Adaptive systems, and Political systems. The doing lessons involve improving the capacity of the research community to put its understanding of coproduction into practice. We highlight steps through which researchers can help build capacities for stakeholder collaboration, social learning, knowledge governance, and researcher training. PMID:27091979

Factors governing risk of cougar attacks on humans

USGS Publications Warehouse

Mattson, David; Logan, Kenneth; Sweanor, Linda

2011-01-01

Since the 1980s wildlife managers in the United States and Canada have expressed increasing concern about the physical threat posed by cougars (Puma concolor) to humans. We developed a conceptual framework and analyzed 386 human–cougar encounters (29 fatal attacks, 171 instances of nonfatal contact, and 186 close-threatening encounters) to provide information relevant to public safety. We conceived of human injury and death as the outcome of 4 transitions affected by different suites of factors: (1) a human encountering a cougar: (2) given an encounter, odds that the cougar would be aggressive; (3) given aggression, odds that the cougar would attack; and (4) given an attack, odds that the human would die. We developed multivariable logistic regression models to explain variation in odds at transitions three and four using variables pertaining to characteristics of involved people and cougars. Young (≤ 2.5 years) or unhealthy (by weight, condition, or disease) cougars were more likely than any others to be involved in close (typically <5 m) encounters that threatened the involved person. Of cougars in close encounters, females were more likely than males to attack, and of attacking animals, adults were more likely than juveniles to kill the victim (32% versus 9% fatality, respectively). During close encounters, victims who used a weapon killed the involved cougar in 82% of cases. Other mitigating behaviors (e.g., yelling, backing away, throwing objects, increasing stature) also substantially lessened odds of attack. People who were moving quickly or erratically when an encounter happened (running, playing, skiing, snowshoeing, biking, ATV-riding) were more likely to be attacked and killed compared to people who were less active (25% versus 8% fatality). Children (≤ 10 years) were more likely than single adults to be attacked, but intervention by people of any age reduced odds of a child’s death by 4.6×. Overall, cougar attacks on people in Canada and the United States were rare (currently 4 to 6/year) compared to attacks by large felids and wolves (Canis lupus) in Africa and Asia (hundreds to thousands/year).

Response to Nadler's Commentary on Arch and Craske's (2011) "Addressing Relapse in Cognitive Behavioral Therapy for Panic Disorder: Methods for Optimizing Long-Term Treatment Outcomes"

ERIC Educational Resources Information Center

Arch, Joanna J.; Craske, Michelle G.

2012-01-01

Nadler (this issue), in his commentary of our article, "Addressing Relapse in Cognitive Behavioral Therapy for Panic Disorder: Methods for Optimizing Long-Term Treatment Outcomes" (Arch & Craske, 2011), argues that we misrepresent the role of panic attacks within learning theory and overlook cognitive treatment targets. He presents several case…

Emergency medical service providers' role in the early heart attack care program: prevention and stratification strategies.

PubMed

MacDonald, G S; Steiner, S R

1997-01-01

Emergency Medical Services-Early Heart Attack Care (EMS-EHAC) is a community-based program where paramedics increase the consumer's awareness about early chest pain symptom recognition. EMS-EHAC prevention, along with seamless chest pain care (between the paramedic and chest pain emergency department) can be the basis for an outcome-based study to examine the impact of advanced life support EMS. Studies that show the impact of care given by paramedics on the outcome of patient care must be designed to demonstrate the value and the cost benefit of providing advanced life support (ALS). Third party payers are going to examine if there are significant quality differences between ALS and basic life support (BLS) services. If significant benefits of ALS care cannot be demonstrated, the cost differences could potentially place the future of advanced life support paramedic programs in jeopardy. A positive outcome resulting in a lower acute cardiac event, and the realization of the cost benefits from the EMS-EHAC program could be utilized by EMS management to justify or expand advanced life support programs.

Corticotropin releasing factor influences aggression and monoamines: Modulation of attacks and retreats

PubMed Central

Carpenter, Russ E.; Korzan, Wayne J.; Bockholt, Craig; Watt, Michael J.; Forster, Gina L.; Renner, Kenneth J.; Summers, Cliff H.

2009-01-01

Salmonids establish social hierarchies as a result of aggressive social interactions. The establishment of dominant or subordinate status is strongly linked to neuroendocrine responses mediated through the stress axis. In this study, we tested the effects of icv CRF on the behavioral outcome, plasma cortisol and monoamine function in trout subjected to a socially aggressive encounter. Rainbow trout were treated with an icv injection of artificial cerebrospinal fluid (aCSF), 500 or 2000 ng ovine CRF, or not injected. Fish were allowed to interact with a similarly sized conspecific for 15 minutes. Following the behavioral interaction, plasma cortisol and central monoamine concentrations were analyzed. Trout treated with CRF were victorious in approximately 60% of the aggressive encounters against aCSF treated opponents. Trout injected with CRF exhibited a reduction in the total number of attacks and decreased latency to attack. When trout were divided winners and losers, only victorious CRF-treated fish exhibited a reduced latency to attack and fewer retreats. Social stress increased cortisol levels in both winners and losers of aggressive interaction. This effect was enhanced with the additional stress incurred from icv injection of aCSF. However, icv CRF in addition to social stress decreased plasma cortisol in both winners and losers. While aggression stimulated significant changes in serotonergic and dopaminergic activity, the magnitude and direction were dependent on limbic brain region, CRF dose, and outcome of social aggression. With broad effects on aggressive behavior, anxiety, stress responsiveness, and central monoaminergic activity, CRF plays an important role modulating the behavioral components of social interaction. PMID:18992791

Pit Bull attack causing limb threatening vascular trauma -A case series.

PubMed

Harnarayan, Patrick; Islam, Shariful; Ramsingh, Christi; Naraynsingh, Vijay

2018-01-01

Non-fatal human dog bites are commonplace amongst animal attacks on human beings and these present with mainly skin and soft tissue injuries. However, they can also present with life threatening head and neck injuries, massive soft tissue trauma, as well as combined orthopedic and vascular extremity injuries where a high possibility of limb loss exists. We present two adult dog bite victims with multiple bites inflicted by large canines identified as Pit-Bull Terriers. They were presented with deep lacerations to the axillary area resulting in limb ischemia and loss of upper limb pulses. The right axillary artery was crushed in both patients whilst the axillary vein was lacerated in one. The vessels were repaired; the wounds debrided and both limbs were salvaged. Canine attacks by Pit Bull Terriers and Rottweiler's can occur at any age and in any anatomical area of the body particularly the limbs. Injuries involving the extremities presenting with no pulses or pulsatile bleeding demand an urgent exploration as any undue delay is intolerable especially if there are bony injuries like fractures or fracture/dislocation. All patients with complex neurovascular injuries should be managed by a multidisciplinary team for an optimal outcome. Attacks by Pit Bull Terriers are more likely to cause severe morbidity than other breeds of dogs. Immediate surgical exploration is required to prevent catastrophic outcomes, especially limb loss. Stronger animal control laws, public education and responsible dog ownership may reduce deaths from these canines. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

The failure of AHERF: 5 important lessons.

PubMed

Goldstein, Lisa

2008-08-01

Important lessons from AHERF's downfall: Strong governance and oversight of management are needed to ensure accountability; Disciplined growth strategies need to be supported by rigorous financial planning and feasibility analysis; Physician integration is critical to grow market share, but needs to be methodical and measured; Robust information systems are necessary to manage costs, maximize revenue, and provide differentiation in quality and clinical outcomes; Disclosure of the financial performance of all of a health system's operations creates greater transparency and builds credibility.

Why the South African NQF Failed: Lessons for Countries Wanting to Introduce National Qualifications Frameworks

ERIC Educational Resources Information Center

Allais, Stephanie Matseleng

2007-01-01

This article examines the South African National Qualifications Framework as a case study of a particular approach to the design of qualifications frameworks, which revolves around the specification of learning outcomes separate from educational institutions or programmes. It shows how an outcomes-led qualifications framework was seen as a…

Impacts of Professional Development in Integrated STEM Education on Teacher Self-Efficacy, Outcome Expectancy, and STEM Career Awareness

ERIC Educational Resources Information Center

Knowles, J. Geoff

2017-01-01

This research analyzed the effects of teacher professional development and lesson implementation in integrated Science, Technology, Engineering, and Math (STEM) on: (1.) Teacher self-efficacy and their confidence to teach specific STEM subjects; (2.) Teaching outcome expectancy beliefs concerning the impact of actions by teachers on student…

Methodological Challenges in International Comparative Post-Secondary Assessment Programs: Lessons Learned and the Road Ahead

ERIC Educational Resources Information Center

Wolf, Raffaela; Zahner, Doris; Benjamin, Roger

2015-01-01

The assessment of student learning outcomes in the tertiary school sector has seen an increase in global popularity in recent years. Measurement instruments that target higher order skills are on the rise, whereas assessments that foster the recall of factual knowledge are declining. The Assessment of Higher Education Learning Outcomes (AHELO)…

Positive Outcomes from Poor Starts: Predictors of Dropping Back In

ERIC Educational Resources Information Center

Hill, Lauren E.; Jepsen, Christopher

2007-01-01

A vast body of research finds an association between missteps taken during the teen years (such as motherhood or dropping out of high school) and poor economic and educational outcomes. However, youth who take major missteps as teens often have subsequent success in school or the labor market. This paper attempts to draw lessons from youth who…

ORD'S ORGANIZATION AND HOW IT IS FUNDED. OVERVIEW OF SCIENTIST-TO-SCIENTIST MINING (TOPICS, OUTCOMES, MAJOR OUTCOMES). FOLLOW-UP ACTION ITEMS.

EPA Science Inventory

This discussion was geered to mining experts and discussed mixed ownership sites, ecological risk ssessments, Good Sam Legislation, and lessons learned on Superfund Sites. An overview of ORD was also presented as well as a dicussion on funding, and the purpose of scientist-to-sc...

Integrating Culture into Language Teaching and Learning: Learner Outcomes

ERIC Educational Resources Information Center

Nguyen, Trang Thi Thuy

2017-01-01

This paper discusses the issue of learner outcomes in learning culture as part of their language learning. First, some brief discussion on the role of culture in language teaching and learning, as well as on culture contents in language lessons is presented. Based on a detailed review of previous literature related to culture in language teaching…

Biomedical Risk, Psychosocial Influences, and Developmental Outcomes: Lessons from the Pediatric HIV Population in Africa

ERIC Educational Resources Information Center

Serpell, Robert; Marfo, Kofi; Abubakar, Amina

2014-01-01

Sub-Saharan Africa is home to millions of HIV-affected children. These children are likely to experience multiple developmental delays. In this chapter, I present data highlighting compromised neurobehavioral, mental health, and scholastic outcomes for children affected by HIV. Furthermore, I discuss biomedical factors (e.g., disease severity and…

Performance indicators analysis at Brazilian and Italian women's volleyball leagues according to game location, game outcome, and set number.

PubMed

Campos, Fabio A D; Stanganélli, Luiz C R; Campos, Leandra C B; Pasquarelli, Bruno N; Gómez, Miguel-Angel

2014-04-01

This study was done to investigate the advantage of playing at home in elite women's volleyball leagues and the influence of performance indicators in the game score according to set number. The sample consisted of 240 games of the Brazilian Volleyball League (n = 132 games) and the Italian Volleyball League (n = 108 games) from the 2011-2012 season. The relationship of performance indicators (including serve, attack, block, and opponents' errors) with the game outcome (win or lose) was assessed. The results showed that there was a home advantage effect in women's volleyball leagues, with a higher prevalence of victory for the home teams in Brazilian and Italian leagues (58 and 56%, respectively). When related to the performance indicators and among the aspects that were most highly correlated with victory, the attack was the technical indicator that explained most of the results of volleyball games.

A two-dimensional air-to-air combat game - Toward an air-combat advisory system

NASA Technical Reports Server (NTRS)

Neuman, Frank

1987-01-01

Air-to-air combat is modeled as a discrete differential game, and by constraining the game to searching for the best guidance laws from the sets of those considered for each opponent, feedback and outcome charts are obtained which can be used to turn one of the automatic opponents into an intelligent opponent against a human pilot. A one-on-one two-dimensional fully automatic, or manned versus automatic, air-to-air combat game has been designed which includes both attack and evasion alternatives for both aircraft. Guidance law selection occurs by flooding the initial-condition space with four simulated fights for each initial condition, depicting the various attack/evasion strategies for the two opponents, and recording the outcomes. For each initial condition, the minimax method from differential games is employed to determine the best choice from the available strategies.

Space Launch System Liftoff and Transition Aerodynamic Characterization in the NASA Langley 14- by 22-Foot Subsonic Wind Tunnel

NASA Technical Reports Server (NTRS)

Pinier, Jeremy T.; Erickson, Gary E.; Paulson, John W.; Tomek, William G.; Bennett, David W.; Blevins, John A.

2015-01-01

A 1.75% scale force and moment model of the Space Launch System was tested in the NASA Langley Research Center 14- by 22-Foot Subsonic Wind Tunnel to quantify the aerodynamic forces that will be experienced by the launch vehicle during its liftoff and transition to ascent flight. The test consisted of two parts: the first was dedicated to measuring forces and moments for the entire range of angles of attack (0deg to 90deg) and roll angles (0 deg. to 360 deg.). The second was designed to measure the aerodynamic effects of the liftoff tower on the launch vehicle for ground winds from all azimuthal directions (0 deg. to 360 deg.), and vehicle liftoff height ratios from 0 to 0.94. This wind tunnel model also included a set of 154 surface static pressure ports. Details on the experimental setup, and results from both parts of testing are presented, along with a description of how the wind tunnel data was analyzed and post-processed in order to develop an aerodynamic database. Finally, lessons learned from experiencing significant dynamics in the mid-range angles of attack due to steady asymmetric vortex shedding are presented.

Critical components required to improve deployable laboratory biological hazards identification

NASA Astrophysics Data System (ADS)

Niemeyer, Debra M.

2004-08-01

An ever-expanding global military mission necessitates quick and accurate identification of biological hazards, whether naturally occurring or man-made. Coupled with an ever-present threat of biological attack, an expanded U.S. presence in worn-torn locations like Southwest Asia presents unique public health challenges. We must heed modern day "lessons learned" from Operation Desert Shield and the Soviet Afghanistan Campaign and guard against rapid incapacitation of troop strength from endemic disease and biological attack. To minimize readiness impacts, field hygiene is enforced, and research on better medical countermeasures such as antibiotics and vaccines continues. However, there are no preventions or remedies for all military-relevant infectious diseases or biological agents. A deployable, streamlined, self-contained diagnostic and public health surveillance laboratory capability with a reach-back communication is critical to meeting global readiness challenges. Current deployable laboratory packages comprise primarily diagnostic or environmental sample testing capabilities. Discussion will focus on critical components needed to improve existing laboratory assets, and to facilitate deployment of small, specialized packages far forward. The ideal laboratory model described will become an essential tool for the Combatant or Incident Commander to maintain force projection in the expeditionary environment.

The effect of prolonged exposure to war-related stress among hospital personnel with different affect types: lessons from the Second Lebanon War and the Gaza "Cast Lead" operation.

PubMed

Palgi, Yuval; Ben-Ezra, Menachem; Shrira, Amit

2012-01-01

Two studies examined peritraumatic symptoms due to war-related stress among hospital personnel with different affect types. In Study 1, we examined 80 Israeli hospital personnel during the period they were exposed to frequent missile attacks in the Second Lebanon War. In Study 2, we examined 67 and 74 Israeli hospital personnel during the time they were exposed and were not exposed, respectively, to missile attacks in the Gaza "Cast Lead" operation. In both studies, hospital personnel completed measures of posttraumatic stress disorder symptoms as well as of positive- and negative-affect items (PA and NA, respectively). Exposed personnel with a positive congruent (high PA and low NA) or a deflated incongruent (low PA and low NA) affective types had a lower level of peritraumatic symptoms compared to those with a negative congruent (low PA and high NA) or an inflated incongruent (high PA and NA) affective types. Study 2 further showed that among non-exposed personnel, only personnel with a negative congruent affective type had a higher level of peritraumatic symptoms compared to personnel with other affective types. Clinical implications and required future studies are discussed.

How moths escape bats: predicting outcomes of predator-prey interactions.

PubMed

Corcoran, Aaron J; Conner, William E

2016-09-01

What determines whether fleeing prey escape from attacking predators? To answer this question, biologists have developed mathematical models that incorporate attack geometries, pursuit and escape trajectories, and kinematics of predator and prey. These models have rarely been tested using data from actual predator-prey encounters. To address this problem, we recorded multi-camera infrared videography of bat-insect interactions in a large outdoor enclosure. We documented 235 attacks by four Myotis volans bats on a variety of moths. Bat and moth flight trajectories from 50 high-quality attacks were reconstructed in 3-D. Despite having higher maximum velocity, deceleration and overall turning ability, bats only captured evasive prey in 69 of 184 attacks (37.5%); bats captured nearly all moths not evading attack (50 of 51; 98%). Logistic regression indicated that prey radial acceleration and escape angle were the most important predictors of escape success (44 of 50 attacks correctly classified; 88%). We found partial support for the turning gambit mathematical model; however, it underestimated the escape threshold by 25% of prey velocity and did not account for prey escape angle. Whereas most prey escaping strikes flee away from predators, moths typically escaped chasing bats by turning with high radial acceleration toward 'safety zones' that flank the predator. This strategy may be widespread in prey engaged in chases. Based on these findings, we developed a novel geometrical model of predation. We discuss implications of this model for the co-evolution of predator and prey kinematics and pursuit and escape strategies. © 2016. Published by The Company of Biologists Ltd.

Symptom recognition of heart attack and stroke in nine European countries: a representative survey

PubMed Central

Mata, Jutta; Frank, Ronald; Gigerenzer, Gerd

2012-01-01

Abstract Background  Cardiovascular diseases are the number one cause of death and a source of chronic disability. Objectives  To assess recognition of and reaction to symptoms of heart attack and stroke, and how recognition is related to the frequency of consulting physicians and other information sources. Design  Face‐to‐face computer‐assisted personal interviews. Participants  Representative sample of 10 228 persons in Austria, France, Germany, Italy, the Netherlands, Poland, Russia, Spain and UK, aged 14–98. Main Outcome Variables  Recognition of heart attack and stroke symptoms and proper reaction to symptoms. Results  Chest pain was the only heart attack symptom recognized by more than 50% of participants. Eight percent knew no symptoms. Of 14 stroke symptoms, none was recognized by more than 50% of participants; 19% could not identify any symptom. For both heart attack and stroke, Germans and Austrians recognized the largest number of symptoms. Persons in Italy, Poland, Russia and Spain knew only about half as many symptoms as in Germany or Austria. Only 51% of Europeans would call an ambulance when someone suffers a stroke, the fewest (33 and 34%) in Germany and Austria. In most countries, people who consulted their physician more frequently had no better recognition of heart attack or stroke symptoms. Conclusions  The majority of persons in nine European countries recognize few heart attack and stroke symptoms; many do not know how to react. This low level of knowledge constitutes a major health risk and likely leads to delay in treatment, contributing to the high mortality and morbidity from these diseases. PMID:22390229

Multi-party quantum key agreement protocol secure against collusion attacks

NASA Astrophysics Data System (ADS)

Wang, Ping; Sun, Zhiwei; Sun, Xiaoqiang

2017-07-01

The fairness of a secure multi-party quantum key agreement (MQKA) protocol requires that all involved parties are entirely peer entities and can equally influence the outcome of the protocol to establish a shared key wherein no one can decide the shared key alone. However, it is found that parts of the existing MQKA protocols are sensitive to collusion attacks, i.e., some of the dishonest participants can collaborate to predetermine the final key without being detected. In this paper, a multi-party QKA protocol resisting collusion attacks is proposed. Different from previous QKA protocol resisting N-1 coconspirators or resisting 1 coconspirators, we investigate the general circle-type MQKA protocol which can be secure against t dishonest participants' cooperation. Here, t < N. We hope the results of the presented paper will be helpful for further research on fair MQKA protocols.

Differentiating ictal panic with low-grade temporal lobe tumors from psychogenic panic attacks.

PubMed

Ghods, Ali J; Ruban, Dmitry S; Wallace, David; Byrne, Richard W

2013-11-01

Indolent low-grade temporal lobe tumors may present with ictal panic that may be difficult to differentiate from psychogenic panic attacks. The current study aims to demonstrate the differences between the two disorders and help physicians generate a diagnostic paradigm. This was a retrospective study of 43 patients who underwent a temporal lobectomy between 1981 and 2008 for the treatment of intractable temporal lobe epilepsy secondary to low-grade neoplasms at Rush University Medical Center. A total of 10 patients in this group presented with ictal panic who were previously being treated for psychogenic panic attacks. Medical records were reviewed for age at seizure onset, duration of symptoms, lateralization of the epileptogenic zone, pathological diagnosis, and postsurgical seizure outcome according to the modified Engel classification. Neuropathologic findings of the 10 tumors were pleomorphic xanthoastrocytoma, ganglioglioma, oligodendroglioma, and dysembryoplastic neuroepithelial. The mean age of the patients undergoing surgery was 28 years (range, 15-49). The mean duration of panic symptoms prior to surgery was 9.8 years (range, 3-23). All patients had unprovoked ictal panic. None had symptoms suggestive of a brain tumor, such as signs of increased intracranial pressure or any focal neurologic deficit. In 5 of the patients, other symptoms associated with the ictal panic, including unusual sounds, nausea, automatism, uprising gastric sensation, and déjà vu were identified. Gross total resection of the lesion resulted in improved seizure outcome in all patients undergoing surgery. Patient follow-up was, on average, 7.4 years (range, 2-14) from time of surgery. Although similar, ictal panic from epilepsy and classic panic attacks are clinically distinguishable entities with different modalities of treatment. A careful history may help differentiate patients with ictal panic from those with psychogenic panic attacks and determine for which patients to obtain neuroimaging studies. © Copyright 2013 Physicians Postgraduate Press, Inc.

Patient confidence regarding secondary lifestyle modification and knowledge of ‘heart attack’ symptoms following percutaneous revascularisation in Japan: a cross-sectional study

PubMed Central

Kitakata, Hiroki; Kohno, Takashi; Kohsaka, Shun; Fujino, Junko; Nakano, Naomi; Fukuoka, Ryoma; Yuasa, Shinsuke; Maekawa, Yuichiro; Fukuda, Keiichi

2018-01-01

Objective To assess patient perspectives on secondary lifestyle modification and knowledge of ‘heart attack’ after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Design Observational cross-sectional study. Setting A single university-based hospital centre in Japan. Participants In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident). Primary outcome measure The primary outcome assessed was the patients’ confidence level regarding lifestyle modification and the recognition of heart attack symptoms. Results Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (<50%) about the maintenance of blood pressure control, healthy diet, body weight and routine exercise (≥3 times/week). After adjustment, male sex (OR 3.61, 95% CI 1.11 to 11.8) and lower educational level (OR 3.25; 95% CI 1.70 to 6.23) were identified as factors associated with lower confidence levels. In terms of confidence in the recognition of heart attack, almost all respondents answered ‘yes’ to the item ‘I should go to the hospital as soon as possible when I have a heart attack’; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions. Conclusions There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care. PMID:29549203

Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians.

PubMed

Qaseem, Amir; Harris, Russell P; Forciea, Mary Ann

2017-01-03

The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of gout. Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials; systematic reviews; and large observational studies published between January 2010 and March 2016. Clinical outcomes evaluated included pain, joint swelling and tenderness, activities of daily living, patient global assessment, recurrence, intermediate outcomes of serum urate levels, and harms. The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute or recurrent gout. ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout. (Grade: strong recommendation, high-quality evidence). ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout. (Grade: strong recommendation, moderate-quality evidence). ACP recommends against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. (Grade: strong recommendation, moderate-quality evidence). ACP recommends that clinicians discuss benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks. (Grade: strong recommendation, moderate-quality evidence).

Effect of ticagrelor with clopidogrel on high on-treatment platelet reactivity in acute stroke or transient ischemic attack (PRINCE) trial: Rationale and design.

PubMed

Wang, Yilong; Lin, Yi; Meng, Xia; Chen, Weiqi; Chen, Guohua; Wang, Zhimin; Wu, Jialing; Wang, Dali; Li, Jianhua; Cao, Yibin; Xu, Yuming; Zhang, Guohua; Li, Xiaobo; Pan, Yuesong; Li, Hao; Liu, Liping; Zhao, Xingquan; Wang, Yongjun

2017-04-01

Rationale and aim Little is known about the safety and efficacy of the combination of ticagrelor and aspirin in acute ischemic stroke. This study aimed to evaluate whether the combination of ticagrelor and aspirin was superior to that of clopidogrel and aspirin in reducing the 90-day high on-treatment platelet reactivity for acute minor stroke or transient ischemic attack, especially for carriers of cytochrome P450 2C19 loss-of-function allele. Sample size and design This study was designed as a prospective, multicenter, randomized, open-label, active-controlled, and blind-endpoint, phase II b trial. The required sample size was 952 patients. It was registered with ClinicalTrials.gov (NCT02506140). Study outcomes The primary outcome was the proportion of patients with high on-treatment platelet reactivity at 90 days. High on-treatment platelet reactivity is defined as the P2Y12 reaction unit >208 measured using the VerifyNow P2Y12 assay. Conclusion The Platelet Reactivity in Acute Non-disabling Cerebrovascular Events study explored whether ticagrelor combined with aspirin could reduce further the proportion of patients with high on-treatment platelet reactivity at 90 days after acute minor stroke or transient ischemic attack compared with clopidogrel and aspirin.

Influence of prehospital airway management on neurological outcome in patients transferred to a heart attack centre following out-of-hospital cardiac arrest.

PubMed

Edwards, Timothy; Williams, Julia; Cottee, Michaela

2018-05-11

To describe the association between prehospital airway management and neurological outcomes in patients transferred by the ambulance service directly to a heart attack centre (HAC) post-return of spontaneous circulation (ROSC). A retrospective observational cohort study in which ambulance records were reviewed to determine prehospital airway management strategy and collect physiological and demographic data. HAC notes were obtained to determine in-hospital management and quantify neurological outcome via the cerebral performance category (CPC) scale. Statistical analyses were performed via χ 2 -test, Mann-Whitney U-test, odds ratios and binomial logistic regression. Two hundred and twenty patients were included between August 2013 and August 2014, with complete outcome data obtained for 209. Median age of patients with complete outcome data was 67 years and 71.3% were male (n = 149). Airway management was provided using a supraglottic airway (SGA) in 72.7% of cases (n = 152) with the remainder undergoing endotracheal intubation (ETI). There was no significant difference in the proportion of patients who had a good neurological outcome (CPC 1 and 2) at discharge between the SGA and ETI groups (P = 0.29). Binomial logistic regression incorporating factors known to influence outcome demonstrated no significant difference in neurological outcomes between the SGA and ETI groups (adjusted OR 0.73, 95% CI 0.34-1.56). In this observational study, there was no significant difference in the proportion of good neurological outcomes in patients managed with SGA versus ETI during cardiac arrest and in the post-ROSC transfer phase. Further research is required to provide more definitive evidence in relation to the optimal airway management strategy in out-of-hospital cardiac arrest. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Infusing Social Responsibility into the Curriculum and Cocurriculum: Campus Examples

ERIC Educational Resources Information Center

Reason, Robert D.

2013-01-01

This chapter highlights good practices and lessons learned for infusing social responsibility--contributing to the larger community and taking seriously the perspectives of others--as outcomes of college.

Four-year follow-up of transient ischemic attacks, strokes, and mimics: a retrospective transient ischemic attack clinic cohort study.

PubMed

Dutta, Dipankar; Bowen, Emily; Foy, Chris

2015-05-01

There is limited information on outcomes from rapid access transient ischemic attack (TIA) clinics. We present 4-year outcomes of TIAs, strokes, and mimics from a UK TIA clinic database. All patients referred between April 2010 and May 2012 were retrospectively identified and outcomes determined. End points were stroke, myocardial infarction, any vascular event (TIA, stroke, or myocardial infarction), and all-cause death. Data were analyzed by survival analysis. Of 1067 patients, 31.6% were TIAs, 18% strokes, and 50.4% mimics. Median assessment time was 4.5 days from onset and follow-up was for 34.9 months. Subsequent strokes occurred in 7.1% of patients with TIA, 10.9% of patients with stroke, and 2.0% of mimics at the end of follow-up. Stroke risk at 90 days was 1.3% for patients diagnosed as TIA or stroke. Compared with mimics, hazard ratios for subsequent stroke were 3.88 (1.90-7.91) for TIA and 5.84 (2.81-12.11) for stroke. Hazard ratio for any subsequent vascular event was 2.91 (1.97-4.30) for TIA and 2.83 (1.81-4.41) for stroke. Hazard ratio for death was 1.68 (1.10-2.56) for TIA and 2.19 (1.38-3.46) for stroke. Our results show a lower 90-day stroke incidence after TIA or minor stroke than in earlier studies, suggesting that rapid access daily TIA clinics may be having a significant effect on reducing strokes. © 2015 American Heart Association, Inc.

Primary care-based multifaceted, interdisciplinary medical educational intervention for patients with systolic heart failure: lessons learned from a cluster randomised controlled trial.

PubMed

Peters-Klimm, Frank; Campbell, Stephen; Müller-Tasch, Thomas; Schellberg, Dieter; Gelbrich, Goetz; Herzog, Wolfgang; Szecsenyi, Joachim

2009-08-13

Chronic (systolic) heart failure (CHF) is a common and disabling condition. Adherence to evidence-based guidelines in primary care has been shown to improve health outcomes. The aim was to explore the impact of a multidisciplinary educational intervention for general practitioners (GPs) (Train the trainer = TTT) on patient and performance outcomes. This paper presents the key findings from the trial and discusses the lessons learned during the implementation of the TTT trial. Primary care practices were randomly assigned to the TTT intervention or to the control group. 37 GPs (18 TTT, 19 control) were randomised and 168 patients diagnosed with ascertained CHF (91 TTT, 77 control) were enrolled. GPs in the intervention group attended four meetings addressing clinical practice guidelines and pharmacotherapy feedback. The primary outcome was patient self-reported quality of life at seven months, using the SF-36 Physical Functioning scale. Secondary outcomes included other SF-36 scales, the Kansas City Cardiomyopathy Questionnaire (KCCQ), total mortality, heart failure hospital admissions, prescribing, depressive disorders (PHQ-9), behavioural change (European Heart Failure Self-Care Behaviour Scale), patient-perceived quality of care (EUROPEP) and improvement of heart failure using NT-proBNP-levels. Because recruitment targets were not achieved an exploratory analysis was conducted. There was high baseline achievement in both groups for many outcomes. At seven months, there were no significant mean difference between groups for the primary outcome measure (-3.3, 95%CI -9.7 to 3.1, p = 0.30). The only difference in secondary outcomes related to the prescribing of aldosterone antagonists by GPs in the intervention group, with significant between group differences at follow-up (42 vs. 24%, adjusted OR = 4.0, 95%CI 1.2-13; p = 0.02). The intervention did not change the primary outcome or most secondary outcomes. Recruitment targets were not achieved and the under-recruitment of practices and patients alongside a selection bias of participating GPs, prohibit definite conclusions, but the CI indicates a non-effectiveness of the intervention in this sample. We describe the lessons learned from conducting the trial for the future planning and conduct of confirmatory trials in primary care. ISRCTN08601529.

Primary care-based multifaceted, interdisciplinary medical educational intervention for patients with systolic heart failure: lessons learned from a cluster randomised controlled trial

PubMed Central

Peters-Klimm, Frank; Campbell, Stephen; Müller-Tasch, Thomas; Schellberg, Dieter; Gelbrich, Goetz; Herzog, Wolfgang; Szecsenyi, Joachim

2009-01-01

Background Chronic (systolic) heart failure (CHF) is a common and disabling condition. Adherence to evidence-based guidelines in primary care has been shown to improve health outcomes. The aim was to explore the impact of a multidisciplinary educational intervention for general practitioners (GPs) (Train the trainer = TTT) on patient and performance outcomes. Methods This paper presents the key findings from the trial and discusses the lessons learned during the implementation of the TTT trial. Primary care practices were randomly assigned to the TTT intervention or to the control group. 37 GPs (18 TTT, 19 control) were randomised and 168 patients diagnosed with ascertained CHF (91 TTT, 77 control) were enrolled. GPs in the intervention group attended four meetings addressing clinical practice guidelines and pharmacotherapy feedback. The primary outcome was patient self-reported quality of life at seven months, using the SF-36 Physical Functioning scale. Secondary outcomes included other SF-36 scales, the Kansas City Cardiomyopathy Questionnaire (KCCQ), total mortality, heart failure hospital admissions, prescribing, depressive disorders (PHQ-9), behavioural change (European Heart Failure Self-Care Behaviour Scale), patient-perceived quality of care (EUROPEP) and improvement of heart failure using NT-proBNP-levels. Because recruitment targets were not achieved an exploratory analysis was conducted. Results There was high baseline achievement in both groups for many outcomes. At seven months, there were no significant mean difference between groups for the primary outcome measure (-3.3, 95%CI -9.7 to 3.1, p = 0.30). The only difference in secondary outcomes related to the prescribing of aldosterone antagonists by GPs in the intervention group, with significant between group differences at follow-up (42 vs. 24%, adjusted OR = 4.0, 95%CI 1.2–13; p = 0.02). Conclusion The intervention did not change the primary outcome or most secondary outcomes. Recruitment targets were not achieved and the under-recruitment of practices and patients alongside a selection bias of participating GPs, prohibit definite conclusions, but the CI indicates a non-effectiveness of the intervention in this sample. We describe the lessons learned from conducting the trial for the future planning and conduct of confirmatory trials in primary care. Trial registration ISRCTN08601529. PMID:19678944

Late onset of atypical paroxysmal non-kinesigenic dyskinesia with remote history of Graves' disease.

PubMed

Rana, Abdul Qayyum; Nadeem, Ambreen; Yousuf, Muhammad Saad; Kachhvi, Zakerabibi M

2013-10-01

Paroxysmal non-kinesigenic dyskinesia (PNKD) is a rare hyperkinetic movement disorder and falls under the category of paroxysmal movement disorders. In this condition, episodes are spontaneous, involuntary, and involve dystonic posturing with choreic and ballistic movements. Attacks last for minutes to hours and rarely occur more than once per day. Attacks are not typically triggered by sudden movement, but may be brought on by alcohol, caffeine, stress, fatigue, or chocolate. We report a patient with multiple atypical features of PNKD. She had a 7-year history of this condition with onset at the age of 59, and a remote history of Graves' disease requiring total thyroidectomy. The frequency of attacks in our case ranged from five to six times a day to a minimum of twice per week, and the duration of episode was short, lasting not more than 2 min. Typically, PNKDs occur at a much younger age and have longer attack durations with low frequency. Administering clonazepam worked to reduce her symptoms, although majority of previous research suggests that pharmacological interventions have poor outcomes.

Community-acquired pneumonia in the age of bio-terrorism.

PubMed

Dattwyler, Raymond J

2005-01-01

The post September 11th anthrax attacks demonstrated just how vulnerable we are to biologic attack. In the first days of the attack, there was confusion and miscommunication. Patients presented to emergency rooms and to their primary care physicians with severe pneumonia. Days passed and a person died before the cause of pneumonia was recognized as Bacillus anthracis. In a biologic attack, the prompt recognition of the biologic agent is key to the outcome for both individual patients and potentially even our society. The three category A bacterial agents, anthrax, tularemia, and plague, can all present as a necrotizing pneumonia. If an attack occurred during flu season when there is already an increase in pneumonia, most physicians will initially have a great deal of difficulty determining that these cases are different. Yet, considering the nature of the world today every physician must be suspicious that the next pneumonia he or she sees could be the index case of anthrax, tularemia, or plague. The challenge for the clinician evaluating a patient presenting with the presumptive diagnosis of community-acquired pneumonia is differentiating between the various possible etiologies that can cause this clinical picture. Each of these three class A agents has it own microbiologic and clinical characteristics. They are discussed here.

Effectiveness of Taste Lessons with and without additional experiential learning activities on children's willingness to taste vegetables.

PubMed

Battjes-Fries, Marieke C E; Haveman-Nies, Annemien; Zeinstra, Gertrude G; van Dongen, Ellen J I; Meester, Hante J; van den Top-Pullen, Rinelle; Van't Veer, Pieter; de Graaf, Kees

2017-02-01

This study assessed the effectiveness of the Dutch school programme Taste Lessons with and without additional experiential learning activities on children's willingness to taste unfamiliar vegetables. Thirty-three primary schools (877 children in grades 6-7 with a mean age of 10.3 years) participated in Taste Lessons Vegetable Menu (TLVM, lessons and extra activities), Taste Lessons (TL, lessons), or a control group. A baseline and follow-up measurement was used to assess for each child: number of four familiar and four unfamiliar vegetables tasted, quantity tasted, choice of vegetable of which to eat more, and number of vegetables willing to taste again later. Furthermore, children filled out a questionnaire on daily vegetable intake and food neophobia. Multilevel and Cox regression analyses were conducted to compare changes in the outcome measures between the three study groups. No significant intervention effects were found on willingness to taste unfamiliar vegetables. Neither were effects found on familiar vegetables, except for number of familiar vegetables tasted (p < 0.05). Furthermore, no significant intervention effects were found on daily vegetable consumption and food neophobia. These results indicate that more intensive school-based nutrition education activities are needed to increase children's willingness to taste unfamiliar vegetables and increase their vegetable intake. Copyright © 2016. Published by Elsevier Ltd.

Improving conceptual and procedural knowledge: The impact of instructional content within a mathematics lesson.

PubMed

Rittle-Johnson, Bethany; Fyfe, Emily R; Loehr, Abbey M

2016-12-01

Students, parents, teachers, and theorists often advocate for direct instruction on both concepts and procedures, but some theorists suggest that including instruction on procedures in combination with concepts may limit learning opportunities and student understanding. This study evaluated the effect of instruction on a math concept and procedure within the same lesson relative to a comparable amount of instruction on the concept alone. Direct instruction was provided before or after solving problems to evaluate whether the type of instruction interacted with the timing of instruction within a lesson. We worked with 180 second-grade children in the United States. In a randomized experiment, children received a classroom lesson on mathematical equivalence in one of four conditions that varied in instruction type (conceptual or combined conceptual and procedural) and in instruction order (instruction before or after solving problems). Children who received two iterations of conceptual instruction had better retention of conceptual and procedural knowledge than children who received both conceptual and procedural instruction in the same lesson. Order of instruction did not impact outcomes. Findings suggest that within a single lesson, spending more time on conceptual instruction may be more beneficial than time spent teaching a procedure when the goal is to promote more robust understanding of target concepts and procedures. © 2016 The British Psychological Society.

The disaster was my fault!

PubMed

Robertson, Mary M; Cavanna, Andrea E

2007-10-01

We report the case of a child affected by Gilles de la Tourette syndrome and comorbid obsessive-compulsive disorder who claimed to have caused the September 11, 2001 terrorist attacks in the United States by failing to accomplish a stereotyped compulsive ritual. Special attention is paid to the relationship between the patient's neuropsychiatric symptoms and the belief that he personally had influenced the outcome of an internationally notorious disaster. Prognostic and treatment implications are also presented, along with a review of the literature on the clinical and psychosocial impact of terrorist attacks and natural disasters on children suffering from neuropsychiatric disorders.

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes).

PubMed

Easton, J Donald; Aunes, Maria; Albers, Gregory W; Amarenco, Pierre; Bokelund-Singh, Sara; Denison, Hans; Evans, Scott R; Held, Peter; Jahreskog, Marianne; Jonasson, Jenny; Minematsu, Kazuo; Molina, Carlos A; Wang, Yongjun; Wong, K S Lawrence; Johnston, S Claiborne

2017-09-05

Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52-1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720. © 2017 American Heart Association, Inc.

CBT for depression: a pilot RCT comparing mobile phone vs. computer.

PubMed

Watts, Sarah; Mackenzie, Anna; Thomas, Cherian; Griskaitis, Al; Mewton, Louise; Williams, Alishia; Andrews, Gavin

2013-02-07

This paper reports the results of a pilot randomized controlled trial comparing the delivery modality (mobile phone/tablet or fixed computer) of a cognitive behavioural therapy intervention for the treatment of depression. The aim was to establish whether a previously validated computerized program (The Sadness Program) remained efficacious when delivered via a mobile application. 35 participants were recruited with Major Depression (80% female) and randomly allocated to access the program using a mobile app (on either a mobile phone or iPad) or a computer. Participants completed 6 lessons, weekly homework assignments, and received weekly email contact from a clinical psychologist or psychiatrist until completion of lesson 2. After lesson 2 email contact was only provided in response to participant request, or in response to a deterioration in psychological distress scores. The primary outcome measure was the Patient Health Questionnaire 9 (PHQ-9). Of the 35 participants recruited, 68.6% completed 6 lessons and 65.7% completed the 3-months follow up. Attrition was handled using mixed-model repeated-measures ANOVA. Both the Mobile and Computer Groups were associated with statistically significantly benefits in the PHQ-9 at post-test. At 3 months follow up, the reduction seen for both groups remained significant. These results provide evidence to indicate that delivering a CBT program using a mobile application, can result in clinically significant improvements in outcomes for patients with depression. Australian New Zealand Clinical Trials Registry ACTRN 12611001257954.

Exploring the use of multiple analogical models when teaching and learning chemical equilibrium

NASA Astrophysics Data System (ADS)

Harrison, Allan G.; de Jong, Onno

2005-12-01

This study describes the multiple analogical models used to introduce and teach Grade 12 chemical equilibrium. We examine the teacher's reasons for using models, explain each model's development during the lessons, and analyze the understandings students derived from the models. A case study approach was used and the data were drawn from the observation of three consecutive Grade 12 lessons on chemical equilibrium, pre- and post-lesson interviews, and delayed student interviews. The key analogical models used in teaching were: the school dance; the sugar in a teacup; the pot of curry; and the busy highway. The lesson and interview data were subject to multiple, independent analyses and yielded the following outcomes: The teacher planned to use the students' prior knowledge wherever possible and he responded to student questions with stories and extended and enriched analogies. He planned to discuss where each analogy broke down but did not. The students enjoyed the teaching but built variable mental models of equilibrium and some of their analogical mappings were unreliable. A female student disliked masculine analogies, other students tended to see elements of the multiple models in isolation, and some did not recognize all the analogical mappings embedded in the teaching plan. Most students learned that equilibrium reactions are dynamic, occur in closed systems, and the forward and reverse reactions are balanced. We recommend the use of multiple analogies like these and insist that teachers always show where the analogy breaks down and carefully negotiate the conceptual outcomes.

Efficacy and implementation of an Internet psychoeducational program for teens with type 1 diabetes.

PubMed

Whittemore, Robin; Liberti, Lauren S; Jeon, Sangchoon; Chao, Ariana; Minges, Karl E; Murphy, Kathryn; Grey, Margaret

2016-12-01

The purpose of the study was to evaluate the participation and preliminary efficacy of an Internet psychoeducational program (Teens.Connect) shown to be efficacious under controlled conditions compared with an open-access diabetes website for youth (Planet D) on the primary outcomes of A1C and quality of life (QoL), and secondary outcomes of psychosocial and behavioral factors. Teens with type 1 diabetes (n = 124, 11-14 yr) from two clinical sites were randomly prescribed one of the programs and completed baseline, 3-month and 6-month data. A1C was obtained from clinic records. Participation data included number of log ins, posts to the discussion board, and lessons completed (Teens.Connect only). Descriptive and mixed model analyses were used. Eighty-five percent (85%) of consented teens registered for their prescribed program. Satisfaction and log ins were similar between groups (satisfaction ranged 3.3-3.5/5; mean log ins = 14/teen). Posts to the discussion forum were higher in Planet D (mean = 28 vs. 19). Participation in the Teens.Connect lessons was low, with only 69% of teens completing any lesson. After 6 months there were no significant differences in A1C, QoL or secondary outcomes between groups. Teens in the Teens.Connect group reported lower perceived stress over time (p < 0.01). Teens do not actively participate in an Internet psychoeducational program when they do not have frequent reminders, which may have contributed to a lack of treatment effect. Teens have many competing demands. Strategic implementation that includes targeted reminders and family support may be necessary to assure participation and improvement in health outcomes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Efficacy and Implementation of an Internet Psychoeducational Program for Teens with Type 1 Diabetes

PubMed Central

Whittemore, Robin; Liberti, Lauren S.; Jeon, Sangchoon; Chao, Ariana; Minges, Karl E.; Murphy, Kathryn; Grey, Margaret

2015-01-01

Objective The purpose of the study was to evaluate the participation and preliminary efficacy of an internet psychoeducational program (Teens.Connect) shown to be efficacious under controlled conditions compared to an open-access diabetes website for youth (Planet D) on the primary outcomes of A1C and quality of life (QOL), and secondary outcomes of psychosocial and behavioral factors. Research Design and Methods Teens with type 1 diabetes (n=124, 11-14yrs) from 2 clinical sites were randomly prescribed one of the programs and completed baseline, 3-month and 6-month data. A1C was obtained from clinic records. Participation data included number of logins, posts to the discussion board, and lessons completed (Teens.Connect only). Descriptive and mixed model analyses were used. Results Eighty-five percent (85%) of consented teens registered for their prescribed program. Satisfaction and logins were similar between groups (satisfaction ranged 3.3–3.5/5; mean logins=14/teen). Posts to the discussion forum were higher in Planet D (mean=28 vs 19). Participation in the Teens.Connect lessons was low, with only 69% of teens completing any lesson. After 6 months there were no significant differences in A1C, QOL or secondary outcomes between groups. Teens in the Teens.Connect group reported lower perceived stress over time (p<.01). Conclusions Teens do not actively participate in an internet psychoeducational program when they do not have frequent reminders, which may have contributed to a lack of treatment effect. Teens have many competing demands. Strategic implementation that includes targeted reminders and family support may be necessary to assure participation and improvement in health outcomes. PMID:26611663

Epidemiology of respiratory health outcomes among World Trade Center disaster workers: review of the literature 10 years after the September 11, 2001 terrorist attacks.

PubMed

Ekenga, Christine C; Friedman-Jiménez, George

2011-09-01

Tens of thousands of workers participated in rescue, recovery, and cleanup activities at the World Trade Center (WTC) site in lower Manhattan after the terrorist attacks on September 11, 2001 (9/11). The collapse of the WTC resulted in the release of a variety of airborne toxicants. To date, respiratory symptoms and diseases have been among the most examined health outcomes in studies of WTC disaster workers. A systematic review of the literature on respiratory health outcomes was undertaken to describe the available information on new onset of respiratory symptoms and diseases among WTC disaster workers after September 11, 2001. Independent risk factors for respiratory health outcomes included being caught in the dust and debris cloud, early arrival at the WTC site, longer duration of work, and delaying mask and respirator use. Methodological challenges in epidemiologic studies of WTC disaster workers involved study design, exposure misclassification, and limited information on potential confounders and effect modifiers. In the 10 years after 9/11, epidemiologic studies of WTC disaster workers have been essential in investigating the respiratory health consequences of WTC exposure. Longitudinal studies along with continued medical surveillance will be vital in understanding the long-term respiratory burden associated with occupational WTC exposure.

Which skills and factors better predict winning and losing in high-level men's volleyball?

PubMed

Peña, Javier; Rodríguez-Guerra, Jorge; Buscà, Bernat; Serra, Núria

2013-09-01

The aim of this study was to determine which skills and factors better predicted the outcomes of regular season volleyball matches in the Spanish "Superliga" and were significant for obtaining positive results in the game. The study sample consisted of 125 matches played during the 2010-11 Spanish men's first division volleyball championship. Matches were played by 12 teams composed of 148 players from 17 different nations from October 2010 to March 2011. The variables analyzed were the result of the game, team category, home/away court factors, points obtained in the break point phase, number of service errors, number of service aces, number of reception errors, percentage of positive receptions, percentage of perfect receptions, reception efficiency, number of attack errors, number of blocked attacks, attack points, percentage of attack points, attack efficiency, and number of blocks performed by both teams participating in the match. The results showed that the variables of team category, points obtained in the break point phase, number of reception errors, and number of blocked attacks by the opponent were significant predictors of winning or losing the matches. Odds ratios indicated that the odds of winning a volleyball match were 6.7 times greater for the teams belonging to higher rankings and that every additional point in Complex II increased the odds of winning a match by 1.5 times. Every reception and blocked ball error decreased the possibility of winning by 0.6 and 0.7 times, respectively.

Advancing Scientific Methods in Community and Cultural Context to Promote Health Equity: Lessons from Intervention Outcomes Research with American Indian and Alaska Native Communities

ERIC Educational Resources Information Center

Whitesell, Nancy Rumbaugh; Sarche, Michelle; Keane, Ellen; Mousseau, Alicia C.; Kaufman, Carol E.

2018-01-01

Evidence-based interventions hold promise for reducing gaps in health equity across diverse populations, but evidence about effectiveness within these populations lags behind the mainstream, often leaving opportunities to fulfill this promise unrealized. Mismatch between standard intervention outcomes research methods and the cultural and…

Epidemiologic Methods Lessons Learned from Environmental Public Health Disasters: Chernobyl, the World Trade Center, Bhopal, and Graniteville, South Carolina

PubMed Central

Svendsen, Erik R.; Runkle, Jennifer R.; Dhara, Venkata Ramana; Lin, Shao; Naboka, Marina; Mousseau, Timothy A.; Bennett, Charles

2012-01-01

Background: Environmental public health disasters involving hazardous contaminants may have devastating effects. While much is known about their immediate devastation, far less is known about long-term impacts of these disasters. Extensive latent and chronic long-term public health effects may occur. Careful evaluation of contaminant exposures and long-term health outcomes within the constraints imposed by limited financial resources is essential. Methods: Here, we review epidemiologic methods lessons learned from conducting long-term evaluations of four environmental public health disasters involving hazardous contaminants at Chernobyl, the World Trade Center, Bhopal, and Graniteville (South Carolina, USA). Findings: We found several lessons learned which have direct implications for the on-going disaster recovery work following the Fukushima radiation disaster or for future disasters. Interpretation: These lessons should prove useful in understanding and mitigating latent health effects that may result from the nuclear reactor accident in Japan or future environmental public health disasters. PMID:23066404

Organizational factors and office workers' health after the World Trade Center terrorist attacks: long-term physical symptoms, psychological distress, and work productivity.

PubMed

Osinubi, Omowunmi Y O; Gandhi, Sampada K; Ohman-Strickland, Pamela; Boglarsky, Cheryl; Fiedler, Nancy; Kipen, Howard; Robson, Mark

2008-02-01

To assess if organizational factors are predictors of workers' health and productivity after the World Trade Center attacks. We conducted a survey of 750 workers and compared those who had direct exposures to the World Trade Center attacks (south of Canal Street workers; primary victims) with those less directly exposed (north of Canal Street workers; other victims and non-victims). South of Canal Street workers reported headache more frequently than north of Canal Street workers did (P = 0.0202). Primary victims reported headache and cough more frequently than did other victims and non-victims (P = 0.0086 and 0.0043, respectively). Defensive organizational culture was an independent predictor of cough and job stress, and job stress was an independent predictor of on-the-job productivity losses. Organizational variables may modify health and productivity outcomes after a large-scale traumatic event in the workplace.

A shark attack treated in a tertiary care centre: Case report and review of the literature.

PubMed

Roy, Mélissa; Plant, Mathew A; Snell, Laura

2018-01-01

Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman's contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries.

A shark attack treated in a tertiary care centre: Case report and review of the literature

PubMed Central

Roy, Mélissa; Plant, Mathew A; Snell, Laura

2018-01-01

Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman’s contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries. PMID:29076325

[Stuttering priapism in children with sickle cell anemia in Togo].

PubMed

Gbadoé, A D; Géraldo, A; Guédénon, K; Koffi, S; Agbétiafa, K; Akpako, P

2007-07-01

To describe clinical aspects and outcome of stuttering priapism (SP) in children with sickle cell anemia. We included the 8 children with sickle cell anemia suffering from SP between 1996 and 2004. Age at onset of SP ranged from 5 to 14 years (mean 9.75+/-3.69 years). SP attacks occurred once a day for 6 patients, and 2 and 3 times by week for the others. It happened during deep sleep, especially in the night (all patients) and sometimes in the day (4 patients). The duration of attacks ranged from 10 min to 2 h in 6 patients and 4 to 5 h in 2 patients. Oral étilefrine was administered to all patients until the cessation of attacks, and continued during 1 month. A long remission was obtained in all patients after 7 days to 7 months treatment (follow-up 2 to 7 years) in spite of 1 or many relapses.

Effects of tonabersat on migraine with aura: a randomised, double-blind, placebo-controlled crossover study.

PubMed

Hauge, Anne W; Asghar, Mohammed S; Schytz, Henrik W; Christensen, Karl; Olesen, Jes

2009-08-01

Migraine with aura is thought likely to be caused by cortical spreading depression (CSD). Tonabersat inhibits CSD, and we therefore investigated whether tonabersat has a preventive effect in migraine with aura. In this randomised, double-blind, placebo-controlled crossover trial, 40 mg tonabersat once daily was compared with matched placebo in patients who had at least one aura attack per month during the past 3 months. Randomisation was by computer-generated list. Patients kept a detailed diary to enable objective diagnosis of each attack as migraine with aura, migraine without aura, or other type of headache. Primary endpoints were a reduction in aura attacks with or without headache and a reduction in migraine headache days with or without an aura. Analysis was per protocol. This trial is registered, number NCT00332007. 39 patients were included in the study, of whom 31 were included in the statistical analysis of efficacy. Median (IQR) attacks of aura were reduced from 3.2 (1.0-5.0) per 12 weeks on placebo to 1.0 (0-3.0) on tonabersat (p=0.01), whereas the other primary outcome measure, median migraine headache days with or without aura, was not significantly different between placebo and tonabersat groups (3.0 days in each group; p=0.09). Tonabersat was well tolerated but overall had more side-effects than placebo. Tonabersat showed a preventive effect on attacks of migraine aura but no efficacy on non-aura attacks, in keeping with its known inhibitory effect on CSD. The results support the theory that auras are caused by CSD and that this phenomenon is not involved in attacks without aura. Minster Pharmaceuticals; Lundbeck Foundation.

The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication

PubMed Central

Kessler, Ronald C.; Chiu, Wai Tat; Jin, Robert; Ruscio, Ayelet Meron; Shear, Katherine; Walters, Ellen E.

2007-01-01

Context Only limited information exists about the epidemiology of DSM-IV panic attacks and panic disorder. Objective To present nationally representative data on the epidemiology of panic attacks and panic disorder with or without agoraphobia based on the National Comorbidity Survey Replication (NCS-R). Design and Setting Nationally representative face-to-face household survey conducted using the fully structured WHO Composite International Diagnostic Interview (CIDI). Participants 9282 English-speaking respondents ages 18 and older. Main Outcome Measures DSM-IV panic attacks (PA) and panic disorder (PD) with and without agoraphobia (AG). Results Lifetime prevalence estimates are 22.7% for isolated panic without agoraphobia (PA-only), 0.8% for PA with agoraphobia without PD (PA-AG), 3.7% for PD without AG (PD-only), and 1.1% for PD with AG (PD-AG). Persistence, number of lifetime attacks, and number of years with attacks all increase monotonically across these four subgroups. All four subgroups are significantly comorbid with other lifetime DSM-IV disorders, with the highest odds for PD-AG and the lowest for PA-only. Scores on the Panic Disorder Severity Scale are also highest for PD-AG (86.3% moderate-severe) and lowest for PA-only (6.7% moderate-severe). Agoraphobia is associated with substantial severity, impairment, and comorbidity. Lifetime treatment is high (from 96.1% PD-AG to 61.1% PA-only), but 12-month treatment meeting published treatment guidelines is low (from 54.9% PD-AG to 18.2% PA-only). Conclusions Although the major societal burden of panic is due to PD and PA-AGG, isolated panic attacks also have high prevalence and meaningful role impairment. PMID:16585471

Defending networks against denial-of-service attacks

NASA Astrophysics Data System (ADS)

Gelenbe, Erol; Gellman, Michael; Loukas, George

2004-11-01

Denial of service attacks, viruses and worms are common tools for malicious adversarial behavior in networks. Experience shows that over the last few years several of these techniques have probably been used by governments to impair the Internet communications of various entities, and we can expect that these and other information warfare tools will be used increasingly as part of hostile behavior either independently, or in conjunction with other forms of attack in conventional or asymmetric warfare, as well as in other forms of malicious behavior. In this paper we concentrate on Distributed Denial of Service Attacks (DDoS) where one or more attackers generate flooding traffic and direct it from multiple sources towards a set of selected nodes or IP addresses in the Internet. We first briefly survey the literature on the subject, and discuss some examples of DDoS incidents. We then present a technique that can be used for DDoS protection based on creating islands of protection around a critical information infrastructure. This technique, that we call the CPN-DoS-DT (Cognitive Packet Networks DoS Defence Technique), creates a self-monitoring sub-network surrounding each critical infrastructure node. CPN-DoS-DT is triggered by a DDoS detection scheme, and generates control traffic from the objects of the DDoS attack to the islands of protection where DDOS packet flows are destroyed before they reach the critical infrastructure. We use mathematical modelling, simulation and experiments on our test-bed to show the positive and negative outcomes that may result from both the attack, and the CPN-DoS-DT protection mechanism, due to imperfect detection and false alarms.

Anxiety After Stroke

PubMed Central

Whiteley, William N.; Dennis, Martin S.; Mead, Gillian E.; Carson, Alan J.

2018-01-01

Background and Purpose— Anxiety after stroke is common and disabling. Stroke trialists have treated anxiety as a homogenous condition, and intervention studies have followed suit, neglecting the different treatment approaches for phobic and generalized anxiety. Using diagnostic psychiatric interviews, we aimed to report the frequency of phobic and generalized anxiety, phobic avoidance, predictors of anxiety, and patient outcomes at 3 months poststroke/transient ischemic attack. Methods— We followed prospectively a cohort of new diagnosis of stroke/transient ischemic attack at 3 months with a telephone semistructured psychiatric interview, Fear Questionnaire, modified Rankin Scale, EuroQol-5D5L, and Work and Social Adjustment Scale. Results— Anxiety disorder was common (any anxiety disorder, 38 of 175 [22%]). Phobic disorder was the predominant anxiety subtype: phobic disorder only, 18 of 175 (10%); phobic and generalized anxiety disorder, 13 of 175 (7%); and generalized anxiety disorder only, 7 of 175 (4%). Participants with anxiety disorder reported higher level of phobic avoidance across all situations on the Fear Questionnaire. Younger age (per decade increase in odds ratio, 0.64; 95% confidence interval, 0.45–0.91) and having previous anxiety/depression (odds ratio, 4.38; 95% confidence interval, 1.94–9.89) were predictors for anxiety poststroke/transient ischemic attack. Participants with anxiety disorder were more dependent (modified Rankin Scale score 3–5, [anxiety] 55% versus [no anxiety] 29%; P<0.0005), had poorer quality of life on EQ-5D5L, and restricted participation (Work and Social Adjustment Scale: median, interquartile range, [anxiety] 19.5, 10–27 versus [no anxiety] 0, 0–5; P<0.001). Conclusions— Anxiety after stroke/transient ischemic attack is predominantly phobic and is associated with poorer patient outcomes. Trials of anxiety intervention in stroke should consider the different treatment approaches needed for phobic and generalized anxiety. PMID:29437982

Anxiety After Stroke: The Importance of Subtyping.

PubMed

Chun, Ho-Yan Yvonne; Whiteley, William N; Dennis, Martin S; Mead, Gillian E; Carson, Alan J

2018-03-01

Anxiety after stroke is common and disabling. Stroke trialists have treated anxiety as a homogenous condition, and intervention studies have followed suit, neglecting the different treatment approaches for phobic and generalized anxiety. Using diagnostic psychiatric interviews, we aimed to report the frequency of phobic and generalized anxiety, phobic avoidance, predictors of anxiety, and patient outcomes at 3 months poststroke/transient ischemic attack. We followed prospectively a cohort of new diagnosis of stroke/transient ischemic attack at 3 months with a telephone semistructured psychiatric interview, Fear Questionnaire, modified Rankin Scale, EuroQol-5D5L, and Work and Social Adjustment Scale. Anxiety disorder was common (any anxiety disorder, 38 of 175 [22%]). Phobic disorder was the predominant anxiety subtype: phobic disorder only, 18 of 175 (10%); phobic and generalized anxiety disorder, 13 of 175 (7%); and generalized anxiety disorder only, 7 of 175 (4%). Participants with anxiety disorder reported higher level of phobic avoidance across all situations on the Fear Questionnaire. Younger age (per decade increase in odds ratio, 0.64; 95% confidence interval, 0.45-0.91) and having previous anxiety/depression (odds ratio, 4.38; 95% confidence interval, 1.94-9.89) were predictors for anxiety poststroke/transient ischemic attack. Participants with anxiety disorder were more dependent (modified Rankin Scale score 3-5, [anxiety] 55% versus [no anxiety] 29%; P <0.0005), had poorer quality of life on EQ-5D5L, and restricted participation (Work and Social Adjustment Scale: median, interquartile range, [anxiety] 19.5, 10-27 versus [no anxiety] 0, 0-5; P <0.001). Anxiety after stroke/transient ischemic attack is predominantly phobic and is associated with poorer patient outcomes. Trials of anxiety intervention in stroke should consider the different treatment approaches needed for phobic and generalized anxiety. © 2018 The Authors.

Lessons From Analyzing the Medical Costs of Civilian Terror Victims: Planning Resources Allocation for a New Era of Confrontations.

PubMed

Ellenberg, Eytan; Taragin, Mark I; Hoffman, Jay R; Cohen, Osnat; Luft-Afik, Daniella; Bar-On, Zvia; Ostfeld, Ishay

2017-12-01

Policy Points: Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror. Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. Based on an 18-month follow-up of the Israeli civilian population following the 2014 war in Gaza, we describe and analyze the medical costs associated with rocket attacks and review the demography of the victims who filed claims for disability compensation. We then propose practical lessons to help health care authorities prepare for future confrontations. Using the National Insurance Institute of Israel's (NII) database, we conducted descriptive and comparative analyses using statistical tests (Fisher's Exact Test, chi-square test, and students' t-tests). The costs were updated until March 30, 2016, and are presented in US dollars. We included only civilian expenses in our analysis. We identified 5,189 victims, 3,236 of whom presented with acute stress reactions during the conflict. Eighteen months after the conflict, the victims' total medical costs reached $4.4 million. The NII reimbursed $2,541,053 for associated medical costs and $1,921,792 for associated mental health costs. A total of 709 victims filed claims with the NII for further support, including rehabilitation, medical devices, and disability pensions. We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror. © 2017 Milbank Memorial Fund.

Exacerbation of primary intestinal lymphangiectasia during late pregnancy and recovery after delivery

PubMed Central

Lu, Jianyang; Zhai, Hongbo

2017-01-01

Abstract Rationale: Primary intestinal lymphangiectasia (PIL) is a rare disease characterized by dilated intestinal lacteals resulting in lymph leakage into the small bowel lumen. Main clinical features include intermittent diarrhea, hypoproteinemia. Scattered case reports suggested that PIL is compatible to pregnancy, but with increased complications. Patient concerns: A 34-year-old woman with endoscopically diagnosed PIL presented to antenatal our clinic at 10 weeks into gestation. She reported strict adherence to low-fat/high-protein diet with medium-chain triglycerides (MCTs) supplementation. She was general well except for moderate edema and hypoalbuminemia. At 33 weeks, she developed diarrhea, nausea, and vomiting, with decreased fetal movements. One week later, she had an asthma attack. Nonstress test showed frequent variable deceleration. Diagnoses: The diagnosis of PIL was established endoscopically 8 years earlier. Interventions: Hypoalbuminemia was corrected with intravenous albumin administration. She also received corticosteroid therapy to promote fetal lung maturation in anticipation to early termination of the pregnancy. Outcomes: A cesarean section was carried out at 34 weeks due to fetal distress. The baby girl was apparently healthy: weighing 2160 g, with an Apgar score of 9 at both 1 and 5 minutes. Symptoms dissipated rapidly after the delivery. The last follow-up visit at 15 months was unremarkable for both the mother and infant. Lessons: PIL could be compatible with pregnancy, but requires strict adherence to dietary treatment, proper management of the symptoms (e.g., hypoalbuminemia), particularly during late gestation. PMID:28858117

Infusing Personal Responsibility into the Curriculum and Cocurriculum: Campus Examples

ERIC Educational Resources Information Center

O'Neill, Nancy

2013-01-01

This chapter highlights good practices and lessons learned for infusing personal responsibility--striving for excellence, cultivating academic integrity, and developing competence in ethical and moral reasoning and action--as outcomes of college.

Efficacy and safety of betahistine treatment in patients with Meniere’s disease: primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial)

PubMed Central

Adrion, Christine; Fischer, Carolin Simone; Wagner, Judith; Gürkov, Robert; Mansmann, Ulrich

2016-01-01

Study question What is the long term efficacy of betahistine dihydrochloride on the incidence of vertigo attacks in patients with Meniere’s disease, compared with placebo? Methods The BEMED trial is a multicentre, double blind, randomised, placebo controlled, three arm, parallel group, phase III, dose defining superiority trial conducted in 14 German tertiary referral centres (for neurology or ear, nose, and throat). Adults aged 21-80 years (mean age 56 years) with definite unilateral or bilateral Meniere’s disease were recruited from March 2008 to November 2012. Participants received placebo (n=74), low dose betahistine (2×24 mg daily, (n=73)), or high dose betahistine (3×48 mg daily, (n=74)) over nine months. The primary outcome was the number of attacks per 30 days, based on patients’ diaries during a three month assessment period at months seven to nine. An internet based randomisation schedule performed a concealed 1:1:1 allocation, stratified by study site. Secondary outcomes included the duration and severity of attacks, change in quality of life scores, and several observer-reported parameters to assess changes in audiological and vestibular function. Study answer and limitations Incidence of attacks related to Meniere’s disease did not differ between the three treatment groups (P=0.759). Compared with placebo, attack rate ratios were 1.036 (95% confidence interval 0.942 to 1.140) and 1.012 (0.919 to 1.114) for low dose and high dose betahistine, respectively. The overall monthly attack rate fell significantly by the factor 0.758 (0.705 to 0.816; P<0.001). The population based, mean monthly incidence averaged over the assessment period was 2.722 (1.304 to 6.309), 3.204 (1.345 to 7.929), and 3.258 (1.685 to 7.266) for the placebo, low dose betahistine, and high dose betahistine groups, respectively. Results were consistent for all secondary outcomes. Treatment was well tolerated with no unexpected safety findings. Without a control group of patients who did not receive any intervention to follow the natural course of the disease, the placebo effect could not be accurately assessed and differentiated from spontaneous remission and fluctuation of symptoms. What this study adds Current evidence is limited as to whether betahistine prevents vertigo attacks caused by Meniere’s disease, compared with placebo. The trial provides information on symptom relief on placebo intervention which is relevant for the design of future studies on potential disease modifying treatments in patients with Meniere’s disease. Funding, competing interests, data sharing Support from the German Federal Ministry of Education and Research (BMBF support code 01KG0708). Potential competing interests have been reported in full at the end of the paper on thebmj.com. Data are available from the corresponding author (Michael.Strupp@med.uni-muenchen.de) or biostatistician (mansmann@ibe.med.uni-muenchen.de). Study registration EudraCT no 2005-000752-32; ISRCTN no ISRCTN44359668. PMID:26797774

Antiplatelet regimens in the long-term secondary prevention of transient ischaemic attack and ischaemic stroke: an updated network meta-analysis

PubMed Central

Niu, Peng-Peng; Guo, Zhen-Ni; Jin, Hang; Xing, Ying-Qi; Yang, Yi

2016-01-01

Objective To examine the comparative efficacy and safety of different antiplatelet regimens in patients with prior non-cardioembolic ischaemic stroke or transient ischaemic attack. Design Systematic review and network meta-analysis. Data sources As on 31 March 2015, all randomised controlled trials that investigated the effects of antiplatelet agents in the long-term (≥3 months) secondary prevention of non-cardioembolic transient ischaemic attack or ischaemic stroke were searched and identified. Outcome measures The primary outcome measure of efficacy was serious vascular events (non-fatal stroke, non-fatal myocardial infarction and vascular death). The outcome measure of safety was any bleeding. Results A total of 36 randomised controlled trials (82 144 patients) were included. Network meta-analysis showed that cilostazol was significantly more effective than clopidogrel (OR 0.77, 95% credible interval 0.60–0.98) and low-dose (75–162 mg daily) aspirin (0.69, 0.55–0.86) in the prevention of serious vascular events. Aspirin (50 mg daily) plus dipyridamole (400 mg daily) and clopidogrel reduced the risk of serious vascular events compared with low-dose aspirin; however, the difference was not statistically significant. Furthermore, low-dose aspirin was as effective as higher daily doses. Cilostazol was associated with a significantly lower bleeding risk than most of the other regimens. Moreover, aspirin plus clopidogrel was associated with significantly more haemorrhagic events than other regimens. Direct comparisons showed similar results as the network meta-analysis. Conclusions Cilostazol was significantly more effective than aspirin and clopidogrel alone in the long-term prevention of serious vascular events in patients with prior non-cardioembolic ischaemic stroke or transient ischaemic attack. Cilostazol was associated with a significantly lower bleeding risk than low-dose aspirin (75–162 mg daily) and aspirin (50 mg daily) plus dipyridamole (400 mg daily). Low-dose aspirin was as effective as higher daily doses. However, further large, randomised, controlled, head-to-head trials are needed, especially in non-Asian ethnic groups. PMID:26988347

Improving Literacy Instruction in Kenya through Teacher Professional Development and Text Messages Support: A Cluster Randomized Trial

ERIC Educational Resources Information Center

Jukes, Matthew C. H.; Turner, Elizabeth L.; Dubeck, Margaret M.; Halliday, Katherine E.; Inyega, Hellen N.; Wolf, Sharon; Zuilkowski, Stephanie Simmons; Brooker, Simon J.

2017-01-01

We evaluated a program to improve literacy instruction on the Kenyan coast using training workshops, semiscripted lesson plans, and weekly text-message support for teachers to understand its impact on students' literacy outcomes and on the classroom practices leading to those outcomes. The evaluation ran from the beginning of Grade 1 to the end of…

Pressure ulcers and nutritional support: a partnership to improve patient outcomes.

PubMed

Barrett, Roseann; Tuttle, Virginia; Whalen, Elizabeth; Gatchell, Carolyn; Dawe, Amy

2010-01-01

Prevention of pressure ulcers in hospitalized patients represents a challenge with great financial impact for hospitals and serious consequences for patients. A partnership composed of dieticians and nurses was assembled to identify best practices for providing nutritional support and intervention to patients at risk for pressure ulcers. This article describes the process, outcomes, recommendations, and lessons learned by the pressure ulcer/nutrition work group.

The Relationship between High School Music Activities and the College Student's Musical Independence. (How Musically Important Are All-State Band, Concert Festival, Private Lessons, Marching Contests, Etc.?).

ERIC Educational Resources Information Center

Bobbett, Gordon C.; And Others

This paper presents a study attempting to identify and evaluate high school activities that impact instrumental student outcome. High school music activities and their impact on student instrumental outcome from a variety of perspectives were examined. There is a subtle difference between musical independence and musical achievement. Musical…

Assuring quality health care outcomes: lessons learned from car dealers?

PubMed Central

Dimsdale, Joel E

2017-01-01

Health care systems want quality but struggle to find the right tools because, typically, they track quality in only one or two ways. Because of the complexity of health care, high quality will emerge only when health care systems employ multiple approaches, including, importantly, patient-reported outcome perspectives. Sustained changes are unlikely to emerge in the absence of such multipronged interventions. PMID:28123314

A randomized clinical trial of cognitive behavioral therapy and interpersonal psychotherapy for panic disorder with agoraphobia.

PubMed

Vos, S P F; Huibers, M J H; Diels, L; Arntz, A

2012-12-01

Interpersonal psychotherapy (IPT) seems to be as effective as cognitive behavioral therapy (CBT) in the treatment of major depression. Because the onset of panic attacks is often related to increased interpersonal life stress, IPT has the potential to also treat panic disorder. To date, a preliminary open trial yielded promising results but there have been no randomized controlled trials directly comparing CBT and IPT for panic disorder. This study aimed to directly compare the effects of CBT versus IPT for the treatment of panic disorder with agoraphobia. Ninety-one adult patients with a primary diagnosis of DSM-III or DSM-IV panic disorder with agoraphobia were randomized. Primary outcomes were panic attack frequency and an idiosyncratic behavioral test. Secondary outcomes were panic and agoraphobia severity, panic-related cognitions, interpersonal functioning and general psychopathology. Measures were taken at 0, 3 and 4 months (baseline, end of treatment and follow-up). Intention-to-treat (ITT) analyses on the primary outcomes indicated superior effects for CBT in treating panic disorder with agoraphobia. Per-protocol analyses emphasized the differences between treatments and yielded larger effect sizes. Reductions in the secondary outcomes were equal for both treatments, except for agoraphobic complaints and behavior and the credibility ratings of negative interpretations of bodily sensations, all of which decreased more in CBT. CBT is the preferred treatment for panic disorder with agoraphobia compared to IPT. Mechanisms of change should be investigated further, along with long-term outcomes.

Hereditary angioedema with C1 inhibitor deficiency: delay in diagnosis in Europe

PubMed Central

2013-01-01

Background Hereditary angioedema (HAE) is a rare, debilitating, and potentially life-threatening disease characterized by recurrent edema attacks. Important advances in HAE treatment have been made, including the development of new therapies for treating or preventing attacks. Nevertheless, the disease is still frequently misdiagnosed and inappropriately treated, potentially exposing patients with laryngeal attacks to the risk of asphyxiation. Methods The Icatibant Outcome Survey (IOS) is an international, observational study that documents the clinical outcome of HAE patients eligible for treatment with icatibant. Patient ages at first symptoms and at diagnosis were recorded at enrolment, and the delay between first symptoms and diagnosis was calculated. Results The median [range] diagnostic delay in HAE type I and II patients across eight countries was 8.5 years [0–62.0]. The median delay in diagnosis was longer for HAE type II versus type I (21 versus 8 years, respectively), although this did not quite reach statistical significance. Conclusions Although it can be difficult to differentiate HAE symptoms from those of more common angioedema sub-types (e.g. idiopathic or acquired angioedema), our results show that HAE type I and II patients have an unacceptable delay in diagnosis, even those with a family history of the disease. Raising physician awareness of this disabling and potentially fatal disease may lead to a more accurate diagnosis and timely treatment. PMID:23937903

The role of the emergency services in the optimisation of primary angioplasty: experience from London and the Heart Attack Team.

PubMed

Dalby, Miles; Whitbread, Mark

2013-08-22

Early ambulance services often confined their activities to a "scoop and run" approach, conveying sick patients quickly to the nearest emergency department. With the advent of modern ST-elevation myocardial infarction (STEMI) management and primary percutaneous coronary intervention (PPCI), the role of the emergency medical service (EMS) has expanded significantly. This review discusses the critical and evolving collaboration between the EMS and the heart attack centre. Speed of reperfusion is a major determinant of outcome in STEMI and, whilst the patient delay (symptom to call time) has a central role in this, system delay (first medical contact to balloon time) is linked to mortality and is used to measure the response of a PPCI programme and is a key element of contemporary guidelines. In addition to rapid diagnosis and transfer to the heart attack centre, the EMS has to deliver a growing number of established treatments including resuscitation and drug therapy. EMS also continually needs to develop expertise in new techniques such as advanced management of cardiac arrest patients, including automated cardiopulmonary resuscitation, and will need to deliver newer therapies if trials support their use, including cooling and preconditioning. Ultimately, the EMS has a central role in the management of STEMI patients which needs to be fully aligned with the heart attack centres. This integration of services is perhaps best regarded as the Heart Attack Team.

Developing smoking cessation programs for chronically ill teens: lessons learned from research with healthy adolescent smokers.

PubMed

Robinson, Leslie A; Emmons, Karen M; Moolchan, Eric T; Ostroff, Jamie S

2008-03-01

Medically fragile teens who smoke need access to smoking cessation programs, because they are at even higher risk than their healthy peers for smoking-related complications. To date, no studies on the outcome of smoking cessation programs for medically ill teens have been conducted. To suggest directions for future research, we turn to the literature on smoking cessation in the general population of teens and occasionally to the literature on adult smokers. Four areas are explored: (a) the prevalence of unaided cessation in healthy teens; (b) the outcomes of various treatments for smoking cessation in healthy adolescents; (c) special issues that should be considered when designing programs for medically ill teens; and (d) lessons learned from previous research. Medically ill teens face a number of medical, emotional, social, and developmental challenges that can affect the quitting process. Research is sorely needed to address the unique needs of this population.

Uric acid therapy improves the outcomes of stroke patients treated with intravenous tissue plasminogen activator and mechanical thrombectomy.

PubMed

Chamorro, Ángel; Amaro, Sergio; Castellanos, Mar; Gomis, Meritxell; Urra, Xabier; Blasco, Jordi; Arenillas, Juan F; Román, Luis S; Muñoz, Roberto; Macho, Juan; Cánovas, David; Marti-Fabregas, Joan; Leira, Enrique C; Planas, Anna M

2017-06-01

Background Numerous neuroprotective drugs have failed to show benefit in the treatment of acute ischemic stroke, making the search for new treatments imperative. Uric acid is an endogenous antioxidant making it a drug candidate to improve stroke outcomes. Aim To report the effects of uric acid therapy in stroke patients receiving intravenous thrombolysis and mechanical thrombectomy. Methods Forty-five patients with proximal vessel occlusions enrolled in the URICO-ICTUS trial received intravenous recombinant tissue plasminogen activator within 4.5 h after stroke onset and randomized to intravenous 1000 mg uric acid or placebo (NCT00860366). These patients also received mechanical thrombectomy because a brain computed tomogaphy angiography confirmed the lack of proximal recanalization at the end of systemic thrombolysis. The primary outcome was good functional outcome at 90 days (modified Rankin Score 0-2). Safety outcomes included mortality, symptomatic intracerebral bleeding, and gout attacks. Results The rate of successful revascularization was >80% in the uric acid and the placebo groups but good functional outcome was observed in 16 out of 24 (67%) patients treated with uric acid and 10 out of 21 (48%) treated with placebo (adjusted Odds Ratio, 6.12 (95% CI 1.08-34.56)). Mortality was observed in two out of 24 (8.3%) patients treated with uric acid and one out of 21 (4.8%) treated with placebo (adjusted Odds Ratio, 3.74 (95% CI 0.06-226.29)). Symptomatic cerebral bleeding and gout attacks were similar in both groups. Conclusions Uric acid therapy was safe and improved stroke outcomes in stroke patients receiving intravenous thrombolysis followed by thrombectomy. Validation of this simple strategy in a larger trial is urgent.

Clinical significance of delta neutrophil index in the differential diagnosis between septic arthritis and acute gout attack within 24 hours after hospitalization

PubMed Central

Pyo, Jung Yoon; Kim, Dae Sik; Jung, Seung Min; Song, Jason Jungsik; Park, Yong-Beom; Lee, Sang-Won

2017-01-01

Abstract The most important differential diagnoses of acute monoarticular arthritis are septic arthritis and acute gout attack. Identifying infection is crucial in preventing the devastating outcome of septic arthritis. The delta neutrophil index (DNI) is a value that corresponds to the fraction of circulating immature granulocytes. As DNI reflects the burden of infection, we evaluated this index as a differentiating marker between septic arthritis and acute gout attack. The medical records of 149 patients with septic arthritis and 194 patients with acute gout attack were reviewed. A specific cell analyzer, ADVIA 2120, was used to measure DNI. Clinical and laboratory markers associated with predicting septic arthritis were assessed by using logistic regression. Patients with septic arthritis showed higher levels of DNI than those with acute gout attack (3.3 vs 0.6%, P < .001). Similar results were observed in patients without monosodium urate (MSU) crystal confirmation or those with normouricemia (3.3 vs 0.5 and 3.1 vs 0.7%, respectively; P < .001 for both). A DNI level of 1.9% was determined as the cutoff value for predicting septic arthritis. In the multivariate analysis, DNI was the most powerful independent value for predicting septic arthritis (odds ratio 14.003). This study showed the possibility of using DNI as a differentiating marker between septic arthritis and acute gout attack at the crucial early phase. DNI showed its relevance regardless of confirmation of MSU crystal deposition or serum level of uric acid. PMID:28746185

Perioperative management of adult patients with a history of stroke or transient ischaemic attack undergoing elective non-cardiac surgery.

PubMed

Mehdi, Zehra; Birns, Jonathan; Partridge, Judith; Bhalla, Ajay; Dhesi, Jugdeep

2016-12-01

It is increasingly common for physicians and anaesthetists to be asked for advice in the medical management of surgical patients who have an incidental history of stroke or transient ischaemic attack (TIA). Advising clinicians requires an understanding of the common predictors, outcomes and management of perioperative stroke. The most important predictor of perioperative stroke is a previous history of stroke, and outcomes associated with such an event are extremely poor. The perioperative management of this patient group needs careful consideration to minimise the thrombotic risk and a comprehensive, individualised approach is crucial. Although there is literature supporting the management of such patients undergoing cardiac surgery, evidence is lacking in the setting of non-cardiac surgical intervention. This article reviews the current evidence and provides a pragmatic interpretation to inform the perioperative management of patients with a history of stroke and/or TIA presenting for elective non-cardiac surgery. © Royal College of Physicians 2016. All rights reserved.

Battles between an insurgent army and an advanced army - focus on strategy

NASA Astrophysics Data System (ADS)

Sen, Surajit; Shanahan, Linda

2008-03-01

Detailed and aggregate analyses of the outcome of past battles focusing on rates of troop losses or on the ratios of forces on each side is at the heart of present knowledge about battles. Here we present non-equilibrium statistical mechanics based studies of possible outcomes of well matched strategic battles by a ``blue'' army against insurgency based attacks by well matched opponents in a ``red'' army in red territory. We assume that the red army attacks with randomly varying force levels to potentially confuse and drive the blue's strategies. The temporal evolution of the model battles incorporate randomness in the deployment of the reds and hence possess attendant history dependence. Our results reveal that while unpredictable events play a major role in battles, a balance between risk of exposure in a battlefield and the use of short range intelligence is needed in determining whether one side can decimate the other, and hence force a battle to end.

A computerized, self-administered questionnaire to evaluate posttraumatic stress among firefighters after the World Trade Center collapse.

PubMed

Corrigan, Malachy; McWilliams, Rita; Kelly, Kerry J; Niles, Justin; Cammarata, Claire; Jones, Kristina; Wartenberg, Daniel; Hallman, William K; Kipen, Howard M; Glass, Lara; Schorr, John K; Feirstein, Ira; Prezant, David J

2009-11-01

We sought to determine the frequency of psychological symptoms and elevated posttraumatic stress disorder (PTSD) risk among New York City firefighters after the World Trade Center (WTC) attack and whether these measures were associated with Counseling Services Unit (CSU) use or mental health-related medical leave over the first 2.5 years after the attack. Shortly after the WTC attack, a computerized, binary-response screening questionnaire was administered. Exposure assessment included WTC arrival time and "loss of a co-worker while working at the collapse." We determined elevated PTSD risk using thresholds derived from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and a sensitivity-specificity analysis. Of 8487 participants, 76% reported at least 1 symptom, 1016 (12%) met criteria for elevated PTSD risk, and 2389 (28%) self-referred to the CSU, a 5-fold increase from before the attack. Higher scores were associated with CSU use, functional job impairment, and mental health-related medical leave. Exposure-response gradients were significant for all outcomes. This screening tool effectively identified elevated PTSD risk, higher CSU use, and functional impairment among firefighters and therefore may be useful in allocating scarce postdisaster mental health resources.

Chemical terrorism for the intensivist.

PubMed

Chalela, Julio A; Burnett, Thomas

2012-05-01

The use of chemical agents for terrorist attacks or military warfare is a major concern at the present time. Chemical agents can cause significant morbidity, are relatively inexpensive, and are easy to store and use. Weaponization of chemical agents is only limited by the physicochemical properties of some agents. Recent incidents involving toxic industrial chemicals and chemical terrorist attacks indicate that critical care services are frequently utilized. For obvious reasons, the critical care literature on chemical terrorism is scarce. This article reviews the clinical aspects of diagnosing and treating victims of chemical terrorism while emphasizing the critical care management. The intensivist needs to be familiar with the chemical agents that could be used in a terrorist attack. The military classification divides agents into lung agents, blood agents, vesicants, and nerve agents. Supportive critical care is the cornerstone of treatment for most casualties, and dramatic recovery can occur in many cases. Specific antidotes are available for some agents, but even without the antidote, aggressive intensive care support can lead to favorable outcome in many cases. Critical care and emergency services can be overwhelmed by a terrorist attack as many exposed but not ill will seek care.

Cat aggression redirected to people: 14 cases (1981-1987).

PubMed

Chapman, B L; Voith, V L

1990-03-15

Among 27 cases of cat aggression manifested toward people, 14 cases were diagnosed as redirected or probable redirected aggression, because the cat was already highly aroused by other stimuli before attacking a person. A detailed behavioral history enabled identification of arousing stimuli. The most common arousing stimulus was the presence of another cat. Other arousing stimuli included high-pitched noises, visitors in the house, a dog, an unusual odor, and being outdoors unexpectedly. Medical problems or other behavioral abnormalities were not detected in any of the cats that could explain their aggressive behavior. Management consisted of avoidance or elimination of arousing stimuli wherever possible and extensive client education. On follow-up there was no recurrence of redirected attacks in 4 cats, variable decreases in the severity and frequency of attacks in 5 cats, and no change in 1 cat. Three cats were euthanatized, including one that had shown some improvement. Follow-up information was not available for the 2 remaining cases. Redirected aggression in cats is not well documented and may be misdiagnosed as idiopathic aggression or other behavioral abnormality. Although redirected attacks may be sudden, severe, and frightening, with careful management, a favorable outcome is possible.

Patient and Stakeholder Engagement in the PCORI Pilot Projects: Description and Lessons Learned.

PubMed

Forsythe, Laura P; Ellis, Lauren E; Edmundson, Lauren; Sabharwal, Raj; Rein, Alison; Konopka, Kristen; Frank, Lori

2016-01-01

Patients and healthcare stakeholders are increasingly becoming engaged in the planning and conduct of biomedical research. However, limited research characterizes this process or its impact. We aimed to characterize patient and stakeholder engagement in the 50 Pilot Projects funded by the Patient-Centered Outcomes Research Institute (PCORI), and identify early contributions and lessons learned. A self-report instrument was completed by researchers between 6 and 12 months following project initiation. Forty-seven principal investigators or their designees (94 % response rate) participated in the study. MAIN MEASURES Self-report of types of stakeholders engaged, stages and levels of engagement, facilitators and barriers to engagement, lessons learned, and contributions from engagement were measured. Most (83 %) reported engaging more than one stakeholder in their project. Among those, the most commonly reported groups were patients (90 %), clinicians (87 %), health system representatives (44 %), caregivers (41 %), and advocacy organizations (41 %). Stakeholders were commonly involved in topic solicitation, question development, study design, and data collection. Many projects engaged stakeholders in data analysis, results interpretation, and dissemination. Commonly reported contributions included changes to project methods, outcomes or goals; improvement of measurement tools; and interpretation of qualitative data. Investigators often identified communication and shared leadership strategies as "critically important" facilitators (53 and 44 % respectively); lack of stakeholder time was the most commonly reported challenge (46 %). Most challenges were only partially resolved. Early lessons learned included the importance of continuous and genuine partnerships, strategic selection of stakeholders, and accommodation of stakeholders' practical needs. PCORI Pilot Projects investigators report engaging a variety of stakeholders across many stages of research, with specific changes to their research attributed to engagement. This study identifies early lessons and barriers that should be addressed to facilitate engagement. While this research suggests potential impact of stakeholder engagement, systematic characterization and evaluation of engagement at multiple stages of research is needed to build the evidence base.

Infrared astronomy in science and education

NASA Astrophysics Data System (ADS)

Mayeur, Paul Anthony

This dissertation looks at the effects of an educator-scientist partnership on the creation of an inquiry based science lesson for the middle school classroom. The lesson was initially created by a scientist following their science research, but changed as the scientist began working with teachers. The changes in the lesson show that scientists and educators may not agree on what is considered appropriate for a science lesson because of time commitment and grade level. However, by working together the partnership is able to reach a compromise of the lesson that allows for the students to get the best possible outcome. This dissertation also shows that science research is a method of inquiry, which can be brought to the classroom through inquiry education. The science research the lesson followed looks at the interstellar dust cloud DC 314.8-5.1, which is unique because of the cloud's proximity to a B-type star with no known association. This thesis did a survey of the area looking for background sources that can be used for future spectroscopical studies. Further, the survey led to the discovery of two possible young stellar objects. In order to fuel educator-scientist interaction and to bring inquiry education into the middle school classroom a scientist created a web-based science lesson that incorporated real NASA data into the middle-school classroom. This lesson was based on the scientist's research in infrared astronomy within the broader context of astrobiology. The lesson includes students plotting real data; in the process the students learn about infrared radiation, star color, and the wavelength/temperature relationship. These are all topics that were studied in the scientist's research, which led the scientist to the idea of creating a lesson for the middle-school classroom. This lesson is based on the principles of inquiry-based learning. Inquiry lessons can bring together these ideas into one place and hopefully inspire new generations to explore the world and universe through science. The scientist then worked with five teachers to edit the lesson for each teacher's classroom. For four of five teachers the lesson changed from an online based lesson that used Excel to a PowerPoint presentation and paper graphing. It is shown here that partnerships between scientists and educators are beneficial for both parties as it allows scientists to understand how to communicate their scientific findings to the general public, while allowing teachers to stay updated with the most advanced science research.

Social integration buffers stress in New York police after the 9/11 terrorist attack.

PubMed

Schwarzer, Ralf; Bowler, Rosemarie M; Cone, James E

2014-01-01

Being socially integrated is regarded as a protective factor enabling people to cope with adversity. The stress-buffering effect reflects an interaction between stress and a social coping resource factor on subsequent outcomes. This study, based on 2943 police officers, examines mental health outcomes among officers who responded to the 9/11 terrorist attack on the World Trade Center. The Wave 1 data collection took place between September 2003 and November 2004 with a follow-up study (Wave 2) conducted from November 2006 through December 2007. A moderated mediation model was specified that uses event exposure as a distal predictor, earlier stress response as a mediator, and later stress response as an outcome, and social integration as a moderator of this relationship. The mediation hypothesis was confirmed, and moderation occurred at two stages. First, there was a multiplicative relationship between exposure levels and social integration: The higher the exposure level, the more stress responses occur, but this effect was buffered by a high level of social integration. Second, Wave 1 stress interacted with social integration on Wave 2 stress: The more the police officers were socially integrated, the lower the Wave 2 stress, which happened in a synergistic manner. The findings contribute to the understanding of mediating and moderating mechanisms that result in health outcomes such as posttraumatic stress disorder or resilience.

[Dangerous marine animals].

PubMed

Antensteiner, G

1999-01-01

Sea-biological basic knowledge for divers is offered only in special lessons for advanced scuba divers. According to statistics, however, five per cent of the deadly diving accidents are caused by underwater organisms. This number could be reduced to a fraction, by correct behaviour during the dive and after an accident. The most frequent accidents with sea animals during water sports are not by unprovoked shark attacks, which cause six deaths world-wide per year on the average, but turn out with usually well camouflaged sea inhabitants, that do not attack humans, rather by their inadvertence coincidentally get in contact with it. The various defense instruments of the often small, inconspicuous organisms reach from teeth over poison stings, pricks, spines, scalpelles, nettle injections and chemical weapons up to poison arrows. Due to that variety of the maritime life, the most important representatives of its type are explained including severity level of the caused injury or contamination. Both, diagnostic position and therapy possibility are described as follows: 1. Porifera (sponge), 2. Hydrozoa (white weed, yellow flower head), Actinaria (sea anemones), 3. Conidae (cone shells), Tridocna (giant clam), octopoda (octopus), 4. Acanthaster planci (crown of thorns), Echinodea (sea urchins), Holothurioidea (sea cucumber), 5. Selachoidei (shark), Batoidei (Ray), Muraenidae (moray), Plotosidae (barbel eels), Synanciidae (stonefish), Scorpaenidae (scorpionfish), Pterois (lion fish), Sphyraena Spec. (barracuda), Balistidae (triggerfish), Ostracionidae (puffer).

Retrospective analysis of institutional scabies outbreaks from 1984 to 2013: lessons learned and moving forward.

PubMed

Mounsey, K E; Murray, H C; King, M; Oprescu, F

2016-08-01

Scabies outbreaks can be disruptive in institutional settings, and are associated with considerable but under-researched morbidity, especially in vulnerable populations. In this paper, we describe key findings from a retrospective review of scabies outbreaks reported in the literature over the past 30 years. We undertook this review to gain insights into the impact of institutional outbreaks, the burden in terms of attack rates, economic costs, treatment trends, the types of index cases and outbreak progression. We found 84 reports over 30 years, with outbreaks most frequently reported in aged care facilities (n = 40) and hospitals (n = 33). On average, scabies outbreaks persisted for 3 months, and the median attack rate was 38%. While 1% lindane was once the most commonly employed acaricide, 5% permethrin and oral ivermectin are increasingly used. Crusted scabies represented the index case for 83% of outbreaks, and scabies was misdiagnosed in 43% outbreaks. The frequency of reported scabies outbreaks has not declined consistently over time suggesting the disease is still highly problematic. We contend that more research and practice emphasis must be paid to improve diagnostic methods, surveillance and control, health staff education and management of crusted scabies to prevent the development of scabies outbreaks in institutional settings.

Computed tomography identifies patients at high risk for stroke after transient ischemic attack/nondisabling stroke: prospective, multicenter cohort study.

PubMed

Wasserman, Jason K; Perry, Jeffrey J; Sivilotti, Marco L A; Sutherland, Jane; Worster, Andrew; Émond, Marcel; Jin, Albert Y; Oczkowski, Wieslaw J; Sahlas, Demetrios J; Murray, Heather; MacKey, Ariane; Verreault, Steve; Wells, George A; Dowlatshahi, Dar; Stotts, Grant; Stiell, Ian G; Sharma, Mukul

2015-01-01

Ischemia on computed tomography (CT) is associated with subsequent stroke after transient ischemic attack. This study assessed CT findings of acute ischemia, chronic ischemia, or microangiopathy for predicting subsequent stroke after transient ischemic attack. This prospective cohort study enrolled patients with transient ischemic attack or nondisabling stroke that had CT scanning within 24 hours. Primary outcome was subsequent stroke within 90 days. Secondary outcomes were stroke at ≤2 or >2 days. CT findings were classified as ischemia present or absent and acute or chronic or microangiopathy. Analysis used Fisher exact test and multivariate logistic regression. A total of 2028 patients were included; 814 had ischemic changes on CT. Subsequent stroke rate was 3.4% at 90 days and 1.5% at ≤2 days. Stroke risk was greater if baseline CT showed acute ischemia alone (10.6%; P=0.002), acute+chronic ischemia (17.4%; P=0.007), acute ischemia+microangiopathy (17.6%; P=0.019), or acute+chronic ischemia+microangiopathy (25.0%; P=0.029). Logistic regression found acute ischemia alone (odds ratio [OR], 2.61; 95% confidence interval [CI[, 1.22-5.57), acute+chronic ischemia (OR, 5.35; 95% CI, 1.71-16.70), acute ischemia+microangiopathy (OR, 4.90; 95% CI, 1.33-18.07), or acute+chronic ischemia+microangiopathy (OR, 8.04; 95% CI, 1.52-42.63) was associated with a greater risk at 90 days, whereas acute+chronic ischemia (OR, 10.78; 95% CI, 2.93-36.68), acute ischemia+microangiopathy (OR, 8.90; 95% CI, 1.90-41.60), and acute+chronic ischemia+microangiopathy (OR, 23.66; 95% CI, 4.34-129.03) had greater risk at ≤2 days. Only acute ischemia (OR, 2.70; 95% CI, 1.01-7.18; P=0.047) was associated with a greater risk at >2 days. In patients with transient ischemic attack/nondisabling stroke, CT evidence of acute ischemia alone or acute ischemia with chronic ischemia or microangiopathy was associated with increased subsequent stroke risk within 90 days. © 2014 American Heart Association, Inc.

A Randomized Trial of Ketorolac vs. Sumatripan vs. Placebo Nasal Spray (KSPN) for Acute Migraine.

PubMed

Rao, Aruna S; Gelaye, Bizu; Kurth, Tobias; Dash, Paul D; Nitchie, Haley; Peterlin, B Lee

2016-02-01

To compare the efficacy of ketorolac nasal spray (NS) vs. placebo and sumatriptan NS for the acute treatment of migraine. This was a randomized, double-blind, placebo and active-comparator, crossover study. Adult migraineurs were randomized to ketorolac NS 31.5 mg, sumatriptan NS 20 mg, or placebo to treat three moderate to severe migraine attacks and switched treatments with each attack. Patients seeking headache care at a headache center or in response to community advertisement were recruited. Adult participants with episodic migraine who experienced ≥2 migraine attacks per month were eligible for the Ketorolac vs. Sumatriptan vs. Placebo Nasal Spray migraine study. Participants were randomized to treatment arms by a research pharmacist, in a 1:1:1 ratio using computer-generated lists. The primary outcome was 2-hour pain relief. Secondary outcomes included 2-hour pain freedom and absence of migraine associated symptoms, and 24-hour sustained pain relief and pain freedom. Of the 72 randomized participants, 54 (75%) treated at least one attack and 49 (68%) completed all three treatments, for a total of 152 treated migraine attacks. Both ketorolac NS (72.5%, P < .001) and sumatriptan NS (69.4%, P = .001) were more effective than placebo (38.3%) for 2-hour pain relief and 2-hour pain freedom (ketorolac: 43.1%, P = .004; sumatriptan: 36.7%, P = .046; placebo: 18.4%). Ketorolac NS, but not sumatriptan NS, was more effective than placebo in 2-hour absence of nausea. Both ketorolac NS and sumatriptan NS were more effective than placebo for 24-hour sustained pain relief (ketorolac: 49%, P < .001; sumatriptan: 31%, P = .01, placebo: 20%). Only ketorolac NS was superior to placebo for 24-hour (ketorolac: 35.3%, P = .003; sumatriptan: 22.4%, P = .18, placebo: 12.2%) sustained pain freedom. Nasal burning and dysgeusia were the most common adverse effects for active treatments. This study supports that ketorolac NS is superior to placebo and that it is non-inferior to sumatriptan NS for the acute abortive treatment of migraine. © 2016 American Headache Society.

A Randomized Trial of Ketorolac vs Sumatripan vs Placebo Nasal Spray (KSPN) for Acute Migraine

PubMed Central

Rao, Aruna S.; Gelaye, Bizu; Kurth, Tobias; Dash, Paul D.; Nitchie, Haley; Peterlin, B. Lee

2016-01-01

Objective To compare the efficacy of ketorolac nasal spray (NS) vs placebo and sumatriptan NS for the acute treatment of migraine. Methods This was a randomized, double-blind, placebo and active-comparator, crossover study. Adult migraineurs were randomized to ketorolac NS 31.5 mg, sumatriptan NS 20 mg, or placebo to treat three moderate to severe migraine attacks and switched treatments with each attack. Patients seeking headache care at a headache center or in response to community advertisement were recruited. Adult participants with episodic migraine who experienced ≥2 migraine attacks per month were eligible for the Ketorolac vs Sumatriptan vs Placebo Nasal Spray migraine study. Participants were randomized to treatment arms by a research pharmacist, in a 1:1:1 ratio using computer-generated lists. The primary outcome was 2-hour pain relief. Secondary outcomes included 2-hour pain freedom and absence of migraine associated symptoms, and 24-hour sustained pain relief and pain freedom. Results Of the 72 randomized participants, 54 (75%) treated at least one attack and 49 (68%) completed all three treatments, for a total of 152 treated migraine attacks. Both ketorolac NS (72.5%, P < .001) and sumatriptan NS (69.4%, P=.001) were more effective than placebo (38.3%) for 2-hour pain relief and 2-hour pain freedom (ketorolac: 43.1%, P=.004; sumatriptan: 36.7%, P=.046; placebo: 18.4%). Ketorolac NS, but not sumatriptan NS, was more effective than placebo in 2-hour absence of nausea. Both ketorolac NS and sumatriptan NS were more effective than placebo for 24-hour sustained pain relief (ketorolac: 49%, P < .001; sumatriptan: 31%, P=.01, placebo: 20%). Only ketorolac NS was superior to placebo for 24-hour (ketorolac: 35.3%, P=.003; sumatriptan: 22.4%, P=.18, placebo: 12.2%) sustained pain freedom. Nasal burning and dysgeusia were the most common adverse effects for active treatments. Conclusions This study supports that ketorolac NS is superior to placebo and that it is non-inferior to sumatriptan NS for the acute abortive treatment of migraine. PMID:26840902

Intercollegiate Athletics and Modeling Multiculturalism

ERIC Educational Resources Information Center

Hirko, Scott

2009-01-01

Research about student athletes contends that participation enhances both learning and character development, including leadership, interpersonal skills, social self-esteem, discipline, personal health, motivation, dedication, and life lessons. Other research expresses concern about the cognitive outcomes of student athletes relative to…

The Relationship between Student Psychological Wellbeing, Behaviour and Educational Outcomes: A Lesson from the MindMatters plus Demonstration Schools

ERIC Educational Resources Information Center

Anderson, Sarah

2005-01-01

The aim of the MM+ initiative is to build the capacity of secondary schools to ensure optimal outcomes of students with high needs in the area of mental health. This is important for many reasons including the fact that poor psychological wellbeing in students has been found to lead to behavioural difficulties at school that can then serve as…

Inuit Legends, Oral Histories, Art, and Science in the Collaborative Development of Lessons That Foster Two-Way Learning: The Return of the Sun in Nunavut

ERIC Educational Resources Information Center

McMillan, Barbara A.

2013-01-01

This paper reports on the development of a science unit for Nunavut students and my collaboration with Louise Uyarak, an early years teacher and a graduate of Arctic College's teacher education program. The unit addresses light outcomes in the "Canadian Common Framework of Science Learning Outcomes, K-12". More importantly, it…

Assessing the Impact of Free Primary Education Using Retrospective and Prospective Data: Lessons from the Nairobi Case Study

ERIC Educational Resources Information Center

Ngware, Moses Waithanji; Oketch, Moses; Ezeh, Alex Chika; Mutisya, Maurice; Ejakait, Charles Epari

2012-01-01

This paper describes the design and methodology used to assess the impact of free primary education (FPE) policy in Nairobi, Kenya. The key outcome of the study was to assess the impact of FPE on schooling outcomes among the urban poor. The study assesses the impact of FPE by examining how two non-comparable groups responded to the introduction of…

Acute and Long-Term Impact of Chemical Weapons: Lessons from the Iran-Iraq War.

PubMed

Haines, D D; Fox, S C

2014-07-01

Chemical weapons have given the human experience of warfare a uniquely terrifying quality that has inspired a general repugnance and led to periodic attempts to ban their use. Nevertheless, since ancient times, toxic agents have been consistently employed to kill and terrorize target populations. The evolution of these weapons is examined here in ways that may allow military, law enforcement, and scientific professionals to gain a perspective on conditions that, in the past, have motivated their use - both criminally and as a matter of national policy during military campaigns. Special emphasis is placed on the genocidal use of chemical weapons by the regime of Saddam Hussein, both against Iranians and on Kurdish citizens of his own country, during the Iran-Iraq War of 1980-88. The historical development of chemical weapons use is summarized to show how progressively better insight into biochemistry and physiology was adapted to this form of warfare. Major attributes of the most frequently used chemical agents and a description of how they affected military campaigns are explained. Portions of this review describing chemical-casualty care devote particular focus to Iranian management of neurotoxic (nerve) agent casualties due to the unique nature of this experience. Both nerve and blistering "mustard" agents were used extensively against Iranian forces. However, Iran is the only nation in history to have sustained large-scale attacks with neurotoxic weapons. For this reason, an understanding of the successes and failures of countermeasures to nerve-agent use developed by the Iranian military are particularly valuable for future civil defense and military planning. A detailed consideration of these strategies is therefore considered. Finally, the outcomes of clinical research into severe chronic disease triggered by mustard-agent exposure are examined in the context of the potential of these outcomes to determine the etiology of illness among US and Allied veterans of the 1991 Persian Gulf War. Copyright © 2014 Central Police University.

Sumatriptan (intranasal route of administration) for acute migraine attacks in adults

PubMed Central

Derry, Christopher J; Derry, Sheena; Moore, R Andrew

2014-01-01

Background Migraine is a highly disabling condition for the individual and also has wide-reaching implications for society, healthcare services, and the economy. Sumatriptan is an abortive medication for migraine attacks, belonging to the triptan family. Intranasal administration may be preferable to oral for individuals experiencing nausea and/or vomiting, although it is primarily absorbed in the gut, not the nasal mucosa. Objectives To determine the efficacy and tolerability of intranasal sumatriptan compared to placebo and other active interventions in the treatment of acute migraine attacks in adults. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, online databases, and reference lists for studies through 13 October 2011. Selection criteria We included randomised, double-blind, placebo- and/or active-controlled studies using intranasal sumatriptan to treat a migraine headache episode, with at least 10 participants per treatment arm. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used numbers of participants achieving each outcome to calculate relative risk (or ‘risk ratio’) and numbers needed to treat to benefit (NNT) or harm (NNH) compared to placebo or a different active treatment. Main results Twelve studies (4755 participants) compared intranasal sumatriptan with placebo or an active comparator. Most of the data were for the 10 mg and 20 mg doses. Sumatriptan surpassed placebo for all efficacy outcomes. For sumatriptan 10 mg versus placebo the NNTs were 7.3, 7.4, and 5.5 for pain-free at two hours, and headache relief at one and two hours, respectively. For sumatriptan 20 mg versus placebo the NNTs were 4.7, 4.9, and 3.5, respectively, for the same outcomes. The 20 mg dose was significantly better than the 10 mg dose for each of these three primary efficacy outcomes. Relief of headache-associated symptoms, including nausea, photophobia, and phonophobia, was greater with sumatriptan than with placebo, and use of rescue medication was lower with sumatriptan than placebo. For the most part, adverse events were transient and mild and were more common with sumatriptan than placebo. Direct comparison of sumatriptan with active treatments was limited to two studies, one comparing sumatriptan 20 mg and dihydroergotamine (DHE) 1 mg, and one comparing sumatriptan 20 mg with rizatriptan 10 mg. Authors’ conclusions Intranasal sumatriptan is effective as an abortive treatment for acute migraine attacks, relieving pain, nausea, photophobia, phonophobia, and functional disability, but is associated with increased adverse events compared with placebo. PMID:22336867

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation.

PubMed

Hollinghurst, Sandra; Sharp, Debbie; Ballard, Kathleen; Barnett, Jane; Beattie, Angela; Evans, Maggie; Lewith, George; Middleton, Karen; Oxford, Frances; Webley, Fran; Little, Paul

2008-12-11

An economic evaluation of therapeutic massage, exercise, and lessons in the Alexander technique for treating persistent back pain. Cost consequences study and cost effectiveness analysis at 12 month follow-up of a factorial randomised controlled trial. 579 patients with chronic or recurrent low back pain recruited from primary care. Normal care (control), massage, and six or 24 lessons in the Alexander technique. Half of each group were randomised to a prescription for exercise from a doctor plus behavioural counselling from a nurse. Costs to the NHS and to participants. Comparison of costs with Roland-Morris disability score (number of activities impaired by pain), days in pain, and quality adjusted life years (QALYs). Comparison of NHS costs with QALY gain, using incremental cost effectiveness ratios and cost effectiveness acceptability curves. Intervention costs ranged from pound30 for exercise prescription to pound596 for 24 lessons in Alexander technique plus exercise. Cost of health services ranged from pound50 for 24 lessons in Alexander technique to pound124 for exercise. Incremental cost effectiveness analysis of single therapies showed that exercise offered best value ( pound61 per point on disability score, pound9 per additional pain-free day, pound2847 per QALY gain). For two-stage therapy, six lessons in Alexander technique combined with exercise was the best value (additional pound64 per point on disability score, pound43 per additional pain-free day, pound5332 per QALY gain). An exercise prescription and six lessons in Alexander technique alone were both more than 85% likely to be cost effective at values above pound20 000 per QALY, but the Alexander technique performed better than exercise on the full range of outcomes. A combination of six lessons in Alexander technique lessons followed by exercise was the most effective and cost effective option.

Supporting Teachers Learning Through the Collaborative Design of Technology-Enhanced Science Lessons

NASA Astrophysics Data System (ADS)

Kafyulilo, Ayoub C.; Fisser, Petra; Voogt, Joke

2015-12-01

This study used the Interconnected Model of Professional Growth (Clarke & Hollingsworth in Teaching and Teacher Education, 18, 947-967, 2002) to unravel how science teachers' technology integration knowledge and skills developed in a professional development arrangement. The professional development arrangement used Technological Pedagogical Content Knowledge as a conceptual framework and included collaborative design of technology-enhanced science lessons, implementation of the lessons and reflection on outcomes. Support to facilitate the process was offered in the form of collaboration guidelines, online learning materials, exemplary lessons and the availability of an expert. Twenty teachers participated in the intervention. Pre- and post-intervention results showed improvements in teachers' perceived and demonstrated knowledge and skills in integrating technology in science teaching. Collaboration guidelines helped the teams to understand the design process, while exemplary materials provided a picture of the product they had to design. The availability of relevant online materials simplified the design process. The expert was important in providing technological and pedagogical support during design and implementation, and reflected with teachers on how to cope with problems met during implementation.

Lessons Learned from Developing a Patient Engagement Panel: An OCHIN Report.

PubMed

Arkind, Jill; Likumahuwa-Ackman, Sonja; Warren, Nate; Dickerson, Kay; Robbins, Lynn; Norman, Kathy; DeVoe, Jennifer E

2015-01-01

There is renewed interest in patient engagement in clinical and research settings, creating a need for documenting and publishing lessons learned from efforts to meaningfully engage patients. This article describes early lessons learned from the development of OCHIN's Patient Engagement Panel (PEP). OCHIN supports a national network of more than 300 community health centers (CHCs) and other primary care settings that serve over 1.5 million patients annually across nearly 20 states. The PEP was conceived in 2009 to harness the CHC tradition of patient engagement in this new era of patient-centered outcomes research and to ensure that patients were engaged throughout the life cycle of our research projects, from conception to dissemination. Developed by clinicians and researchers within our practice-based research network, recruitment of patients to serve as PEP members began in early 2012. The PEP currently has a membership of 18 patients from 3 states. Over the past 24 months, the PEP has been involved with 12 projects. We describe developing the PEP and challenges and lessons learned (eg, recruitment, funding model, creating value for patient partners, compensation). These lessons learned are relevant not only for research but also for patient engagement in quality improvement efforts and other clinical initiatives. © Copyright 2015 by the American Board of Family Medicine.

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

Belangia, David Warren

The Home Depot Data Breach is the second largest data breach on record. It has or will affect up to 56 million debit or credit cards. A trusted vendor account, coupled with the use of a previously unknown variant of malware that allowed the establishment of a foothold, was the entry point into the Home Depot network. Once inside the perimeter, privilege escalation provided an avenue to obtain the desired information. Home Depot did, however, learn some lessons from Target. Home Depot certainly communicated better than Target, procured insurance, and instituted as secure an environment as possible. There are specificmore » measures an institution should undertake to prepare for a data breach, and everyone can learn from this breach. Publicly available information about the Home Depot Data Breach provides insight into the attack, an old malware variant with a new twist.While the malware was modified as to be unrecognizable with tools, it probably should have been detected. There are also concerns with Home Depot’s insurance and the insurance provider’s apparent lack of fully reimbursing Home Depot for their losses. The effect on shareholders and Home Depot’s stock price was short lived. This story is still evolving but provides interesting lessons learned concerning how an organization should prepare for it inevitable breach.« less

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

PubMed

1995-09-01

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

Risk-based decision making for terrorism applications.

PubMed

Dillon, Robin L; Liebe, Robert M; Bestafka, Thomas

2009-03-01

This article describes the anti-terrorism risk-based decision aid (ARDA), a risk-based decision-making approach for prioritizing anti-terrorism measures. The ARDA model was developed as part of a larger effort to assess investments for protecting U.S. Navy assets at risk and determine whether the most effective anti-terrorism alternatives are being used to reduce the risk to the facilities and war-fighting assets. With ARDA and some support from subject matter experts, we examine thousands of scenarios composed of 15 attack modes against 160 facility types on two installations and hundreds of portfolios of 22 mitigation alternatives. ARDA uses multiattribute utility theory to solve some of the commonly identified challenges in security risk analysis. This article describes the process and documents lessons learned from applying the ARDA model for this application.

Moderate-to-vigorous physically active academic lessons and academic engagement in children with and without a social disadvantage: a within subject experimental design.

PubMed

Mullender-Wijnsma, Marijke J; Hartman, Esther; de Greeff, Johannes W; Bosker, Roel J; Doolaard, Simone; Visscher, Chris

2015-04-19

Integration of physical active academic lessons in the school curriculum may be an innovative way to improve academic outcomes. This study examined the effect of physically active academic lessons (Fit en Vaardig op school) on academic engagement of socially disadvantaged children and children without this disadvantage. In addition, the relationship between lesson time spent in moderate to vigorous physical activity and academic engagement was examined. From four elementary schools, 86 children who participated in the 22-weeks intervention were recruited (23 socially disadvantaged children). Academic engagement was determined by observing time-on-task during three classroom observation moments (start, midway and end observation). Every moment consisted of lesson observations after intervention lessons (post-intervention) and after regular classroom lessons (post-control). Differences in time-on-task between socially disadvantaged children and children without this disadvantage were analyzed using independent samples t-test. Differences between post-intervention and post-control observations were analyzed using multilevel analysis. Heart rate monitors measured the lesson time spent in moderate to vigorous physical activity. The relationship between percentage of moderate to vigorous physical activity during the intervention lessons and time-on-task was analyzed by calculation of partial correlations. Time-on-task of socially disadvantaged children was lower than that of children without this disadvantage, differences were significant at the start post-control (t(65) = 2.39, p < 0.05) and post-intervention (t(71) = 2.75, p < 0.05) observation and at the midway post-control (t(68) = 2.45, p < 0.05) observation. Multilevel analysis showed that the time-on-task of all children was significantly higher during post-intervention in comparison with post-control lessons (ES = 0.41). No significant difference was found at the start observation, but there were significant differences at the midway (ES = 0.60) and end (ES = 0.59) observation. On average, the children were exercising in moderate to vigorous physical activity during 60% of de lesson time (14 minutes of an average lesson of 23 minutes). No significant relationships were found between percentage of moderate to vigorous physical activity during the intervention and time-on-task in the post-intervention lessons. Physically active academic lessons may positively influence time-on-task in children, which can contribute to academic success in the long term.

Analytical model for instantaneous lift and shape deformation of an insect-scale flapping wing in hover

PubMed Central

Kang, Chang-kwon; Shyy, Wei

2014-01-01

In the analysis of flexible flapping wings of insects, the aerodynamic outcome depends on the combined structural dynamics and unsteady fluid physics. Because the wing shape and hence the resulting effective angle of attack are a priori unknown, predicting aerodynamic performance is challenging. Here, we show that a coupled aerodynamics/structural dynamics model can be established for hovering, based on a linear beam equation with the Morison equation to account for both added mass and aerodynamic damping effects. Lift strongly depends on the instantaneous angle of attack, resulting from passive pitch associated with wing deformation. We show that both instantaneous wing deformation and lift can be predicted in a much simplified framework. Moreover, our analysis suggests that resulting wing kinematics can be explained by the interplay between acceleration-related and aerodynamic damping forces. Interestingly, while both forces combine to create a high angle of attack resulting in high lift around the midstroke, they offset each other for phase control at the end of the stroke. PMID:25297319

Industrial Control Systems/SCADA systems risk assessment in the energy sector

NASA Astrophysics Data System (ADS)

Falodun, Babatunde

The energy sector is one of the most critical components of our national infrastructure. It not only provides the electrical power and petroleum required to run day-to-day operations and mechanisms in society, it's also an important element that directly impacts the economy with regard to growth and stability. Industrial Control Systems (ICS) /Supervisory Control and Data Acquisition Systems (SCADA) are computerized mechanisms, they are both software and hardware that are used to control real time processes and operations in power plants and oil production facilities. A significant attack on these control systems that leads to widespread disruption of energy could result in catastrophic consequences for any major city and even the nation. This research paper explores cyber threats and vulnerabilities faced by ICS/SCADA systems in the energy sector and also highlights possible outcomes of a successful breach. Furthermore, the research underscores mitigation strategies that could be used to prevent and respond to an attack. Keywords: Cybersecurity, SCADA, Cyber Attacks, Threats, Vulnerabilities, Risk Assessment, Dr. Albert Orbinati.

Differentiating Experts' Anticipatory Skills in Beach Volleyball

ERIC Educational Resources Information Center

Canal-Bruland, Rouwen; Mooren, Merel; Savelsbergh, Geert J. P.

2011-01-01

In this study, we examined how perceptual-motor expertise and watching experience contribute to anticipating the outcome of opponents' attacking actions in beach volleyball. To this end, we invited 8 expert beach volleyball players, 8 expert coaches, 8 expert referees, and 8 control participants with no beach volleyball experience to watch videos…

Unravelling the effect of the Dutch school-based nutrition programme Taste Lessons: the role of dose, appreciation and interpersonal communication.

PubMed

Battjes-Fries, Marieke C E; van Dongen, Ellen J I; Renes, Reint Jan; Meester, Hante J; Van't Veer, Pieter; Haveman-Nies, Annemien

2016-08-05

To unravel the effect of school-based nutrition education, insight into the implementation process is needed. In this study, process indicators of Taste Lessons (a nutrition education programme for Dutch elementary schools) and their association with changes in behavioural determinants relevant to healthy eating behaviour are studied. The study sample consisted of 392 Dutch primary school children from 12 schools. Data were collected using teacher and child questionnaires at baseline, and at one and six months after the intervention. Multilevel regression analyses were conducted to study the association between dose, appreciation and children's engagement in interpersonal communication (talking about Taste Lessons with others after the lessons), and change in knowledge, awareness, skills, attitude, emotion, subjective norm and intention towards two target behaviours. With an average implementation of a third of the programme activities, dose positively predicted change in children's subjective norm of the teacher after one month. Teachers and children highly appreciated Taste Lessons. Whereas teacher appreciation was inversely associated, child appreciation was positively associated with children's change in awareness, emotion and subjective norm of teachers after one month and in attitude and subjective norm of parents after six months. Interpersonal communication was positively associated with children's change in five determinants after one month and in attitude and intention after six months. The implementation process is related to the programme outcomes of Taste Lessons. Process data provide valuable insights into factors that contribute to the effect of interventions in real-life settings.

An Audit of the Use of Gonadorelin Analogues to Prevent Recurrent Acute Symptoms in Patients with Acute Porphyria in the United Kingdom.

PubMed

Schulenburg-Brand, Danja; Gardiner, Tricia; Guppy, Simon; Rees, David C; Stein, Penelope; Barth, Julian; Felicity Stewart, M; Badminton, Michael

2017-01-01

Severe recurrent acute attacks of porphyria have traditionally been treated with either prophylactic human haemin or gonadorelin analogues (GnA) in females. Evidence on the most effective treatment for this patient subgroup is lacking. This audit surveyed the use of prophylactic GnA in the UK.Twenty female patients (who experienced between 2 and 45 acute attacks of porphyria requiring hospitalisation and treatment with human haemin prior to GnA prophylaxis) were included in the audit. Data was retrospectively collected based on patient history and case review.Twenty three treatment courses were given lasting a median period of 12 months. Monthly subcutaneous Goserelin was most commonly used. In three patients in whom timing with the menstrual cycle was not considered, an acute attack occurred after initiation of the first dose. The majority of patients experienced oestrogen deficiency symptoms during treatment. Fifty percent of the prescribed courses of GnA resulted in a degree of clinical benefit. This successfully treated group experienced between 3 and 20 acute attacks prior to and between 0 and 6 acute attacks during GnA treatment.The audit revealed large variation in practice in the United Kingdom regarding indication, duration of treatment, specific drug used and management of side effects. In view of the limited treatment options available for this cohort and the mixed outcome successes reported, we believe it is reasonable for porphyria specialists to continue offering GnA treatment to women with severe recurrent debilitating acute attacks of porphyria associated with the menstrual cycle, and we propose best practice guidelines to standardise management.

Retrospective evaluation of coyote attacks in dogs: 154 cases (1997-2012).

PubMed

Frauenthal, Virginia M; Bergman, Philip; Murtaugh, Robert J

2017-05-01

To describe the clinical presentation and outcome of known attacks in client-owned dogs caused by the common coyote, Canis latrans. Retrospective observational study. Private referral hospital. One hundred fifty-four client-owned dogs known to be attacked by coyotes. None. Records from a private referral hospital from May 1997 through December 2012 were reviewed. Time of day and month/season of year, signalment, body temperature, heart rate, respiratory rate, body weight, location and severity of wounds inflicted, common injuries, length of hospitalization, necessity of surgical wound repair under anesthesia, antimicrobial use and mortality were recorded. Eighty-six percent of dogs presenting following coyote attack weighed <10 kg. Overall mortality rate was 15.6%. Dogs with bite wounds to the thorax had the highest mortality at 21.3%. Criteria for systemic inflammatory response syndrome (SIRS) based on admission vital signs were met in 58.8% of dogs and the presence of SIRS was significantly associated with mortality (P < 0.001). Common coyote-induced injuries included rib fracture (38/154; 24.6%), pulmonary contusion (30/154; 19.4%), tracheal tear (18/154; 11.6%), pneumothorax (16/154; 10.3%), abdominal wall hernia (9/154; 5.8%), and abdominal penetrating wounds (8/146; 5.5%). Dogs <10 kg were significantly more likely to incur wounds to multiple body parts or sustain abdominal penetrating wounds. The presence of rib fracture was significantly associated with mortality. Frequency of coyote attacks over the time of this study increased by 330%. Coyote attacks on dogs are a problem in Southern California and are associated with substantial morbidity and mortality, especially in dogs with wounds to the thorax. Aggressive management involving surgical wound repair was associated with survival to discharge. © Veterinary Emergency and Critical Care Society 2017.

An update of clinical management of acute intermittent porphyria

PubMed Central

Pischik, Elena; Kauppinen, Raili

2015-01-01

Acute intermittent porphyria (AIP) is due to a deficiency of the third enzyme, the hydroxymethylbilane synthase, in heme biosynthesis. It manifests with occasional neuropsychiatric crises associated with overproduction of porphyrin precursors, aminolevulinic acid and porphobilinogen. The clinical criteria of an acute attack include the paroxysmal nature and various combinations of symptoms, such as abdominal pain, autonomic dysfunction, hyponatremia, muscle weakness, or mental symptoms, in the absence of other obvious causes. Intensive abdominal pain without peritoneal signs, acute peripheral neuropathy, and encephalopathy usually with seizures or psychosis are the key symptoms indicating possible acute porphyria. More than fivefold elevation of urinary porphobilinogen excretion together with typical symptoms of an acute attack is sufficient to start a treatment. Currently, the prognosis of the patients with AIP is good, but physicians should be aware of a potentially fatal outcome of the disease. Mutation screening and identification of type of acute porphyria can be done at the quiescent phase of the disease. The management of patients with AIP include following strategies: A, during an acute attack: 1) treatment with heme preparations, if an acute attack is severe or moderate; 2) symptomatic treatment of autonomic dysfunctions, polyneuropathy and encephalopathy; 3) exclusion of precipitating factors; and 4) adequate nutrition and fluid therapy. B, during remission: 1) exclusion of precipitating factors (education of patients and family doctors), 2) information about on-line drug lists, and 3) mutation screening for family members and education about precipitating factors in mutation-positive family members. C, management of patients with recurrent attacks: 1) evaluation of the lifestyle, 2) evaluation of hormonal therapy in women, 3) prophylactic heme therapy, and 4) liver transplantation in patients with severe recurrent attacks. D, follow-up of the AIP patients for long-term complications: chronic hypertension, chronic kidney insufficiency, chronic pain syndrome, and hepatocellular carcinoma. PMID:26366103

Treatment of intractable chronic cluster headache by occipital nerve stimulation: a cohort of 51 patients.

PubMed

Miller, S; Watkins, L; Matharu, M

2017-02-01

Chronic cluster headache is a rare, highly disabling primary headache condition. When medically intractable, occipital nerve stimulation can offer effective treatment. Open-label series have provided data on small cohorts only. We analyzed 51 subjects to evaluate the long-term outcomes of highly intractable chronic cluster headache with occipital nerve stimulation. Patients with intractable chronic cluster headache were implanted with occipital nerve stimulators during the period 2007-2014. The primary endpoint was improvement in daily attack frequency. Secondary endpoints included attack severity, attack duration, quality-of-life measures, headache disability scores and adverse events. We studied 51 patients [35 males; mean age at implant 47.78 (range 31-70) years; mean follow-up 39.17 (range 2-81) months]. Nineteen patients had other chronic headache types in addition in chronic cluster headache. At final follow-up, there was a 46.1% improvement in attack frequency (P < 0001) across all patients, 49.5% (P < 0.001) in those with cluster headache alone and 40.3% (P = 0.036) in those with multiple phenotypes. There were no significant differences in response in those with or without multiple headache types. The overall response rate (defined as at least a 50% improvement in attack frequency) was 52.9%. Significant reductions were also seen in attack duration and severity. Improvements were noted in headache disability scores and quality-of-life measures. Triptan use of responders dropped by 62.56%, resulting in significant cost savings. Adverse event rates were highly favorable. Occipital nerve stimulation appears to be a safe and efficacious treatment for highly intractable chronic cluster headache even after a mean follow-up of over 3 years. © 2016 EAN.

ADJUSTMENT AMONG CHILDREN WITH RELATIVES WHO PARTICIPATED IN THE MANHUNT FOLLOWING THE BOSTON MARATHON ATTACK

PubMed Central

Comer, Jonathan S.; Kerns, Caroline E.; Elkins, R. Meredith; Edson, Aubrey L.; Chou, Tommy; Dantowitz, Annie; Miguel, Elizabeth; Brown, Bonnie; Coxe, Stefany; Green, Jennifer Greif

2014-01-01

Background Following the Boston Marathon attack, the extraordinary interagency manhunt and shelter-in-place made for a truly unprecedented experience for area families. Although research on Boston youth has found robust associations between manhunt-related experiences and post-attack functioning, such work does little to identify the specific needs of a particularly vulnerable population—i.e., children with a relative who participated in the manhunt. Understanding the adjustment of these youth is critical for informing clinical efforts. Methods Survey of Boston-area parents/caretakers (N = 460) reporting on their child’s attack/manhunt-related experiences, as well as psychosocial functioning in the first six post-attack months; analyses compared youth with and without a relative in law enforcement or the armed services who participated in the manhunt. Results The proportion of youth with likely PTSD was 5.7 times higher among youth with relatives in the manhunt than among youth without. After accounting for child demographics, blast exposure, and children’s own exposure to manhunt events (e.g., hearing/seeing gunfire/explosions, having officers enter/search home), having a relative in the manhunt significantly predicted child PTSD symptoms, emotional symptoms, and hyperactivity/inattention. Fear during the manhunt that a loved one could be hurt mediated relationships between having a relative in the manhunt and clinical outcomes; living within the zone of greatest manhunt activity did not moderate observed relationships. Conclusions Children with relatives called upon to participate in the unprecedented interagency manhunt following the Boston Marathon attack carried a particularly heavy mental health burden. Continued research is needed to clarify the clinical needs of youth with relatives in high-risk occupations. PMID:24865569

Coronary heart disease risk in patients with stroke or transient ischemic attack and no known coronary heart disease: findings from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial.

PubMed

Amarenco, Pierre; Goldstein, Larry B; Sillesen, Henrik; Benavente, Oscar; Zweifler, Richard M; Callahan, Alfred; Hennerici, Michael G; Zivin, Justin A; Welch, K Michael A

2010-03-01

Noncoronary forms of atherosclerosis (including transient ischemic attacks or stroke of carotid origin or >50% stenosis of the carotid artery) are associated with a 10-year vascular risk of >20% and are considered as a coronary heart disease (CHD) -risk equivalent from the standpoint of lipid management. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial included patients with stroke or transient ischemic attack and no known CHD regardless of the presence of carotid atherosclerosis. We evaluated the risk of developing clinically recognized CHD in SPARCL patients. A total of 4731 patients (mean age, 63 years) was randomized to 80 mg/day atorvastatin placebo. The rates of major coronary event, any CHD event, and any revascularization procedure were evaluated. After 4.9 years of follow-up, the risks of a major coronary event and of any CHD end point in the placebo group were 5.1% and 8.6%, respectively. The rate of outcome of stroke decreased over time, whereas the major coronary event rate was stable. Relative to those having a large vessel-related stroke at baseline, those having a transient ischemic attack, hemorrhagic stroke, small vessel stroke, or a stroke of unknown cause had similar absolute rates for a first major coronary event and for any CHD event; transient ischemic attack, small vessel, and unknown cause groups had lower absolute revascularization procedure rates. Major coronary event, any CHD event, and any revascularization procedure rates were similarly reduced in all baseline stroke subtypes in the atorvastatin arm compared with placebo with no heterogeneity between groups. CHD risk can be substantially reduced by atorvastatin therapy in patients with recent stroke or transient ischemic attack regardless of stroke subtype.

Adjustment among children with relatives who participated in the manhunt following the Boston Marathon attack.

PubMed

Comer, Jonathan S; Kerns, Caroline E; Elkins, R Meredith; Edson, Aubrey L; Chou, Tommy; Dantowitz, Annie; Miguel, Elizabeth; Brown, Bonnie; Coxe, Stefany; Green, Jennifer Greif

2014-07-01

Following the Boston Marathon attack, the extraordinary interagency manhunt and shelter-in-place made for a truly unprecedented experience for area families. Although research on Boston youth has found robust associations between manhunt-related experiences and post-attack functioning, such work does little to identify the specific needs of a particularly vulnerable population--i.e., children with a relative who participated in the manhunt. Understanding the adjustment of these youth is critical for informing clinical efforts. Survey of Boston-area parents/caretakers (N = 460) reporting on their child's attack/manhunt-related experiences, as well as psychosocial functioning in the first six post-attack months; analyses compared youth with and without a relative in law enforcement or the armed services who participated in the manhunt. The proportion of youth with likely PTSD was 5.7 times higher among youth with relatives in the manhunt than among youth without. After accounting for child demographics, blast exposure, and children's own exposure to manhunt events (e.g., hearing/seeing gunfire/explosions, having officers enter/search home), having a relative in the manhunt significantly predicted child PTSD symptoms, emotional symptoms, and hyperactivity/inattention. Fear during the manhunt that a loved one could be hurt mediated relationships between having a relative in the manhunt and clinical outcomes; living within the zone of greatest manhunt activity did not moderate observed relationships. Children with relatives called upon to participate in the unprecedented interagency manhunt following the Boston Marathon attack carried a particularly heavy mental health burden. Continued research is needed to clarify the clinical needs of youth with relatives in high-risk occupations. © 2014 Wiley Periodicals, Inc.

Aftermath of Terror: A Nationwide Longitudinal Study of Posttraumatic Stress and Worry Across the Decade Following the September 11, 2001 Terrorist Attacks.

PubMed

Garfin, Dana Rose; Poulin, Michael J; Blum, Scott; Silver, Roxane Cohen

2018-02-01

Research conducted in the early years after the September 11, 2001 (9/11) terrorist attacks in New York, Pennsylvania, and Washington, DC demonstrated adverse psychological outcomes among residents of the United States who were exposed to the attacks both directly and indirectly via the media. However, less is known about the impact of this collective trauma over time. Beginning at the end of December 2006, a longitudinal study of a nationally representative sample of U.S. residents (Cohort 2, N = 1,613) examined the long-term effects of 9/11, with annual assessments administered every year for 3 years. We assessed rates of 9/11-related posttraumatic stress (PTS) annually during the first 2 years of the study; during the second and third years of the study, we assessed fear and worry regarding future terrorism. Rates of PTS among participants were compared with those assessed annually in a nationally representative sample between 2002 and 2004 (Cohort 1); results indicated a relatively stable pattern of 9/11-related PTS symptoms for 6 years following the attacks. Five to six years after 9/11, we found an association between 9/11-related PTS and both direct, B = 8.45, 95% CI [4.32, 12.59] and media-based (live television), B = 1.78, 95% CI [0.90, 2.65] exposure to the attacks. Six to 7 years post-9/11, fear and worry regarding future terrorism were predicted by 9/11-related PTS symptoms that had been reported approximately 5 years after the attacks, B = 0.04, 95% CI [0.03, 0.05]. The psychological legacy of 9/11 was perceptible among many U.S. residents throughout the decade that followed. Copyright © 2018 International Society for Traumatic Stress Studies.

PubMed Central

CANZI, P.; OCCHINI, A.; PAGELLA, F.; MARCHAL, F.; BENAZZO, M.

2013-01-01

SUMMARY Juvenile recurrent parotitis (JRP) is the second most frequent salivary gland disease in childhood, defined as a recurrent non-suppurative and non-obstructive parotid inflammation. The recurring attacks actually represent the most dramatic and serious aspect of this pathology, since they significantly influence the quality of life, and there are no recognized therapies to avoid them. In recent years, there are reports of many international experiences related to the management of JRP by sialendoscopy. In this context, several authors have stressed the striking role of sialendoscopy in the prevention of JRP attacks. The objective of the current review is to overview the existing literature with particular regards to diagnostic and therapeutic outcomes after the application of sialendoscopy in patients suffering from JRP. PMID:24376291

Opportunistic quantum network coding based on quantum teleportation

NASA Astrophysics Data System (ADS)

Shang, Tao; Du, Gang; Liu, Jian-wei

2016-04-01

It seems impossible to endow opportunistic characteristic to quantum network on the basis that quantum channel cannot be overheard without disturbance. In this paper, we propose an opportunistic quantum network coding scheme by taking full advantage of channel characteristic of quantum teleportation. Concretely, it utilizes quantum channel for secure transmission of quantum states and can detect eavesdroppers by means of quantum channel verification. What is more, it utilizes classical channel for both opportunistic listening to neighbor states and opportunistic coding by broadcasting measurement outcome. Analysis results show that our scheme can reduce the times of transmissions over classical channels for relay nodes and can effectively defend against classical passive attack and quantum active attack.

MI: Not a Heart Attack but a Gut Attack.

PubMed

Lee, Rosemary K; Cabrera, Ana M

2018-02-01

Mesenteric ischemia and infarction are infrequent but often deadly conditions in acute and critically ill patients. Mesenteric ischemia may be a primary admission diagnosis or may develop secondary to another diagnosis. Having a high index of suspicion for patients at risk of mesenteric ischemia and mesenteric infarction can alter a poor outcome. This article reviews the pathophysiology, risk factors, assessment, medical and nursing diagnoses, as well as collaborative management for mesenteric ischemia. Early identification of patients at risk and the appropriate diagnostic testing are stressed. Nurses armed with the knowledge of this condition are better able to provide safe care to their patients. ©2018 American Association of Critical-Care Nurses.

Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: a review of the literature among highly exposed populations.

PubMed

Neria, Yuval; DiGrande, Laura; Adams, Ben G

2011-09-01

The September 11, 2001 (9/11), terrorist attacks were unprecedented in their magnitude and aftermath. In the wake of the attacks, researchers reported a wide range of mental and physical health outcomes, with posttraumatic stress disorder (PTSD) the one most commonly studied. In this review, we aim to assess the evidence about PTSD among highly exposed populations in the first 10 years after the 9/11 attacks. We performed a systematic review. Eligible studies included original reports based on the full Diagnostic and Statistical Manual of Mental Disorders (4th ed., rev.; American Psychiatric Association, 2000) criteria of PTSD among highly exposed populations such as those living or working within close proximity to the World Trade Center (WTC) and the Pentagon in New York City and Washington, DC, respectively, and first responders, including rescue, cleaning, and recovery workers. The large body of research conducted after the 9/11 attacks in the past decade suggests that the burden of PTSD among persons with high exposure to 9/11 was substantial. PTSD that was 9/11-related was associated with a wide range of correlates, including sociodemographic and background factors, event exposure characteristics, loss of life of significant others, and social support factors. Few studies used longitudinal study design or clinical assessments, and no studies reported findings beyond six years post-9/11, thus hindering documentation of the long-term course of confirmed PTSD. Future directions for research are discussed. © 2011 American Psychological Association

Posttraumatic Stress Disorder Following the September 11, 2001, Terrorist Attacks

PubMed Central

Neria, Yuval; DiGrande, Laura; Adams, Ben G.

2012-01-01

The September 11, 2001 (9/11), terrorist attacks were unprecedented in their magnitude and aftermath. In the wake of the attacks, researchers reported a wide range of mental and physical health outcomes, with posttraumatic stress disorder (PTSD) the one most commonly studied. In this review, we aim to assess the evidence about PTSD among highly exposed populations in the first 10 years after the 9/11 attacks. We performed a systematic review. Eligible studies included original reports based on the full Diagnostic and Statistical Manual of Mental Disorders (4th ed., rev.; American Psychiatric Association, 2000) criteria of PTSD among highly exposed populations such as those living or working within close proximity to the World Trade Center (WTC) and the Pentagon in New York City and Washington, DC, respectively, and first responders, including rescue, cleaning, and recovery workers. The large body of research conducted after the 9/11 attacks in the past decade suggests that the burden of PTSD among persons with high exposure to 9/11 was substantial. PTSD that was 9/11-related was associated with a wide range of correlates, including sociodemographic and background factors, event exposure characteristics, loss of life of significant others, and social support factors. Few studies used longitudinal study design or clinical assessments, and no studies reported findings beyond six years post-9/11, thus hindering documentation of the long-term course of confirmed PTSD. Future directions for research are discussed. PMID:21823772

The ins and outs of terrorist bus explosions: injury profiles of on-board explosions versus explosions occurring adjacent to a bus.

PubMed

Golan, Ron; Soffer, Dror; Givon, Adi; Peleg, Kobi

2014-01-01

Terrorist explosions occurring in varying settings have been shown to lead to significantly different injury patterns among the victims, with more severe injuries generally arising in confined space attacks. Increasing numbers of terrorist attacks have been targeted at civilian buses, yet most studies focus on events in which the bomb was detonated within the bus. This study focuses on the injury patterns and hospital utilisation among casualties from explosive terrorist bus attacks with the bomb detonated either within a bus or adjacent to a bus. All patients hospitalised at six level I trauma centres and four large regional trauma centres following terrorist explosions that occurred in and adjacent to buses in Israel between November 2000 and August 2004 were reviewed. Injury severity scores (ISS) were used to assess severity. Hospital utilisation data included length of hospital stay, surgical procedures performed, and intensive care unit (ICU) admission. The study included 262 victims of 22 terrorist attacks targeted at civilian bus passengers and drivers; 171 victims were injured by an explosion within a bus (IB), and 91 were injured by an explosion adjacent to a bus (AB). Significant differences were noted between the groups, with the IB population having higher ISS scores, more primary blast injury, more urgent surgical procedures performed, and greater ICU utilisation. Both groups had percentages of nearly 20% for burn injury, had high percentages of injuries to the head/neck, and high percentages of surgical wound and burn care. Explosive terrorist attacks detonated within a bus generate more severe injuries among the casualties and require more urgent surgical and intensive level care than attacks occurring adjacent to a bus. The comparison and description of the outcomes to these terrorist attacks should aid in the preparation and response to such devastating events. Copyright © 2013 Elsevier Ltd. All rights reserved.

Public health consequences of terrorism on maternal-child health in New York City and Madrid.

PubMed

Sherrieb, Kathleen; Norris, Fran H

2013-06-01

Past research provides evidence for trajectories of health and wellness among individuals following disasters that follow specific pathways of resilience, resistance, recovery, or continued dysfunction. These individual responses are influenced by event type and pre-event capacities. This study was designed to utilize the trajectories of health model to determine if it translates to population health. We identified terrorist attacks that could potentially impact population health rather than only selected individuals within the areas of the attacks. We chose to examine a time series of population birth outcomes before and after the terrorist events of the New York City (NYC) World Trade Center (WTC) attacks of 2001 and the Madrid, Spain train bombings of 2004 to determine if the events affected maternal-child health of those cities and, if so, for how long. For percentages of low birth weight (LBW) and preterm births, we found no significant effects from the WTC attacks in NYC and transient but significant effects on rates of LBW and preterm births following the bombings in Madrid. We did find a significant positive and sustained effect on infant mortality rate in NYC following the WTC attacks but no similar effect in Madrid. There were no effects on any of the indicator variables in the comparison regions of New York state and the remainder of Spain. Thus, population maternal-health in New York and Madrid showed unique adverse effects after the terrorist attacks in those cities. Short-term effects on LBW and preterm birth rates in Madrid and long-term effects on infant mortality rates in NYC were found when quarterly data were analyzed from 1990 through 2008/2009. These findings raise questions about chronic changes in the population's quality of life following catastrophic terrorist attacks. Public health should be monitored and interventions designed to address chronic stress, environmental, and socioeconomic threats beyond the acute aftermath of events.

Lessons learned for the National Children's Study from the National Institute of Environmental Health Sciences/U.S. Environmental Protection Agency Centers for Children's Environmental Health and Disease Prevention Research.

PubMed

Kimmel, Carole A; Collman, Gwen W; Fields, Nigel; Eskenazi, Brenda

2005-10-01

This mini-monograph was developed to highlight the experiences of the National Institute of Environmental Health Sciences (NIEHS)/U.S. Environmental Protection Agency (EPA) Centers for Children's Environmental Health and Disease Prevention Research, focusing particularly on several areas of interest for the National Children's Study. These include general methodologic issues for conducting longitudinal birth cohort studies and community-based participatory research and for measuring air pollution exposures, pesticide exposures, asthma, and neurobehavioral toxicity. Rather than a detailed description of the studies in each of the centers, this series of articles is intended to provide information on the practicalities of conducting such intensive studies and the lessons learned. This explication of lessons learned provides an outstanding opportunity for the planners of the National Children's Study to draw on past experiences that provide information on what has and has not worked when studying diverse multiracial and multiethnic groups of children with unique urban and rural exposures. The Children's Centers have addressed and overcome many hurdles in their efforts to understand the link between environmental exposures and health outcomes as well as interactions between exposures and a variety of social and cultural factors. Some of the major lessons learned include the critical importance of long-term studies for assessing the full range of developmental consequences of environmental exposures, recognition of the unique challenges presented at different life stages for both outcome and exposure measurement, and the importance of ethical issues that must be dealt with in a changing medical and legal environment. It is hoped that these articles will be of value to others who are embarking on studies of children's environmental health.

Contest experience and body size affect different types of contest decisions.

PubMed

Chen, Yu-Ju; Hsu, Yuying

2016-11-01

This study examined the relative importance of contest experience and size differences to behavioral decisions over the course of contests. Using a mangrove rivulus fish, Kryptolebias marmoratus, we showed that although contest experience and size differences jointly determined contest outcomes, they affected contestants' interactions at different stages of contests. Contest experience affected behavioral decisions at earlier stages of contests, including the tendency and latency to launch attacks, the tendency to escalate contests into mutual attacks and the outcome of non-escalated contests. Once contests were escalated into mutual attacks, the degree of size difference affected the fish's persistence in escalation and chance of winning, but contest experience did not. These results support the hypothesis that contest experience modifies individuals' estimation of their fighting ability rather than their actual strength. Furthermore, (1) in contests between two naïve contestants, more than 60 % of fish that were 2-3 mm smaller than their opponent escalated the contest to physical fights, even though their larger opponents eventually won 92 % of escalated fights and (2) fish with a losing experience were very likely to retreat in the face of an opponent 2-3 mm smaller than them without escalating. The result that a 2-3 mm size advantage could not offset the influence of a losing experience on the tendency to escalate suggests that, as well as depending on body size, the fish's physical strength is influenced by other factors which require further investigation.

Short-term effect of winter air pollution on respiratory health of asthmatic children in Paris.

PubMed

Segala, C; Fauroux, B; Just, J; Pascual, L; Grimfeld, A; Neukirch, F

1998-03-01

There is controversy as to whether low levels of air pollution affect the symptoms and lung function in asthma. We addressed this by examining the short-term effects of winter air pollution on childhood asthma in Paris. We performed a 6 month follow-up of 84 medically diagnosed asthmatic children classified into two groups of severity. The outcomes included incidence and prevalence of asthma attacks, symptoms and use of supplementary beta2-agonists, peak expiratory flow (PEF) value and its variability. The statistical analysis controlled the lack of independence between daily health outcomes, trends and meteorology. Air pollution was associated with an increase in reports and duration of asthma attacks and asthma-like symptoms in mild asthmatic children. The strongest association was the risk of asthma attack for an increase of 50 microg x m(-3) of sulphur dioxide (SO2) on the same day (odds ratio (OR)=2.86). Maximum reduction in morning peak expiratory flow (PEF) (5%) and maximum increase in PEF variability (2%) were observed at a lag of 3 days for an increase of 50 microg x m(-3) of SO2 in the subgroup of mild asthmatics receiving no regular inhaled medication. In moderate asthmatic children, the duration of supplementary beta2-agonist use was strongly associated with air pollution. The general pattern of our results provides evidence of the effect of the low levels of air pollution encountered in Western Europe on symptoms and lung function in childhood asthma.

Outbreaks of influenza-like illness in long-term care facilities in Winnipeg, Canada.

PubMed

Mahmud, Salaheddin M; Thompson, Laura H; Nowicki, Deborah L; Plourde, Pierre J

2013-11-01

Outbreaks of influenza-like illness (ILI) are common in long-term care facilities (LTCFs) and result in significant morbidity and mortality among residents. We describe patterns of reported ILI outbreaks in LTCFs in Winnipeg, Canada, and examine LTCF and outbreak characteristics that influence the clinical outcomes of these outbreaks. We analyzed the electronic records of all ILI outbreaks reported by LTCFs in Winnipeg from 2003 to 2011. Outbreak duration, ILI attack rates among staff and residents, and residents' death rates were calculated by presumed viral etiology, staff vaccination rates, type of influenza chemoprophylaxis used, and time to notification to public health. Of a total of 154 reported outbreaks, most (N=80) were attributed to influenza, and these outbreaks tended to have higher attack and death rates among LTCF residents compared with outbreaks caused by other respiratory viruses (12) or those of unknown etiology (62). About 92% of residents and 38% of staff of the average LTCFs were vaccinated. Chemoprophylaxis was used in 57·5% of influenza outbreaks. Regardless of presumed viral etiology, outbreaks reported within 3 days of onset ended sooner and had lower attack and mortality rates among residents. Influenza-like illness outbreaks still occur among highly immunized LTCF residents, so in addition to vaccination of staff and residents, it is important to maintain competent infection control practices. Early identification and notification to public health authorities and possibly early initiation of control measures could improve clinical outcomes of ILI outbreaks. © 2012 John Wiley & Sons Ltd.

Medium-term effectiveness of online behavioral training in migraine self-management: A randomized trial controlled over 10 months.

PubMed

Sorbi, M J; Kleiboer, A M; van Silfhout, H G; Vink, G; Passchier, J

2015-06-01

This randomized, controlled trial examined the medium-term effectiveness of online behavioral training in migraine self-management (oBT; N = 195) versus waitlist control (WLC; N = 173) on attack frequency, indicators of self-management (primary outcomes), headache top intensity, use of rescue medications, quality of life and disability (secondary outcomes). An online headache diary following the ICHD-II and questionnaires were completed at baseline (T0), post-training (T1) and six months later (T2). Missing data (T1: 24%; T2: 37%) were handled by multiple imputation. We established effect sizes (ES) and tested between-group differences over time with linear mixed modelling techniques based on the intention-to-treat principle. At T2, attack frequency had improved significantly in oBT (-23%, ES = 0.66) but also in WLC (-19%; ES = 0.52). Self-efficacy, internal and external control in migraine management--and triptan use--improved only in oBT, however. This indicates different processes in both groups and could signify (the start of) active self-management in oBT. Also, only oBT improved migraine-specific quality of life to a sizable extent. oBT produced self-management gains but could not account for improved attack frequency, because WLC improved as well. The perspective that BT effects develop gradually, and that online delivery will boost BT outreach, justifies further research. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

[Utility of treatment with atorvastatin 40 mg plus ezetimibe 10 mg versus atorvastatin 80 mg in reducing the levels of LDL cholesterol in patients with ischaemic stroke or transient ischaemic attack].

PubMed

Palacio, Enrique; Viadero-Cervera, Raquel; Revilla, Marián; Larrosa-Campo, Davinia; Acha-Salazar, Olga; Novo-Robledo, Francisco; Oterino, Agustín

2016-03-01

After an ischaemic stroke, to reduce LDL cholesterol (LDLc) levels decreases the risk of recurrence. The risk of recurrence is lower with more intense reductions in LDLc levels. To evaluate the efficacy and security of atorvastatin 40 mg plus ezetimibe 10 mg after ischaemic stroke or transient ischaemic attack (TIA). We retrospectively evaluated stroke or TIA patients admitted to our hospital who received atorvastatin 40 mg plus ezetimibe 10 mg (n = 34) or atorvastatin 80 mg (n = 52) at discharge. We analyzed changes in lipid parameters and established as a primary outcome LDLc <= 70 mg/dL and/or reduction in LDLc >= 50%. Furthermore, safety parameters were assessed. Predictors associated with primary outcome achievement were treatment with atorvastatin 40 mg plus ezetimibe 10 mg (odds ratio: 11.94; 95% CI: 2.82-50.64; p = 0.001) and male (odds ratio: 4.76; 95% CI: 1.35-16.67; p = 0.02). Treatment with atorvastatin 40 mg plus ezetimibe 10 mg achieved significantly greater reductions in LDLc (p < 0.001), total cholesterol (p < 0.001) and non-HDLc (p < 0.001). Both treatments were safe and well tolerated, with a low number of secondary effects. Compared with atorvastatin 80 mg, atorvastatin 40 mg plus ezetimibe 10 mg increases the likelihood of achieving LDLc goals after ischaemic stroke or transient ischaemic attack. Both treatments were safe and well tolerated.

One-shot, low-dosage intratympanic gentamicin for Ménière's disease: Clinical, posturographic and vestibular test findings.

PubMed

Daneshi, Ahmad; Jahandideh, Hesam; Pousti, Seyed Behzad; Mohammadi, Shabahang

2014-01-01

Ménière's disease has been remained as a difficult therapeutic challenge. The present study aimed to determine the effects of one-shot low-dosage intratympanic gentamicin on vertigo control, auditory outcomes and findings of computerized dynamic posturography and vestibular evoked myogenic potentials in patients with unilateral Ménière's disease. In a prospective clinical study, 30 patients with unilateral Ménière's disease were treated with one-shot intratympanic injection of 20 milligrams gentamicin. Main outcome measures included clinical, audiometric, postural and vestibular outcomes evaluated 1 and 9 months after the treatment. Mean vertigo attacks frequency, pure tone average threshold and functional level scale significantly decreased after the treatment (P < 0.05). Effective vertigo control (class A and B) obtained in 95.8% of the patients. In total, 75% of patients reported decrease in both aural fullness and tinnitus. Vestibular evoked myogenic potentials became absent in all the patients but four of them. Posturographic scores were improved after the treatment. One-shot low-dosage gentamicin was effective in controlling vertigo attacks in Ménière's disease and has useful effects on aural fullness and tinnitus of patients as well. Postural and vestibular tests only have adjunctive role for monitoring therapeutic responses in intratympanic gentamicin-therapy.

Creating a winning team: lessons from football.

PubMed

Simons, Sherri Lee

2005-01-01

There are tasks best done on an individual basis when caring for a neonate, but the ultimate outcome for infants and their families results from a team effort. Incorporating ten strategies drawn from football can help the NICU manager create and foster effective teamwork.

Lessons Learned from Large-Scale Randomized Experiments

ERIC Educational Resources Information Center

Slavin, Robert E.; Cheung, Alan C. K.

2017-01-01

Large-scale randomized studies provide the best means of evaluating practical, replicable approaches to improving educational outcomes. This article discusses the advantages, problems, and pitfalls of these evaluations, focusing on alternative methods of randomization, recruitment, ensuring high-quality implementation, dealing with attrition, and…

Effects of school-based intervention by emergency medical technicians on students and their parents: a community-based prospective study of the Akashi project

PubMed Central

Tomari, Shinya; Yokota, Chiaki; Nishimura, Kunihiro; Hino, Tenyu; Ohyama, Satoshi; Arimizu, Takuro; Wada, Shinichi; Ohnishi, Hideyuki; Toyoda, Kazunori; Minematsu, Kazuo

2017-01-01

Objective Stroke lessons for youth provided by emergency medical technicians (EMTs) may be an effective strategy to facilitate early intervention for patients with stroke. The aim of this study was to examine how effective EMT-led lessons on stroke awareness for schoolchildren were at disseminating stroke information. Setting, participants and outcome measures The study was performed in the city of Akashi, Hyogo, Japan (Akashi project). Children (aged 9–10 years old) at 11 public elementary schools and their parents were enrolled in this study. EMTs from the firefighting headquarters provided lessons on stroke to the children using our educational materials between September 2014 and October 2015. Each child was given our educational materials to take home and discuss stroke with their parents. The children and their parents answered questionnaires on stroke knowledge before, immediately and at 3 months after the lesson. Results A total of 763 children and 489 parents were enrolled (ie, 64% of children). The scores of either stroke symptoms or risk factors were significantly higher immediately and at 3 months after the lesson, compared with before the lesson, both in children and the parents (p<0.01). Compared with the baseline in both groups (58% in children, 83% in parents), the meaning of the FAST mnemonic at 3 months (88%, 94%), as well as at immediately after the lesson (90%, 89%), was significantly higher (p<0.001). Conclusion Stroke education by EMTs was effective in increasing stroke awareness in elementary school children, as well as their parents. PMID:29038179

Patient confidence regarding secondary lifestyle modification and knowledge of 'heart attack' symptoms following percutaneous revascularisation in Japan: a cross-sectional study.

PubMed

Kitakata, Hiroki; Kohno, Takashi; Kohsaka, Shun; Fujino, Junko; Nakano, Naomi; Fukuoka, Ryoma; Yuasa, Shinsuke; Maekawa, Yuichiro; Fukuda, Keiichi

2018-03-16

To assess patient perspectives on secondary lifestyle modification and knowledge of 'heart attack' after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Observational cross-sectional study. A single university-based hospital centre in Japan. In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident). The primary outcome assessed was the patients' confidence level regarding lifestyle modification and the recognition of heart attack symptoms. Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (<50%) about the maintenance of blood pressure control, healthy diet, body weight and routine exercise (≥3 times/week). After adjustment, male sex (OR 3.61, 95% CI 1.11 to 11.8) and lower educational level (OR 3.25; 95% CI 1.70 to 6.23) were identified as factors associated with lower confidence levels. In terms of confidence in the recognition of heart attack, almost all respondents answered 'yes' to the item 'I should go to the hospital as soon as possible when I have a heart attack'; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions. There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cost-effectiveness comparison of response strategies to a large-scale anthrax attack on the chicago metropolitan area: impact of timing and surge capacity.

PubMed

Kyriacou, Demetrios N; Dobrez, Debra; Parada, Jorge P; Steinberg, Justin M; Kahn, Adam; Bennett, Charles L; Schmitt, Brian P

2012-09-01

Rapid public health response to a large-scale anthrax attack would reduce overall morbidity and mortality. However, there is uncertainty about the optimal cost-effective response strategy based on timing of intervention, public health resources, and critical care facilities. We conducted a decision analytic study to compare response strategies to a theoretical large-scale anthrax attack on the Chicago metropolitan area beginning either Day 2 or Day 5 after the attack. These strategies correspond to the policy options set forth by the Anthrax Modeling Working Group for population-wide responses to a large-scale anthrax attack: (1) postattack antibiotic prophylaxis, (2) postattack antibiotic prophylaxis and vaccination, (3) preattack vaccination with postattack antibiotic prophylaxis, and (4) preattack vaccination with postattack antibiotic prophylaxis and vaccination. Outcomes were measured in costs, lives saved, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We estimated that postattack antibiotic prophylaxis of all 1,390,000 anthrax-exposed people beginning on Day 2 after attack would result in 205,835 infected victims, 35,049 fulminant victims, and 28,612 deaths. Only 6,437 (18.5%) of the fulminant victims could be saved with the existing critical care facilities in the Chicago metropolitan area. Mortality would increase to 69,136 if the response strategy began on Day 5. Including postattack vaccination with antibiotic prophylaxis of all exposed people reduces mortality and is cost-effective for both Day 2 (ICER=$182/QALY) and Day 5 (ICER=$1,088/QALY) response strategies. Increasing ICU bed availability significantly reduces mortality for all response strategies. We conclude that postattack antibiotic prophylaxis and vaccination of all exposed people is the optimal cost-effective response strategy for a large-scale anthrax attack. Our findings support the US government's plan to provide antibiotic prophylaxis and vaccination for all exposed people within 48 hours of the recognition of a large-scale anthrax attack. Future policies should consider expanding critical care capacity to allow for the rescue of more victims.

Cost-Effectiveness Comparison of Response Strategies to a Large-Scale Anthrax Attack on the Chicago Metropolitan Area: Impact of Timing and Surge Capacity

PubMed Central

Dobrez, Debra; Parada, Jorge P.; Steinberg, Justin M.; Kahn, Adam; Bennett, Charles L.; Schmitt, Brian P.

2012-01-01

Rapid public health response to a large-scale anthrax attack would reduce overall morbidity and mortality. However, there is uncertainty about the optimal cost-effective response strategy based on timing of intervention, public health resources, and critical care facilities. We conducted a decision analytic study to compare response strategies to a theoretical large-scale anthrax attack on the Chicago metropolitan area beginning either Day 2 or Day 5 after the attack. These strategies correspond to the policy options set forth by the Anthrax Modeling Working Group for population-wide responses to a large-scale anthrax attack: (1) postattack antibiotic prophylaxis, (2) postattack antibiotic prophylaxis and vaccination, (3) preattack vaccination with postattack antibiotic prophylaxis, and (4) preattack vaccination with postattack antibiotic prophylaxis and vaccination. Outcomes were measured in costs, lives saved, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We estimated that postattack antibiotic prophylaxis of all 1,390,000 anthrax-exposed people beginning on Day 2 after attack would result in 205,835 infected victims, 35,049 fulminant victims, and 28,612 deaths. Only 6,437 (18.5%) of the fulminant victims could be saved with the existing critical care facilities in the Chicago metropolitan area. Mortality would increase to 69,136 if the response strategy began on Day 5. Including postattack vaccination with antibiotic prophylaxis of all exposed people reduces mortality and is cost-effective for both Day 2 (ICER=$182/QALY) and Day 5 (ICER=$1,088/QALY) response strategies. Increasing ICU bed availability significantly reduces mortality for all response strategies. We conclude that postattack antibiotic prophylaxis and vaccination of all exposed people is the optimal cost-effective response strategy for a large-scale anthrax attack. Our findings support the US government's plan to provide antibiotic prophylaxis and vaccination for all exposed people within 48 hours of the recognition of a large-scale anthrax attack. Future policies should consider expanding critical care capacity to allow for the rescue of more victims. PMID:22845046

The 2015 Nepal Earthquake(s): Lessons Learned From the Disability and Rehabilitation Sector's Preparation for, and Response to, Natural Disasters.

PubMed

Landry, Michel D; Sheppard, Phillip S; Leung, Kit; Retis, Chiara; Salvador, Edwin C; Raman, Sudha R

2016-11-01

The frequency of natural disasters appears to be mounting at an alarming rate, and the degree to which people are surviving such traumatic events also is increasing. Postdisaster survival often triggers increases in population and individual disability-related outcomes in the form of impairments, activity limitations, and participation restrictions, all of which have an important impact on the individual, his or her family, and their community. The increase in postdisaster disability-related outcomes has provided a rationale for the increased role of the disability and rehabilitation sector's involvement in emergency response, including physical therapists. A recent major earthquake that has drawn the world's attention occurred in the spring of 2015 in Nepal. The response of the local and international communities was large and significant, and although the collection of complex health and disability issues have yet to be fully resolved, there has been a series of important lessons learned from the 2015 Nepal earthquake(s). This perspective article outlines lessons learned from Nepal that can be applied to future disasters to reduce overall disability-related outcomes and more fully integrate rehabilitation in preparation and planning. First, information is presented on disasters in general, and then information is presented that focuses on the earthquake(s) in Nepal. Next, field experience in Nepal before, during, and after the earthquake is described, and actions that can and should be adopted prior to disasters as part of disability preparedness planning are examined. Then, the emerging roles of rehabilitation providers such as physical therapists during the immediate and postdisaster recovery phases are discussed. Finally, approaches are suggested that can be adopted to "build back better" for, and with, people with disabilities in postdisaster settings such as Nepal. © 2016 American Physical Therapy Association.

Impacts of Professional Development in Integrated STEM Education on Teacher Self-Efficacy, Outcome Expectancy, and Stem Career Awareness

NASA Astrophysics Data System (ADS)

Knowles, J. Geoff

This research analyzed the effects of teacher professional development and lesson implementation in integrated Science, Technology, Engineering, and Math (STEM) on: 1.) Teacher self-efficacy and their confidence to teach specific STEM subjects; 2.) Teaching outcome expectancy beliefs concerning the impact of actions by teachers on student learning; and 3.) Teacher awareness of STEM careers. High school science and technology education teachers participating in the Teachers and Researchers Advancing Integrated Lessons in STEM (TRAILS) project experimental group attended a ten-day summer professional development institute designed to educate teachers in using an integrated STEM education model to implement integrated STEM lessons. The research design utilized a quasi-experimental nonequivalent comparison group design that incorporated an experimental group and an untreated comparison group with both pretest, posttest, and delayed posttest assessments on non-randomized participants. Teacher self-efficacy has been identified as a key factor in effective teaching and student learning, and teacher awareness of STEM careers impacts students as they consider career choices. The T-STEM Survey for teachers was given for the pretest and posttest assessments to measure attitudes and beliefs toward the specific constructs of this study. Significant effects of the TRAILS professional development were found in the teacher group (experimental or comparison) and teacher subject (technology or science) in pretest and posttest scores using cumulative link models for the constructs of teacher self-efficacy and beliefs to teach STEM subjects, teacher outcome expectancy beliefs, and teacher awareness of STEM careers. Effect sizes ranged from small to large varying by construct and assessment time. Highly significant p-values and effect sizes revealed impacts on science teachers were greater when teacher subject groups were analyzed separately.

Surgical adverse outcome reporting as part of routine clinical care.

PubMed

Kievit, J; Krukerink, M; Marang-van de Mheen, P J

2010-12-01

In The Netherlands, health professionals have created a doctor-driven standardised system to report and analyse adverse outcomes (AO). The aim is to improve healthcare by learning from past experiences. The key elements of this system are (1) an unequivocal definition of an adverse outcome, (2) appropriate contextual information and (3) a three-dimensional hierarchical classification system. First, to assess whether routine doctor-driven AO reporting is feasible. Second, to investigate how doctors can learn from AO reporting and analysis to improve the quality of care. Feasibility was assessed by how well doctors reported AO in the surgical department of a Dutch university hospital over a period of 9 years. AO incidence was analysed per patient subgroup and over time, in a time-trend analysis of three equal 3-year periods. AO were analysed case by case and statistically, to learn lessons from past events. In 19,907 surgical admissions, 9189 AOs were reported: one or more AO in 18.2% of admissions. On average, 55 lessons were learnt each year (in 4.3% of AO). More AO were reported in P3 than P1 (OR 1.39 (1.23-1.57)). Although minor AO increased, fatal AO decreased over time (OR 0.59 (0.45-0.77)). Doctor-driven AO reporting is shown to be feasible. Lessons can be learnt from case-by-case analyses of individual AO, as well as by statistical analysis of AO groups and subgroups (illustrated by time-trend analysis), thus contributing to the improvement of the quality of care. Moreover, by standardising AO reporting, data can be compared across departments or hospitals, to generate (confidential) mirror information for professionals cooperating in a peer-review setting.

Surgical adverse outcome reporting as part of routine clinical care

PubMed Central

Krukerink, M; Marang-van de Mheen, P J

2010-01-01

Background In The Netherlands, health professionals have created a doctor-driven standardised system to report and analyse adverse outcomes (AO). The aim is to improve healthcare by learning from past experiences. The key elements of this system are (1) an unequivocal definition of an adverse outcome, (2) appropriate contextual information and (3) a three-dimensional hierarchical classification system. Objectives First, to assess whether routine doctor-driven AO reporting is feasible. Second, to investigate how doctors can learn from AO reporting and analysis to improve the quality of care. Methods Feasibility was assessed by how well doctors reported AO in the surgical department of a Dutch university hospital over a period of 9 years. AO incidence was analysed per patient subgroup and over time, in a time-trend analysis of three equal 3-year periods. AO were analysed case by case and statistically, to learn lessons from past events. Results In 19 907 surgical admissions, 9189 AOs were reported: one or more AO in 18.2% of admissions. On average, 55 lessons were learnt each year (in 4.3% of AO). More AO were reported in P3 than P1 (OR 1.39 (1.23–1.57)). Although minor AO increased, fatal AO decreased over time (OR 0.59 (0.45–0.77)). Conclusions Doctor-driven AO reporting is shown to be feasible. Lessons can be learnt from case-by-case analyses of individual AO, as well as by statistical analysis of AO groups and subgroups (illustrated by time-trend analysis), thus contributing to the improvement of the quality of care. Moreover, by standardising AO reporting, data can be compared across departments or hospitals, to generate (confidential) mirror information for professionals cooperating in a peer-review setting. PMID:20430928

X-31 Mishap: Lessons Learned

NASA Technical Reports Server (NTRS)

Larson, Richard R.

2007-01-01

The experimental X-31 High Angle of Attack Research Aircraft crashed during a 1995 test mission flight conducted by NASA at Edwards Air Force Base, California. The pilot lost control of the airplane and was forced to eject, sustaining a permanent back injury that ended his flying career. Prior to this incident the airplane had a perfect record of several hundred non-eventful flights supported by an experienced team. During the subsequent investigation by a mishap committee it was discovered that a series of cascading events contributed to this accident. Some of the identified contributing factors that resulted in this mishap are common to aircraft design and to flight-test in general. The mistakes and the solutions are presented here so that the flight-test community may consider and learn from them. The primary cause of the crash was icing and, ultimately, a complete blockage of the pitot-static nose probe. The icing was caused by a freak weather phenomenon that was neither expected nor known to exist on the day of the mishap. The normal probe had been replaced with a special Kiel probe to allow total pressure measurements of up to 70 degrees angle of attack for flight-test purposes. The Kiel probe did not include a heater, because it was assumed that the airplane would not be flown in the clouds or in conditions conducive to icing. This assumption was later proven to be incorrect. The iced Kiel probe caused incorrect gain scheduling in the flight control system, resulting in an unstable aircraft. This failure was essentially undetected because of a faulty design in the flight control system architecture. There were, however, also a number of other issues that lead up to this situation that never should have happened. This presentation discusses what the issues were that contributed to the incident. After the incident was investigated, some of these issues were addressed and some changes were made. The second X-31 aircraft flew the remainder of the flight tests, and the program was successfully completed without incident. This presentation also shows a video of the mishap including lessons learned, and the changes that were made to resume the flight-test program are presented.

A Computerized, Self-Administered Questionnaire to Evaluate Posttraumatic Stress Among Firefighters After the World Trade Center Collapse

PubMed Central

Corrigan, Malachy; McWilliams, Rita; Kelly, Kerry J.; Niles, Justin; Cammarata, Claire; Jones, Kristina; Wartenberg, Daniel; Hallman, William K.; Kipen, Howard M.; Glass, Lara; Schorr, John K.; Feirstein, Ira

2009-01-01

Objectives. We sought to determine the frequency of psychological symptoms and elevated posttraumatic stress disorder (PTSD) risk among New York City firefighters after the World Trade Center (WTC) attack and whether these measures were associated with Counseling Services Unit (CSU) use or mental health–related medical leave over the first 2.5 years after the attack. Methods. Shortly after the WTC attack, a computerized, binary-response screening questionnaire was administered. Exposure assessment included WTC arrival time and “loss of a co-worker while working at the collapse.” We determined elevated PTSD risk using thresholds derived from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and a sensitivity-specificity analysis. Results. Of 8487 participants, 76% reported at least 1 symptom, 1016 (12%) met criteria for elevated PTSD risk, and 2389 (28%) self-referred to the CSU, a 5-fold increase from before the attack. Higher scores were associated with CSU use, functional job impairment, and mental health–related medical leave. Exposure–response gradients were significant for all outcomes. Conclusions. This screening tool effectively identified elevated PTSD risk, higher CSU use, and functional impairment among firefighters and therefore may be useful in allocating scarce postdisaster mental health resources. PMID:19890176

Effects of non-invasive vagus nerve stimulation on attack frequency over time and expanded response rates in patients with chronic cluster headache: a post hoc analysis of the randomised, controlled PREVA study.

PubMed

Gaul, Charly; Magis, Delphine; Liebler, Eric; Straube, Andreas

2017-12-01

In the PREVention and Acute treatment of chronic cluster headache (PREVA) study, attack frequency reductions from baseline were significantly more pronounced with non-invasive vagus nerve stimulation plus standard of care (nVNS + SoC) than with SoC alone. Given the intensely painful and frequent nature of chronic cluster headache attacks, additional patient-centric outcomes, including the time to and level of therapeutic response, were evaluated in a post hoc analysis of the PREVA study. After a 2-week baseline phase, 97 patients with chronic cluster headache entered a 4-week randomised phase to receive nVNS + SoC (n = 48) or SoC alone (n = 49). All 92 patients who continued into a 4-week extension phase received nVNS + SoC. Compared with SoC alone, nVNS + SoC led to a significantly lower mean weekly attack frequency by week 2 of the randomised phase; the attack frequency remained significantly lower in the nVNS + SoC group through week 3 of the extension phase (P < 0.02). Attack frequencies in the nVNS + SoC group were significantly lower at all study time points than they were at baseline (P < 0.05). Response rates were significantly greater with nVNS + SoC than with SoC alone when response was defined as attack frequency reductions of ≥25%, ≥50%, and ≥75% from baseline (≥25% and ≥50%, P < 0.001; ≥75%, P = 0.009). The 100% response rate was 8% with nVNS + SoC and 0% with SoC alone. Prophylactic nVNS led to rapid, significant, and sustained reductions in chronic cluster headache attack frequency within 2 weeks after its addition to SoC and was associated with significantly higher ≥25%, ≥50%, and ≥75% response rates than SoC alone. The rapid decrease in weekly attack frequency justifies a 4-week trial period to identify responders to nVNS, with a high degree of confidence, among patients with chronic cluster headache.

Preparing pre-service teachers to integrate technology into inquiry-based science education: Three case studies in The Netherlands

NASA Astrophysics Data System (ADS)

Tran, Trinh-Ba; van den Berg, Ed; Ellermeijer, Ton; Beishuizen, Jos

2016-05-01

Integration of technology ( e.g. measuring with sensors, video measurement, and modeling) into secondary-school science teaching is a need globally recognized. A central issue of incorporating these technologies in teaching is how to turn manipulations of equipment and software into manipulations of ideas. Therefore, preparation for pre-service teachers to apply ICT tools should be combined with the issues of minds-on inquiring and meaning-making. From this perspective, we developed a course within the post-graduate teacher-education program in the Netherlands. During the course, pre-service teachers learnt not only to master ICT skills but also to design, teach, and evaluate an inquiry-based lesson in which the ICT tool was integrated. Besides three life sessions, teachers' learning scenario also consisted of individual tasks which teachers could carry out mostly in the school or at home with support materials and online assistance. We taught three iterations of the course within a design-research framework in 2013, 2014 and collected data on the teacher learning processes and outcomes. The analyses of these data from observation, interviews, questionnaires, and documents were to evaluate implementation of the course, then suggest for revisions of the course set-up, which was executed and then assessed again in a subsequent case study. Main outcomes of the three case studies can be summarized as follows: within a limited time (3 life sessions spread over 2-3 months), the heterogeneous groups of pre-service teachers achieved a reasonable level of competence regarding the use of ICT tools in inquiry-based lessons. The blended set-up with support materials, especially the Coach activities and the lesson-plan form for an ICT-integrated inquiry-based lesson, contributed to this result under the condition that the course participants really spent considerable time outside the life sessions. There was a need for more time for hands-on, in-group activities in life sessions and more detailed feedback on individual reports of pre-service teachers. The majority of the pre-service teachers were able to design a lesson plan aimed at a certain inquiry level with integration of ICT, but just a few could implement it faithfully in the classroom. There was still a considerable difference between intended inquiry activities and actual realized inquiry which parallels results from the literature for experienced teachers. The participants had to struggle with science --ICT conceptual issues as well as getting their students to focus on inquiry and concept learning in the classroom. Each evaluation guided iteration of the course resulted in better learning outcomes.

A decision framework for coordinating bioterrorism planning: lessons from the BioNet program.

PubMed

Manley, Dawn K; Bravata, Dena M

2009-01-01

Effective disaster preparedness requires coordination across multiple organizations. This article describes a detailed framework developed through the BioNet program to facilitate coordination of bioterrorism preparedness planning among military and civilian decision makers. The authors and colleagues conducted a series of semistructured interviews with civilian and military decision makers from public health, emergency management, hazardous material response, law enforcement, and military health in the San Diego area. Decision makers used a software tool that simulated a hypothetical anthrax attack, which allowed them to assess the effects of a variety of response actions (eg, issuing warnings to the public, establishing prophylaxis distribution centers) on performance metrics. From these interviews, the authors characterized the information sources, technologies, plans, and communication channels that would be used for bioterrorism planning and responses. The authors used influence diagram notation to describe the key bioterrorism response decisions, the probabilistic factors affecting these decisions, and the response outcomes. The authors present an overview of the response framework and provide a detailed assessment of two key phases of the decision-making process: (1) pre-event planning and investment and (2) incident characterization and initial responsive measures. The framework enables planners to articulate current conditions; identify gaps in existing policies, technologies, information resources, and relationships with other response organizations; and explore the implications of potential system enhancements. Use of this framework could help decision makers execute a locally coordinated response by identifying the critical cues of a potential bioterrorism event, the information needed to make effective response decisions, and the potential effects of various decision alternatives.

A pre-test post-test study of a brief educational intervention demonstrates improved knowledge of potential acute myocardial infarction symptoms and appropriate responses in cardiac rehabilitation patients.

PubMed

Gallagher, Robyn; Roach, Kellie; Belshaw, Julie; Kirkness, Ann; Sadler, Leonie; Warrington, Darrell

2013-05-01

Patient delay in recognizing and responding to potential acute myocardial infarction (AMI) symptoms is an international issue. Cardiac rehabilitation provides an ideal opportunity to deliver an intervention. This study examines an individual educational intervention on knowledge of heart attack warning signs and specific chest pain action plans for people with coronary heart disease. Cardiac rehabilitation participants at five hospitals were assessed at program entry and tailored education was provided using the Heart Foundation of Australia's Heart Attack Warning Signs campaign educational tool. Participants (n=137) were reassessed at program conclusion (six to eight weeks). Study participants had a mean age of 64.48 years (SD 12.22), were predominantly male (78%) and most commonly presented with a current referral diagnosis of a percutaneous coronary intervention (PCI) (80%) and/or AMI (60%). There were statistically significant improvements in the reporting of 11 of the 14 warning signs of heart attack, with patients reporting 2.56 more warning signs on average at outcome (p<.0001). Patients reported more heart attack warning signs if they had completed high school education (β=1.14) or had better knowledge before the intervention (β=.57). There were statistically significant improvements in reporting of all appropriate actions in response to potential AMI symptoms, with patients reporting an average of 1.3 more actions at outcome (p<.001), with no change in the median time they would tolerate symptoms (p=.16). A brief education session using a single standardised tool and adapted to a patient assessment is effective in improving knowledge of potential AMI symptoms and appropriate responses in cardiac rehabilitation up to two months following. Copyright © 2012 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Comprehensive cardiac rehabilitation for secondary prevention after transient ischemic attack or mild stroke: I: feasibility and risk factors.

PubMed

Prior, Peter L; Hachinski, Vladimir; Unsworth, Karen; Chan, Richard; Mytka, Sharon; O'Callaghan, Christina; Suskin, Neville

2011-11-01

Comprehensive cardiac rehabilitation (CCR), which integrates structured lifestyle interventions and medications, reduces morbidity and mortality among cardiac patients. CCR has not typically been used with cerebrovascular populations, despite important commonalities with heart patients. We tested feasibility and effectiveness of 6-month outpatient CCR for secondary prevention after transient ischemic attack or mild, nondisabling stroke. This article presents risk factors. A future article will discuss psychological outcomes. Consecutive consenting subjects having sustained a transient ischemic attack or mild, nondisabling stroke within the previous 12 months (mean, 11.5 weeks; event-to-CCR entry) with ≥1 vascular risk factor, were recruited from a stroke prevention clinic providing usual care. We measured 6-month CCR outcomes following a prospective cohort design. Of 110 subjects recruited from January 2005 to April 2006, 100 subjects (mean age, 64.9 years; 46 women) entered and 80 subjects completed CCR. We obtained favorable, significant intake-to-exit changes in: aerobic capacity (+31.4%; P<0.001), total cholesterol (-0.30 mmol/L; P=0.008), total cholesterol/high-density lipoprotein (-11.6%; P<0.001), triglycerides (-0.27 mmol/L; P=0.003), waist circumference (-2.44 cm; P<0.001), body mass index (-0.53 kg/m(2); P=0.003), and body weight (-1.43 kg; P=0.001). Low-density lipoprotein (-0.24 mmol/L), high-density lipoprotein (+0.06 mmol/L), systolic (-3.21 mm Hg) and diastolic (-2.34 mm Hg) blood pressure changed favorably, but nonsignificantly. A significant shift toward nonsmoking occurred (P=0.008). Compared with intake, 11 more individuals (25.6% increase) finished CCR in the lowest-mortality risk category of the Duke Treadmill Score (P<0.001). CCR is feasible and effective for secondary prevention after transient ischemic attack or mild, nondisabling stroke, offering a promising model for vascular protection across chronic disease entities. We know of no similar previous investigation, and are now conducting a randomized trial.

Biomedical laboratory science education: standardising teaching content in resource-limited countries.

PubMed

Arneson, Wendy; Robinson, Cathy; Nyary, Bryan

2013-01-01

There is a worldwide shortage of qualified laboratory personnel to provide adequate testing for the detection and monitoring of diseases. In an effort to increase laboratory capacity in developing countries, new skills have been introduced into laboratory services. Curriculum revision with a focus on good laboratory practice is an important aspect of supplying entry-level graduates with the competencies needed to meet the current needs. Gaps in application and problem-solving competencies of newly graduated laboratory personnel were discovered in Ethiopia, Tanzania and Kenya. New medical laboratory teaching content was developed in Ethiopia, Tanzania and Kenya using national instructors, tutors, and experts and consulting medical laboratory educators from the United States of America (USA). Workshops were held in Ethiopia to create standardised biomedical laboratory science (BMLS) lessons based on recently-revised course objectives with an emphasis on application of skills. In Tanzania, course-module teaching guides with objectives were developed based on established competency outcomes and tasks. In Kenya, example interactive presentations and lesson plans were developed by the USA medical laboratory educators prior to the workshop to serve as resources and templates for the development of lessons within the country itself. The new teaching materials were implemented and faculty, students and other stakeholders reported successful outcomes. These approaches to updating curricula may be helpful as biomedical laboratory schools in other countries address gaps in the competencies of entry-level graduates.

Creating a balanced scorecard for a hospital system.

PubMed

Pink, G H; McKillop, I; Schraa, E G; Preyra, C; Montgomery, C; Baker, G R

2001-01-01

In 1999, hospitals in Ontario, Canada, collaborated with a university-based research team to develop a report on the relative performance of individual hospitals in Canada's most populated province. The researchers used the balanced-scorecard framework advocated by Kaplan and Norton. Indicators of performance were developed in four areas: clinical utilization and outcomes, patient satisfaction, system integration and change, and financial performance and condition. The process of selecting, calculating, and validating meaningful indicators of financial performance and condition is outlined. Lessons learned along the way are provided. These lessons may prove valuable to other finance researchers and practitioners who are engaged in performance measurement endeavors.

School-based prevention of bullying and relational aggression in adolescence: the fairplayer.manual.

PubMed

Scheithauer, Herbert; Hess, Markus; Schultze-Krumbholz, Anja; Bull, Heike Dele

2012-01-01

The fairplayer.manual is a school-based program to prevent bullying. The program consists of fifteen to seventeen consecutive ninety-minute lessons using cognitive-behavioral methods, methods targeting group norms and group dynamics, and discussions on moral dilemmas. Following a two-day training session, teachers, together with skilled fairplayer.teamers, implement fairplayer.manual in the classroom during regular school lessons. This chapter offers a summary of the program's conception and underlying prevention theory and summarizes the results from two evaluation studies. Standardized questionnaires showed a positive impact of the intervention program on several outcome variables. Copyright © 2012 Wiley Periodicals, Inc., A Wiley Company.

Maximizing Service Provider Relationships: Best Practices through Blended Management.

ERIC Educational Resources Information Center

Scherrens, Maurice W.

This book examines the institutional movement toward outsourcing support services, focusing on the development of outcome-oriented performance indicators and continuous self-assessment. Using 125 "lessons" based on support service theories, philosophies, and practices at George Mason University (Virginia), which collectively are termed…

FutureTox III: Bridges for Translation

EPA Science Inventory

The present document describes key discussion points and outcomes of a Society of Toxicology (SOT) Contemporary Concepts in Toxicology (CCT) Workshop, entitled FutureTox III1,2 that was held in Crystal City, Virginia, November 19-20, 2015. The workshop built on the many lessons l...

Playing, Creativity, Possibility

ERIC Educational Resources Information Center

Gude, Olivia

2010-01-01

Although virtually all contemporary art teachers list "enhancing creativity" as a key desired outcome of their programs, analysis of lesson plans used in schools suggests that in practice very little curriculum is specifically geared to developing creative abilities. In this paper, the author describes how she developed the curriculum…

Learning Organization.

ERIC Educational Resources Information Center

1996

This document consists of three papers presented at a symposium on the learning organization moderated by Roger Miller at the 1996 conference of the Academy of Human Resource Development (AHRD). "Creating a Learning Organization: A Case Study of Outcomes and Lessons Learned" (Laura L. Bierema, David M. Berdish) reports a study…

Navigating change: how outreach facilitators can help clinicians improve patient outcomes.

PubMed

Laferriere, Dianne; Liddy, Clare; Nash, Kate; Hogg, William

2012-01-01

The objective of this study was to describe outreach facilitation as an effective method of assisting and supporting primary care practices to improve processes and delivery of care. We spent 4 years working with 83 practices in Eastern Ontario, Canada, on the Improved Delivery of Cardiovascular Care through the Outreach Facilitation program. Primary care practices, even if highly motivated, face multiple challenges when providing quality patient care. Outreach facilitation can be an effective method of assisting and supporting practices to make the changes necessary to improve processes and delivery of care. Multiple jurisdictions use outreach facilitation for system redesign, improved efficiencies, and advanced access. The development and implementation of quality improvement programs using practice facilitation can be challenging. Our research team has learned valuable lessons in developing tools, finding resources, and assisting practices to reach their quality improvement goals. These lessons can lead to improved experiences for the practices and overall improved outcomes for the patients they serve.

Integrated Basin-Scale Modelling and Assessment: Lessons and Challenges in Linking Biophysical and Socioeconomic Sciences for Enhancing Sustainability Outcomes

NASA Astrophysics Data System (ADS)

Jakeman, A. J.; Croke, B. F.; Letcher, R. A.; Newham, L. T.; Norton, J. P.

2004-12-01

Integrated Assessment (IA) and Integrated Scenario Modelling (ISM) are being increasingly used to assess sustainability options and, in particular, the effects of policy changes, land use management, climate forcing and other uncontrollable drivers on a wide range of river basin outcomes. IA and ISM are processes that invoke the necessary range of biophysical and socioeconomic disciplines and embrace stakeholder involvement as an essential ingredient. The authors report on their IA studies in Australian and Asian river basins. They illustrate a range of modelling frameworks and tools that were used to perform the assessments, engage the relevant interest groups and promote systems understanding and social learning. The studies cover a range of issues and policies including poverty alleviation, industrial investments, infrastructure provision, erosion and sedimentation, water supply allocation, and ecological protection. The positive impacts of these studies are presented, as well as the lessons learnt and the challenges for modellers and disciplinary experts in advancing the reputation and performance of integrated assessment exercises.

Multidisciplinary Pediatric Obesity Clinic via Telemedicine Within the Los Angeles Metropolitan Area: Lessons Learned.

PubMed

Slusser, Wendy; Whitley, Margaret; Izadpanah, Nilufar; Kim, Sion L; Ponturo, Don

2016-03-01

Telemedicine has been shown to be effective for rural populations, but little is reported on pediatric obesity care via telemedicine in urban settings. This study aims to assess feasibility and acceptability of multidisciplinary pediatric obesity care via telemedicine within the same metropolitan area in terms of information technology, coordination, patient care, and clinical outcomes. All project notes and communications were reviewed to extract key lessons from implementation. Patient and Provider Satisfaction Questionnaires were conducted to assess overall satisfaction; baseline and follow-up information were collected from chart reviews to evaluate clinical outcomes. Based on the questionnaires, 93% of responding patients (n = 28) and 88.3% of referring providers (n = 17) felt satisfied with the appointment. Chart review indicated a trend for decreased or stabilized body mass index and blood pressure (n = 32). Implementation of telemedicine for tertiary multidisciplinary pediatric obesity care in urban settings is both feasible and acceptable to patients and health care providers. © The Author(s) 2015.

Enhancing Teacher Preparation and Improving Faculty Teaching Skills: Lessons Learned from Implementing ``Science That Matters'' a Standards Based Interdisciplinary Science Course Sequence

NASA Astrophysics Data System (ADS)

Potter, Robert; Meisels, Gerry

2005-06-01

In a highly collaborative process we developed an introductory science course sequence to improve science literacy especially among future elementary and middle school education majors. The materials and course features were designed using the results of research on teaching and learning to provide a rigorous, relevant and engaging, standard based science experience. More than ten years of combined planning, development, implementation and assessment of this college science course sequence for nonmajors/future teachers has provided significant insights and success in achieving our goal. This paper describes the history and iterative nature of our ongoing improvements, changes in faculty instructional practice, strategies used to overcome student resistance, significant student learning outcomes, support structures for faculty, and the essential and informative role of assessment in improving the outcomes. Our experience with diverse institutions, students and faculty provides the basis for the lessons we have learned and should be of help to others involved in advancing science education.

Pd-catalyzed allylic alkylation of dienyl carbonates with nitromethane with high C-5 regioselectivity.

PubMed

Yang, Xiao-Fei; Li, Xiao-Hui; Ding, Chang-Hua; Xu, Chao-Fan; Dai, Li-Xin; Hou, Xue-Long

2014-01-14

A highly regioselective palladium-catalyzed allylic alkylation of dienyl esters with nitromethane has been developed, providing selective access to the C-5 attacked products. The structures of the ligands as well as the steric effect of the substrates are important factors in determining the regiochemical outcome of the reaction.

Multiple statistical tests: Lessons from a d20.

PubMed

Madan, Christopher R

2016-01-01

Statistical analyses are often conducted with α= .05. When multiple statistical tests are conducted, this procedure needs to be adjusted to compensate for the otherwise inflated Type I error. In some instances in tabletop gaming, sometimes it is desired to roll a 20-sided die (or 'd20') twice and take the greater outcome. Here I draw from probability theory and the case of a d20, where the probability of obtaining any specific outcome is (1)/ 20, to determine the probability of obtaining a specific outcome (Type-I error) at least once across repeated, independent statistical tests.

Effectiveness of Influenza Vaccines in Asthma: A Systematic Review and Meta-Analysis

PubMed Central

Vasileiou, Eleftheria; Sheikh, Aziz; Butler, Chris; El Ferkh, Karim; von Wissmann, Beatrix; McMenamin, Jim; Ritchie, Lewis; Schwarze, Jürgen; Papadopoulos, Nikolaos G; Johnston, Sebastian L; Tian, Lilly; Simpson, Colin R

2017-01-01

Abstract There is uncertainty about the effectiveness of influenza vaccination in persons with asthma and its impact on asthma outcomes, which may contribute to the suboptimal vaccination rates in persons with asthma. This systematic review and meta-analysis involved searching 12 international databases for randomized controlled trials (RCTs) and high-quality quasi-experimental and epidemiological studies (1970–2016). The risk of bias was low for 3 included RCTs. The quality of 3 included observational studies was moderate. The quality of evidence was very low for all study outcomes. Pooled vaccine effectiveness in 1825 persons with asthma from 2 test-negative design case-control studies was 45% (95% confidence interval [CI], 31%–56%) for laboratory-confirmed influenza. Pooled efficacy of live vaccines in reducing influenza was 81% (95% CI, 33%– 94%). Live vaccine reduced febrile illness by 72% (95% CI, 20%–90%). Influenza vaccine prevented 59%–78% of asthma attacks leading to emergency visits and/or hospitalizations. For persons with asthma, influenza vaccination may be effective in both reducing influenza infection and asthma attacks. PMID:28591866

Hydrogen Fuel Cell Analysis: Lessons Learned from Stationary Power Generation Final Report

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

Scott E. Grasman; John W. Sheffield; Fatih Dogan

2010-04-30

This study considered opportunities for hydrogen in stationary applications in order to make recommendations related to RD&D strategies that incorporate lessons learned and best practices from relevant national and international stationary power efforts, as well as cost and environmental modeling of pathways. The study analyzed the different strategies utilized in power generation systems and identified the different challenges and opportunities for producing and using hydrogen as an energy carrier. Specific objectives included both a synopsis/critical analysis of lessons learned from previous stationary power programs and recommendations for a strategy for hydrogen infrastructure deployment. This strategy incorporates all hydrogen pathways andmore » a combination of distributed power generating stations, and provides an overview of stationary power markets, benefits of hydrogen-based stationary power systems, and competitive and technological challenges. The motivation for this project was to identify the lessons learned from prior stationary power programs, including the most significant obstacles, how these obstacles have been approached, outcomes of the programs, and how this information can be used by the Hydrogen, Fuel Cells & Infrastructure Technologies Program to meet program objectives primarily related to hydrogen pathway technologies (production, storage, and delivery) and implementation of fuel cell technologies for distributed stationary power. In addition, the lessons learned address environmental and safety concerns, including codes and standards, and education of key stakeholders.« less

Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilated patients: one-year outcomes and lessons learned.

PubMed

Burns, Suzanne M; Earven, Sidenia; Fisher, Charles; Lewis, Rose; Merrell, Paul; Schubart, Jane R; Truwit, Jonathon D; Bleck, Thomas P

2003-12-01

To determine the effect of an institutional approach to the care of patients requiring mechanical ventilation for longer than three consecutive days in five adult intensive care units (ICU) on clinical and financial outcomes. A multidisciplinary team was selected from five adult ICUs to design the approach. Planning occurred from August 1999 to September 2000. The process was called outcomes management (OM) and included an evidence-based clinical pathway, protocols for weaning and sedation use, and the selection of four advanced practice nurses (called outcomes managers) to manage and monitor the program. The project was completed in a 550-bed mid-Atlantic academic medical center. The ICUs included the following: coronary care, medical ICU, neuroscience ICU, surgical trauma ICU, and thoracic cardiovascular ICU. The sample included 595 pre-OM patients and 510 post-OM patients mechanically ventilated for greater than three consecutive days. Full implementation of the OM approach occurred in March 2001. Retrospective baseline (18 months pre-OM) and prospective (12 months OM) clinical and financial data were compared. Statistically significant differences in clinical outcomes were demonstrated in the managed patients compared with those managed before the institutional approach. Outcomes include ventilator duration (median days declined from ten to nine; p =.0001), ICU length of stay (median days declined from 15 to 12; p =.0008), hospital length of stay (median days declined from 22 to 20; p =.0001), and mortality rate (declined from 38% to 31%, p =.02). More than 3,000,000 US dollars cost savings were realized in the OM group. This institutional approach to the care of patients ventilated >3 days improved all clinical and financial outcomes of interest. To date, few similar initiatives have demonstrated similar results. The approach and lessons learned in this process improvement project may be helpful to other institutions attempting to improve outcomes in this vulnerable population.

Modeling the spread of polio in an IPV-vaccinated population: lessons learned from the 2013 silent outbreak in southern Israel.

PubMed

Yaari, Rami; Kaliner, Ehud; Grotto, Itamar; Katriel, Guy; Moran-Gilad, Jacob; Sofer, Danit; Mendelson, Ella; Miller, Elizabeth; Huppert, Amit; Anis, E; Kopel, E; Manor, Y; Mor, O; Shulman, L; Singer, R; Weil, M

2016-06-23

Polio eradication is an extraordinary globally coordinated health program in terms of its magnitude and reach, leading to the elimination of wild poliovirus (WPV) in most parts of the world. In 2013, a silent outbreak of WPV was detected in Israel, a country using an inactivated polio vaccine (IPV) exclusively since 2005. The outbreak was detected using environmental surveillance (ES) of sewage reservoirs. Stool surveys indicated the outbreak to be restricted mainly to children under the age of 10 in the Bedouin population of southern Israel. In order to curtail the outbreak, a nationwide vaccination campaign using oral polio vaccine (OPV) was conducted, targeting all children under 10. A transmission model, fitted to the results of the stool surveys, with additional conditions set by the ES measurements, was used to evaluate the prevalence of WPV in Bedouin children and the effectiveness of the vaccination campaign. Employing the parameter estimates of the model fitting, the model was used to investigate the effect of alternative timings, coverages and dosages of the OPV campaign on the outcome of the outbreak. The mean estimate for the mean reproductive number was 1.77 (95 % credible interval, 1.46-2.30). With seasonal variation, the reproductive number maximum range was between zero and six. The mean estimate for the mean infectious periods was 16.8 (8.6-24.9) days. The modeling indicates the OPV campaign was effective in curtailing the outbreak. The mean estimate for the attack rate in Bedouin children under 10 at the end of 2014 was 42 % (22-65 %), whereas without the campaign the mean projected attack rate was 57 % (35-74 %). The campaign also likely shortened the duration of the outbreak by a mean estimate of 309 (2-846) days. A faster initiation of the OPV campaign could have reduced the incidence of WPV even if a lower coverage was reached, at the risk of prolonging the outbreak. OPV campaigns are essential for interrupting WPV transmission, even in a developed country setting with a high coverage of IPV. In this setting, establishing ES of WPV circulation is particularly crucial for early detection and containment of an outbreak.

Sialendoscopy in juvenile recurrent parotitis: a review of the literature.

PubMed

Canzi, P; Occhini, A; Pagella, F; Marchal, F; Benazzo, M

2013-12-01

Juvenile recurrent parotitis (JRP) is the second most frequent salivary gland disease in childhood, defined as a recurrent non-suppurative and non-obstructive parotid inflammation. The recurring attacks actually represent the most dramatic and serious aspect of this pathology, since they significantly influence the quality of life, and there are no recognized therapies to avoid them. In recent years, there are reports of many international experiences related to the management of JRP by sialendoscopy. In this context, several authors have stressed the striking role of sialendoscopy in the prevention of JRP attacks. The objective of the current review is to overview the existing literature with particular regards to diagnostic and therapeutic outcomes after the application of sialendoscopy in patients suffering from JRP.

Using State Student Unit Record Data to Increase Community College Student Success

ERIC Educational Resources Information Center

Ewell, Peter; Jenkins, Davis

2008-01-01

This chapter examines lessons learned by states that are using student unit record (SUR) data to improve outcomes for community college students and recommends steps states can take to strengthen their use of SUR databases to benefit students and communities. (Contains 1 exhibit.)

Deconstructing Normalisation: Clearing the Way for Inclusion.

ERIC Educational Resources Information Center

Culham, Andrew; Nind, Melanie

2003-01-01

This paper considers two major movements affecting the lives of people with intellectual disabilities: normalization and inclusion. It reviews the aims, processes, and outcomes of the normalization and social role valorization movement and explores its compatibility with inclusion. Lessons from normalization are applied to the inclusion movement.…

Deadly Lessons: Understanding Lethal School Violence.

ERIC Educational Resources Information Center

Moore, Mark H., Ed.; Petrie, Carol V., Ed.; Braga, Anthony A., Ed.; McLaughlin, Brenda L., Ed.

This collection of papers is the outcome of the National Academies' effort to glean information from six different case studies of student-perpetrated school shootings. Part 1, "Case Studies of Lethal School Violence," includes: "The Copycat Factor: Mental Illness, Guns, and the Shooting Incident at Heritage High School, Rockdale…

World Trade Organization: Seattle Ministerial: Outcomes and Lessons Learned,

DTIC Science & Technology

2000-02-08

Agricultural Policy . The Common Agricultural Policy is intended to preserve farm incomes and rural economies by supporting high domestic prices for a wide...variety of agricultural commodities and products. EU member states have taken a very strong position on maintaining the Common Agricultural Policy , which

The road to virtual: the Sauls Memorial Virtual Library journey.

PubMed

Waddell, Stacie; Harkness, Amy; Cohen, Mark L

2014-01-01

The Sauls Memorial Virtual Library closed its physical space in 2012. This article outlines the reasons for this change and how the library staff and hospital leadership planned and executed the enormous undertaking. Outcomes of the change and lessons learned from the process are discussed.

Laptop Lessons: Exploring the Promise of One-to-One Computing.

ERIC Educational Resources Information Center

Carter, Kim

2001-01-01

Describes benefits of programs where schools provide laptop computers for each student. Topics include results of studies that show positive learning outcomes; funding options; implementation; protecting the equipment; resources for learning about laptop programs; staff training and support; and future possibilities, including the implications of…

Creating a Learning Organization: A Case Study of Outcomes and Lessons Learned.

ERIC Educational Resources Information Center

Bierema, Laura L.; Berdish, David M.

1999-01-01

Discusses how organizations are gaining a competitive edge in a global business environment through learning and highlights a learning organization implementation case study of a division of Ford Motor Company. Examines the strategic initiative; performance improvement results; individual learning, including interpersonal development and…

Secure VM for Monitoring Industrial Process Controllers

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

Dasgupta, Dipankar; Ali, Mohammad Hassan; Abercrombie, Robert K

2011-01-01

In this paper, we examine the biological immune system as an autonomic system for self-protection, which has evolved over millions of years probably through extensive redesigning, testing, tuning and optimization process. The powerful information processing capabilities of the immune system, such as feature extraction, pattern recognition, learning, memory, and its distributive nature provide rich metaphors for its artificial counterpart. Our study focuses on building an autonomic defense system, using some immunological metaphors for information gathering, analyzing, decision making and launching threat and attack responses. In order to detection Stuxnet like malware, we propose to include a secure VM (or dedicatedmore » host) to the SCADA Network to monitor behavior and all software updates. This on-going research effort is not to mimic the nature but to explore and learn valuable lessons useful for self-adaptive cyber defense systems.« less

Twitter as a Sentinel in Emergency Situations: Lessons from the Boston Marathon Explosions

PubMed Central

Cassa, Christopher A.; Chunara, Rumi; Mandl, Kenneth; Brownstein, John S

2013-01-01

Immediately following the Boston Marathon attacks, individuals near the scene posted a deluge of data to social media sites. Previous work has shown that these data can be leveraged to provide rapid insight during natural disasters, disease outbreaks and ongoing conflicts that can assist in the public health and medical response. Here, we examine and discuss the social media messages posted immediately after and around the Boston Marathon bombings, and find that specific keywords appear frequently prior to official public safety and news media reports. Individuals immediately adjacent to the explosions posted messages within minutes via Twitter which identify the location and specifics of events, demonstrating a role for social media in the early recognition and characterization of emergency events. *Christopher Cassa and Rumi Chunara contributed equally to this work. PMID:23852273

Elements of impact assessment: a case study with cyber attacks

NASA Astrophysics Data System (ADS)

Yang, Shanchieh Jay; Holsopple, Jared; Liu, Daniel

2009-05-01

Extensive discussions have taken place in recent year regarding impact assessment - what is it and how can we do it? It is especially intriguing in this modern era where non-traditional warfare has caused either information overload or limited understanding of adversary doctrines. This work provides a methodical discussion of key elements for the broad definition of impact assessment (IA). The discussion will start with a process flow involving components related to IA. Two key functional components, impact estimation and threat projection, are compared and illustrated in detail. These details include a discussion of when to model red and blue knowledge. Algorithmic approaches will be discussed, augmented with lessons learned from our IA development for cyber situation awareness. This paper aims at providing the community with a systematic understanding of IA and its open issues with specific examples.

Comparative efficacy trial of cupping and serkangabin versus conventional therapy of migraine headaches: A randomized, open-label, comparative efficacy trial.

PubMed

Firoozabadi, Mohammad Dehghani; Navabzadeh, Maryam; Roudsari, Mohammad Khodashenas; Zahmatkash, Mohsen

2014-12-01

Migraine headaches are the most common acute and recurrent headaches. Current treatment of a migraine headache consists of multiple medications for control and prevention of recurrent attacks. Global emergence of alternative medicine led us to examine the efficacy of cupping therapy plus serkangabin syrup in the treatment of migraine headaches. This study was a randomized, controlled, open-label, comparative efficacy trial. We randomly assigned patients with migraine into cupping therapy plus serkangabin group (30 patients) and conventional treatment group (30 patients). An investigator assessed the severity of headache, frequency of attacks in a week and duration of attacks per hour in 5 visits (at the end of 2 weeks, 1, 3 and 6 months). Generalized estimating equations approach was used to analyze repeated measures data to compare outcomes in both groups. Average age for cupping therapy group and conventional treatment group were 31.7 (±7.6) and 32.6 (±12.7) years, respectively (P = 0.45). After treatment for 2 weeks; and 1, 3 and 6 months, severity of headache (P = 0.80), frequency of migraine attacks (P = 0.63) and duration of attacks per hours (P = 0.48) were similar in conventional and cupping groups but these symptoms were decreased in each group during the study (P < 0.001). There was no significant difference between cupping plus serkangabin therapy and conventional treatment in the treatment and prophylaxis of migraine. The alternative therapy may be used in cases of drug intolerance, no medication response, and in primary care.

Comparative efficacy trial of cupping and serkangabin versus conventional therapy of migraine headaches: A randomized, open-label, comparative efficacy trial

PubMed Central

Firoozabadi, Mohammad Dehghani; Navabzadeh, Maryam; Roudsari, Mohammad Khodashenas; Zahmatkash, Mohsen

2014-01-01

Background: Migraine headaches are the most common acute and recurrent headaches. Current treatment of a migraine headache consists of multiple medications for control and prevention of recurrent attacks. Global emergence of alternative medicine led us to examine the efficacy of cupping therapy plus serkangabin syrup in the treatment of migraine headaches. Materials and Methods: This study was a randomized, controlled, open-label, comparative efficacy trial. We randomly assigned patients with migraine into cupping therapy plus serkangabin group (30 patients) and conventional treatment group (30 patients). An investigator assessed the severity of headache, frequency of attacks in a week and duration of attacks per hour in 5 visits (at the end of 2 weeks, 1, 3 and 6 months). Generalized estimating equations approach was used to analyze repeated measures data to compare outcomes in both groups. Results: Average age for cupping therapy group and conventional treatment group were 31.7 (±7.6) and 32.6 (±12.7) years, respectively (P = 0.45). After treatment for 2 weeks; and 1, 3 and 6 months, severity of headache (P = 0.80), frequency of migraine attacks (P = 0.63) and duration of attacks per hours (P = 0.48) were similar in conventional and cupping groups but these symptoms were decreased in each group during the study (P < 0.001). Conclusion: There was no significant difference between cupping plus serkangabin therapy and conventional treatment in the treatment and prophylaxis of migraine. The alternative therapy may be used in cases of drug intolerance, no medication response, and in primary care. PMID:25709653

How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack?

PubMed

Doijiri, Ryosuke; Uno, Hisakazu; Miyashita, Kotaro; Ihara, Masafumi; Nagatsuka, Kazuyuki

2016-10-01

The sudden development of vertigo or dizziness without focal neurological symptoms is generally attributable to vestibular diseases such as benign paroxysmal positional vertigo. Isolated vertigo or dizziness attack needs more attention than vestibular diseases. This retrospective study was performed to elucidate the frequency of strokes in patients with isolated vertigo or dizziness attack. We enrolled 221 patients (men, 119; women, 102; mean age, 68.4 ± 10.3 years) who were admitted to our hospital over the last 10 years because of sudden isolated vertigo or dizziness attack without other neurological symptoms except for nystagmus, deafness, or tinnitus. We investigated the clinical features, final diagnosis, neuroimaging findings, and short- or long-term outcome of these patients. One hundred eighteen patients had vertigo whereas the other 103 had dizziness. Brain computed tomography or magnetic resonance imaging revealed recent stroke lesions in 25 patients (11.3%) (ischemic, 21; hemorrhagic, 4).The lesions were generally small and localized in the cerebellum (n = 21), pons (n = 1), medulla oblongata (n = 1), or corona radiata (n = 1). Of the 25 patients, 19 (76%) had dizzy-type spells; none had neurological dysfunction at the time of discharge. In the remaining 196 patients, no stroke was detected on computed tomography or magnetic resonance imaging. Stroke was found in 11% of patients with isolated vertigo or dizziness attack. The posterior inferior cerebellar artery area was the most frequently implicated for isolated vertigo or dizziness. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Coloring of the past via respondent's current psychological state, mediation, and the association between childhood disadvantage and morbidity in adulthood.

PubMed

Sheikh, Mashhood Ahmed

2018-05-31

Many researchers view retrospective reports with skepticism. Indeed, the observed association between retrospectively-reported childhood disadvantage (CD) and morbidity in adulthood has been criticized as an artefactual correlation driven by the psychological state of the respondent at the time of reporting (current psychological state). The aim of this study was to assess the role of current psychological state in the association between childhood disadvantage and morbidity in adulthood. The present analysis used cross-sectional data collected in 2007-2008 within the framework of the Tromsø Study (N = 10,765), a representative study of adult men and women in Norway. The association between CD and the physical health outcomes heart attack, angina pectoris, chronic bronchitis/emphysema/COPD, diabetes mellitus, hypothyroid/low metabolism, migraine, hypertension, and comorbidity (i.e., the sum of these physical health outcomes) was assessed with Poisson regression models. Relative risks (RR) and 95% confidence intervals (CI) were estimated. A wide range of indicators of respondents' current psychological state were included in the models to assess the % attenuation in estimates. CD was associated with an increased risk of heart attack, angina pectoris, chronic bronchitis/emphysema/COPD, diabetes mellitus, hypothyroid/low metabolism, migraine, hypertension, and comorbidity (p < 0.05), independent of respondents' current psychological state. A sizeable proportion (23-42%) of the association between CD and physical health outcomes was driven by recall bias or mediation via respondents' current psychological state. Controlling for indicators of current psychological state reduced the strength of associations between CD and physical health outcomes; however, the independent associations remained in the same direction. The association between retrospectively-reported CD and physical health outcomes in adulthood is not driven entirely by respondent's current psychological state. Copyright © 2018 Elsevier Ltd. All rights reserved.

The cycle of violence and victimization: a study of the school-based intervention of a multidisciplinary youth violence-prevention program.

PubMed

Nadel, H; Spellmann, M; Alvarez-Canino, T; Lausell-Bryant, L L; Landsberg, G

1996-01-01

This article reports on the school-based intervention component of a multidisciplinary program intended to reduce and prevent youth violence in the East New York neighborhood of Brooklyn. This intervention is based on three theories. The first theory posits that modifying beliefs, attitudes, and norms will help youths develop behaviors that support nonviolence. The second theoretical construct asserts that enhancing relationships with peers and family will buffer youths from the effects of exposure to violence. Finally, the third theory suggests that changing aspects of the setting and climate that contribute to violent behavior will prevent violence. The school-based intervention, the Safe Harbor, is a victim-assistance and violence-prevention program. The Safe Harbor offers activities including a 20-lesson violence-prevention and victim-assistance curriculum, counseling, parent involvement, teacher training, and school-change campaigns. The evaluation design is a panel study, with cohorts surveyed longitudinally at nonequivalent intervals. One hundred and fifteen seventh- and eighth-grade students who receive the curriculum and other services are the experimental group; the other 879 students in the seventh and eighth grades serve as the comparison group. Baseline data were collected through a survey of the entire school before the program's implementation in January 1995. Subsequent data collection will include interviews and focus groups; future analysis will address how participation in other parts of the Safe Harbor program or other programs in the school affects outcomes. The participation rate for the baseline survey in the experimental group was 86%, in the comparison group 76%. Responses to the survey questions were virtually identical between the two groups. Preliminary analyses reflect a climate of pervasive violence in the school, family, and community. More than half of the sample reported witnessing a severe beating in the school or their community within the past four months. Forty-four percent witnessed someone being attacked with a weapon in their neighborhood. The psychological consequences of exposure to violence were severe-51% of the sample reported post-traumatic stress disorder (PTSD) symptoms. A number of lessons have been learned from implementing and evaluating this project, including the importance of fostering community partnership and strong relationships with the school, and addressing both reactions to victimization and norms and beliefs about aggression.

More effective and less expensive: lessons from five studies examining community approaches to care.

PubMed

Browne, G; Roberts, J; Gafni, A; Weir, R; Watt, S; Byrne, C

1995-11-01

Does the nature of community health services used by chronically ill clients and their caregivers have an impact on utilization of services, expenditure and well-being outcomes? A series of five studies, (four historic cohort and one randomized trial) examined clients suffering from a variety of chronic conditions in a number of community settings in different regions of Southern Ontario. Study sample composition and size varied. Each study was designed to quantify the well-being outcomes, and expenditure associated with different community approaches is covered under a nation-wide system of health insurance plans. As a collective, these studies represent increasing methodological rigor. Multiple-perspective client well-being outcome measures were used. Caregiver burden was also analyzed. A common approach to quantification and evaluation of expenditure for service consumption was applied across all five studies. The nature of community health services (proactive versus reactive approaches to care) was found to have direct and measurable impact on total expenditure for health service utilization and client well-being outcomes. A recurring pattern of lower expenditure for community health service utilization and equal or better client outcomes was associated with well-integrated proactive services when compared with individual fragmented, reactive approaches to care. The main lesson emerging from examining the five studies on approaches to community care is that it is as, or more, effective and less expensive to offer complete proactive health care services to chronically ill people in the early stages of their illness than to provide services on demand in a piecemeal manner.

Analytical model for instantaneous lift and shape deformation of an insect-scale flapping wing in hover.

PubMed

Kang, Chang-kwon; Shyy, Wei

2014-12-06

In the analysis of flexible flapping wings of insects, the aerodynamic outcome depends on the combined structural dynamics and unsteady fluid physics. Because the wing shape and hence the resulting effective angle of attack are a priori unknown, predicting aerodynamic performance is challenging. Here, we show that a coupled aerodynamics/structural dynamics model can be established for hovering, based on a linear beam equation with the Morison equation to account for both added mass and aerodynamic damping effects. Lift strongly depends on the instantaneous angle of attack, resulting from passive pitch associated with wing deformation. We show that both instantaneous wing deformation and lift can be predicted in a much simplified framework. Moreover, our analysis suggests that resulting wing kinematics can be explained by the interplay between acceleration-related and aerodynamic damping forces. Interestingly, while both forces combine to create a high angle of attack resulting in high lift around the midstroke, they offset each other for phase control at the end of the stroke. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Transient ischameic attack/stroke electronic decision support: a 14-month safety audit.

PubMed

Lavin, Timothy L; Ranta, Annemarei

2014-02-01

To assess the safety of a Transient Ischameic Attack (TIA)/Stroke Electronic Decision Support (EDS) tool in the primary care setting intended to aid general practitioners in the timely management of transient ischemic attacks (TIAs). A 14-month safety audit reviewing all patients managed with the help of the TIA/Stroke EDS tool. Major morbidity and mortality were assessed by screening patients for subsequent hospital admissions and investigating potential links to EDS use. Seventy-nine patients were managed with the aid of the TIA/Stroke EDS. EDS use resulted in 8 appropriate immediate hospital admissions because of patients being at high risk of stroke. Three patients had delayed admission, but care was fully guideline based and patients had no adverse outcome. Eleven admissions were unrelated to EDS use. Two deaths occurred; these did not result from inappropriate EDS advice. Results suggest that TIA/Stroke EDS use is not associated with major morbidity or mortality. Larger studies are needed to draw more definite conclusions regarding the utility of this TIA/Stroke EDS in preventing strokes. Copyright © 2014 National Stroke Association. All rights reserved.

Evaluating a Cross-Continent EU Simulation

ERIC Educational Resources Information Center

Jones, Rebecca

2008-01-01

Assessment of learning outcomes and evaluation of teaching methods are necessary in order to ensure that students are learning the lessons that faculty believe they are conveying. Quantitative data on the effectiveness of various pedagogical methods allows faculty to make adjustments to classes over time. Regular assessment of student learning…