20 CFR 10.116 - What additional evidence is needed in cases based on occupational disease?

Code of Federal Regulations, 2014 CFR

2014-04-01

... based on occupational disease? 10.116 Section 10.116 Employees' Benefits OFFICE OF WORKERS' COMPENSATION... of Proof § 10.116 What additional evidence is needed in cases based on occupational disease? (a) The... particular occupational diseases. The medical report should also include the information specified on the...

An Analysis of Earth Science Data Analytics Use Cases

NASA Technical Reports Server (NTRS)

Shie, Chung-Lin; Kempler, Steve

2014-01-01

The increase in the number and volume, and sources, of globally available Earth science data measurements and datasets have afforded Earth scientists and applications researchers unprecedented opportunities to study our Earth in ever more sophisticated ways. In fact, the NASA Earth Observing System Data Information System (EOSDIS) archives have doubled from 2007 to 2014, to 9.1 PB (Ramapriyan, 2009; and https:earthdata.nasa.govaboutsystem-- performance). In addition, other US agency, international programs, field experiments, ground stations, and citizen scientists provide a plethora of additional sources for studying Earth. Co--analyzing huge amounts of heterogeneous data to glean out unobvious information is a daunting task. Earth science data analytics (ESDA) is the process of examining large amounts of data of a variety of types to uncover hidden patterns, unknown correlations and other useful information. It can include Data Preparation, Data Reduction, and Data Analysis. Through work associated with the Earth Science Information Partners (ESIP) Federation, a collection of Earth science data analytics use cases have been collected and analyzed for the purpose of extracting the types of Earth science data analytics employed, and requirements for data analytics tools and techniques yet to be implemented, based on use case needs. ESIP generated use case template, ESDA use cases, use case types, and preliminary use case analysis (this is a work in progress) will be presented.

RISK COMMUNICATION IN ACTION: CASE STUDIES IN FISH ADVISORIES

EPA Science Inventory

This Handbook provides both general and specific information on how to enhance mercury risk communication activities and their associated outreach efforts. Additionally, it provides information on how to facilitate communication in areas where information is not available. Chapte...

Pattern analysis of fraud case in Taiwan, China and Indonesia

NASA Astrophysics Data System (ADS)

Kusumo, A. H.; Chi, C.-F.; Dewi, R. S.

2017-11-01

The current study analyzed 125 successful fraud cases happened in Taiwan, China, and Indonesia from 2008 to 2012 published in the English online newspapers. Each of the case report was coded in terms of scam principle, information media (information exchange between fraudsters and victim), money media (media used by fraudsters to obtain unauthorized financial benefit) and other additional information which was judged to be relevant. The Chi-square Automatic Interaction Detector (CHAID) was applied to the coded data of information, scam principle and money media to find a subset of predictors that might derive meaningful classifications. A series of flow diagrams was constructed based on CHAID result to illustrate the flow of information (scam) travelling from information media to money media.

Explicit Instruction of Graphic Organizers as an Informational Text Reading Comprehension Strategy: Third-Grade Students' Strategies and Perceptions

ERIC Educational Resources Information Center

Fealy, Erin Marie

2010-01-01

The purpose of this case study research was to explore the effects of explicit instruction of graphic organizers to support students' understandings of informational text. An additional purpose was to investigate students' perceptions of using graphic organizers as a comprehension strategy. Using case study methodology, this study occurred…

49 CFR 15.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2012 CFR

2012-10-01

... DOT or DHS component or agency. (d) Additional requirements for critical infrastructure information. In the case of information that is both SSI and has been designated as critical infrastructure...

49 CFR 15.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2013 CFR

2013-10-01

... DOT or DHS component or agency. (d) Additional requirements for critical infrastructure information. In the case of information that is both SSI and has been designated as critical infrastructure...

49 CFR 15.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2014 CFR

2014-10-01

... DOT or DHS component or agency. (d) Additional requirements for critical infrastructure information. In the case of information that is both SSI and has been designated as critical infrastructure...

Mental Retardation and the Law: A Report on Status of Current Court Cases.

ERIC Educational Resources Information Center

President's Committee on Mental Retardation, Washington, DC.

Featured in the issue is an analysis of the consent Decree in New York State Association for Retarded Children v. Carey (Willowbrook case). In addition, summaries and updated information are presented for 25 new cases and 34 cases previously reported regarding the following topics: architectural barriers, classification, commitment, custody,…

Changes in frequency of recall recommendations of examinations depicting cancer with the availability of either priors or digital breast tomosynthesis

NASA Astrophysics Data System (ADS)

Hakim, Christiane M.; Bandos, Andriy I.; Ganott, Marie A.; Catullo, Victor J.; Chough, Denise M.; Kelly, Amy E.; Shinde, Dilip D.; Sumkin, Jules H.; Wallace, Luisa P.; Nishikawa, Robert M.; Gur, David

2016-03-01

Performance changes in a binary environment when using additional information is affected only when changes in recommendations are made due to the additional information in question. In a recent study, we have shown that, contrary to general expectation, introducing prior examinations improved recall rates, but not sensitivity. In this study, we assessed cancer detection differences when prior examinations and/or digital breast tomosynthesis (DBT) were made available to the radiologist. We identified a subset of 21 cancer cases with differences in the number of radiologists who recalled these cases after reviewing either a prior examination or DBT. For the cases with differences in recommendations after viewing either priors or DBT, separately, we evaluated the total number of readers that changed their recommendations, regardless of the specific radiologist in question. Confidence intervals for the number of readers and a test for the hypothesis of no difference was performed using the non-parameteric bootstrap approach addressing both case and reader-related sources of variability by resampling cases and readers. With the addition of priors, there were 14 cancer cases (out of 15) where the number of "recalling radiologists" decreased. With the addition of DBT, the number of "recalling radiologists" decreased in only five cases (out of 15) while increasing in the remaining 9 cases. Unlike most new approaches to breast imaging DBT seems to improve both recall rates and cancer detection rates. Changes in recommendations were noted by all radiologists for all cancers by type, size, and breast density.

Description of 103 Cases of Hypobaric Sickness from NASA-sponsored Research

NASA Technical Reports Server (NTRS)

Conkin, Johnny; Klein, Jill S.; Acock, Keena E.

2003-01-01

One hundred and three cases of hypobaric decompression sickness (DCS) are documented, with 6 classified as Type II DCS. The presence and grade of venous gas emboli (VGE) are part of the case descriptions. Cases were diagnosed from 731 exposures in 5 different altitude chambers from 4 different laboratories between the years 1982 and 1999. Research was funded by NASA to develop operational prebreathe (PB) procedures that would permit safe extravehicular activity from the Space Shuttle and International Space Station using an extravehicular mobility unit (spacesuit) operated at 4.3 psia. Both vehicles operate at 14.7 psia with an "air" atmosphere, so a PB procedure is required to reduce nitrogen partial pressure in the tissues to an acceptable level prior to depressurization to 4.3 psia. Thirty-two additional descriptions of symptoms that were not diagnosed as DCS together with VGE information are also included. The information for each case resides in logbooks from 32 different tests. Additional information is stored in the NASA Decompression Sickness Database and the Prebreathe Reduction Protocol Database, both maintained by the Environmental Physiology Laboratory at the Johnson Space Center. Both sources were reviewed to provide the narratives that follow.

75 FR 42296 - Safe, Efficient Use and Preservation of the Navigable Airspace

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-21

... facilitates the aeronautical study process and has reduced the overall processing time for these cases. The... cases to be processed, particularly if additional information, via public comment period, was necessary... the permit application is not necessary. There are cases where circulating the proposal for public...

49 CFR 1520.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2011 CFR

2011-10-01

... inform TSA or the applicable DOT or DHS component or agency. (d) Additional Requirements for Critical Infrastructure Information. In the case of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland Security Act, any covered person who is a Federal...

49 CFR 1520.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2013 CFR

2013-10-01

... inform TSA or the applicable DOT or DHS component or agency. (d) Additional Requirements for Critical Infrastructure Information. In the case of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland Security Act, any covered person who is a Federal...

49 CFR 1520.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2014 CFR

2014-10-01

... inform TSA or the applicable DOT or DHS component or agency. (d) Additional Requirements for Critical Infrastructure Information. In the case of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland Security Act, any covered person who is a Federal...

49 CFR 1520.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2012 CFR

2012-10-01

... inform TSA or the applicable DOT or DHS component or agency. (d) Additional Requirements for Critical Infrastructure Information. In the case of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland Security Act, any covered person who is a Federal...

75 FR 41173 - Call for Information: Information on Greenhouse Gas Emissions Associated With Bioenergy and Other...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-15

... oversimplify a complex issue. If this is the case, what alternative approaches or additional analytical tools... Information to solicit information and viewpoints from interested parties on approaches to accounting for... comment on developing an approach for such emissions under the Prevention of Significant Deterioration...

Use of an Additional 19-G EBUS-TBNA Needle Increases the Diagnostic Yield of EBUS-TBNA.

PubMed

Garrison, Garth; Leclair, Timothy; Balla, Agnes; Wagner, Sarah; Butnor, Kelly; Anderson, Scott R; Kinsey, C Matthew

2018-06-12

Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has an excellent diagnostic yield, there remain cases where the diagnosis is not obtained. We hypothesized that additional sampling with a 19-G EBUS-TBNA needle may increase diagnostic yield in a subset of cases where additional tissue sampling was required. Indications for use of the 19-G needle following 22-G sampling with rapid on-site cytologic examination were: (1) diagnostic uncertainty of the on-site cytopathologist (eg, nondiagnostic, probable lymphoma, etc.), (2) non-small cell lung cancer with probable need for molecular genetic and/or PD-L1 testing, or (3) need for a larger tissue sample for consideration of inclusion in a research protocol. A 19-G EBUS-TBNA needle was utilized following standard sampling with a 22-G needle in 48 patients (50 sites) during the same procedure. Although the diagnostic yield between the needles was equivalent, the concordance rate was only 83%. The 19-G determined a diagnosis in 4 additional patients (8%) and provided additional histopathologic information in 6 other cases (12%). Conversely, in 3 cases (6%) diagnostic information was provided only by the 22-G needle. Compared with 22-G EBUS-TBNA alone, sampling with both the 22- and 19-G EBUS needles resulted in an increase in diagnostic yield from 92% to 99% (P=0.045) and a number needed to sample of 13 patients to provide one additional diagnosis. There were no significant complications. In select cases where additional tissue may be needed, sampling with a 19-G EBUS needle following standard aspiration with a 22-G needle results in an increase in diagnostic yield.

Systematic review of general thoracic surgery articles to identify predictors of operating room case durations.

PubMed

Dexter, Franklin; Dexter, Elisabeth U; Masursky, Danielle; Nussmeier, Nancy A

2008-04-01

Previous studies of operating room (OR) information systems data over the past two decades have shown how to predict case durations using the combination of scheduled procedure(s), individual surgeon and assistant(s), and type of anesthetic(s). We hypothesized that the accuracy of case duration prediction could be improved by the use of other electronic medical record data (e.g., patient weight or surgeon notes using standardized vocabularies). General thoracic surgery was used as a model specialty because much of its workload is elective (scheduled) and many of its cases are long. PubMed was searched for thoracic surgery papers reporting operative time, surgical time, etc. The systematic literature review identified 48 papers reporting statistically significant differences in perioperative times. There were multiple reports of differences in OR times based on the procedure(s), perioperative team including primary surgeon, and type of anesthetic, in that sequence of importance. All such detail may not be known when the case is originally scheduled and thus may require an updated duration the day before surgery. Although the use of these categorical data from OR systems can result in few historical data for estimating each case's duration, bias and imprecision of case duration estimates are unlikely to be affected. There was a report of a difference in case duration based on additional information. However, the incidence of the procedure for the diagnosis was so uncommon as to be unlikely to affect OR management. Matching findings of prior studies using OR information system data, multiple case series show that it is important to rely on the precise procedure(s), surgical team, and type of anesthetic when estimating case durations. OR information systems need to incorporate the statistical methods designed for small numbers of prior surgical cases. Future research should focus on the most effective methods to update the prediction of each case's duration as these data become available. The case series did not reveal additional data which could be cost-effectively integrated with OR information systems data to improve the accuracy of predicted durations for general thoracic surgery cases.

Leveraging social networking sites for disease surveillance and public sensing: the case of the 2013 avian influenza A(H7N9) outbreak in China.

PubMed

Zhang, Emma Xuxiao; Yang, Yinping; Di Shang, Richard; Simons, Joseph John Pyne; Quek, Boon Kiat; Yin, Xiao Feng; See, Wanhan; Oh, Olivia Seen Huey; Nandar, Khine Sein Tun; Ling, Vivienne Ruo Yun; Chan, Pei Pei; Wang, Zhaoxia; Goh, Rick Siow Mong; James, Lyn; Tey, Jeannie Su Hui

2015-01-01

We conducted in-depth analysis on the use of a popular Chinese social networking and microblogging site, Sina Weibo, to monitor an avian influenza A(H7N9) outbreak in China and to assess the value of social networking sites in the surveillance of disease outbreaks that occur overseas. Two data sets were employed for our analysis: a line listing of confirmed cases obtained from conventional public health information channels and case information from Weibo posts. Our findings showed that the level of activity on Weibo corresponded with the number of new cases reported. In addition, the reporting of new cases on Weibo was significantly faster than those of conventional reporting sites and non-local news media. A qualitative review of the functions of Weibo also revealed that Weibo enabled timely monitoring of other outbreak-relevant information, provided access to additional crowd-sourced epidemiological information and was leveraged by the local government as an interactive platform for risk communication and monitoring public sentiment on the policy response. Our analysis demonstrated the potential for social networking sites to be used by public health agencies to enhance traditional communicable disease surveillance systems for the global surveillance of overseas public health threats. Social networking sites also can be used by governments for calibration of response policies and measures and for risk communication.

Leveraging social networking sites for disease surveillance and public sensing: the case of the 2013 avian influenza A(H7N9) outbreak in China

PubMed Central

Zhang, Emma Xuxiao; Yang, Yinping; Di Shang, Richard; Simons, Joseph John Pyne; Quek, Boon Kiat; Yin, Xiao Feng; See, Wanhan; Oh, Olivia Seen Huey; Nandar, Khine Sein Tun; Ling, Vivienne Ruo Yun; Chan, Pei Pei; Wang, Zhaoxia; Goh, Rick Siow Mong; James, Lyn

2015-01-01

We conducted in-depth analysis on the use of a popular Chinese social networking and microblogging site, Sina Weibo, to monitor an avian influenza A(H7N9) outbreak in China and to assess the value of social networking sites in the surveillance of disease outbreaks that occur overseas. Two data sets were employed for our analysis: a line listing of confirmed cases obtained from conventional public health information channels and case information from Weibo posts. Our findings showed that the level of activity on Weibo corresponded with the number of new cases reported. In addition, the reporting of new cases on Weibo was significantly faster than those of conventional reporting sites and non-local news media. A qualitative review of the functions of Weibo also revealed that Weibo enabled timely monitoring of other outbreak-relevant information, provided access to additional crowd-sourced epidemiological information and was leveraged by the local government as an interactive platform for risk communication and monitoring public sentiment on the policy response. Our analysis demonstrated the potential for social networking sites to be used by public health agencies to enhance traditional communicable disease surveillance systems for the global surveillance of overseas public health threats. Social networking sites also can be used by governments for calibration of response policies and measures and for risk communication. PMID:26306219

Diagnostic value of contrast-enhanced ultrasonography in the characterization of ovarian tumors☆

PubMed Central

Sconfienza, L.M.; Perrone, N.; Delnevo, A.; Lacelli, F.; Murolo, C.; Gandolfo, N.; Serafini, G.

2009-01-01

Introduction Vascularity influences the characteristics of gynecologic tumors observed with direct imaging techniques that reveal the macrovascular component of these lesions (color and power Doppler) and with indirect imaging involving the administration of contrast agents to examine the microcirculation and interstitial perfusion (contrast-enhanced computed tomography [CT] and magnetic resonance [MR] imaging). The purpose of this study was to determine whether contrast-enhanced ultrasonography (CEUS) of ovarian lesions provides useful information that cannot be obtained with conventional US. Materials and methods We used CEUS to assess 72 nonspecific adnexal lesions in 61 patients. CEUS was performed with a 4.8-ml bolus of a second-generation ultrasonographic contrast agent and dedicated imaging algorithms. For each lesion, B-mode morphology, CEUS morphology, and time/intensity curves were evaluated. Results In 8/61 cases (13.1%) CEUS offered no additional morphovascular information. In 38/61 cases (62.3%), it provided additional information that did not modify the management of the lesion, and in 15/61 cases (24.6%) it gave additional information that modified the management of the lesion. Malignant lesions were characterized by significantly shorter times to peak enhancement (11.9 ± 3.1 s vs 19.8 ± 4.0 s p < 0.01) and significantly higher peak intensity (24.7 ± 4.2 dB vs 17.8 ± 3.3 dB p < 0.01) compared with benign lesions. Conclusions CEUS improves diagnostic confidence in the characterization of liquid-corpuscular lesions where conventional US is inconclusive. CEUS can be proposed as a valid alternative to CT and MR. However, information obtained by CEUS influences the therapy in a limited percentage of cases (24.6%). PMID:23396092

Diagnostic value of contrast-enhanced ultrasonography in the characterization of ovarian tumors().

PubMed

Sconfienza, L M; Perrone, N; Delnevo, A; Lacelli, F; Murolo, C; Gandolfo, N; Serafini, G

2010-03-01

Vascularity influences the characteristics of gynecologic tumors observed with direct imaging techniques that reveal the macrovascular component of these lesions (color and power Doppler) and with indirect imaging involving the administration of contrast agents to examine the microcirculation and interstitial perfusion (contrast-enhanced computed tomography [CT] and magnetic resonance [MR] imaging). The purpose of this study was to determine whether contrast-enhanced ultrasonography (CEUS) of ovarian lesions provides useful information that cannot be obtained with conventional US. We used CEUS to assess 72 nonspecific adnexal lesions in 61 patients. CEUS was performed with a 4.8-ml bolus of a second-generation ultrasonographic contrast agent and dedicated imaging algorithms. For each lesion, B-mode morphology, CEUS morphology, and time/intensity curves were evaluated. In 8/61 cases (13.1%) CEUS offered no additional morphovascular information. In 38/61 cases (62.3%), it provided additional information that did not modify the management of the lesion, and in 15/61 cases (24.6%) it gave additional information that modified the management of the lesion. Malignant lesions were characterized by significantly shorter times to peak enhancement (11.9 ± 3.1 s vs 19.8 ± 4.0 s p < 0.01) and significantly higher peak intensity (24.7 ± 4.2 dB vs 17.8 ± 3.3 dB p < 0.01) compared with benign lesions. CEUS improves diagnostic confidence in the characterization of liquid-corpuscular lesions where conventional US is inconclusive. CEUS can be proposed as a valid alternative to CT and MR. However, information obtained by CEUS influences the therapy in a limited percentage of cases (24.6%).

Emerging Technologies for Real-Time Continuous Monitoring of Wellbore Integrity

NASA Astrophysics Data System (ADS)

Freifeld, B. M.

2017-12-01

Assessment of a well's integrity has traditionally been carried out through periodic wireline logging, often performed only when an operational problem was noted at the surface. There are several emerging technologies that can be installed permanently as part of the well completion and offer the ability to monitor operations while providing continuous indicators to evaluate the structural health of a well. Permanent behind casing instrumentation, such as pressure and temperature gauges can monitor for behind casing leakage. Similarly, fiber-optic distributed temperature and acoustic sensing provide additional information for assessing unwanted movement of fluid, which is indicative of problems either inside or outside of casing. Furthermore, these technologies offer the benefit of providing real-time continuous streams of information that serve as leading-indicators of wellbore problems to allow for early intervention. Additional research is still needed to develop best practices for the installation and operation of these technologies, as they increase cost and add additional risks that must be managed.

Issues in Developing Programmes to Support Teachers of Philology in Using Information and Communications Technologies in Greek Schools: A Case Study

ERIC Educational Resources Information Center

Fragkouli, Elpiniki; Hammond, Michael

2007-01-01

This paper reports on a case study of an in-service teacher-training programme for Greek philology teachers, from 2002 to 2003, which was designed to develop the use of information and communications technologies in their teaching. It draws on questionnaires and interviews with 34 teachers who took part in the training. In addition, the three…

Analytical 3D views and virtual globes — scientific results in a familiar spatial context

NASA Astrophysics Data System (ADS)

Tiede, Dirk; Lang, Stefan

In this paper we introduce analytical three-dimensional (3D) views as a means for effective and comprehensible information delivery, using virtual globes and the third dimension as an additional information carrier. Four case studies are presented, in which information extraction results from very high spatial resolution (VHSR) satellite images were conditioned and aggregated or disaggregated to regular spatial units. The case studies were embedded in the context of: (1) urban life quality assessment (Salzburg/Austria); (2) post-disaster assessment (Harare/Zimbabwe); (3) emergency response (Lukole/Tanzania); and (4) contingency planning (faked crisis scenario/Germany). The results are made available in different virtual globe environments, using the implemented contextual data (such as satellite imagery, aerial photographs, and auxiliary geodata) as valuable additional context information. Both day-to-day users and high-level decision makers are addressees of this tailored information product. The degree of abstraction required for understanding a complex analytical content is balanced with the ease and appeal by which the context is conveyed.

Joint Forces Command - Operation United Assistance Case Study: Lessons and Best Practices

DTIC Science & Technology

2016-07-01

additional and prioritized computers and access in the operations center for these mission requirements are essential. 127 JFC-OUA CASE STUDY Issue...this publication is welcomed and highly encouraged. Joint Forces Command – Operation United Assistance Case Study JFC-OUA CASE STUDY iii Foreword...Based on information drawn from various sources including after action reports, lessons learned, case studies , umbrella-week visits, and key-leader

Case managers and the use of Medicare, Part D.

PubMed

Hensley, Melissa Anne

2011-01-01

The purpose of this study was to examine the experiences and opinions of community-based mental health case managers with the Medicare prescription drug benefit. A qualitative approach, consisting of analysis of data from 3 case manager focus groups, was used to achieve an understanding of the role that case managers played in beneficiaries' access to and use of prescription medicines. Two urban nonprofit community-based mental health agencies. Adults who are disabled by mental illness depend on case managers for information about their prescription drug insurance, help with formulary and plan switching information, and assistance with tasks related to medication adherence in the community. Common themes in the case managers' discussion were managing beneficiary problems, stress for beneficiaries, information and paperwork issues, and cynicism regarding health care reform. The critical role of case managers in the use of Medicare Part D is not well understood or appreciated. Case managers need to be informed about Medicare Part D and ready to advocate for their clients in the community. In addition, it is important for case managers to understand how Medicare Part D affects not only older adults, but also adults living with serious and persistent mental illness.

77 FR 5062 - Privacy Act of 1974; Consolidation of National Labor Relations Board Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-01

... information and associated electronic case files, permitting the accurate and timely collection, retrieval, and retention of information maintained by offices of the Agency, regarding those offices' handling of... systems remain accessible, but no additional, unique information is being added to them. At this time...

Arctic Capability Inventory Tool User Guide: Version 2 (International References)

DTIC Science & Technology

2011-07-01

drawn from the primary source documents. In cases where the analyst included additional information, the text is included in [square brackets]. The...following: FERPistheallhazardsplanforacoordinatedfederalresponsetoemergencies. Inmost cases ,departmentsmanageemergencieswithevent...signed—(20)Andorra,Azerbaijan, Ecuador ,Eritrea,Israel,Kazakhstan, Kyrgyzstan,Peru,SanMarino,Syria,Tajikistan,TimorLeste,Turkey

Imprecise (fuzzy) information in geostatistics

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

Bardossy, A.; Bogardi, I.; Kelly, W.E.

1988-05-01

A methodology based on fuzzy set theory for the utilization of imprecise data in geostatistics is presented. A common problem preventing a broader use of geostatistics has been the insufficient amount of accurate measurement data. In certain cases, additional but uncertain (soft) information is available and can be encoded as subjective probabilities, and then the soft kriging method can be applied (Journal, 1986). In other cases, a fuzzy encoding of soft information may be more realistic and simplify the numerical calculations. Imprecise (fuzzy) spatial information on the possible variogram is integrated into a single variogram which is used in amore » fuzzy kriging procedure. The overall uncertainty of prediction is represented by the estimation variance and the calculated membership function for each kriged point. The methodology is applied to the permeability prediction of a soil liner for hazardous waste containment. The available number of hard measurement data (20) was not enough for a classical geostatistical analysis. An additional 20 soft data made it possible to prepare kriged contour maps using the fuzzy geostatistical procedure.« less

The Science Manager's Guide to Case Studies

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

Branch, Kristi M.; Peffers, Melissa S.; Ruegg, Rosalie T.

2001-09-24

This guide takes the science manager through the steps of planning, implementing, validating, communicating, and using case studies. It outlines the major methods of analysis, describing their relative merits and applicability while providing relevant examples and sources of additional information. Well-designed case studies can provide a combination of rich qualitative and quantitative information, offering valuable insights into the nature, outputs, and longer-term impacts of the research. An objective, systematic, and credible approach to the evaluation of U.S. Department of Energy Office of Science programs adds value to the research process and is the subject of this guide.

An approach to peer review in forensic pathology.

PubMed

Sims, D Noel; Langlois, Neil E I; Byard, Roger W

2013-07-01

Peer review in forensic pathology has been a long time in evolution but may provide a very useful mechanism to check for, and to correct, errors, in addition to establishing an important educative vehicle for pathologists. A process is reported that has been established at our institution that involves both informal peer review in the mortuary and formal auditing of a set number of cases. Every autopsy case is discussed at a daily meeting of pathologists before a provisional cause of death is released. In addition, one in ten cases including all homicides, deaths in custody, suspicious and paediatric cases, and randomly selected additional cases undergo formal auditing by a second pathologist. Finally, administrative staff check the completed report. This formalized process, in a jurisdiction where autopsies are usually performed by only one pathologist, has been extremely useful in standardizing autopsy reports and in enabling pathologists to discuss cases and associated issues on a regular basis. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

A Relative Ranking Approach for Nano-Enabled Applications to Improve Risk-Based Decision Making: A Case Study of Army Materiel

DTIC Science & Technology

2014-12-24

scenarios. The USACEHR has been conducting research and devel- opment efforts on the incorporation of various ENMs into Army materiel, ranging from food ...materiel characteristics, and (3) apply the algorithm and associated risk ranking tool to prioritize additional assessments based on the human health risk...online correspondence to confirm, edit, and supplement the inventory with additional information (See Section 1 in Supplementary Information (SI) for

THE COMMAND OF THE TREND: SOCIAL MEDIA AS A WEAPON IN THE INFORMATION AGE

DTIC Science & Technology

2017-06-01

and a bot network) based on the analysis within this case study . Table 3. ISIS Case Study Analysis Propaganda Narratives 1. ISIS is strong...get started with an interview and included me in a cyber think-tank for the study of ISIS activity on social media. Additionally, I am still... study demonstrates how social media is a tool for modern warfare in the information age. The report builds on analysis of three distinct topics

[The Hospital Information System of the Brazilian National Unified Health System: a preliminary evaluation of performance in monitoring RhD hemolytic disease of the newborn].

PubMed

Lobato, Gustavo; Reichenheim, Michael Eduardo; Coeli, Claudia Medina

2008-03-01

This study aimed to evaluate the adequacy of the Hospital Information System of the National Unified Health System (SIH-SUS) in identifying cases of RhD hemolytic disease of the newborn (HDN) at the Fernandes Figueira Institute (IFF/FIOCRUZ) from 1998 to 2003. Neonatal records, data from the Medical Archives, and AIH (Hospital Admissions Authorization Form) data consolidated in the SIH-SUS were analyzed. Cases were identified according to the following fields: principal diagnosis, secondary diagnosis, and procedure performed. During the period studied, 194 cases of HDN were diagnosed. The Medical Archives registered 148 newborns with HDN, however only 147 AIHs were issued and 145 consolidated in the SIH-SUS. Among these 145 cases, 84 cited HDN as the principal diagnosis, while secondary diagnosis identified 38 additional cases and the procedures performed failed to identify any further cases. Thus, the SIH-SUS identified only 122 (62.9%) of the 194 cases of HDN treated at the IFF/FIOCRUZ. Although it is necessary to evaluate other units, the SIH-SUS does not appear to be reliable for monitoring HDN. Additional studies are essential for employing secondary administrative data in the context of epidemiological surveillance.

Evaluating the effects of cognitive support on psychiatric clinical comprehension.

PubMed

Dalai, Venkata V; Khalid, Sana; Gottipati, Dinesh; Kannampallil, Thomas; John, Vineeth; Blatter, Brett; Patel, Vimla L; Cohen, Trevor

2014-10-01

Clinicians' attention is a precious resource, which in the current healthcare practice is consumed by the cognitive demands arising from complex patient conditions, information overload, time pressure, and the need to aggregate and synthesize information from disparate sources. The ability to organize information in ways that facilitate the generation of effective diagnostic solutions is a distinguishing characteristic of expert physicians, suggesting that automated systems that organize clinical information in a similar manner may augment physicians' decision-making capabilities. In this paper, we describe the design and evaluation of a theoretically driven cognitive support system (CSS) that assists psychiatrists in their interpretation of clinical cases. The system highlights, and provides the means to navigate to, text that is organized in accordance with a set of diagnostically and therapeutically meaningful higher-level concepts. To evaluate the interface, 16 psychiatry residents interpreted two clinical case scenarios, with and without the CSS. Think-aloud protocols captured during their interpretation of the cases were transcribed and analyzed qualitatively. In addition, the frequency and relative position of content related to key higher-level concepts in a verbal summary of the case were evaluated. In addition the transcripts from both groups were compared to an expert derived reference standard using latent semantic analysis (LSA). Qualitative analysis showed that users of the system better attended to specific clinically important aspects of both cases when these were highlighted by the system, and revealed ways in which the system mediates hypotheses generation and evaluation. Analysis of the summary data showed differences in emphasis with and without the system. The LSA analysis suggested users of the system were more "expert-like" in their emphasis, and that cognitive support was more effective in the more complex case. Cognitive support impacts upon clinical comprehension. This appears to be largely helpful, but may also lead to neglect of information (such as the psychosocial history) that the system does not highlight. The results have implications for the design of CSSs for clinical narratives including the role of information organization and textual embellishments for more efficient clinical case presentation and comprehension. Copyright © 2014 Elsevier B.V. All rights reserved.

Evaluating the effects of cognitive support on psychiatric clinical comprehension

PubMed Central

Dalai, Venkata V.; Khalid, Sana; Gottipati, Dinesh; Kannampallil, Thomas; John, Vineeth; Blatter, Brett; Patel, Vimla L.; Cohen, Trevor

2014-01-01

Objective Clinicians’ attention is a precious resource, which in the current healthcare practice is consumed by the cognitive demands arising from complex patient conditions, information overload, time pressure, and the need to aggregate and synthesize information from disparate sources. The ability to organize information in ways that facilitate the generation of effective diagnostic solutions is a distinguishing characteristic of expert physicians, suggesting that automated systems that organize clinical information in a similar manner may augment physicians’ decision-making capabilities. In this paper, we describe the design and evaluation of a theoretically driven cognitive support system (CSS) that assists psychiatrists in their interpretation of clinical cases. The system highlights, and provides the means to navigate to, text that is organized in accordance with a set of diagnostically and therapeutically meaningful higher-level concepts. Methods and Materials To evaluate the interface, 16 psychiatry residents interpreted two clinical case scenarios, with and without the CSS. Think-aloud protocols captured during their interpretation of the cases were transcribed and analyzed qualitatively. In addition, the frequency and relative position of content related to key higher-level concepts in a verbal summary of the case were evaluated. In addition the transcripts from both groups were compared to an expert derived reference standard using latent semantic analysis (LSA). Results Qualitative analysis showed that users of the system better attended to specific clinically important aspects of both cases when these were highlighted by the system, and revealed ways in which the system mediates hypotheses generation and evaluation. Analysis of the summary data showed differences in emphasis with and without the system. The LSA analysis suggested users of the system were more “expert-like” in their emphasis, and that cognitive support was more effective in the more complex case. Conclusions Cognitive support impacts upon clinical comprehension. This appears to be largely helpful, but may also lead to neglect of information (such as the psychosocial history) that the system does not highlight. The results have implications for the design of CSSs for clinical narratives including the role of information organization and textual embellishments for more efficient clinical case presentation and comprehension. PMID:25179216

Key Information-Problem Solving Skills to Learn in Secondary Education: A Qualitative, Multi-Case Study

ERIC Educational Resources Information Center

Argelagós, Esther; Pifarré, Manoli

2016-01-01

Internet has become one of the most important information sources for students' personal and academic life. In addition, the World Wide Web is receiving increased attention in education because of its potential to support new forms of learning. However, using the information from the net for learning requires the development of a set of abilities…

The role of strategy and redundancy in diagnostic reasoning.

PubMed

Bloch, Ralph F; Hofer, Daniel; Feller, Sabine; Hodel, Maria

2003-01-24

Diagnostic reasoning is a key competence of physicians. We explored the effects of knowledge, practice and additional clinical information on strategy, redundancy and accuracy of diagnosing a peripheral neurological defect in the hand based on sensory examination. Using an interactive computer simulation that includes 21 unique cases with seven sensory loss patterns and either concordant, neutral or discordant textual information, 21 3rd year medical students, 21 6th year and 21 senior neurology residents each examined 15 cases over the course of one session. An additional 23 psychology students examined 24 cases over two sessions, 12 cases per session. Subjects also took a seven-item MCQ exam of seven classical patterns presented visually. Knowledge of sensory patterns and diagnostic accuracy are highly correlated within groups (R2 = 0.64). The total amount of information gathered for incorrect diagnoses is no lower than that for correct diagnoses. Residents require significantly fewer tests than either psychology or 6th year students, who in turn require fewer than the 3rd year students (p < 0.001). The diagnostic accuracy of subjects is affected both by level of training (p < 0.001) and concordance of clinical information (p < 0.001). For discordant cases, refutation testing occurs significantly in 6th year students (p < 0.001) and residents (p < 0.01), but not in psychology or 3rd year students. Conversely, there is a stable 55% excess of confirmatory testing, independent of training or concordance. Knowledge and practice are both important for diagnostic success. For complex diagnostic situations reasoning components employing redundancy seem more essential than those using strategy.

Concepts and Measurements for Manpower and Occupational Analysis.

ERIC Educational Resources Information Center

Scoville, James G.

This volume contains information on occupational data and their uses, jobs-theories, case studies, and improved data bases. A survey was made of current applications of occupational information data and conceptual bases and practical shortcomings of the more frequently used classification systems. In addition, an economic theory was developed to…

Exploring the role of the internet in juvenile prostitution cases coming to the attention of law enforcement.

PubMed

Wells, Melissa; Mitchell, Kimberly J; Ji, Kai

2012-01-01

This exploratory analysis examines the role of the Internet in juvenile prostitution cases coming to the attention of law enforcement. The National Juvenile Prostitution Study (N-JPS) collected information from a national sample of law enforcement agencies about the characteristics of juvenile prostitution cases. In comparison to non-Internet juvenile prostitution cases, Internet juvenile prostitution cases involved younger juveniles and police were more likely to treat juveniles as victims rather than offenders. In addition, these cases were significantly more likely to involve a family or acquaintance exploiter. This analysis suggests that the role of the Internet may impact legal and social service response to juveniles involved in prostitution. In addition, it highlights the need for interventions that acknowledge the vulnerabilities of youth involved in this type of commercial sexual exploitation.

Pituitary Imaging.

PubMed

Pressman, Barry D

2017-09-01

Modern pituitary imaging is MRI. However, computed tomography (CT) still has limited usefulness. In addition, because CT offers much better bone detail and calcium detection, there are some cases in which such additional information is necessary. Before the advent of CT, plain radiography, pneumoencephalography, and angiography were used to diagnose pituitary masses. More recently, CT, and then especially MRI, made it possible to primarily delineate lesions within and around the pituitary gland rather than depend on secondary information that could only suggest their presence. Copyright © 2017 Elsevier Inc. All rights reserved.

Illustrative case using the RISK21 roadmap and matrix: prioritization for evaluation of chemicals found in drinking water

PubMed Central

Wolf, Douglas C.; Bachman, Ammie; Barrett, Gordon; Bellin, Cheryl; Goodman, Jay I.; Jensen, Elke; Moretto, Angelo; McMullin, Tami; Pastoor, Timothy P.; Schoeny, Rita; Slezak, Brian; Wend, Korinna; Embry, Michelle R.

2016-01-01

ABSTRACT The HESI-led RISK21 effort has developed a framework supporting the use of twenty-first century technology in obtaining and using information for chemical risk assessment. This framework represents a problem formulation-based, exposure-driven, tiered data acquisition approach that leads to an informed decision on human health safety to be made when sufficient evidence is available. It provides a transparent and consistent approach to evaluate information in order to maximize the ability of assessments to inform decisions and to optimize the use of resources. To demonstrate the application of the framework’s roadmap and matrix, this case study evaluates a large number of chemicals that could be present in drinking water. The focus is to prioritize which of these should be considered for human health risk as individual contaminants. The example evaluates 20 potential drinking water contaminants, using the tiered RISK21 approach in combination with graphical representation of information at each step, using the RISK21 matrix. Utilizing the framework, 11 of the 20 chemicals were assigned low priority based on available exposure data alone, which demonstrated that exposure was extremely low. The remaining nine chemicals were further evaluated, using refined estimates of toxicity based on readily available data, with three deemed high priority for further evaluation. In the present case study, it was determined that the greatest value of additional information would be from improved exposure models and not from additional hazard characterization. PMID:26451723

Illustrative case using the RISK21 roadmap and matrix: prioritization for evaluation of chemicals found in drinking water.

PubMed

Wolf, Douglas C; Bachman, Ammie; Barrett, Gordon; Bellin, Cheryl; Goodman, Jay I; Jensen, Elke; Moretto, Angelo; McMullin, Tami; Pastoor, Timothy P; Schoeny, Rita; Slezak, Brian; Wend, Korinna; Embry, Michelle R

2016-01-01

The HESI-led RISK21 effort has developed a framework supporting the use of twenty-first century technology in obtaining and using information for chemical risk assessment. This framework represents a problem formulation-based, exposure-driven, tiered data acquisition approach that leads to an informed decision on human health safety to be made when sufficient evidence is available. It provides a transparent and consistent approach to evaluate information in order to maximize the ability of assessments to inform decisions and to optimize the use of resources. To demonstrate the application of the framework's roadmap and matrix, this case study evaluates a large number of chemicals that could be present in drinking water. The focus is to prioritize which of these should be considered for human health risk as individual contaminants. The example evaluates 20 potential drinking water contaminants, using the tiered RISK21 approach in combination with graphical representation of information at each step, using the RISK21 matrix. Utilizing the framework, 11 of the 20 chemicals were assigned low priority based on available exposure data alone, which demonstrated that exposure was extremely low. The remaining nine chemicals were further evaluated, using refined estimates of toxicity based on readily available data, with three deemed high priority for further evaluation. In the present case study, it was determined that the greatest value of additional information would be from improved exposure models and not from additional hazard characterization.

Target detection in active polarization images perturbed with additive noise and illumination nonuniformity.

PubMed

Bénière, Arnaud; Goudail, François; Dolfi, Daniel; Alouini, Mehdi

2009-07-01

Active imaging systems that illuminate a scene with polarized light and acquire two images in two orthogonal polarizations yield information about the intensity contrast and the orthogonal state contrast (OSC) in the scene. Both contrasts are relevant for target detection. However, in real systems, the illumination is often spatially or temporally nonuniform. This creates artificial intensity contrasts that can lead to false alarms. We derive generalized likelihood ratio test (GLRT) detectors, for which intensity information is taken into account or not and determine the relevant expressions of the contrast in these two situations. These results are used to determine in which cases considering intensity information in addition to polarimetric information is relevant or not.

Home Education in the Post-Communist Countries: Case Study of the Czech Republic

ERIC Educational Resources Information Center

Kostelecká, Yvona

2010-01-01

The paper analyzes the emergence of home education in European post-communist countries after 1989. The case of the Czech Republic representing the development and characteristic features of home education in the whole region is studied in detail. Additional information about homeschooling in other post-communist countries are provided wherever…

Adjusting Estimates of the Expected Value of Information for Implementation: Theoretical Framework and Practical Application.

PubMed

Andronis, Lazaros; Barton, Pelham M

2016-04-01

Value of information (VoI) calculations give the expected benefits of decision making under perfect information (EVPI) or sample information (EVSI), typically on the premise that any treatment recommendations made in light of this information will be implemented instantly and fully. This assumption is unlikely to hold in health care; evidence shows that obtaining further information typically leads to "improved" rather than "perfect" implementation. To present a method of calculating the expected value of further research that accounts for the reality of improved implementation. This work extends an existing conceptual framework by introducing additional states of the world regarding information (sample information, in addition to current and perfect information) and implementation (improved implementation, in addition to current and optimal implementation). The extension allows calculating the "implementation-adjusted" EVSI (IA-EVSI), a measure that accounts for different degrees of implementation. Calculations of implementation-adjusted estimates are illustrated under different scenarios through a stylized case study in non-small cell lung cancer. In the particular case study, the population values for EVSI and IA-EVSI were £ 25 million and £ 8 million, respectively; thus, a decision assuming perfect implementation would have overestimated the expected value of research by about £ 17 million. IA-EVSI was driven by the assumed time horizon and, importantly, the specified rate of change in implementation: the higher the rate, the greater the IA-EVSI and the lower the difference between IA-EVSI and EVSI. Traditionally calculated measures of population VoI rely on unrealistic assumptions about implementation. This article provides a simple framework that accounts for improved, rather than perfect, implementation and offers more realistic estimates of the expected value of research. © The Author(s) 2015.

Public risk perception of food additives and food scares. The case in Suzhou, China.

PubMed

Wu, Linhai; Zhong, Yingqi; Shan, Lijie; Qin, Wei

2013-11-01

This study examined the factors affecting public risk perception of food additive safety and possible resulting food scares using a survey conducted in Suzhou, Jiangsu Province, China. The model was proposed based on literature relating to the role of risk perception and information perception of public purchase intention under food scares. Structural equation modeling (SEM) was used for data analysis. The results showed that attitude towards behavior, subjective norm and information perception exerted moderate to high effect on food scares, and the effects were also mediated by risk perceptions of additive safety. Significant covariance was observed between attitudes toward behavior, subjective norm and information perception. Establishing an effective mechanism of food safety risk communication, releasing information of government supervision on food safety in a timely manner, curbing misleading media reports on public food safety risk, and enhancing public knowledge of the food additives are key to the development and implementation of food safety risk management policies by the Chinese government. Copyright © 2013 Elsevier Ltd. All rights reserved.

Recruitment strategies for a hand dermatitis prevention programme in the food industry.

PubMed

Kaatz, Martin; Ladermann, Regina; Stadeler, Martina; Fluhr, Joachim Wilhelm; Elsner, Peter; Bauer, Andrea

2008-09-01

An interdisciplinary 'Skin Disease Prevention Programme (SDPP) in the baking, hotel, and catering industries' was established. However, only 30% of the eligible employees suffering from occupational hand dermatitis (OHD) participated in the programme. The aim of the present study was to increase the participation rate in the SDPP from 30% to 50% by specific recruitment strategies. Two hundred and twenty five baker and catering trade employees suffering from OHD were included in a prospective controlled intervention study. The employees were invited to take part in the SDPP using (i) a standard invitation letter (n = 40), (ii) a newly developed, personalized, and targeted invitation letter (n = 52), (iii) the new invitation letter and a case report (n = 75), and (iv) the new invitation letter, the case report, and the additional information (n = 58). The commitment of the employees to join the SDPP increased significantly from 30% to 54% (P < 0.02) in the group receiving the new personalized targeted invitation letter. Neither the additional case report nor the supplementation with additional information concerning the SDPP did further increase the recruitment. The strategy to personalize and target the new invitation letter was successful to influence the employees' commitment to participate in the SDPP.

Educational Information System for Ontario. Final Report, March 1977-April 1978.

ERIC Educational Resources Information Center

Auster, Ethel; Lawton, Stephen B.

This final report describing the operation and research of the EISO project, which provides online bibliographic search services to educators of Ontario, briefly summarizes the first and second interim reports. In addition, it discusses users and the uses of EISO information by providing mini-case studies to illustrate quantitative data and…

76 FR 60086 - Proposed Extension of the Approval of Information Collection Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-28

... of an employee and necessary accommodations; first aid and safety personnel may be informed, when... circumstances of the particular case. When an employee seeks leave for the first time for an FMLA-qualifying... qualifying exigency to certify the need for leave. In addition, the first time an employee requests leave for...

Extending Adoption of Innovation Theory with Consumer Influence the Case of Personal Health Records (PHRs) and Patient Portals

ERIC Educational Resources Information Center

Baird, Aaron

2012-01-01

A long tradition of adoption of innovations research in the information systems context suggests that innovative information systems are typically adopted by the largest companies, with the most slack resources and the most management support within competitive markets. Additionally, five behavioral characteristics (relative advantage,…

Improved navigation by combining VOR/DME information with air or inertial data

NASA Technical Reports Server (NTRS)

Bobick, J. C.; Bryson, A. E., Jr.

1972-01-01

The improvement was determined in navigational accuracy obtainable by combining VOR/DME information (from one or two stations) with air data (airspeed and heading) or with data from an inertial navigation system (INS) by means of a maximum-likelihood filter. It was found that the addition of air data to the information from one VOR/DME station reduces the RMS position error by a factor of about 2, whereas the addition of inertial data from a low-quality INS reduces the RMS position error by a factor of about 3. The use of information from two VOR/DME stations with air or inertial data yields large factors of improvement in RMS position accuracy over the use of a single VOR/DME station, roughly 15 to 20 for the air-data case and 25 to 35 for the inertial-data case. As far as position accuracy is concerned, at most one VOR station need be used. When continuously updating an INS with VOR/DME information, the use of a high-quality INS (0.01 deg/hr gyro drift) instead of a low-quality INS (1.0 deg/hr gyro drift) does not substantially improve position accuracy.

Lung Cancer Risk from Occupational and Environmental Radon and Role of Smoking in Two Czech Nested Case-Control Studies

PubMed Central

Tomasek, Ladislav

2013-01-01

The aim of the present study was to evaluate the risk of lung cancer from combined exposure to radon and smoking. Methodologically, it is based on case-control studies nested within two Czech cohort studies of nearly 11,000 miners followed-up for mortality in 1952–2010 and nearly 12,000 inhabitants exposed to high levels of radon in homes, with mortality follow-up in 1960–2010. In addition to recorded radon exposure, these studies use information on smoking collected from the subjects or their relatives. A total of 1,029 and 370 cases with smoking information have been observed in the occupational and environmental (residential) studies, respectively. Three or four control subjects have been individually matched to cases according to sex, year of birth, and age. The combined effect from radon and smoking is analyzed in terms of geometric mixture models of which the additive and multiplicative models are special cases. The resulting models are relatively close to the additive interaction (mixing parameter 0.2 and 0.3 in the occupational and residential studies, respectively). The impact of the resulting model in the residential radon study is illustrated by estimates of lifetime risk in hypothetical populations of smokers and non-smokers. In comparison to the multiplicative risk model, the lifetime risk from the best geometric mixture model is considerably higher, particularly in the non-smoking population. PMID:23470882

Usefulness of three-dimensional echocardiography in the assessment of valvular involvement in Loeffler endocarditis.

PubMed

Hernandez, Carlos M; Arisha, Mohammed J; Ahmad, Amier; Oates, Ethan; Nanda, Navin C; Nanda, Anil; Wasan, Anita; Caleti, Beda E; Bernal, Cinthia L P; Gallardo, Sergio M

2017-07-01

Loeffler endocarditis is a complication of hypereosinophilic syndrome resulting from eosinophilic infiltration of heart tissue. We report a case of Loeffler endocarditis in which three-dimensional transthoracic and transesophageal echocardiography provided additional information to what was found by two-dimensional transthoracic echocardiography alone. Our case illustrates the usefulness of combined two- and three-dimensional echocardiography in the assessment of Loeffler endocarditis. In addition, a summary of the features of hypereosinophilic syndrome and Loeffler endocarditis is provided in tabular form. © 2017, Wiley Periodicals, Inc.

Assessing Commercially Available Personal Health Records for Home Health: Recommendations for Design.

PubMed

Kneale, Laura; Choi, Yong; Demiris, George

2016-01-01

Home health nurses and clients experience unmet information needs when transitioning from hospital to home health. Personal health records (PHRs) support consumer-centered information management activities. Previous work has assessed PHRs associated with healthcare providers, but these systems leave home health nurses unable to access necessary information. To evaluate the ability of publically available PHRs to accept, manage, and share information from a home health case study. Two researchers accessed the publically available PHRs on myPHR.com, and attempted to enter, manage, and share the case study data. We qualitatively described the PHR features, and identified gaps between the case study information and PHR functionality. Eighteen PHRs were identified in our initial search. Seven systems met our inclusion criteria, and are included in this review. The PHRs were able to accept basic medical information. Gaps occurred when entering, managing, and/or sharing data from the acute care and home health episodes. The PHRs that were reviewed were unable to effectively manage the case study information. Therefore, increasing consumer health literacy through these systems may be difficult. The PHRs that we reviewed were also unable to electronically share their data. The gap between the existing functionality and the information needs from the case study may make these PHRs difficult to use for home health environments. Additional work is needed to increase the functionality of the PHR systems to better fit the data needs of home health clients.

Precision Information Environment (PIE) for International Safeguards: Pre-Demonstration Development Use Cases

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

Gastelum, Zoe N.; Henry, Michael J.

2013-11-13

In FY2013, the PIE International Safeguards team demonstrated our development progress to U.S. Department of Energy (DOE) staff from the Office of Nonproliferation and International Security (NA-24, our client) and the Office of Defense Nuclear Nonproliferation Research and Development (NA-22). Following the demonstration, the team was asked by our client to complete additional development prior to a planned demonstration at the International Atomic Energy Agency (IAEA), scheduled tentatively for January or spring of 2014. The team discussed four potential areas for development (in priority order), and will develop them as time and funding permit prior to an IAEA demonstration. Themore » four capability areas are: 1. Addition of equipment manuals to PIE-accessible files 2. Optical character recognition (OCR) of photographed text 3. Barcode reader with information look-up from a database 4. Add Facilities to Data Model 5. Geospatial capabilities with information integration Each area will be described below in a use case.« less

Planning Intervention Using Dynamic Assessments: A Case Study

ERIC Educational Resources Information Center

Hasson, Natalie; Dodd, Barbara

2014-01-01

Dynamic assessments (DA) of language have been shown to be a useful addition to the battery of tests used to diagnose language impairments in children, and to evaluate their skills. The current article explores the value of the information gained from a DA in planning intervention for a child with language impairment. A single case study was used…

The Importance of Decision Making: A Gifted Case Report

ERIC Educational Resources Information Center

Nauta, Noks; Ronner, Sieuwke; Groeneveld, Benno

2009-01-01

In this article the story of a fictional young university-educated woman is presented who struggles with making choices in her career and in her life. In this case report background information on gifted people at work is provided. In addition to that jobs and companies which are appropriate for highly gifted are mentioned. Besides that…

Tuberculosis treatment outcome monitoring in England, Wales and Northern Ireland for cases reported in 2001

PubMed Central

Antoine, Delphine; French, Clare E; Jones, Jane; Watson, John M

2007-01-01

Background Tuberculosis treatment outcome monitoring was introduced in England, Wales and Northern Ireland in 2002 based on cases reported in 2001. Objective To estimate the proportion of treatment success and to identify predictors of non‐completion for cases reported in 2001. Method At 12 months after the start of treatment, outcome was assessed according to a protocol based on standardised European recommendations. Results The proportion of cases completing treatment by 12 months was 79% if calculated for cases in whom outcome information was reported, and 62% of all cases regardless of whether information on outcome was reported or not. Of the new smear‐positive pulmonary cases for whom information on outcome was reported, 77% completed treatment. Non‐completion of treatment was associated with male sex, age ⩾65 years, recent entry into UK for those born abroad, residence outside London, pulmonary disease and drug resistance. Conclusions Despite the resources of an industrialised country with a low incidence of tuberculosis, the World Health Organization treatment success target of 85% was not achieved. This was partly due to the number of deaths in the elderly, and partly due to missing outcome information for 21% of the cases. As in other low‐incidence countries, additional outcome measures such as the proportion of those aged <65 years completing treatment would provide a more comparable indicator for assessment of treatment success. This first year of data collection has shown the importance of increasing the proportion of cases for whom outcome is ascertained, and of ensuring the validity of information provided. PMID:17372289

Using Supercomputers to Speed Execution of the CAISO/PLEXOS 33% RPS Study

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

Meyers, C; Streitz, F; Yao, Y

2011-09-19

The study's official title is 'ISO Study of Operational Requirements and Market Impacts at 33% Renewable Portfolio Standard (RPS).' The stated objectives are twofold: (1) identifying operational requirements and resource options to reliably operate the ISO-controlled grid under a 33% RPS in 2020; and (2) inform market, planning, and policy/regulatory decisions by the ISO, state agencies, market participants, and other stakeholders. The first of these objectives requires the hourly estimates of integration requirements, measured in terms of operational ramp, load following and regulation capacity and ramp rates, as well as additional capacity to resolve operational violations. It also involves considerationmore » of other variables that affect the results, such as the impact of different mixes of renewable technologies, and the impact of forecasting error and variability. The second objective entails supporting the CPUC to identify long-term procurement planning needs, costs, and options, as well as informing other decisions made by the CPUC and state agencies. For the ISO itself this includes informing state-wide transmission planning needs for renewables up to a 33% RPS, and informing design of wholesale markets for energy and ancillary services to facilitate provision of integration capacities. The study is designed in two phases. The first (current) phase is focused on operational requirements and addressing these requirements with existing and new conventional fossil generation; for instance, gas turbines and/or combined cycle units. The second (planned) phase will address the same operational requirements with a combination of conventional fossil generation resources, new non-generation resources, and a renewable resource dispatch. There are seven different scenarios considered in the current phase: a 20% RPS reference case; four 33% RPS cases (a reference case, a high out-of-state case, a high distributed generation case, and a low load case); an alternative 27.5% RPS case; and an all-gas case (no new renewables after 2008). In addition, the CPUC is planning a new set of cases that will alter the anticipated sets of runs.« less

FDDI information management system for centralizing interactive, computerized multimedia clinical experiences in pediatric rheumatology/Immunology.

PubMed

Rouhani, R; Cronenberger, H; Stein, L; Hannum, W; Reed, A M; Wilhelm, C; Hsiao, H

1995-01-01

This paper describes the design, authoring, and development of interactive, computerized, multimedia clinical simulations in pediatric rheumatology/immunology and related musculoskeletal diseases, the development and implementation of a high speed information management system for their centralized storage and distribution, and analytical methods for evaluating the total system's educational impact on medical students and pediatric residents. An FDDI fiber optic network with client/server/host architecture is the core. The server houses digitized audio, still-image video clips and text files. A host station houses the DB2/2 database containing case-associated labels and information. Cases can be accessed from any workstation via a customized interface in AVA/2 written specifically for this application. OS/2 Presentation Manager controls, written in C, are incorporated into the interface. This interface allows SQL searches and retrievals of cases and case materials. In addition to providing user-directed clinical experiences, this centralized information management system provides designated faculty with the ability to add audio notes and visual pointers to image files. Users may browse through case materials, mark selected ones and download them for utilization in lectures or for editing and converting into 35mm slides.

Swapping horses midstream: factors related to physicians' changing their minds about a diagnosis.

PubMed

Eva, Kevin W; Link, Carol L; Lutfey, Karen E; McKinlay, John B

2010-07-01

Premature closure has been identified as the single most common cause of diagnostic error. This factorial experiment explored which variables exert an unconfounded influence on physicians' diagnostic flexibility (changing their minds about the most likely diagnosis during a clinical case presentation). In 2007-2008, 256 practicing physicians viewed a clinically authentic vignette simulating a patient presenting with possible coronary heart disease (CHD) and provided their initial impression midway through the case. At the end, they answered questions about the case, indicated how they would continue their clinical investigation, and made a final diagnosis. The authors used general linear models to determine which patient factors (age, gender, socioeconomic status, race), physician factors (gender, age/experience), and process variables were related to the likelihood of physicians' changing their minds about the most likely diagnosis. Physicians who had less experience, those who named a non-CHD diagnosis as their initial impression, and those who did not ask for information about the patient's prior cardiac disease history were the most likely to change their minds. Participants' certainty in their initial diagnosis, the additional information desired, the diagnostic hypotheses generated, and the follow-up intended were not related to the likelihood of change in diagnostic hypotheses. Although efforts encouraging physicians to avoid cognitive biases and to reason in a more analytic manner may yield some benefit, this study suggests that experience is a more important determinant of diagnostic flexibility than is the consideration of additional diagnoses or the amount of additional information collected.

75 FR 57020 - Agency Information Collection Activities: Final Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-17

... use only in those cases where the company chooses to make use of some aspects of the additional... the option of ``Ex-Im Bank Sole Risk'' as an obligor type; added the option ``CAD or SDDP'' to the...: 3048-0021. Type of Review: Regular. Need and Use: The information collected enables Ex-Im Bank to...

Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register: current status and recent enhancement of an Electronic Mental Health Record-derived data resource.

PubMed

Perera, Gayan; Broadbent, Matthew; Callard, Felicity; Chang, Chin-Kuo; Downs, Johnny; Dutta, Rina; Fernandes, Andrea; Hayes, Richard D; Henderson, Max; Jackson, Richard; Jewell, Amelia; Kadra, Giouliana; Little, Ryan; Pritchard, Megan; Shetty, Hitesh; Tulloch, Alex; Stewart, Robert

2016-03-01

The South London and Maudsley National Health Service (NHS) Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register and its Clinical Record Interactive Search (CRIS) application were developed in 2008, generating a research repository of real-time, anonymised, structured and open-text data derived from the electronic health record system used by SLaM, a large mental healthcare provider in southeast London. In this paper, we update this register's descriptive data, and describe the substantial expansion and extension of the data resource since its original development. Descriptive data were generated from the SLaM BRC Case Register on 31 December 2014. Currently, there are over 250,000 patient records accessed through CRIS. Since 2008, the most significant developments in the SLaM BRC Case Register have been the introduction of natural language processing to extract structured data from open-text fields, linkages to external sources of data, and the addition of a parallel relational database (Structured Query Language) output. Natural language processing applications to date have brought in new and hitherto inaccessible data on cognitive function, education, social care receipt, smoking, diagnostic statements and pharmacotherapy. In addition, through external data linkages, large volumes of supplementary information have been accessed on mortality, hospital attendances and cancer registrations. Coupled with robust data security and governance structures, electronic health records provide potentially transformative information on mental disorders and outcomes in routine clinical care. The SLaM BRC Case Register continues to grow as a database, with approximately 20,000 new cases added each year, in addition to extension of follow-up for existing cases. Data linkages and natural language processing present important opportunities to enhance this type of research resource further, achieving both volume and depth of data. However, research projects still need to be carefully tailored, so that they take into account the nature and quality of the source information. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

RadPath: A Web-based System for Integrating and Correlating Radiology and Pathology Findings During Cancer Diagnosis.

PubMed

Arnold, Corey W; Wallace, W Dean; Chen, Shawn; Oh, Andrea; Abtin, Fereidoun; Genshaft, Scott; Binder, Scott; Aberle, Denise; Enzmann, Dieter

2016-01-01

The current paradigm of cancer diagnosis involves uncoordinated communication of findings from radiology and pathology to downstream physicians. Discordance between these findings can require additional time from downstream users to resolve, or given incorrect resolution, may adversely impact treatment decisions. To mitigate this problem, we developed a web-based system, called RadPath, for correlating and integrating radiology and pathology reporting. RadPath includes interfaces to our institution's clinical information systems, which are used to retrieve reports, images, and test results that are structured into an interactive compendium for a diagnostic patient case. The system includes an editing interface for physicians, allowing for the inclusion of additional clinical data, as well as the ability to retrospectively correlate and contextualize imaging findings following pathology diagnosis. During pilot deployment and testing over the course of 1 year, physicians at our institution have completed 60 RadPath cases, requiring an average of 128 seconds from a radiologist and an average of 93 seconds from a pathologist per case. Several technical and workflow challenges were encountered during development, including interfacing with diverse clinical information systems, automatically structuring report contents, and determining the appropriate physicians to create RadPath summaries. Reaction to RadPath has been positive, with users valuing the system's ability to consolidate diagnostic information. With the increasing complexity of medicine and the movement toward team-based disease management, there is a need for improved clinical communication and information exchange. RadPath provides a platform for generating coherent and correlated diagnostic summaries in cancer diagnosis with minimal additional effort from physicians. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Knowledge Management in Sensor Enabled Online Services

NASA Astrophysics Data System (ADS)

Smyth, Dominick; Cappellari, Paolo; Roantree, Mark

The Future Internet, has as its vision, the development of improved features and usability for services, applications and content. In many cases, services can be provided automatically through the use of monitors or sensors. This means web generated sensor data becoming available not only to the companies that own the sensors but also to the domain users who generate the data and to information and knowledge workers who harvest the output. The goal is improving the service through better usage of the information provided by the service. Applications and services vary from climate, traffic, health and sports event monitoring. In this paper, we present the WSW system that harvests web sensor data to provide additional and, in some cases, more accurate information using an analysis of both live and warehoused information.

Twelve tips on writing a discussion case that facilitates teaching and engages learners.

PubMed

Cohen, David A; Newman, Lori R; Fishman, Laurie N

2017-02-01

The authors share twelve practical tips on writing a case that engages learners in active learning and discussion. They first advise that, during the initial preparation of the case, authors should (1) identify the case goals and objectives, and (2) identify the level of the learners. When writing the case, authors should (3) use active and colorful language; (4) use patients' own descriptions rather than medical language; (5) allow the learners to interpret data themselves; (6) allow for natural discovery rather than presenting information chronologically; and (7) be realistic about interruptions in patient care. In addition, case authors should pay attention to methods that enhance discussion by (8) creating barriers to diagnostic or treatment options; (9) promoting questions and discussion over answers; (10) using cues to assure discussion flow and knowledge exploration; and (11) omitting details or inserting informational distractors. Finally, well-crafted questions are essential during the case presentation to engage learners in higher-order thinking; and to (12) stimulate curiosity and reflection.

SU-E-I-58: Experiences in Setting Up An Online Fluoroscopy Tracking System in a Large Healthcare System

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

Fisher, R; Wunderle, K; Lingenfelter, M

Purpose: Transitioning from a paper based to an online system for tracking fluoroscopic case information required by state regulation and to conform to NCRP patient dose tracking suggestions. Methods: State regulations require documentation of operator, equipment, and some metric of tube output for fluoroscopy exams. This information was previously collected in paper logs, which was cumbersome and inefficient for the large number of fluoroscopic units across multiple locations within the system. The “tech notes” feature within Siemens’ Syngo workflow RIS was utilized to create an entry form for technologists to input case information, which was sent to a third partymore » vendor for archiving and display though an online web based portal. Results: Over 55k cases were logged in the first year of implementation, with approximately 6,500 cases per month once fully online. A system was built for area managers to oversee and correct data, which has increased the accuracy of inputted values. A high-dose report was built to automatically send notifications when patients exceed trigger levels. In addition to meeting regulatory requirements, the new system allows for larger scale QC in fluoroscopic cases by allowing comparison of data from specific procedures, locations, equipment, and operators so that instances that fall outside of reference levels can be identified for further evaluation. The system has also drastically improved identification of operators without documented equipment specific training. Conclusion: The transition to online fluoroscopy logs has improved efficiency in meeting state regulatory requirements as well as allowed for identification of particular procedures, equipment, and operators in need of additional attention in order to optimize patient and personnel doses, while high dose alerts improve patient care and follow up. Future efforts are focused on incorporating case information from outside of radiology, as well as on automating processes for increased efficiencies.« less

28 CFR 16.3 - Requirements for making requests.

Code of Federal Regulations, 2011 CFR

2011-07-01

... request should include specific information about each record sought, such as the date, title or name, author, recipient, and subject matter of the record. In addition, if you want records about a court case...

28 CFR 16.3 - Requirements for making requests.

Code of Federal Regulations, 2010 CFR

2010-07-01

... request should include specific information about each record sought, such as the date, title or name, author, recipient, and subject matter of the record. In addition, if you want records about a court case...

European option pricing under the Student's t noise with jumps

NASA Astrophysics Data System (ADS)

Wang, Xiao-Tian; Li, Zhe; Zhuang, Le

2017-03-01

In this paper we present a new approach to price European options under the Student's t noise with jumps. Through the conditional delta hedging strategy and the minimal mean-square-error hedging, a closed-form solution of the European option value is obtained under the incomplete information case. In particular, we propose a Value-at-Risk-type procedure to estimate the volatility parameter σ such that the pricing error is in accord with the risk preferences of investors. In addition, the numerical results of us show that options are not priced in some cases in an incomplete information market.

Exploring the Transformative Potential of Recognition of Prior Informal Learning for Learners: A Case Study in Scotland

ERIC Educational Resources Information Center

Brown, Julie

2017-01-01

This article presents an overview of the findings of a recently completed study exploring the potentially transformative impact upon learners of recognition of prior informal learning (RPL). The specific transformative dimension being reported is learner identity. In addition to providing a starting point for an evidence base within Scotland, the…

Information Management for the Watershed Approach in the Pacific Northwest

EPA Pesticide Factsheets

A collection of interviews with leaders and key participants in the statewide watershed approach activities in the State of Washington. Additionally, there are reviews of Washington’s statewide watershed activities in a case study fashion.

MRSA Screening

MedlinePlus

... they are isolated in a culture . These additional research tests can identify the type and subtype of S. aureus ... 14. Case, M. (2006 March 15). Fast staph test limits spread, at a high price. Post-gazette.com [On-line information]. Available online at ...

Brazil Nuts on Eros: Size-Sorting of Asteroid Regolith

NASA Technical Reports Server (NTRS)

Asphaug, E.; King, P. J.; Swift, M. R.; Merrifield, M. R.

2001-01-01

We consider the hypothesis that frequent cratering produces size- or compositionally-sorted asteroid regolith, affecting the structure, texture, and in extreme cases the shape of asteroids. Additional information is contained in the original extended abstract.

Shuttle Case Study Collection Website Development

NASA Technical Reports Server (NTRS)

Ransom, Khadijah S.; Johnson, Grace K.

2012-01-01

As a continuation from summer 2012, the Shuttle Case Study Collection has been developed using lessons learned documented by NASA engineers, analysts, and contractors. Decades of information related to processing and launching the Space Shuttle is gathered into a single database to provide educators with an alternative means to teach real-world engineering processes. The goal is to provide additional engineering materials that enhance critical thinking, decision making, and problem solving skills. During this second phase of the project, the Shuttle Case Study Collection website was developed. Extensive HTML coding to link downloadable documents, videos, and images was required, as was training to learn NASA's Content Management System (CMS) for website design. As the final stage of the collection development, the website is designed to allow for distribution of information to the public as well as for case study report submissions from other educators online.

Number needed to benefit from information (NNBI): proposal from a mixed methods research study with practicing family physicians.

PubMed

Pluye, Pierre; Grad, Roland M; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Marlow, Bernard; Ricarte, Ivan Luiz Marques

2013-01-01

We wanted to describe family physicians' use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008-2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported.

Number Needed to Benefit From Information (NNBI): Proposal From a Mixed Methods Research Study With Practicing Family Physicians

PubMed Central

Pluye, Pierre; Grad, Roland M.; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Marlow, Bernard; Ricarte, Ivan Luiz Marques

2013-01-01

PURPOSE We wanted to describe family physicians’ use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. METHODS We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008–2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. RESULTS In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). CONCLUSION The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported. PMID:24218380

Development of a Prototype Continuity of Care Record with Context-Specific Links to Meet the Information Needs of Case Managers for Persons Living with HIV

PubMed Central

Cimino, James J.; Bakken, Suzanne

2012-01-01

Objectives (1) To develop a prototype Continuity of Care Record (CCR) with context-specific links to electronic HIV information resources; and (2) to assess case managers’ perceptions regarding the usability of the prototype. Methods We integrated context-specific links to HIV case management information resources into a prototype CCR using the Infobutton Manager and Librarian Infobutton Tailoring Environment (LITE). Case managers (N=9) completed a think-aloud protocol and the Computer System Usability Questionnaire (CSUQ) to evaluate the usability of the prototype. Verbalizations from the think-aloud protocol were summarized using thematic analysis. CSUQ data were analyzed with descriptive statistics. Results Although participants expressed positive comments regarding the usability of the prototype, the think-aloud protocol also identified the need for improvement in resource labels and for additional resources. On a scale ranging from 1 (strongly agree) to 7 (strongly disagree), the average CSUQ overall satisfaction was 2.25 indicating that users (n=9) were generally satisfied with the system. Mean CSUQ factor scores were: System Usefulness (M=2.13), Information Quality (M=2.46), and Interface Quality (M=2.26). Conclusion Our novel application of the Infobutton Manager and LITE in the context of case management for persons living with HIV in community-based settings resulted in a prototype CCR with infobuttons that met the majority of case managers’ information needs and received relatively positive usability ratings. Findings from this study inform future integration of context-specific links into CCRs and electronic health records and support their use for meeting end-users information needs. PMID:22632821

The prevalence of ADHD in a population-based sample

PubMed Central

Rowland, Andrew S.; Skipper, Betty J.; Umbach, David M.; Rabiner, David L.; Campbell, Richard A.; Naftel, A. Jack; Sandler, Dale P.

2014-01-01

Objective Few studies of ADHD prevalence have used population-based samples, multiple informants, and DSM-IV criteria. In addition, children who are asymptomatic while receiving ADHD mediction often have been misclassified. Therefore, we conducted a population-based study to estimate the prevalence of ADHD in elementary school children using DSM-IV critera. Methods We screened 7587 children for ADHD. Teachers of 81% of the children completed a DSM-IV checklist. We then interviewed parents using a structured interview (DISC). Of these, 72% participated. Parent and teacher ratings were combined to determine ADHD status. We also estimated the proportion of cases attributable to other conditions. Results Overall, 15.5% of our sample (95% confidence interval (C.I.) 14.6%-16.4%) met DSM-IV-TR criteria for ADHD. Over 40% of cases reported no previous diagnosis. With additional information, other conditions explained about 9% of cases. Conclusions The prevalence of ADHD in this population-based sample was higher than the 3-7% commonly reported. To compare study results, the methods used to implement the DSM criteria need to be standardized. PMID:24336124

Solving crimes with hypnosis.

PubMed

Wester, William C; Hammond, D Corydon

2011-04-01

Following a brief review of the literature on hypnosis and memory, this paper overviews the procedures that are used in conducting forensic hypnosis interviews. Ten forensic hypnosis cases are then described. These real world cases are in stark contrast to research done in an artificial laboratory setting where the information to be recalled lacks personal relevance and was not associated with emotionally arousing situations. These cases illustrate how forensic hypnosis can result in obtaining important additional investigative leads which lead to the solving of crimes.

A regularized variable selection procedure in additive hazards model with stratified case-cohort design.

PubMed

Ni, Ai; Cai, Jianwen

2018-07-01

Case-cohort designs are commonly used in large epidemiological studies to reduce the cost associated with covariate measurement. In many such studies the number of covariates is very large. An efficient variable selection method is needed for case-cohort studies where the covariates are only observed in a subset of the sample. Current literature on this topic has been focused on the proportional hazards model. However, in many studies the additive hazards model is preferred over the proportional hazards model either because the proportional hazards assumption is violated or the additive hazards model provides more relevent information to the research question. Motivated by one such study, the Atherosclerosis Risk in Communities (ARIC) study, we investigate the properties of a regularized variable selection procedure in stratified case-cohort design under an additive hazards model with a diverging number of parameters. We establish the consistency and asymptotic normality of the penalized estimator and prove its oracle property. Simulation studies are conducted to assess the finite sample performance of the proposed method with a modified cross-validation tuning parameter selection methods. We apply the variable selection procedure to the ARIC study to demonstrate its practical use.

Swapping Horses Midstream: Factors Related to Physicians’ Changing Their Minds About a Diagnosis

PubMed Central

Eva, Kevin W.; Link, Carol L.; Lutfey, Karen E.; McKinlay, John B.

2013-01-01

Purpose Premature closure has been identified as the single most common cause of diagnostic error. The authors conducted a factorial experiment to explore which variables exert an unconfounded influence on physicians’ diagnostic flexibility (changing their minds about the most likely diagnosis during a clinical case presentation). Methods In 2007–2008, 256 practicing physicians viewed a clinically authentic vignette simulating a patient presenting with possible coronary heart disease (CHD), provided their initial impression midway through the case, answered questions about the case, indicated how they would continue their clinical investigation, and made a final diagnosis. The authors used general linear models to determine which patient factors (age, gender, socioeconomic status, race), physician factors (gender, age/experience), and process variables were related to the likelihood of physicians’ changing their minds about the most likely diagnosis. Results Physicians who had less experience, those who named a non-CHD diagnosis as their initial impression, and those who did not ask for information about the patient’s prior cardiac disease history were the most likely to change their minds. Participants’ certainty in their initial diagnosis, the additional information desired, the diagnostic hypotheses generated, and the follow-up intended were not related to the likelihood of change in diagnostic hypotheses. Discussion While efforts encouraging physicians to avoid cognitive biases and to reason in a more analytic manner may yield some benefit, this study suggests that experience is a more important determinant of diagnostic flexibility than is the consideration of additional diagnoses or the amount of additional information collected. PMID:20592506

Identifying Human Trafficking Victims on a Psychiatry Inpatient Service: a Case Series.

PubMed

Nguyen, Phuong T; Lamkin, Joanna; Coverdale, John H; Scott, Samuel; Li, Karen; Gordon, Mollie R

2018-06-01

Human trafficking is a serious and prevalent human rights violation that closely intersects with mental health. Limited empirical attention has been paid to the presentations and identification of trafficking victims in psychiatric settings. The primary goal of this paper is to describe the varied presentations of trafficking victims on an urban inpatient psychiatric unit. A literature review was conducted to identify relevant empirical articles to inform our examination of cases. Adult inpatient cases meeting criteria for known or possible human trafficking were systematically identified and illustrative cases were described. Six cases were identified including one male and five females. Two had been labor trafficked and four were suspected or confirmed to have been sex trafficked. The cases demonstrated a tremendous diversity of demographic and psychiatric identifying factors. These cases indicate the importance of routinely screening for trafficking victims in inpatient psychiatry settings. Identification of cases is a requisite step in providing informed and evidence-based treatments and enabling the secondary prevention of re-exploitation. Additional research is warranted given the limited current empirical research on this topic area.

Modernization of the International Volcanic Ash Website - a global resource for ashfall preparedness and impact guidance.

NASA Astrophysics Data System (ADS)

Wallace, K.; Leonard, G.; Stewart, C.; Wilson, T. M.; Randall, M.; Stovall, W. K.

2015-12-01

The internationally collaborative volcanic ash website (http://volcanoes.usgs.gov/ash/) has been an important global information resource for ashfall preparedness and impact guidance since 2004. Recent volcanic ashfalls with significant local, regional, and global impacts highlighted the need to improve the website to make it more accessible and pertinent to users worldwide. Recently, the Volcanic Ash Impacts Working Group (Cities and Volcanoes Commission of IAVCEI) redesigned and modernized the website. Improvements include 1) a database-driven back end, 2) reorganized menu navigation, 3) language translation, 4) increased downloadable content, 5) addition of ash-impact case studies, 7) expanded and updated references , 8) an image database, and 9) inclusion of cooperating organization's logos. The database-driven platform makes the website more dynamic and efficient to operate and update. New menus provide information about specific impact topics (buildings, transportation, power, health, agriculture, water and waste water, equipment and communications, clean up) and updated content has been added throughout all topics. A new "for scientists" menu includes information on ash collection and analysis. Website translation using Google translate will significantly increase user base. Printable resources (e.g. checklists, pamphlets, posters) provide information to people without Internet access. Ash impact studies are used to improve mitigation measures during future eruptions, and links to case studies will assist communities' preparation and response plans. The Case Studies menu is intended to be a living topic area, growing as new case studies are published. A database of all images from the website allows users to access larger resolution images and additional descriptive details. Logos clarify linkages among key contributors and assure users that the site is authoritative and science-based.

Interactive Model-Centric Systems Engineering (IMCSE) Phase Two

DTIC Science & Technology

2015-02-28

109 Backend Implementation...42 Figure 10. Interactive Epoch-Era Analysis leverages humans-in-the-loop analysis and supporting infrastructure ...preliminary supporting 10 infrastructure . This will inform the transition strategies, additional case application and prototype user testing. • The

Representations in Calculus: Two Contrasting Cases.

ERIC Educational Resources Information Center

Aspinwall, Leslie; Shaw, Kenneth L.

2002-01-01

Illustrates the contrasting thinking processes of two beginning calculus students' geometric and analytic schemes for the derivative function. Suggests that teachers can enhance students' understanding by continuing to demonstrate how different representations of the same mathematical concept provide additional information. (KHR)

Ground-source heat pump case studies and utility programs

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

Lienau, P.J.; Boyd, T.L.; Rogers, R.L.

1995-04-01

Ground-source heat pump systems are one of the promising new energy technologies that has shown rapid increase in usage over the past ten years in the United States. These systems offer substantial benefits to consumers and utilities in energy (kWh) and demand (kW) savings. The purpose of this study was to determine what existing monitored data was available mainly from electric utilities on heat pump performance, energy savings and demand reduction for residential, school and commercial building applications. In order to verify the performance, information was collected for 253 case studies from mainly utilities throughout the United States. The casemore » studies were compiled into a database. The database was organized into general information, system information, ground system information, system performance, and additional information. Information was developed on the status of demand-side management of ground-source heat pump programs for about 60 electric utility and rural electric cooperatives on marketing, incentive programs, barriers to market penetration, number units installed in service area, and benefits.« less

The use of multiple models in case-based diagnosis

NASA Technical Reports Server (NTRS)

Karamouzis, Stamos T.; Feyock, Stefan

1993-01-01

The work described in this paper has as its goal the integration of a number of reasoning techniques into a unified intelligent information system that will aid flight crews with malfunction diagnosis and prognostication. One of these approaches involves using the extensive archive of information contained in aircraft accident reports along with various models of the aircraft as the basis for case-based reasoning about malfunctions. Case-based reasoning draws conclusions on the basis of similarities between the present situation and prior experience. We maintain that the ability of a CBR program to reason about physical systems is significantly enhanced by the addition to the CBR program of various models. This paper describes the diagnostic concepts implemented in a prototypical case based reasoner that operates in the domain of in-flight fault diagnosis, the various models used in conjunction with the reasoner's CBR component, and results from a preliminary evaluation.

15 CFR 50.5 - Fee structure for age search and citizenship information.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Foreign Trade BUREAU OF THE CENSUS, DEPARTMENT OF COMMERCE SPECIAL SERVICES AND STUDIES BY THE BUREAU OF... to the $65.00 transcript fee. Note: An additional charge of $20.00 per case is charged for expedited...

Recent Aqueous Environments in Impact Craters and the Astrobiological Exploration of Mars

NASA Technical Reports Server (NTRS)

Cabrol, N. A.; Wynn-Williams, D. D.; Crawford, D. A.; Grin, E. A.

2001-01-01

Three cases of recent aqueous environments are surveyed at Mars Orbiting Camera (MOC) high-resolution in the E-Gorgonum, Newton and Hale craters and their astrobiological implications assessed. Additional information is contained in the original extended abstract.

Improving Assistive Technology Service by Using 3D Printing: Three Case Studies.

PubMed

Watanabe, Takashi; Hatakeyama, Takuro; Tomiita, Mitsuru

2015-01-01

Assistive technology services are essential for adapting assistive devices to the individual needs of users with disabilities. In this study, we attempted to apply three-dimensional (3D) printing technology to three actual cases, and to study its use, effectiveness, and future applications. We assessed the usefulness of 3D printing technology by categorizing its utilization after reviewing the outcomes of these case studies. In future work, we aim to gather additional case studies and derive information on using 3D printing technology that will enable its effective application in the process of assistive technology services.

Medical malpractice of prostate brachytherapy.

PubMed

Elliott, Kathryn; Wallner, Kent; Merrick, Gregory; Herstein, Paul

2004-01-01

To summarize the basis for brachytherapy-associated legal complaints. The cases summarized here were those worked on by one author (KW) from 1992 through 2002. Summary information about cases is kept solely for the purpose of informing opposing counsel regarding past experience as a defendant or expert witness. No information summarized here is kept for medical research purposes. KW was the defendant in three cases, and an expert witness in the remaining 10 cases. Eleven cases were initiated due to a prostatic-rectal fistula--an abnormal communication between the prostatic urethra and rectum formed because of breakdown of irradiated tissue. Of the cases not involving a fistula, one was initiated due to chronic urinary burning, and the other arose from a patient identification mix-up, such that the plaintiff was treated with the implant planned for another patient. The principal physician defendant(s), after pre-trial winnowing, was the radiation oncologist alone in eight cases and the radiation oncologist and the urologist in five cases. In no case was a urologist named as a defendant without the radiation oncologist. None of the eleven rectal fistula cases involved an egregious seed placement error. Instead, plaintiff attorneys typically claimed breach of standard for care for what most physicians would likely consider to be variations within the standard of care. Prostate brachytherapists should brace themselves for the likelihood of more lawsuits. In addition to fistulas, plaintiff attorneys are likely to devise more bases for lawsuits in the future.

Value-informed space systems design and acquisition

NASA Astrophysics Data System (ADS)

Brathwaite, Joy

Investments in space systems are substantial, indivisible, and irreversible, characteristics that make them high-risk, especially when coupled with an uncertain demand environment. Traditional approaches to system design and acquisition, derived from a performance- or cost-centric mindset, incorporate little information about the spacecraft in relation to its environment and its value to its stakeholders. These traditional approaches, while appropriate in stable environments, are ill-suited for the current, distinctly uncertain, and rapidly changing technical and economic conditions; as such, they have to be revisited and adapted to the present context. This thesis proposes that in uncertain environments, decision-making with respect to space system design and acquisition should be value-based, or at a minimum value-informed. This research advances the value-centric paradigm by providing the theoretical basis, foundational frameworks, and supporting analytical tools for value assessment of priced and unpriced space systems. For priced systems, stochastic models of the market environment and financial models of stakeholder preferences are developed and integrated with a spacecraft-sizing tool to assess the system's net present value. The analytical framework is applied to a case study of a communications satellite, with market, financial, and technical data obtained from the satellite operator, Intelsat. The case study investigates the implications of the value-centric versus the cost-centric design and acquisition choices. Results identify the ways in which value-optimal spacecraft design choices are contingent on both technical and market conditions, and that larger spacecraft for example, which reap economies of scale benefits, as reflected by their decreasing cost-per-transponder, are not always the best (most valuable) choices. Market conditions and technical constraints for which convergence occurs between design choices under a cost-centric and a value-centric approach are identified and discussed. In addition, an innovative approach for characterizing value uncertainty through partial moments, a technique used in finance, is adapted to an engineering context and applied to priced space systems. Partial moments disaggregate uncertainty into upside potential and downside risk, and as such, they provide the decision-maker with additional insights for value-uncertainty management in design and acquisition. For unpriced space systems, this research first posits that their value derives from, and can be assessed through, the value of information they provide. To this effect, a Bayesian framework is created to assess system value in which the system is viewed as an information provider and the stakeholder an information recipient. Information has value to stakeholders as it changes their rational beliefs enabling them to yield higher expected pay-offs. Based on this marginal increase in expected pay-offs, a new metric, Value-of-Design (VoD), is introduced to quantify the unpriced system’s value. The Bayesian framework is applied to the case of an Earth Science satellite that provides hurricane information to oil rig operators using nested Monte Carlo modeling and simulation. Probability models of stakeholders’ beliefs, and economic models of pay-offs are developed and integrated with a spacecraft payload generation tool. The case study investigates the information value generated by each payload, with results pointing to clusters of payload instruments that yielded higher information value, and minimum information thresholds below which it is difficult to justify the acquisition of the system. In addition, an analytical decision tool, probabilistic Pareto fronts, is developed in the Cost-VoD trade space to provide the decision-maker with additional insights into the coupling of a system's probable value generation and its associated cost risk.

Influenza forecasting with Google Flu Trends.

PubMed

Dugas, Andrea Freyer; Jalalpour, Mehdi; Gel, Yulia; Levin, Scott; Torcaso, Fred; Igusa, Takeru; Rothman, Richard E

2013-01-01

We developed a practical influenza forecast model based on real-time, geographically focused, and easy to access data, designed to provide individual medical centers with advanced warning of the expected number of influenza cases, thus allowing for sufficient time to implement interventions. Secondly, we evaluated the effects of incorporating a real-time influenza surveillance system, Google Flu Trends, and meteorological and temporal information on forecast accuracy. Forecast models designed to predict one week in advance were developed from weekly counts of confirmed influenza cases over seven seasons (2004-2011) divided into seven training and out-of-sample verification sets. Forecasting procedures using classical Box-Jenkins, generalized linear models (GLM), and generalized linear autoregressive moving average (GARMA) methods were employed to develop the final model and assess the relative contribution of external variables such as, Google Flu Trends, meteorological data, and temporal information. A GARMA(3,0) forecast model with Negative Binomial distribution integrating Google Flu Trends information provided the most accurate influenza case predictions. The model, on the average, predicts weekly influenza cases during 7 out-of-sample outbreaks within 7 cases for 83% of estimates. Google Flu Trend data was the only source of external information to provide statistically significant forecast improvements over the base model in four of the seven out-of-sample verification sets. Overall, the p-value of adding this external information to the model is 0.0005. The other exogenous variables did not yield a statistically significant improvement in any of the verification sets. Integer-valued autoregression of influenza cases provides a strong base forecast model, which is enhanced by the addition of Google Flu Trends confirming the predictive capabilities of search query based syndromic surveillance. This accessible and flexible forecast model can be used by individual medical centers to provide advanced warning of future influenza cases.

Evaluation of a research diagnostic algorithm for DSM-5 neurocognitive disorders in a population-based cohort of older adults.

PubMed

Eramudugolla, Ranmalee; Mortby, Moyra E; Sachdev, Perminder; Meslin, Chantal; Kumar, Rajeev; Anstey, Kaarin J

2017-03-04

There is little information on the application and impact of revised criteria for diagnosing dementia and mild cognitive impairment (MCI), now termed major and mild neurocognitive disorders (NCDs) in the DSM-5. We evaluate a psychometric algorithm for diagnosing DSM-5 NCDs in a community-dwelling sample, and characterize the neuropsychological and functional profile of expert-diagnosed DSM-5 NCDs relative to DSM-IV dementia and International Working Group criteria for MCI. A population-based sample of 1644 adults aged 72-78 years was assessed. Algorithmic diagnostic criteria used detailed neuropsychological data, medical history, longitudinal cognitive performance, and informant interview. Those meeting all criteria for at least one diagnosis had data reviewed by a neurologist (expert diagnosis) who achieved consensus with a psychiatrist for complex cases. The algorithm accurately classified DSM-5 major NCD (area under the curve (AUC) = 0.95, 95% confidence interval (CI) 0.92-0.97), DSM-IV dementia (AUC = 0.91, 95% CI 0.85-0.97), DSM-5 mild NCD (AUC = 0.75, 95% CI 0.70-0.80), and MCI (AUC = 0.76, 95% CI 0.72-0.81) when compared to expert diagnosis. Expert diagnosis of dementia using DSM-5 criteria overlapped with 90% of DSM-IV dementia cases, but resulted in a 127% increase in diagnosis relative to DSM-IV. Additional cases had less severe memory, language impairment, and instrumental activities of daily living (IADL) impairments compared to cases meeting DSM-IV criteria for dementia. DSM-5 mild NCD overlapped with 83% of MCI cases and resulted in a 19% increase in diagnosis. These additional cases had a subtly different neurocognitive profile to MCI cases, including poorer social cognition. DSM-5 NCD criteria can be operationalized in a psychometric algorithm in a population setting. Expert diagnosis using DSM-5 NCD criteria captured most cases with DSM-IV dementia and MCI in our sample, but included many additional cases suggesting that DSM-5 criteria are broader in their categorization.

Balancing effort and information transmission during language acquisition: Evidence from word order and case marking

PubMed Central

Fedzechkina, Maryia; Newport, Elissa L.; Jaeger, T. Florian

2015-01-01

Across languages of the world, some grammatical patterns have been argued to be more common than expected by chance. These are sometimes referred to as (statistical) language universals. One such universal is the correlation between constituent order freedom and the presence of a case system in a language. Here we explore whether this correlation can be explained by a bias to balance production effort and informativity of cues to grammatical function. Two groups of learners were presented with miniature artificial languages containing optional case marking and either flexible or fixed constituent order. Learners of the flexible order language used case marking significantly more often. This result parallels the typological correlation between constituent order flexibility and the presence of case marking in a language and provides a possible explanation for the historical development of Old English to Modern English, from flexible constituent order with case marking to relatively fixed order without case marking. Additionally, learners of the flexible order language conditioned case marking on constituent order, using more case marking with the cross-linguistically less frequent order, again mirroring typological data. These results suggest that some cross-linguistic generalizations originate in functionally motivated biases operating during language learning. PMID:26901374

Antenatal diagnosis of anophthalmia by three-dimensional ultrasound: a novel application of the reverse face view.

PubMed

Wong, H S; Parker, S; Tait, J; Pringle, K C

2008-07-01

The prenatal diagnosis of anophthalmia can be made on the demonstration of absent eye globe and lens on the affected side(s) on two-dimensional ultrasound examination, but when the fetal head position is unfavorable three-dimensional (3D) ultrasound may reveal additional diagnostic sonographic features, including sunken eyelids and small or hypoplastic orbit on the affected side(s). We present two cases of isolated anophthalmia diagnosed on prenatal ultrasound examination in which 3D ultrasound provided additional diagnostic information. The reverse face view provides valuable information about the orbits and the eyeballs for prenatal diagnosis and assessment of anophthalmia.

Out of sight, out of mind: the presence of forensic evidence counts more than its absence.

PubMed

Eerland, Anita; Post, Lysanne S; Rassin, Eric; Bouwmeester, Samantha; Zwaan, Rolf A

2012-05-01

Recent evidence suggests that decision makers in criminal procedures are susceptible to biases. We previously found support for the presence of a feature positive effect (FPE, i.e., people attach more meaning to present than to absent information) in legal-decision making. In this study, we tried to uncover the mechanisms behind the FPE. Taking a cue from the literature on situation models in language comprehension, we investigated whether a FPE manifests itself in the memorization and use of forensic evidence. Students read a case file about a fistfight as well as additional evidence. The forensic evidence was manipulated such that a FPE on guilt estimation and conviction rate could be assessed. While subjects read additional forensic evidence, their eye movements were recorded to explore the presence of FPE in online processing. Afterwards, subjects were asked to decide on the suspect's guilt. They had to recall all information they remembered from the case file and indicate which parts of information they considered relevant to this decision. The results provided evidence for the occurrence of FPE in memorization and use of information and can be explained by the theoretical construct of situation models. Copyright © 2012 Elsevier B.V. All rights reserved.

Fission Xenon on Mars

NASA Technical Reports Server (NTRS)

Mathew, K. J.; Marti, K.; Marty, B.

2002-01-01

Fission Xe components due to Pu-244 decay in the early history of Mars have been identified in nakhlites; as in the case of ALH84001 and Chassigny the fission gas was assimilated into indigenous solar-type Xe. Additional information is contained in the original extended abstract.

Development of Next Generation Energy Audit Protocols for the Rapid and Advanced Analysis of Building Energy Use

NASA Astrophysics Data System (ADS)

Hartley, Christopher Ahlvin

Current building energy auditing techniques are outdated and lack targeted, actionable information. These analyses only use one year's worth of monthly electricity and gas bills to define energy conservation and efficiency measures. These limited data sets cannot provide robust, directed energy reduction recommendations. The need is apparent for an overhaul of existing energy audit protocols to utilize all data that is available from the building's utility provider, installed energy management system (EMS), and sub-metering devices. This thesis analyzed the current state-of-the-art in energy audits, generated a next generation energy audit protocol, and conducted both audits types on four case study buildings to find out what additional information can be obtained from additional data sources and increased data gathering resolutions. Energy data from each case study building were collected using a variety of means including utility meters, whole building energy meters, EMS systems, and sub-metering devices. In addition to conducting an energy analysis for each case study building using the current and next generation energy audit protocols, two building energy models were created using the programs eQuest and EnergyPlus. The current and next generation energy audit protocol results were compared to one another upon completion. The results show that using the current audit protocols, only variations in season are apparent. Results from the developed next generation energy audit protocols show that in addition to seasonal variations, building heating, ventilation and air conditioning (HVAC) schedules, occupancy schedules, baseline and peak energy demand levels, and malfunctioning equipment can be found. This new protocol may also be used to quickly generate accurate building models because of the increased resolution that yields scheduling information. The developed next generation energy auditing protocol is scalable and can work for many building types across the United States, and perhaps the world.

Tutorial for Thermophysics Universal Research Framework

DTIC Science & Technology

2017-07-30

DS1V are compared in Section 3.4.5. 3.4.2 Description of the Example Problem In a fluid, disturbance information is communicated within a medium at the...Universal Research Framework development (TURF-DEV) package on a case-by-case basis. Brief descriptions of the operations are provided in Tables 4.1 and...of additional experimental (E) and research (R) operations included in TURF-DEV. Module Operation Description DSMC SPDistDirectDSMCCellMergeOp (R

A Guide to Resources and Sources of Information for Acquisition Research

DTIC Science & Technology

1980-01-01

State, and Federal, plus the full text of all Federal cases from 1961. Public contract law decisions are included in the case files. (9) LEXIS, Mead...expensive and would be difficult to justify simply for research in public contract law . On the other hand, law schools or organizations with...reflecting a particular emphasis in the area of Government contract law . In addition to a comprehensive collection of statutes, opinions and

Characterizing liability for cranial nerve injuries: a detailed analysis of 209 malpractice trials.

PubMed

Svider, Peter F; Sunaryo, Peter L; Keeley, Brieze R; Kovalerchik, Olga; Mauro, Andrew C; Eloy, Jean Anderson

2013-05-01

The potential for adverse events with lasting functional effects makes cranial nerve (CN) injury a target for litigation. Our objective was to comprehensively examine records of malpractice trials and detail issues influencing outcomes. Retrospective analysis. The Westlaw database (Thomson Reuters, New York, NY) was searched for jury verdict reports related to medical malpractice and CN injury. After excluding nonrelevant cases, we examined 209 trials for characteristics including nerve(s) injured, alleged causes of malpractice, demographic information, specialty, and outcome. The most commonly litigated CNs were VII (24.4%) and II (19.6%). Sixty-nine (33.0%) trials resulted in damages awarded. Outcomes varied, ranging from a 29.2% plaintiff success rate for CN XI injury to 48.4% for CN II injury. Plaintiffs had less success with increasing age. Average damages awarded were $1.7 million. The most commonly named defendants were otolaryngologists and general surgeons. Individual considerations varied but commonly included alleged deficits in informed consent (25.4%), unnecessary procedures (14.8%), undergoing additional surgery (25.8%), and untimely recognition of complications (23.9%). Malpractice trials were resolved in the defendant's favor the majority of the time. In cases where plaintiffs were successful, however, awards were considerable, averaging nearly $2 million. Factors influencing case outcome included age, location, perceived deficits in informed consent, allegedly unnecessary surgery, requiring additional surgery to repair a complication, and untimely recognition of complications. Although specific factors should be taken into consideration with each procedure, providing detailed informed consent and communicating with patients regarding expectations may minimize liability. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

The Effect of Information Analysis Automation Display Content on Human Judgment Performance in Noisy Environments.

PubMed

Bass, Ellen J; Baumgart, Leigh A; Shepley, Kathryn Klein

2013-03-01

Displaying both the strategy that information analysis automation employs to makes its judgments and variability in the task environment may improve human judgment performance, especially in cases where this variability impacts the judgment performance of the information analysis automation. This work investigated the contribution of providing either information analysis automation strategy information, task environment information, or both, on human judgment performance in a domain where noisy sensor data are used by both the human and the information analysis automation to make judgments. In a simplified air traffic conflict prediction experiment, 32 participants made probability of horizontal conflict judgments under different display content conditions. After being exposed to the information analysis automation, judgment achievement significantly improved for all participants as compared to judgments without any of the automation's information. Participants provided with additional display content pertaining to cue variability in the task environment had significantly higher aided judgment achievement compared to those provided with only the automation's judgment of a probability of conflict. When designing information analysis automation for environments where the automation's judgment achievement is impacted by noisy environmental data, it may be beneficial to show additional task environment information to the human judge in order to improve judgment performance.

A Case Study of the Technology Use and Information Flow at a Hospital-Driven Telemedicine Service.

PubMed

Smaradottir, Berglind; Fensli, Rune

2017-01-01

Health care services face the challenge of providing individualised treatment to a growing ageing population prone to chronic conditions and multi-morbidities. The research project Patients and Professionals in Productive Teams aims to study health care services that are run with a patient-centred teamwork approach. In this context, a case study was made of a hospital-driven telemedicine service for chronic obstructive pulmonary disease patients after hospital discharge, with a focus on information flow and technology use. The methods used were observation and interviews with key informants. The results showed that the technology was perceived as well-functioning for telemedicine support, but the technology used was a standalone system and not integrated with the electronic health record of the hospital. In addition, there was lack of support to provide the patients at home with written instructions on advices of medical treatment and care. The electronic information used for this telemedicine services, allowed shared access of information for teamwork between professional only within the hospital.

Implementation of an Anesthesia Information Management System (AIMS)

PubMed Central

Douglas, James R.; Ritter, Melody J.

2011-01-01

During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care–related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applications and laboratory computers. The AIMS facilitates chart entries such as drug doses and case narratives. Benefits of an AIMS include improved legibility of the anesthesia record and greater efficiency in documentation efforts. Use of the AIMS assists the practitioner with decision support logic, such as the timing of antibiotic administration and the inclusion of legally required documentation. Upon case completion, the AIMS data are immediately available to other information systems, such as billing and medical records. Data can be made available from a single case or, more important, from thousands of cases to analyze variables such as efficiency of services, adherence to best practices, patient outcomes, and clinical research. The AIMS was deployed at the main campus of the Ochsner Health System on March 26, 2009. In this article, we discuss the issues involved in the AIMS implementation process: the successes, surprises, and continued challenges. PMID:21734847

Implementation of an Anesthesia Information Management System (AIMS).

PubMed

Douglas, James R; Ritter, Melody J

2011-01-01

During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care-related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applications and laboratory computers. The AIMS facilitates chart entries such as drug doses and case narratives. Benefits of an AIMS include improved legibility of the anesthesia record and greater efficiency in documentation efforts. Use of the AIMS assists the practitioner with decision support logic, such as the timing of antibiotic administration and the inclusion of legally required documentation. Upon case completion, the AIMS data are immediately available to other information systems, such as billing and medical records. Data can be made available from a single case or, more important, from thousands of cases to analyze variables such as efficiency of services, adherence to best practices, patient outcomes, and clinical research. The AIMS was deployed at the main campus of the Ochsner Health System on March 26, 2009. In this article, we discuss the issues involved in the AIMS implementation process: the successes, surprises, and continued challenges.

42 CFR 455.1 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for a State fraud detection and investigation program, and for disclosure of information on ownership... Security Act, Subpart A provides State plan requirements for the identification, investigation, and referral of suspected fraud and abuse cases. In addition, the subpart requires that the State— (1) Report...

Analytical Study of Cockpit Information Requirements.

DTIC Science & Technology

1981-04-01

monitoring and control of engine case heating and cooling . Generally, the crew will be buffered from these changes by the increasingly more...advantages of color for prioritization, data separation and added dimensionality should apply equally well here as with conventional EADI and EHSI formats...addition of position/time control to a 3-D RNAV system converts it into a 4-D system. A 3-D system requires the addition of a time source plus software

Getting the most out of additional guidance information in deformable image registration by leveraging multi-objective optimization

NASA Astrophysics Data System (ADS)

Alderliesten, Tanja; Bosman, Peter A. N.; Bel, Arjan

2015-03-01

Incorporating additional guidance information, e.g., landmark/contour correspondence, in deformable image registration is often desirable and is typically done by adding constraints or cost terms to the optimization function. Commonly, deciding between a "hard" constraint and a "soft" additional cost term as well as the weighting of cost terms in the optimization function is done on a trial-and-error basis. The aim of this study is to investigate the advantages of exploiting guidance information by taking a multi-objective optimization perspective. Hereto, next to objectives related to match quality and amount of deformation, we define a third objective related to guidance information. Multi-objective optimization eliminates the need to a-priori tune a weighting of objectives in a single optimization function or the strict requirement of fulfilling hard guidance constraints. Instead, Pareto-efficient trade-offs between all objectives are found, effectively making the introduction of guidance information straightforward, independent of its type or scale. Further, since complete Pareto fronts also contain less interesting parts (i.e., solutions with near-zero deformation effort), we study how adaptive steering mechanisms can be incorporated to automatically focus more on solutions of interest. We performed experiments on artificial and real clinical data with large differences, including disappearing structures. Results show the substantial benefit of using additional guidance information. Moreover, compared to the 2-objective case, additional computational cost is negligible. Finally, with the same computational budget, use of the adaptive steering mechanism provides superior solutions in the area of interest.

Virtual patients: the influence of case design and teamwork on students' perception and knowledge - a pilot study.

PubMed

Jäger, Frederik; Riemer, Martin; Abendroth, Martin; Sehner, Susanne; Harendza, Sigrid

2014-07-08

Virtual patient (VP) cases are an effective teaching method, although little is known about how to design and implement them for maximum effectiveness. The aim of this study was to explore the effect of case design and teamwork on students' learning outcome. One hundred forty-six undergraduate medical students participated in a mandatory medical computer science course consisting of five seminars. At the end of each seminar, they worked on one VP case, either in teams of two or individually. Each student filled out an introductory and a final survey and a feedback sheet after completing each case. Additionally, there was a surprise multiple choice (MC) test after the last seminar with three questions regarding each case. Students with more clinical experience and students who had worked in a team performed significantly better on MC questions. Students with less clinical experience more frequently used information which had been positioned less prominently on the case material. Certain aspects of case design were rated more positively by students who had an interest in e-learning. In general, students preferred to work on cases for less than 15 minutes. Clinically more advanced students and students working with a partner seem to benefit most from short VP cases with prominently presented information.

Forensic Evidence and Criminal Investigations: The Impact of Ballistics Information on the Investigation of Violent Crime in Nine Cities.

PubMed

King, William R; Campbell, Bradley A; Matusiak, Matthew C; Katz, Charles M

2017-07-01

We explore the impact of information from ballistics imaging hit reports on the investigation into violent crimes. Ballistics imaging hits link two crimes involving the same firearm by forensically matching tool marks on the fired bullets or cartridge cases. Interview data collected from detectives who received a hit report were used to explore the relationship between the presence of a hit report and outcomes in 65 gun-related violent crime investigations in nine U.S. police agencies. Findings indicate hit reports rarely contribute to identification, arrest, charging, or sentencing of suspects, because of delays in producing hit reports. On average, hit reports were completed 181.4 days after the focal crime. This delay forces investigations to proceed without the benefit of information from ballistics analysis. Additionally, hit reports rarely contained detailed information that was immediately useful to investigators. Instead, hit reports required additional research by the investigator to unlock useful information. © 2017 American Academy of Forensic Sciences.

THE PARAMETERS OF INFORMED CONSENT

PubMed Central

Raab, Edward L

2004-01-01

ABSTRACT Purpose To describe the components of a proper informed consent; which risks must be disclosed and which need not; additional safeguards for incapacitated persons, minors, and research subjects; and where the law will imply consent that is not otherwise obtained. Methods Summarization of current law obtained from legal treatises, reports of recent cases, and personal experience as a reviewer and expert. Results Lack of informed consent can reinforce a claim of medical malpractice or serve as an alternative point of attack when the case is otherwise weak. Special requirements must be met when patients are the subjects of clinical research. Conclusion Demonstration of a well-conducted process, not merely of a paper, not only protects the physician from exposure to liability, but increases the patient’s autonomy in decisions concerning health and encourages compliance with treatment. PMID:15747761

Capabilities and applications of the Program to Optimize Simulated Trajectories (POST). Program summary document

NASA Technical Reports Server (NTRS)

Brauer, G. L.; Cornick, D. E.; Stevenson, R.

1977-01-01

The capabilities and applications of the three-degree-of-freedom (3DOF) version and the six-degree-of-freedom (6DOF) version of the Program to Optimize Simulated Trajectories (POST) are summarized. The document supplements the detailed program manuals by providing additional information that motivates and clarifies basic capabilities, input procedures, applications and computer requirements of these programs. The information will enable prospective users to evaluate the programs, and to determine if they are applicable to their problems. Enough information is given to enable managerial personnel to evaluate the capabilities of the programs and describes the POST structure, formulation, input and output procedures, sample cases, and computer requirements. The report also provides answers to basic questions concerning planet and vehicle modeling, simulation accuracy, optimization capabilities, and general input rules. Several sample cases are presented.

A Global Electric Circuit on Mars

NASA Technical Reports Server (NTRS)

Delory, G. T.; Farrell, W. M.; Desch, M. D.

2001-01-01

We describe conditions on the surface of Mars conducive to the formation of a martian global electric circuit, in a direct analogy to the terrestrial case where atmospheric currents and electric fields are generated worldwide through the charging in thunderstorms. Additional information is contained in the original extended abstract.

Defense Health Care Reform: Additional Implementation Details Would Increase Transparency of DOD’s Plans and Enhance Accountability

DTIC Science & Technology

2013-11-01

on timelines; and was not required to include information on shared services because the reporting time frame was not applicable. GAO also assessed...implementation costs and aggregated cost-savings estimates for the consolidation of four shared services . However, some key details of a sound business...case were missing, such as the basis for the savings. DOD’s business cases aggregated the separate business lines of its shared services , which

Characterizing Treatable Causes of Small-Fiber Polyneuropathy in Gulf War Veterans

DTIC Science & Technology

2017-10-01

this study Global experts participated in additional rounds of a Delphi process to determine the most reliable markers for SFPN ( Case Definition). We...We supplemented the pertinent information on SFPN and added a link to this study as a recruitment tool. The public portion of the website may be...propose as part of the Case Definition. The database currently contains data on 3,495 subjects consisting of 3,087 patients and 408 healthy controls

Survey of diagnostic and treatment practices for multiple sclerosis in Europe.

PubMed

Fernández, O; Delvecchio, M; Edan, G; Fredrikson, S; Gionvannoni, G; Hartung, H-P; Havrdova, E; Kappos, L; Pozzilli, C; Soerensen, P S; Tackenberg, B; Vermersch, P; Comi, G

2017-03-01

Up-to-date information is needed on the extent to which neurologists treating multiple sclerosis (MS) in Europe are integrating rapidly evolving diagnostic criteria, disease-modifying therapies and recommendations for monitoring disease activity into their clinical practice. A steering committee of MS neurologists used a modified Delphi process to develop case- and practice-based questions for two sequential surveys distributed to MS neurologists throughout Europe. Case-based questions were developed for radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS) and RRMS with breakthrough disease. Multiple sclerosis neurologists from 11 European countries responded to survey 1 (n = 233) and survey 2 (n = 171). Respondents agreed that they would not treat the patients in the RIS or CIS cases but would treat a patient with a relatively mild form of RRMS. Choice of treatment was evenly distributed among first-line injectables and oral treatments for mild RRMS, and moved to second-line treatment as the RRMS case increased in severity. Additional results on RRMS with breakthrough disease are presented. Although there was general agreement on some aspects of treatment, responses to other management and clinical practice questions varied considerably. These results, which reflect current clinical practice patterns, highlight the need for additional MS treatment education and awareness and may help inform the development of MS practice guidelines in Europe. © 2017 EAN.

Phrase Lengths and the Perceived Informativeness of Prosodic Cues in Turkish.

PubMed

Dinçtopal Deniz, Nazik; Fodor, Janet Dean

2017-12-01

It is known from previous studies that in many cases (though not all) the prosodic properties of a spoken utterance reflect aspects of its syntactic structure, and also that in many cases (though not all) listeners can benefit from these prosodic cues. A novel contribution to this literature is the Rational Speaker Hypothesis (RSH), proposed by Clifton, Carlson and Frazier. The RSH maintains that listeners are sensitive to possible reasons for why a speaker might introduce a prosodic break: "listeners treat a prosodic boundary as more informative about the syntax when it flanks short constituents than when it flanks longer constituents," because in the latter case the speaker might have been motivated solely by consideration of optimal phrase lengths. This would effectively reduce the cue value of an appropriately placed prosodic boundary. We present additional evidence for the RSH from Turkish, a language typologically different from English. In addition, our study shows for the first time that the RSH also applies to a prosodic break which conflicts with the syntactic structure, reducing its perceived cue strength if it might have been motivated by length considerations. In this case, the RSH effect is beneficial. Finally, the Turkish data show that prosody-based explanations for parsing preferences such as the RSH do not take the place of traditional syntax-sensitive parsing strategies such as Late Closure. The two sources of guidance co-exist; both are used when available.

Breaching the security of the Kaiser Permanente Internet patient portal: the organizational foundations of information security.

PubMed

Collmann, Jeff; Cooper, Ted

2007-01-01

This case study describes and analyzes a breach of the confidentiality and integrity of personally identified health information (e.g. appointment details, answers to patients' questions, medical advice) for over 800 Kaiser Permanente (KP) members through KP Online, a web-enabled health care portal. The authors obtained and analyzed multiple types of qualitative data about this incident including interviews with KP staff, incident reports, root cause analyses, and media reports. Reasons at multiple levels account for the breach, including the architecture of the information system, the motivations of individual staff members, and differences among the subcultures of individual groups within as well as technical and social relations across the Kaiser IT program. None of these reasons could be classified, strictly speaking, as "security violations." This case study, thus, suggests that, to protect sensitive patient information, health care organizations should build safe organizational contexts for complex health information systems in addition to complying with good information security practice and regulations such as the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Imperfect information facilitates the evolution of reciprocity.

PubMed

Kurokawa, Shun

2016-06-01

The existence of cooperation demands explanation since cooperation is costly to the actor. Reciprocity has long been regarded as a potential explanatory mechanism for the existence of cooperation. Reciprocity is a mechanism wherein a cooperator responds to an opponent's behavior by switching his/her own behavior. Hence, a possible problematic case relevant to the theory of reciprocity evolution arises when the mechanism is such that the information regarding an opponent's behavior is imperfect. Although it has been confirmed also by previous theoretical studies that imperfect information interferes with the evolution of reciprocity, this argument is based on the assumption that there are no mistakes in behavior. And, a previous study presumed that it might be expected that when such mistakes occur, reciprocity can more readily evolve in the case of imperfect information than in the case of perfect information. The reason why the previous study considers so is that in the former case, reciprocators can miss defections incurred by other reciprocators' mistakes due to imperfect information, allowing cooperation to persist when such reciprocators meet. However, contrary to this expectation, the previous study has shown that even when mistakes occur, imperfect information interferes with the evolution of reciprocity. Nevertheless, the previous study assumed that payoffs are linear (i.e., that the effect of behavior is additive and there are no synergetic effects). In this study, we revisited the same problem but removed the assumption that payoffs are linear. We used evolutionarily stable strategy analysis to compare the condition for reciprocity to evolve when mistakes occur and information is imperfect with the condition for reciprocity to evolve when mistakes occur and information is perfect. Our study revealed that when payoffs are not linear, imperfect information can facilitate the evolution of reciprocity when mistakes occur; while when payoffs are linear, imperfect information disturbs the evolution of reciprocity even when mistakes occur. Imperfect information can encourage the evolution of cooperation. Copyright © 2016 Elsevier Inc. All rights reserved.

Decrease of Fisher information and the information geometry of evolution equations for quantum mechanical probability amplitudes.

PubMed

Cafaro, Carlo; Alsing, Paul M

2018-04-01

The relevance of the concept of Fisher information is increasing in both statistical physics and quantum computing. From a statistical mechanical standpoint, the application of Fisher information in the kinetic theory of gases is characterized by its decrease along the solutions of the Boltzmann equation for Maxwellian molecules in the two-dimensional case. From a quantum mechanical standpoint, the output state in Grover's quantum search algorithm follows a geodesic path obtained from the Fubini-Study metric on the manifold of Hilbert-space rays. Additionally, Grover's algorithm is specified by constant Fisher information. In this paper, we present an information geometric characterization of the oscillatory or monotonic behavior of statistically parametrized squared probability amplitudes originating from special functional forms of the Fisher information function: constant, exponential decay, and power-law decay. Furthermore, for each case, we compute both the computational speed and the availability loss of the corresponding physical processes by exploiting a convenient Riemannian geometrization of useful thermodynamical concepts. Finally, we briefly comment on the possibility of using the proposed methods of information geometry to help identify a suitable trade-off between speed and thermodynamic efficiency in quantum search algorithms.

Decrease of Fisher information and the information geometry of evolution equations for quantum mechanical probability amplitudes

NASA Astrophysics Data System (ADS)

Cafaro, Carlo; Alsing, Paul M.

2018-04-01

The relevance of the concept of Fisher information is increasing in both statistical physics and quantum computing. From a statistical mechanical standpoint, the application of Fisher information in the kinetic theory of gases is characterized by its decrease along the solutions of the Boltzmann equation for Maxwellian molecules in the two-dimensional case. From a quantum mechanical standpoint, the output state in Grover's quantum search algorithm follows a geodesic path obtained from the Fubini-Study metric on the manifold of Hilbert-space rays. Additionally, Grover's algorithm is specified by constant Fisher information. In this paper, we present an information geometric characterization of the oscillatory or monotonic behavior of statistically parametrized squared probability amplitudes originating from special functional forms of the Fisher information function: constant, exponential decay, and power-law decay. Furthermore, for each case, we compute both the computational speed and the availability loss of the corresponding physical processes by exploiting a convenient Riemannian geometrization of useful thermodynamical concepts. Finally, we briefly comment on the possibility of using the proposed methods of information geometry to help identify a suitable trade-off between speed and thermodynamic efficiency in quantum search algorithms.

Balancing Effort and Information Transmission During Language Acquisition: Evidence From Word Order and Case Marking.

PubMed

Fedzechkina, Maryia; Newport, Elissa L; Jaeger, T Florian

2017-03-01

Across languages of the world, some grammatical patterns have been argued to be more common than expected by chance. These are sometimes referred to as (statistical) language universals. One such universal is the correlation between constituent order freedom and the presence of a case system in a language. Here, we explore whether this correlation can be explained by a bias to balance production effort and informativity of cues to grammatical function. Two groups of learners were presented with miniature artificial languages containing optional case marking and either flexible or fixed constituent order. Learners of the flexible order language used case marking significantly more often. This result parallels the typological correlation between constituent order flexibility and the presence of case marking in a language and provides a possible explanation for the historical development of Old English to Modern English, from flexible constituent order with case marking to relatively fixed order without case marking. In addition, learners of the flexible order language conditioned case marking on constituent order, using more case marking with the cross-linguistically less frequent order, again mirroring typological data. These results suggest that some cross-linguistic generalizations originate in functionally motivated biases operating during language learning. Copyright © 2016 Cognitive Science Society, Inc.

Survey of Information Sharing Related to the Occupational Considerations of Working Cancer Patients Between Occupational Physicians and Treating Physicians.

PubMed

Furuya, Yuko; Takahashi, Miyako; Tateishi, Seiichiro; Tomita, Makiko; Hiraoka, Kou; Shibata, Yoshiyuki; Mori, Koji

2016-06-07

Although a vital element in providing career support to workers with medical ailments is coordination between the worker, the treating physician, and the company (the occupational health staff), little is known about factors that promote or impede coordination between these parties. This study aims to demonstrate what kinds of actions by treating physicians promote or impede the occupational considerations made by occupational physicians. A total of 43 occupational physicians who had completed the postgraduate training course (4 years) at the University of Occupational and Environmental Health Japan and were current or former instructors at the Occupational Health Training Center were surveyed using a self-reported questionnaire form. The questionnaire asked about individual attributes (age, years of experience as an occupational physician, etc.) and actions taken by treating physicians that were useful in making occupational considerations in the workplace (good practice cases) or that impeded such considerations (trouble cases). Responses about cases were obtained as freely written descriptions. Case content was analyzed qualitatively according to the KJ method. During the survey period from December 17, 2013 to January 18, 2014, responses were received from 33 occupational physicians (valid response rate, 76.7%; mean age, 37.4±6.1 years). Of these, 60.6% exclusively specialized in occupational medicine. Respondents provided 32 good practice cases and 16 trouble cases. The timing of coordination was the period of rehabilitation in 35 of the 48 cases (72.9%). Actions by the treating physicians that influenced occupational considerations were divided into seven major categories: "providing treatment information," "providing physical information," "appropriateness of rehabilitation or occupational considerations," "consistency of information provided," "issuing documentation," "communication that was cognizant of the occupational physician's presence," and "providing information unknown to the worker." This study clarified the kind of actions by the treating physicians that were relevant to occupational support provided by occupational physicians. Additionally, this study clarified the need for information sharing with occupational physician and treating physician. The good practice cases and trouble cases presented by the respondents were inextricably linked, and actions by the treating physicians that are based on good practices are highly likely to lead to smooth information sharing and occupational considerations.

Data fraud in clinical trials

PubMed Central

George, Stephen L; Buyse, Marc

2015-01-01

Highly publicized cases of fabrication or falsification of data in clinical trials have occurred in recent years and it is likely that there are additional undetected or unreported cases. We review the available evidence on the incidence of data fraud in clinical trials, describe several prominent cases, present information on motivation and contributing factors and discuss cost-effective ways of early detection of data fraud as part of routine central statistical monitoring of data quality. Adoption of these clinical trial monitoring procedures can identify potential data fraud not detected by conventional on-site monitoring and can improve overall data quality. PMID:25729561

Computer model for refinery operations with emphasis on jet fuel production. Volume 2: Data and technical bases

NASA Technical Reports Server (NTRS)

Dunbar, D. N.; Tunnah, B. G.

1978-01-01

The FORTRAN computing program predicts the flow streams and material, energy, and economic balances of a typical petroleum refinery, with particular emphasis on production of aviation turbine fuel of varying end point and hydrogen content specifications. The program has provision for shale oil and coal oil in addition to petroleum crudes. A case study feature permits dependent cases to be run for parametric or optimization studies by input of only the variables which are changed from the base case. The report has sufficient detail for the information of most readers.

Influenza A(H1N1)v in Germany: the first 10,000 cases.

PubMed

Gilsdorf, Andreas; Poggensee, Gabriele

2009-08-27

The analysis of the first 10,000 cases of influenza A(H1N1)v in Germany confirms findings from other sources that the virus is currently mainly causing mild diseases, affecting mostly adolescents and young adults. Overall hospitalisation rate for influenza A(H1N1)v was low (7%). Only 3% of the cases had underlying conditions and pneumonia was rare (0.4%). Both reporting and testing requirements have been adapted recently, taking into consideration the additional information available on influenza A(H1N1)v infections.

Implementing Generalized Additive Models to Estimate the Expected Value of Sample Information in a Microsimulation Model: Results of Three Case Studies.

PubMed

Rabideau, Dustin J; Pei, Pamela P; Walensky, Rochelle P; Zheng, Amy; Parker, Robert A

2018-02-01

The expected value of sample information (EVSI) can help prioritize research but its application is hampered by computational infeasibility, especially for complex models. We investigated an approach by Strong and colleagues to estimate EVSI by applying generalized additive models (GAM) to results generated from a probabilistic sensitivity analysis (PSA). For 3 potential HIV prevention and treatment strategies, we estimated life expectancy and lifetime costs using the Cost-effectiveness of Preventing AIDS Complications (CEPAC) model, a complex patient-level microsimulation model of HIV progression. We fitted a GAM-a flexible regression model that estimates the functional form as part of the model fitting process-to the incremental net monetary benefits obtained from the CEPAC PSA. For each case study, we calculated the expected value of partial perfect information (EVPPI) using both the conventional nested Monte Carlo approach and the GAM approach. EVSI was calculated using the GAM approach. For all 3 case studies, the GAM approach consistently gave similar estimates of EVPPI compared with the conventional approach. The EVSI behaved as expected: it increased and converged to EVPPI for larger sample sizes. For each case study, generating the PSA results for the GAM approach required 3 to 4 days on a shared cluster, after which EVPPI and EVSI across a range of sample sizes were evaluated in minutes. The conventional approach required approximately 5 weeks for the EVPPI calculation alone. Estimating EVSI using the GAM approach with results from a PSA dramatically reduced the time required to conduct a computationally intense project, which would otherwise have been impractical. Using the GAM approach, we can efficiently provide policy makers with EVSI estimates, even for complex patient-level microsimulation models.

Hearing-Impaired Children in Venezuela: 1985.

ERIC Educational Resources Information Center

Schildroth, Arthur; And Others

1987-01-01

The 1984-85 Venezuelan Survey of Deaf Children collected information on 804 deaf students between ages 3 and 14. Among findings were that 29% of the cases were caused by maternal rubella, that 36% had additional handicaps, and that meningitis was the most frequently reported after-birth cause of hearing losses. (Author/DB)

40 CFR 147.2918 - Permit application information.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., including total dissolved solids, chlorides, and additives. (4) Geologic data on the injection and confining..., showing: (i) Total depth or plug-back depth; (ii) Depth to top and bottom of injection interval; (iii) Depths to tops and bottoms of casing and cemented intervals, and amount of cement to be used; (iv) Size...

40 CFR 147.2918 - Permit application information.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., including total dissolved solids, chlorides, and additives. (4) Geologic data on the injection and confining..., showing: (i) Total depth or plug-back depth; (ii) Depth to top and bottom of injection interval; (iii) Depths to tops and bottoms of casing and cemented intervals, and amount of cement to be used; (iv) Size...

40 CFR 147.2918 - Permit application information.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., including total dissolved solids, chlorides, and additives. (4) Geologic data on the injection and confining..., showing: (i) Total depth or plug-back depth; (ii) Depth to top and bottom of injection interval; (iii) Depths to tops and bottoms of casing and cemented intervals, and amount of cement to be used; (iv) Size...

40 CFR 147.2918 - Permit application information.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., including total dissolved solids, chlorides, and additives. (4) Geologic data on the injection and confining..., showing: (i) Total depth or plug-back depth; (ii) Depth to top and bottom of injection interval; (iii) Depths to tops and bottoms of casing and cemented intervals, and amount of cement to be used; (iv) Size...

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

Urman, M.; O'Sullivan, R.A.; Nugent, R.A.

This case concerns a patient with intracranial extramedullary hematopoiesis (EH) suspected on a CT scan and subsequently confirmed with In-111 chloride and Tc-99m SC bone marrow scans. The bone marrow scans also provided additional information by demonstrating other sites of EH in the paravertebral tissues and bone marrow expansion into the distal extremities.

An Evaluation of the Mode of Action Framework for MutagenicCarcinogens Case Study II: Chromium (VI).

EPA Science Inventory

In response to the 2005 revised U.S Environmental Protection Agency’s (EPA) Cancer Guidelines, a strategy is being developed to include all mutagenicity and other genotoxicity data with any additional information to determine whether a carcinogen operates through a mutagenic mode...

THE EFFECT OF FLUORIDE ON CONVENTIONAL WATER TREATMENT USING ALUMINUM SULFATE

EPA Science Inventory

Based on the Information Collection Rule survey results of 600 large utilities, approximately 50% of them fluoridate their water and of those, 15-20% do so at the location of coagulant addition. In this case, the effect of fluoride on the coagulation process, floc properties, coa...

Integration of DNA sample collection into a multi-site birth defects case-control study.

PubMed

Rasmussen, Sonja A; Lammer, Edward J; Shaw, Gary M; Finnell, Richard H; McGehee, Robert E; Gallagher, Margaret; Romitti, Paul A; Murray, Jeffrey C

2002-10-01

Advances in quantitative analysis and molecular genotyping have provided unprecedented opportunities to add biological sampling and genetic information to epidemiologic studies. The purpose of this article is to describe the incorporation of DNA sample collection into the National Birth Defects Prevention Study (NBDPS), an ongoing case-control study in an eight-state consortium with a primary goal to identify risk factors for birth defects. Babies with birth defects are identified through birth defects surveillance systems in the eight participating centers. Cases are infants with one or more of over 30 major birth defects. Controls are infants without defects from the same geographic area. Epidemiologic information is collected through an hour-long interview with mothers of both cases and controls. We added the collection of buccal cytobrush DNA samples for case-infants, control-infants, and their parents to this study. We describe here the methods by which the samples have been collected and processed, establishment of a centralized resource for DNA banking, and quality control, database management, access, informed consent, and confidentiality issues. Biological sampling and genetic analyses are important components to epidemiologic studies of birth defects aimed at identifying risk factors. The DNA specimens collected in this study can be used for detection of mutations, study of polymorphic variants that confer differential susceptibility to teratogens, and examination of interactions among genetic risk factors. Information on the methods used and issues faced by the NBDPS may be of value to others considering the addition of DNA sampling to epidemiologic studies.

Context-Aware Recommender Systems

NASA Astrophysics Data System (ADS)

Adomavicius, Gediminas; Tuzhilin, Alexander

The importance of contextual information has been recognized by researchers and practitioners in many disciplines, including e-commerce personalization, information retrieval, ubiquitous and mobile computing, data mining, marketing, and management. While a substantial amount of research has already been performed in the area of recommender systems, most existing approaches focus on recommending the most relevant items to users without taking into account any additional contextual information, such as time, location, or the company of other people (e.g., for watching movies or dining out). In this chapter we argue that relevant contextual information does matter in recommender systems and that it is important to take this information into account when providing recommendations. We discuss the general notion of context and how it can be modeled in recommender systems. Furthermore, we introduce three different algorithmic paradigms - contextual prefiltering, post-filtering, and modeling - for incorporating contextual information into the recommendation process, discuss the possibilities of combining several contextaware recommendation techniques into a single unifying approach, and provide a case study of one such combined approach. Finally, we present additional capabilities for context-aware recommenders and discuss important and promising directions for future research.

Notes from the field: Acute pesticide-related illness resulting from occupational exposure to acrolein - Washington and California, 1993-2009.

PubMed

2013-04-26

Acrolein is an aquatic herbicide used in the western United States to prevent impaired water flow in irrigation canals. Despite its toxicity, few cases of acrolein-related illness have been reported in the literature. On August 15, 2012, an irrigation district notified the Washington State Department of Labor & Industries (L&I) of acrolein-related illness in one of its pesticide applicators. L&I inspected the site and interviewed the exposed worker, coworkers, and employer. The Washington State Department of Health assisted by obtaining medical records, interviewing the patient and hospital staff, and reviewing information obtained from L&I. To look for additional cases, CDC reviewed data from the SENSOR-Pesticides program* and the California Department of Pesticide Regulation for 1993-2009, the most recent years of data availability, and identified seven additional cases of acute acrolein-related illness.

The value of pathogen information in treating clinical mastitis.

PubMed

Cha, Elva; Smith, Rebecca L; Kristensen, Anders R; Hertl, Julia A; Schukken, Ynte H; Tauer, Loren W; Welcome, Frank L; Gröhn, Yrjö T

2016-11-01

The objective of this study was to determine the economic value of obtaining timely and more accurate clinical mastitis (CM) test results for optimal treatment of cows. Typically CM is first identified when the farmer observes recognisable outward signs. Further information of whether the pathogen causing CM is Gram-positive, Gram-negative or other (including no growth) can be determined by using on-farm culture methods. The most detailed level of information for mastitis diagnostics is obtainable by sending milk samples for culture to an external laboratory. Knowing the exact pathogen permits the treatment method to be specifically targeted to the causation pathogen, resulting in less discarded milk. The disadvantages are the additional waiting time to receive test results, which delays treating cows, and the cost of the culture test. Net returns per year (NR) for various levels of information were estimated using a dynamic programming model. The Value of Information (VOI) was then calculated as the difference in NR using a specific level of information as compared to more detailed information on the CM causative agent. The highest VOI was observed where the farmer assumed the pathogen causing CM was the one with the highest incidence in the herd and no pathogen specific CM information was obtained. The VOI of pathogen specific information, compared with non-optimal treatment of Staphylococcus aureus where recurrence and spread occurred due to lack of treatment efficacy, was $20.43 when the same incorrect treatment was applied to recurrent cases, and $30.52 when recurrent cases were assumed to be the next highest incidence pathogen and treated accordingly. This indicates that negative consequences associated with choosing the wrong CM treatment can make additional information cost-effective if pathogen identification is assessed at the generic information level and if the pathogen can spread to other cows if not treated appropriately.

Prevalence of Giardia infection in households of Giardia cases and risk factors for household transmission.

PubMed

Waldram, Alison; Vivancos, Roberto; Hartley, Catherine; Lamden, Kenneth

2017-07-11

Giardia is a leading but neglected cause of infectious gastroenteritis worldwide and is treatable. There is a substantial burden of undetected Giardia in the UK and for every one case of Giardia reported to national surveillance there are 14 cases in the community. We aimed to ascertain the prevalence of, and risk factors associated with secondary household Giardia infections to assess the burden of infection and inform control measures. We identified all giardiasis cases notified in nine local authorities in Lancashire between June 2014 and June 2015, and invited their household contacts to submit faecal specimens for Giardia testing and complete a risk factor questionnaire. We estimated the proportion of households with additional Giardia infection. We compared household risk factors between households with and without additional Giardia using Fisher's exact test. We used multivariable logistic regression to identify independent risk factors for additional Giardia infections. We identified additional Giardia infections in 30% (27/91) of included households. A total of 41 infections were found from 212 household members, of which 37 were asymptomatic. The majority of infections were assemblage B (57%) but there were also a high number of mixed infections (20%). Risk factors significantly associated with additional household infections were; having children under 5 years in the household (odds ratio 42; 95% confidence intervals 10-178) and the presence of gastrointestinal illness in the household before the onset of the index case (odds ratio 9; 95% confidence intervals 1.5-48). Our finding of a high household prevalence of asymptomatic infection has raised the public health question of whether treatment of asymptomatic household contacts may be justified in preventing Giardia re-infection of the index case or in preventing secondary cases and household clusters. We recommend the communication of this risk in household contacts of Giardia and reinforcement of standard hygiene controls.

The Effect of Information Analysis Automation Display Content on Human Judgment Performance in Noisy Environments

PubMed Central

Bass, Ellen J.; Baumgart, Leigh A.; Shepley, Kathryn Klein

2014-01-01

Displaying both the strategy that information analysis automation employs to makes its judgments and variability in the task environment may improve human judgment performance, especially in cases where this variability impacts the judgment performance of the information analysis automation. This work investigated the contribution of providing either information analysis automation strategy information, task environment information, or both, on human judgment performance in a domain where noisy sensor data are used by both the human and the information analysis automation to make judgments. In a simplified air traffic conflict prediction experiment, 32 participants made probability of horizontal conflict judgments under different display content conditions. After being exposed to the information analysis automation, judgment achievement significantly improved for all participants as compared to judgments without any of the automation's information. Participants provided with additional display content pertaining to cue variability in the task environment had significantly higher aided judgment achievement compared to those provided with only the automation's judgment of a probability of conflict. When designing information analysis automation for environments where the automation's judgment achievement is impacted by noisy environmental data, it may be beneficial to show additional task environment information to the human judge in order to improve judgment performance. PMID:24847184

The dilemma of allergy to food additives.

PubMed

Bahna, Sami L; Burkhardt, Joshua G

2018-01-01

To provide a brief summary on food additives and to outline a practical approach for evaluating subjects suspected of having reactions to food additives. Information was derived from selected reviews and original articles published in peer-reviewed journals, supplemented by the clinical experience of the authors. Priority was given to studies that used blinded, placebo controlled, oral challenges to confirm adverse reactions to food additives. In addition, selected, appropriately evaluated case reports were included. A large number of food additives are widely used in the food industry. Allergic reactions to additives seem to be rare but are very likely underdiagnosed, primarily due to a low index of suspicion. A wide variety of symptoms to food additives have been reported, but a cause-and-effect relationship has not been well documented in the majority of cases. Reactions to food additives should be suspected in patients who report symptoms related to multiple foods or to a certain food when commercially prepared but not when home made. It is also prudent to investigate food additives in subjects considered to have "idiopathic" reactions. Except for a limited number of natural additives, there is a small role for skin tests or in vitro testing. Oral challenge, in stages, with commonly used additives is the definitive procedure for detecting the offending agent. Once the specific additive is identified, management is strict avoidance, which can be difficult.

Integrating non-animal test information into an adaptive testing strategy - skin sensitization proof of concept case.

PubMed

Jaworska, Joanna; Harol, Artsiom; Kern, Petra S; Gerberick, G Frank

2011-01-01

There is an urgent need to develop data integration and testing strategy frameworks allowing interpretation of results from animal alternative test batteries. To this end, we developed a Bayesian Network Integrated Testing Strategy (BN ITS) with the goal to estimate skin sensitization hazard as a test case of previously developed concepts (Jaworska et al., 2010). The BN ITS combines in silico, in chemico, and in vitro data related to skin penetration, peptide reactivity, and dendritic cell activation, and guides testing strategy by Value of Information (VoI). The approach offers novel insights into testing strategies: there is no one best testing strategy, but the optimal sequence of tests depends on information at hand, and is chemical-specific. Thus, a single generic set of tests as a replacement strategy is unlikely to be most effective. BN ITS offers the possibility of evaluating the impact of generating additional data on the target information uncertainty reduction before testing is commenced.

The Pericles Space Case: Preserving Earth Observation Data for the Future

NASA Astrophysics Data System (ADS)

Muller, C.; Pandey, P.; Pericles Consortium

2016-08-01

PERICLES (Promoting and Enhancing the Reuse of Information throughout the Content Lifecycle exploiting Evolving Semantics) is an FP7 project started on February 2013. It aims at preserving by design large and complex data sets. PERICLES is coordinated by King's College London, UK and its partners are University of Borås (Sweden), CERT (Greece), DotSoft(Greece), GeorgAugustUniversität, Göttingen (Germany), University of Liverpool (UK), Space Application Services (Belgium), XEROX France and University of Edinburgh (UK). Two additional partners provide the case studies: Tate Gallery (UK) brings the digital art and media case study and B.USOC (Belgian Users Support and Operations Centre) brings the space science case study.

Case for real-time systems development - Quo vadis?

NASA Technical Reports Server (NTRS)

Erb, Dona M.

1991-01-01

The paper focuses on the distinctive issues of computer-aided software engineering (CASE) products for the development of real-time systems. CASE technologies and associated standardization efforts are evolving from sets of conflicting interests. The majority of case products are intended for use in the development of management information systems. CASE products to support the development of large, complex real-time systems must provide additional capabilities. Generic concerns include the quality of the implementation of the required method for the phase of the system's development and whether the vendor is stable and committed to evolving the products in parallel with nonproprietary standards. The CASE market is undergoing considerable consolidation. The paper describes the major forces, cooperating entities, and remaining uncertainties that need to be weighed in near-term CASE procurements to limit risk of loss of investment in project time, trianing, and money.

Non-physician-assisted suicide in The Netherlands: a cross-sectional survey among the general public.

PubMed

Schoonman, Merel Kristi; van Thiel, Ghislaine José Madeleine Wilhelmien; van Delden, Johannes Jozef Marten

2014-12-01

In The Netherlands, approximately 45% of patients' requests for euthanasia are granted by a physician. After a rejected request, some patients approach non-physicians and ask them for assistance in suicide. Recently, a non-physician who assisted his mother's suicide was declared guilty without punishment. The aim of the current study was to investigate the opinion of the Dutch general public on non-physician-assisted suicide. A cross-sectional survey among the Dutch general public was performed. A total of 1113 respondents were included (response rate 80%). The survey covered two case descriptions in which a patient asks a non-physician for assisted suicide after a non-granted request for physician-assisted dying. In both cases, a son, friend or professional facilitates the suicide by either the provision of information or the purchase of lethal medication. Respondents were invited to give their opinion on these cases and in addition on 10 propositions on non-physician-assisted suicide. When a son provides information on how to acquire lethal medication in case of a patient with a terminal illness, this involvement is accepted by 62% of the respondents. The actual purchase of lethal medication receives less support (38%). If the patient suffers without a serious disease, both forms of assistance are less accepted (46% and 24%, respectively). In addition, only 21% support the legalisation of non-physician-assisted suicide. The Dutch public prefer involvement of a physician in assisted suicide (69%). The Dutch general public consider non-physician-assisted suicide in some specific cases a tolerable alternative for patients with a rejected request for physician-assisted dying if the assistance is limited to the provision of information. However, the majority do not support the legalisation of non-physician-assisted suicide. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Virtual patients: the influence of case design and teamwork on students’ perception and knowledge – a pilot study

PubMed Central

2014-01-01

Background Virtual patient (VP) cases are an effective teaching method, although little is known about how to design and implement them for maximum effectiveness. The aim of this study was to explore the effect of case design and teamwork on students’ learning outcome. Methods One hundred forty-six undergraduate medical students participated in a mandatory medical computer science course consisting of five seminars. At the end of each seminar, they worked on one VP case, either in teams of two or individually. Each student filled out an introductory and a final survey and a feedback sheet after completing each case. Additionally, there was a surprise multiple choice (MC) test after the last seminar with three questions regarding each case. Results Students with more clinical experience and students who had worked in a team performed significantly better on MC questions. Students with less clinical experience more frequently used information which had been positioned less prominently on the case material. Certain aspects of case design were rated more positively by students who had an interest in e-learning. In general, students preferred to work on cases for less than 15 minutes. Conclusions Clinically more advanced students and students working with a partner seem to benefit most from short VP cases with prominently presented information. PMID:25000965

The success of a management information system in health care - a case study from Finland.

PubMed

Kivinen, Tuula; Lammintakanen, Johanna

2013-02-01

The purpose of this article is to describe perspectives on information availability and information use among users of a management information system in one specialized health care organization. The management information system (MIS) is defined as the information system that provides management with information about financial and operational aspects of hospital management. The material for this qualitative case study was gathered by semi-structured interviews. The interviewees were purposefully selected from one specialized health care organization. The organization has developed its management information system in recent years. Altogether 13 front-line, middle and top-level managers were interviewed. The two themes discussed were information availability and information use. The data were analyzed using inductive content analysis using ATLAS.ti computer program. The main category "usage of management information system" consisted of four sub-categories: (1) system quality, (2) information quality, (3) use and user satisfaction and (4) development of information culture. There were many organizational and cultural aspects which influence the use of MIS in addition to factors concerning system usability and users. The connection between information culture and information use was recognized and the managers proposed numerous ways to increase the use of information in management work. The implementation and use of management information system did not seem to be planned as an essential tool in strategic information management in the health care organization studied. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The impact of extended longitudinal observation on the assessment of personality disorders.

PubMed

Pedersen, G; Karterud, S; Hummelen, B; Wilberg, T

2013-11-01

Multiple sources of information are necessary for a valid assessment of personality disorders (PDs). This study investigates the impact of longitudinal observation. The sample comprised 1217 patients from 15 different treatment units. PDs were assessed at admission to treatment using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) and additional clinical information (best estimate diagnosis). After approximately 18 weeks of treatment, the SCID-II protocols were re-examined at clinical conferences and the diagnostic status reassessed on the basis of longitudinal observations in multiple group situations (longitudinal, expert, all data principle). Using this procedure, 78% of the patients' diagnostic criteria sets were changed, and 32% of patients' diagnostic statuses were changed. Many (32%) patients who were evaluated initially as not having a PD received a PD diagnosis after re-examination. The information provided by customary clinical assessment has important limitations, and longitudinal observation provides additional information that may change the diagnostic status in approximately one-third of PD cases. Copyright © 2013 John Wiley & Sons, Ltd.

Secure Retrieval of FFTF Testing, Design, and Operating Information

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

Butner, R. Scott; Wootan, David W.; Omberg, Ronald P.

One of the goals of the Advanced Fuel Cycle Initiative (AFCI) is to preserve the knowledge that has been gained in the United States on Liquid Metal Reactors (LMR). In addition, preserving LMR information and knowledge is part of a larger international collaborative activity conducted under the auspices of the International Atomic Energy Agency (IAEA). A similar program is being conducted for EBR-II at the Idaho Nuclear Laboratory (INL) and international programs are also in progress. Knowledge preservation at the FFTF is focused on the areas of design, construction, startup, and operation of the reactor. As the primary function ofmore » the FFTF was testing, the focus is also on preserving information obtained from irradiation testing of fuels and materials. This information will be invaluable when, at a later date, international decisions are made to pursue new LMRs. In the interim, this information may be of potential use for international exchanges with other LMR programs around the world. At least as important in the United States, which is emphasizing large-scale computer simulation and modeling, this information provides the basis for creating benchmarks for validating and testing these large scale computer programs. Although the preservation activity with respect to FFTF information as discussed below is still underway, the team of authors above is currently retrieving and providing experimental and design information to the LMR modeling and simulation efforts for use in validating their computer models. On the Hanford Site, the FFTF reactor plant is one of the facilities intended for decontamination and decommissioning consistent with the cleanup mission on this site. The reactor facility has been deactivated and is being maintained in a cold and dark minimal surveillance and maintenance mode until final decommissioning is pursued. In order to ensure protection of information at risk, the program to date has focused on sequestering and secure retrieval. Accomplishments include secure retrieval of: more than 400 boxes of FFTF information, several hundred microfilm reels including Clinch River Breeder Reactor (CRBR) information, and 40 boxes of information on the Fuels and Materials Examination Facility (FMEF). All information preserved to date is now being stored and categorized consistent with the IAEA international standardized taxonomy. Earlier information largely related to irradiation testing is likewise being categorized. The fuel test results information exists in several different formats depending upon the final stage of the test evaluation. In some cases there is information from both non-destructive and destructive examination while in other cases only non-destructive results are available. Non-destructive information would include disassembly records, dimensional profilometry, gamma spectrometry, and neutron radiography. Information from destructive examinations would include fission gas analysis, metallography, and photomicrographs. Archiving of FFTF data, including both the reactor plant and the fuel test information, is being performed in coordination with other data archiving efforts underway under the aegis of the AFCI program. In addition to the FFTF efforts, archiving of data from the EBR-II reactor is being carried out by INL. All material at risk associated with FFTF documentation has been secured in a timely manner consistent with the stated plan. This documentation is now being categorized consistent with internationally agreed upon IAEA standards. Documents are being converted to electronic format for transfer to a large searchable electronic database being developed by INL. In addition, selected FFTF information is being used to generate test cases for large-scale simulation modeling efforts and for providing Design Data Need (DDN) packages as requested by the AFCI program.« less

Investment Evaluation of RFID TechnologyApplications: An Evolution Perspective

NASA Astrophysics Data System (ADS)

Dimakopoulou, Andriana; Pramatari, Katerina; Karagiannaki, Angeliki; Papadopoulos, George; Paraskevopoulos, Antonis

Prior empirical research on the evaluation of RFID technologytreats and assesses individual RFID applications independently and in isolation from each other. However, literature on investment evaluation of information technologies has recognised and utilised the significance of evaluating "interdependent" information systems (IS) projects with synergies. Moreover, previous studies when appraising the business value of an RFID investment ignore its opportunity to offer and evolve into additional follow-on investments in the future. Nevertheless, the importance of this notion has been acknowledged by the pertinent literature for the evaluation of other information technologies. This chapter proposes an approach for the investment evaluation of RFID applications considering them rather as a bundle of interdependent and sequential investments than as stand-alone ones. The results from a case study demonstrate how the proposed approach can be employed for the evaluation of RFID projects and offering an additional insight into evaluating investments in RFID applications.

Semantic and phonological information in sentence recall: converging psycholinguistic and neuropsychological evidence.

PubMed

Schweppe, Judith; Rummer, Ralf; Bormann, Tobias; Martin, Randi C

2011-12-01

We present one experiment and a neuropsychological case study to investigate to what extent phonological and semantic representations contribute to short-term sentence recall. We modified Potter and Lombardi's (1990) intrusion paradigm, in which retention of a list interferes with sentence recall such that on the list a semantically related lure is presented, which is expected to intrude into sentence recall. In our version, lure words are either semantically related to target words in the sentence or semantically plus phonologically related. With healthy participants, intrusions are more frequent when lure and target overlap phonologically in addition to semantically than when they solely overlap semantically. When this paradigm is applied to a patient with a phonological short-term memory impairment, both lure types induce the same amount of intrusions. These findings indicate that usually phonological information is retained in sentence recall in addition to semantic information.

Teachers' Attitudes toward Information and Communication Technologies: The Case of Syrian EFL Teachers

ERIC Educational Resources Information Center

Albirini, Abdulkafi

2006-01-01

Based on the new technology initiative in Syrian education, this study explored the attitudes of high school English as a Foreign Language (EFL) teachers in Syria toward ICT. In addition, the study investigated the relationship between computer attitudes and five independent variables: computer attributes, cultural perceptions, computer…

Teachers' Perspectives on Their Use of ICT in Teaching and Learning: A Case Study

ERIC Educational Resources Information Center

Kafyulilo, Ayoub; Keengwe, Jared

2014-01-01

This article presents the perspectives of science and mathematics teachers on their use of information and communication technology (ICT) in teaching and learning in Tanzania. The findings show that few teachers used computers for teaching and learning purposes while majority of them used computers for administrative purposes. Additionally,…

Problem-Based Learning in Formal and Informal Learning Environments

ERIC Educational Resources Information Center

Shimic, Goran; Jevremovic, Aleksandar

2012-01-01

Problem-based learning (PBL) is a student-centered instructional strategy in which students solve problems and reflect on their experiences. Different domains need different approaches in the design of PBL systems. Therefore, we present one case study in this article: A Java Programming PBL. The application is developed as an additional module for…

Questions about Physics: The Case of a Turkish "Ask a Scientist" Website

ERIC Educational Resources Information Center

Yerdelen-Damar, Sevda; Eryilmaz, Ali

2010-01-01

The physics questions submitted to an "ask a scientist" website were classified with respect to field of interest in physics, type of requested information in the question (factual, explanatory, etc.), and motivation for asking the question (applicative or non-applicative). In addition, differences in the number of females' and males'…

Research Experiences of Staff within a Specialist UK Higher Education Institution: Challenges, Opportunities and Priorities

ERIC Educational Resources Information Center

Hemmings, Brian; Hill, Doug; Sharp, John

2013-01-01

The study discussed here was based on a collective case approach involving a specialist UK higher education institution. Six individual interviews were carried out with a cross-sectional sample of the institution's staff members. Additional information was gained through observations and examination of relevant documents. These data were…

Family Systems Assessment: Intervention with Individuals Having a Chronic Disability.

ERIC Educational Resources Information Center

Fohs, Mark W.

1991-01-01

Responds to case study, presented in previous article, of young adult male with chronic back pain who has been unable to work. Sees counselor's role as determining how to establish rapport with client, create situation conducive to his adjustment to circumstances, and mobilize energy for change. Identifies areas where additional information is…

Case Study on Education Opportunities for Hill Tribes in Northern Thailand: Implications for Sustainable Rural Development.

ERIC Educational Resources Information Center

Fujioka, Rika

This research analyzes the impact of the Thai government's activities to promote educational opportunities for people of the northern hill tribes. In addition to interviews with government and nongovernmental organization staff, field surveys were conducted in hill tribe villages. The introductory chapter provides background information on the…

32 CFR 776.45 - Extra-tribunal statements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... disseminated by means of public communication if the covered attorney knows or reasonably should know that it..., offense, or defense; (ii) The information contained in a public record; (iii) That an investigation of the... the public interest; and (vii) In a criminal case, in addition to paragraphs (a)(3)(i) through (a)(3...

32 CFR 776.45 - Extra-tribunal statements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... disseminated by means of public communication if the covered attorney knows or reasonably should know that it..., offense, or defense; (ii) The information contained in a public record; (iii) That an investigation of the... the public interest; and (vii) In a criminal case, in addition to paragraphs (a)(3)(i) through (a)(3...

32 CFR 776.45 - Extra-tribunal statements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... disseminated by means of public communication if the covered attorney knows or reasonably should know that it..., offense, or defense; (ii) The information contained in a public record; (iii) That an investigation of the... the public interest; and (vii) In a criminal case, in addition to paragraphs (a)(3)(i) through (a)(3...

32 CFR 776.45 - Extra-tribunal statements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... disseminated by means of public communication if the covered attorney knows or reasonably should know that it..., offense, or defense; (ii) The information contained in a public record; (iii) That an investigation of the... the public interest; and (vii) In a criminal case, in addition to paragraphs (a)(3)(i) through (a)(3...

Australian Institute of Aboriginal Studies; Catalogue of Tape Archive No. 7.

ERIC Educational Resources Information Center

Australian Inst. of Aboriginal Studies, Canberra.

Entries in this aboriginal studies catalogue are listed under language/tribe and subject indexes, and include linguistic studies, myths and stories, songs and dances, songs and music, and speech. Language/tribe headings are from the Institute's Preliminary Tribal Index. Summaries are brief, but in most cases, additional information is available…

Occupational dental erosion from exposure to acids: a review.

PubMed

Wiegand, Annette; Attin, Thomas

2007-05-01

Dental erosion is characterized as a disorder with a multifactorial aetiology including environmental acid exposure. The purpose of this article was to summarize and discuss the available information concerning occupational dental erosion. Information from original scientific papers, case reports and reviews with additional case reports listed in PubMed, Medline or EMBASE [search term: (dental OR enamel OR dentin) AND (erosion OR tooth wear) AND (occupational OR worker)] were included in the review. References from the identified publications were manually searched to identify additional relevant articles. The systematic search resulted in 59 papers, of which 42 were suitable for the present review. Seventeen papers demonstrated evidence that battery, galvanizing and associated workers exposed to sulphuric or hydrochloric acid were at higher risk of dental erosion. For other industrial workers, wine tasters and competitive swimmers, only a few clinical studies exist and these do not allow the drawing of definitive conclusions. Occupational acid exposure might increase the risk of dental erosion. Evidence for occupational dental erosion is limited to battery and galvanizing workers, while data for other occupational groups need to be confirmed by further studies.

Physician Surveys to Assess Customary Care in Medical Malpractice Cases

PubMed Central

Hartz, Arthur; Lucas, Joshua; Cramm, Timothy; Green, Michael; Bentler, Suzanne; Ely, John; Wolfe, Steven; James, Paul

2002-01-01

OBJECTIVE Physician experts hired and prepared by the litigants provide most information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, we examined the feasibility and potential value of surveying community physicians to assess standard of care. DESIGN Seven physician surveys of mutually exclusive groups of randomly selected physicians. SETTING Iowa. PARTICIPANTS Community and academic primary care physicians and relevant specialists. INTERVENTIONS Included in each survey was a case vignette of a primary care malpractice case and key quotes from medical experts on each side of the case. Surveyed physicians were asked whether the patient should have been referred to a specialist for additional evaluation. The 7 case vignettes included 3 closed medical malpractice cases, 3 modifications of these cases, and 1 active case. MEASUREMENTS AND MAIN RESULTS Sixty-three percent of 350 community primary care physicians and 51% of 216 community specialists completed the questionnaire. For 3 closed cases, 47%, 78%, and 88% of primary care physician respondents reported that they would have made a different referral decision than the defendant. Referral percentages were minimally affected by modifying patient outcome but substantially changed by modifying patient presentation. Most physicians, even those whose referral decisions were unusual, assumed that other physicians would make similar referral decisions. For each case, at least 65% of the primary care physicians disagreed with the testimony of one of the expert witnesses. In the active case, the response rate was high (71%), and the respondents did not withhold criticism of the defendant doctor. CONCLUSIONS Randomly selected peer physicians are willing to participate in surveys of medical malpractice cases. The surveys can be used to construct the distribution of physician self-reported practice relevant to a particular malpractice case. This distribution may provide more information about customary practice or standard of care than the opinion of a single physician expert. PMID:12133145

ESIP's Emerging Provenance and Context Content Standard Use Cases: Developing Examples and Models for Data Stewardship

NASA Astrophysics Data System (ADS)

Ramdeen, S.; Hills, D. J.

2013-12-01

Earth science data collections range from individual researchers' private collections to large-scale data warehouses, from computer-generated data to field or lab based observations. These collections require stewardship. Fundamentally, stewardship ensures long term preservation and the provision of access to the user community. In particular, stewardship includes capturing appropriate metadata and documentation--and thus the context of the data's creation and any changes they underwent over time --to enable data reuse. But scientists and science data managers must translate these ideas into practice. How does one balance the needs of current and (projected) future stakeholders? In 2011, the Data Stewardship Committee (DSC) of the Federation of Earth Science Information Partners (ESIP) began developing the Provenance and Context Content Standard (PCCS). As an emerging standard, PCCS provides a framework for 'what' must be captured or preserved as opposed to describing only 'how' it should be done. Originally based on the experiences of NASA and NOAA researchers within ESIP, the standard currently provides data managers with content items aligned to eight key categories. While the categories and content items are based on data life cycles of remote sensing missions, they can be generalized to cover a broader set of activities, for example, preservation of physical objects. These categories will include the information needed to ensure the long-term understandability and usability of earth science data products. In addition to the PCCS, the DSC is developing a series of use cases based on the perspectives of the data archiver, data user, and the data consumer that will connect theory and practice. These cases will act as specifications for developing PCCS-based systems. They will also provide for examination of the categories and content items covered in the PCCS to determine if any additions are needed to cover the various use cases, and also provide rationale and indicate priorities for preservation. Though the use cases currently focus on two areas, 'creating' a data set and 'using' a data set, the use cases will eventually cover the full data lifecycle. Currently developing a template to be used in future use case creation, the DSC is also preparing and testing more use case scenarios. This presentation will introduce the ESIP use cases based on the PCCS. It will at once expand stakeholder participation and show the application of these materials beyond the ESIP community in which they were developed. More information about the ESIP use case activities can be found on the DSC wiki - http://wiki.esipfed.org/index.php/Preservation_Use_Case_Activity.

Attributes of the Federal Energy Management Program's Federal Site Building Characteristics Database

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

Loper, Susan A.; Sandusky, William F.

2010-12-31

Typically, the Federal building stock is referred to as a group of about one-half million buildings throughout the United States. Additional information beyond this level is generally limited to distribution of that total by agency and maybe distribution of the total by state. However, additional characterization of the Federal building stock is required as the Federal sector seeks ways to implement efficiency projects to reduce energy and water use intensity as mandated by legislation and Executive Order. Using a Federal facility database that was assembled for use in a geographic information system tool, additional characterization of the Federal building stockmore » is provided including information regarding the geographical distribution of sites, building counts and percentage of total by agency, distribution of sites and building totals by agency, distribution of building count and floor space by Federal building type classification by agency, and rank ordering of sites, buildings, and floor space by state. A case study is provided regarding how the building stock has changed for the Department of Energy from 2000 through 2008.« less

[FADCC in NIHS for prior consultation system of application of food additives].

PubMed

Akiyama, Hiroshi; Sato, Kyoko

2015-01-01

An increasing number of inquiries about application of food additives have been made from businesses in and outside Japan. The Ministry of Health, Labour and Welfare (MHLW) is requested to expedite the procedure for designation and revision of use standards. In June 2014, the MHLW set up a center for consultation on application concerning food additives (Food Additive Designation Consultation Center, FADCC) in the National Institute of Health Sciences, aiming to smoothly and expeditiously handle clerical work for designation or revision of the use standards. FADCC gives advice on how to prepare documents on the information such as physicochemical characteristics, effectiveness, safety, daily intake and use standards, based on actual cases and experience.

Evident or doubtful? How lexical hints in written information influence laypersons' understanding of influenza.

PubMed

Mayweg-Paus, Elisabeth; Jucks, Regina

2015-01-01

There are clear differences in the way written information on health issues presents research findings. In some cases, the source of a piece of information (e.g. "expert professor") is highlighted to emphasize its credibility and relevance. In other cases, the impact of a certain argument is stressed by avoiding hints on tentativeness such as "mostly" or "up to now." This article examines whether and how far such differences influence laypersons' comprehension of the contents provided. In an experimental setting, 157 laypersons were asked to read an online article on a new approach to preventing influenza. The texts manipulated whether there were (a) hints on the source of information and (b) lexical hints on the tentativeness of the information (hedges). After reading the text, participants were asked to write an essay reporting their opinion on the topic. Their argumentation on vaccination was assessed with content analysis and their attitudes toward vaccination were surveyed with a questionnaire. Results indicated that when lexical hints were given, tentativeness led participants to focus more on the actual information in the text. Additionally, decisions more strongly favored the direction implied in the text when the source of the medical information was not reported. Consequences for the way health information should be presented to laypersons are discussed.

Exploring the role of contextual information in bloodstain pattern analysis: A qualitative approach.

PubMed

Osborne, Nikola K P; Taylor, Michael C; Zajac, Rachel

2016-03-01

During Bloodstain Pattern Analysis (BPA), an analyst may encounter various sources of contextual information. Although contextual bias has emerged as a valid concern for the discipline, little is understood about how contextual information informs BPA. To address this issue, we asked 15 experienced bloodstain pattern analysts from New Zealand and Australia to think aloud as they classified bloodstain patterns from two homicide cases. Analysts could request items of contextual information, and were required to state how each item would inform their analysis. Pathology reports and additional photographs of the scene were the most commonly requested items of information. We coded analysts' reasons for requesting contextual information--and the way in which they integrated this information--according to thematic analysis. We identified considerable variation in both of these variables, raising important questions about the role and necessity of contextual information in decisions about bloodstain pattern evidence. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Using narrative text and coded data to develop hazard scenarios for occupational injury interventions

PubMed Central

Lincoln, A; Sorock, G; Courtney, T; Wellman, H; Smith, G; Amoroso, P

2004-01-01

Objective: To determine whether narrative text in safety reports contains sufficient information regarding contributing factors and precipitating mechanisms to prioritize occupational back injury prevention strategies. Design, setting, subjects, and main outcome measures: Nine essential data elements were identified in narratives and coded sections of safety reports for each of 94 cases of back injuries to United States Army truck drivers reported to the United States Army Safety Center between 1987 and 1997. The essential elements of each case were used to reconstruct standardized event sequences. A taxonomy of the event sequences was then developed to identify common hazard scenarios and opportunities for primary interventions. Results: Coded data typically only identified five data elements (broad activity, task, event/exposure, nature of injury, and outcomes) while narratives provided additional elements (contributing factor, precipitating mechanism, primary source) essential for developing our taxonomy. Three hazard scenarios were associated with back injuries among Army truck drivers accounting for 83% of cases: struck by/against events during motor vehicle crashes; falls resulting from slips/trips or loss of balance; and overexertion from lifting activities. Conclusions: Coded data from safety investigations lacked sufficient information to thoroughly characterize the injury event. However, the combination of existing narrative text (similar to that collected by many injury surveillance systems) and coded data enabled us to develop a more complete taxonomy of injury event characteristics and identify common hazard scenarios. This study demonstrates that narrative text can provide the additional information on contributing factors and precipitating mechanisms needed to target prevention strategies. PMID:15314055

Making the most of injury surveillance data: Using narrative text to identify exposure information in case-control studies

PubMed Central

Graves, Janessa M.; Whitehill, Jennifer M.; Hagel, Brent E.; Rivara, Frederick P.

2015-01-01

Introduction Free-text fields in injury surveillance databases can provide detailed information beyond routinely coded data. Additional data, such as exposures and covariates can be identified from narrative text and used to conduct case-control studies. Methods To illustrate this, we developed a text-search algorithm to identify helmet status (worn, not worn, use unknown) in the U.S. National Electronic Injury Surveillance System (NEISS) narratives for bicycling and other sports injuries from 2005 to 2011. We calculated adjusted odds ratios (ORs) for head injury associated with helmet use, with non-head injuries representing controls. For bicycling, we validated ORs against published estimates. ORs were calculated for other sports and we examined factors associated with helmet reporting. Results Of 105,614 bicycling injury narratives reviewed, 14.1% contained sufficient helmet information for use in the case-control study. The adjusted ORs for head injuries associated with helmet-wearing were smaller than, but directionally consistent, with previously published estimates (e.g., 1999 Cochrane Review). ORs illustrated a protective effect of helmets for other sports as well (less than 1). Conclusions This exploratory analysis illustrates the potential utility of relatively simple text-search algorithms to identify additional variables in surveillance data. Limitations of this study include possible selection bias and the inability to identify individuals with multiple injuries. A similar approach can be applied to study other injuries, conditions, risks, or protective factors. This approach may serve as an efficient method to extend the utility of injury surveillance data to conduct epidemiological research. PMID:25498331

Multimodal psychoanalytically informed aid work with children traumatized by the Chechen war.

PubMed

Cerfolio, Nina E

2009-01-01

As demonstrated in three cases, this paper illustrates how psychoanalytically informed multimodal care was an essential element of effective medical treatment of children traumatized by the Chechen war. Multimodal psychoanalytically informed aid work involves holding a variety of psychoanalytic viewpoints, including but not restricted to those represented by the Freudian, Interpersonal, and Relational orientations; its purpose is to allow for greater clarity in conceptualizing the traumatized child's response to war in order to provide the necessary care during the therapeutic process. Among the issues addressed are how traumatic memory can initially be expressed nonverbally, and therefore the use of embodied life-metaphors and witnessing are central to the survivors' ability to remember and symbolize. In addition, the significance of cultural awareness and sensitivity are explored as key components to the children's care. In the first case, the author illustrates how a traumatic life-metaphor can be resolved at an embodied, rather than an exclusively verbal, level. In the second case, cultural tradition and relativism have a significant impact on addressing medical and quality of life issues for the child. The third case illustrates how the analyst functions as recognizing witness to a parent's trauma; the "being with" of the relationship becomes the agent of the parent's change.

Dealing with uncertainty in the probability of overtopping of a flood mitigation dam

NASA Astrophysics Data System (ADS)

Michailidi, Eleni Maria; Bacchi, Baldassare

2017-05-01

In recent years, copula multivariate functions were used to model, probabilistically, the most important variables of flood events: discharge peak, flood volume and duration. However, in most of the cases, the sampling uncertainty, from which small-sized samples suffer, is neglected. In this paper, considering a real reservoir controlled by a dam as a case study, we apply a structure-based approach to estimate the probability of reaching specific reservoir levels, taking into account the key components of an event (flood peak, volume, hydrograph shape) and of the reservoir (rating curve, volume-water depth relation). Additionally, we improve information about the peaks from historical data and reports through a Bayesian framework, allowing the incorporation of supplementary knowledge from different sources and its associated error. As it is seen here, the extra information can result in a very different inferred parameter set and consequently this is reflected as a strong variability of the reservoir level, associated with a given return period. Most importantly, the sampling uncertainty is accounted for in both cases (single-site and multi-site with historical information scenarios), and Monte Carlo confidence intervals for the maximum water level are calculated. It is shown that water levels of specific return periods in a lot of cases overlap, thus making risk assessment, without providing confidence intervals, deceiving.

Diagnostic value of the fast-FLAIR sequence in MR imaging of intracranial tumors.

PubMed

Husstedt, H W; Sickert, M; Köstler, H; Haubitz, B; Becker, H

2000-01-01

The aim of this study was to quantify imaging characteristics of fast fluid-attenuated inversion recovery (FLAIR) sequence in brain tumors compared with T1-postcontrast- and T2-sequences. Fast-FLAIR-, T2 fast spin echo (FSE)-, and T1 SE postcontrast images of 74 patients with intracranial neoplasms were analyzed. Four neuroradiologists rated signal intensity and inhomogeneity of the tumor, rendering of cystic parts, demarcation of the tumor vs brain, of the tumor vs edema and of brain vs edema, as well as the presence of motion and of other artifacts. Data analysis was performed for histologically proven astrocytomas, glioblastomas, and meningiomas, for tumors with poor contrast enhancement, and for all patients pooled. Only for tumors with poor contrast enhancement (n = 12) did fast FLAIR provide additional information about the lesion. In these cases, signal intensity, demarcation of the tumor vs brain, and differentiation of the tumor vs edema were best using fast FLAIR. In all cases, rendering of the tumor's inner structure was poor. For all other tumor types, fast FLAIR did not give clinically relevant information, the only exception being a better demarcation of the edema from brain tissue. Artifacts rarely interfered with evaluation of fast-FLAIR images. Thus, fast FLAIR cannot replace T2-weighted series. It provides additional information only in tumors with poor contrast enhancement. It is helpful for defining the exact extent of the edema of any tumor but gives little information about their inner structure.

Compressed Secret Key Agreement:Maximizing Multivariate Mutual Information per Bit

NASA Astrophysics Data System (ADS)

Chan, Chung

2017-10-01

The multiterminal secret key agreement problem by public discussion is formulated with an additional source compression step where, prior to the public discussion phase, users independently compress their private sources to filter out strongly correlated components for generating a common secret key. The objective is to maximize the achievable key rate as a function of the joint entropy of the compressed sources. Since the maximum achievable key rate captures the total amount of information mutual to the compressed sources, an optimal compression scheme essentially maximizes the multivariate mutual information per bit of randomness of the private sources, and can therefore be viewed more generally as a dimension reduction technique. Single-letter lower and upper bounds on the maximum achievable key rate are derived for the general source model, and an explicit polynomial-time computable formula is obtained for the pairwise independent network model. In particular, the converse results and the upper bounds are obtained from those of the related secret key agreement problem with rate-limited discussion. A precise duality is shown for the two-user case with one-way discussion, and such duality is extended to obtain the desired converse results in the multi-user case. In addition to posing new challenges in information processing and dimension reduction, the compressed secret key agreement problem helps shed new light on resolving the difficult problem of secret key agreement with rate-limited discussion, by offering a more structured achieving scheme and some simpler conjectures to prove.

Using patient experiences on Dutch social media to supervise health care services: exploratory study.

PubMed

van de Belt, Tom H; Engelen, Lucien J L P G; Verhoef, Lise M; van der Weide, Marian J A; Schoonhoven, Lisette; Kool, Rudolf B

2015-01-15

Social media has become mainstream and a growing number of people use it to share health care-related experiences, for example on health care rating sites. These users' experiences and ratings on social media seem to be associated with quality of care. Therefore, information shared by citizens on social media could be of additional value for supervising the quality and safety of health care services by regulatory bodies, thereby stimulating participation by consumers. The objective of the study was to identify the added value of social media for two types of supervision by the Dutch Healthcare Inspectorate (DHI), which is the regulatory body charged with supervising the quality and safety of health care services in the Netherlands. These were (1) supervision in response to incidents reported by individuals, and (2) risk-based supervision. We performed an exploratory study in cooperation with the DHI and searched different social media sources such as Twitter, Facebook, and healthcare rating sites to find additional information for these incidents and topics, from five different sectors. Supervision experts determined the added value for each individual result found, making use of pre-developed scales. Searches in social media resulted in relevant information for six of 40 incidents studied and provided relevant additional information in 72 of 116 cases in risk-based supervision of long-term elderly care. The results showed that social media could be used to include the patient's perspective in supervision. However, it appeared that the rating site ZorgkaartNederland was the only source that provided information that was of additional value for the DHI, while other sources such as forums and social networks like Twitter and Facebook did not result in additional information. This information could be of importance for health care inspectorates, particularly for its enforcement by risk-based supervision in care of the elderly. Further research is needed to determine the added value for other health care sectors.

Using Patient Experiences on Dutch Social Media to Supervise Health Care Services: Exploratory Study

PubMed Central

Engelen, Lucien JLPG; Verhoef, Lise M; van der Weide, Marian JA; Schoonhoven, Lisette; Kool, Rudolf B

2015-01-01

Background Social media has become mainstream and a growing number of people use it to share health care-related experiences, for example on health care rating sites. These users’ experiences and ratings on social media seem to be associated with quality of care. Therefore, information shared by citizens on social media could be of additional value for supervising the quality and safety of health care services by regulatory bodies, thereby stimulating participation by consumers. Objective The objective of the study was to identify the added value of social media for two types of supervision by the Dutch Healthcare Inspectorate (DHI), which is the regulatory body charged with supervising the quality and safety of health care services in the Netherlands. These were (1) supervision in response to incidents reported by individuals, and (2) risk-based supervision. Methods We performed an exploratory study in cooperation with the DHI and searched different social media sources such as Twitter, Facebook, and healthcare rating sites to find additional information for these incidents and topics, from five different sectors. Supervision experts determined the added value for each individual result found, making use of pre-developed scales. Results Searches in social media resulted in relevant information for six of 40 incidents studied and provided relevant additional information in 72 of 116 cases in risk-based supervision of long-term elderly care. Conclusions The results showed that social media could be used to include the patient’s perspective in supervision. However, it appeared that the rating site ZorgkaartNederland was the only source that provided information that was of additional value for the DHI, while other sources such as forums and social networks like Twitter and Facebook did not result in additional information. This information could be of importance for health care inspectorates, particularly for its enforcement by risk-based supervision in care of the elderly. Further research is needed to determine the added value for other health care sectors. PMID:25592481

Continuous Evaluation in Ethics Education: A Case Study.

PubMed

McIntosh, Tristan; Higgs, Cory; Mumford, Michael; Connelly, Shane; DuBois, James

2018-04-01

A great need for systematic evaluation of ethics training programs exists. Those tasked with developing an ethics training program may be quick to dismiss the value of training evaluation in continuous process improvement. In the present effort, we use a case study approach to delineate how to leverage formative and summative evaluation measures to create a high-quality ethics education program. With regard to formative evaluation, information bearing on trainee reactions, qualitative data from the comments of trainees, in addition to empirical findings, can ensure that the training program operates smoothly. Regarding summative evaluation, measures examining trainee cognition, behavior, and organization-level results provide information about how much trainees have changed as a result of taking the ethics training. The implications of effective training program evaluation are discussed.

Real life juvenile toxicity case studies: the good, the bad and the ugly.

PubMed

De Schaepdrijver, Luc; Rouan, Marie-Claude; Raoof, Araz; Bailey, Graham P; De Zwart, Loeckie; Monbaliu, Johan; Coogan, Timothy P; Lammens, Lieve; Coussement, Werner

2008-09-01

With the growing experience in the conduct of juvenile toxicity studies for multiple classes of compound, the 'case-by-case' approach has become under much more pressure. Instead, a general screen or 'standard design' is now commonly expected by regulatory authorities with more routine inclusion of neurological and reproductive assessments. Minor modifications or additions can be made to the design to address specific questions according to the class of drug or intended clinical use. This drift from a 'case-by-case' approach to a 'standard design' approach is present within certain reviewing divisions of the FDA, often requesting by default a rodent and non-rodent juvenile animal study. However, juvenile animal studies should be designed thoughtfully to fulfil a purpose based on scientific rationale, with each endpoint carefully considered in terms of practicality and interpretability of data generated. Only when using the appropriate strategy and design may juvenile studies add value by (1) identifying potential safety or pharmacokinetic issues for drugs intended for paediatric use, (2) suggesting additional clinical endpoints and (3) adding new information to the product label. As the knowledge from juvenile animal studies in various species grows, a better understanding of the significance/relevance of findings will be achieved.

Sonoelastography for the evaluation of an axillary schwannoma in a case of quadrilateral space syndrome.

PubMed

Hung, Chen-Yu; Chang, Ke-Vin; Chen, Pei-Tsen; Ho, Yu-Tsun; Han, Der-Sheng; Chen, Wen-Shiang; Wang, Tyng-Guey

2014-01-01

Entrapment axillary neuropathy at the quadrilateral space, also known as quadrilateral space syndrome (QSS), is a rare cause of posterior shoulder pain. We present a case of an axillary schwannoma causing QSS evaluated by both conventional ultrasound and sonoelastography. The application of sonoelastography is useful in elaborating the elastic feature of a soft tissue tumor, which provides additional information to conventional ultrasound regarding its growth pattern, and can help the differential diagnosis and guide the management. Copyright © 2014 Elsevier Inc. All rights reserved.

The NASTRAN user's manual (level 17.0)

NASA Technical Reports Server (NTRS)

1979-01-01

NASTRAN embodies a lumped element approach, wherein the distributed physical properties of a structure are represented by a model consisting of a finite number of idealized substructures or elements that are interconnected at a finite of grid points, to which loads are applied. All input and output data pertain to the idealized structural model. The general procedures for defining structural models are described and instructions are given for each of the bulk data cards and case control cards. Additional information on the case control cards and use of parameters is included for each rigid format.

Atypical thyrotropin-secreting pituitary microadenoma revealed by severe osteoporosis in a young man.

PubMed

de Rougemont, Alexis; Mourot, Marie-Gabrielle; Riou, Jean-Paul

2009-01-01

For 10 years, a young man was followed for a severe osteoporosis associated with a considerable reduction in height and a massive weight loss. The constant increase of signs of tissue impregnation with thyroid hormones and the molar ratios of alpha-TSH suggested an inappropriate secretion of thyrotropin. Magnetic resonance imaging finally revealed a thyrotropic microadenoma of the pituitary gland. This case gives some new additional information on thyrotropin-induced osteoporosis. To our knowledge such a case has never been reported in the literature.

Subtotal resection and omentoplasty of the epidermoid splenic cyst: a case report

PubMed Central

Spahija, Gazmend S; Hashani, Shemsedin I; Osmani, Eshref A; Hoxha, Sejdullah A; Hamza, Astrit H; Gashi-Luci, Lumturije H

2009-01-01

Introduction Nonparasitic splenic cysts are uncommon clinical entity and because of it, there is no information regarding their optimal surgical treatment. Case presentation A 41-years-old female with incidentally diagnosed nonparasitic splenic cyst which initially was asymptomatic. After two years of follow up, the patient underwent surgery; subtotal cystectomy and omentoplasty as an additional procedure. Postoperative course was uneventful. Conclusion Short and mid term results showed that near total cystectomy with omentoplasty was a safe successful procedure for treatment of epidermoid splenic cyst. PMID:19829799

Radiology image perception and observer performance: How does expertise and clinical information alter interpretation? Stroke detection explored through eye-tracking

NASA Astrophysics Data System (ADS)

Cooper, Lindsey; Gale, Alastair; Darker, Iain; Toms, Andoni; Saada, Janak

2009-02-01

Historically, radiology research has been dominated by chest and breast screening. Few studies have examined complex interpretative tasks such as the reading of multidimensional brain CT or MRI scans. Additionally, no studies at the time of writing have explored the interpretation of stroke images; from novices through to experienced practitioners using eye movement analysis. Finally, there appears a lack of evidence on the clinical effects of radiology reports and their influence on image appraisal and clinical diagnosis. A computer-based, eye-tracking study was designed to assess diagnostic accuracy and interpretation in stroke CT and MR imagery. Eight predetermined clinical cases, five images per case, were presented to participants (novices, trainee, and radiologists; n=8). The presence or absence of abnormalities was rated on a five-point Likert scale and their locations reported. Half cases of the cases were accompanied by clinical information; half were not, to assess the impact of information on observer performance. Results highlight differences in visual search patterns amongst novice, trainee and expert observers; the most marked differences occurred between novice readers and experts. Experts spent more time in challenging areas of interest (AOI) than novices and trainee, and were more confident unless a lesion was large and obvious. The time to first AOI fixation differed by size, shape and clarity of lesion. 'Time to lesion' dropped significantly when recognition appeared to occur between slices. The influence of clinical information was minimal.

Does a child's language ability affect the correspondence between parent and teacher ratings of ADHD symptoms?

PubMed

Gooch, Debbie; Maydew, Harriet; Sears, Claire; Norbury, Courtenay Frazier

2017-04-05

Rating scales are often used to identify children with potential Attention-Deficit/Hyperactivity Disorder (ADHD), yet there are frequently discrepancies between informants which may be moderated by child characteristics. The current study asked whether correspondence between parent and teacher ratings on the Strengths and Weakness of ADHD symptoms and Normal behaviour scale (SWAN) varied systematically with child language ability. Parent and teacher SWAN questionnaires were returned for 200 children (aged 61-81 months); 106 had low language ability (LL) and 94 had typically developing language (TL). After exploring informant correspondence (using Pearson correlation) and the discrepancy between raters, we report inter-class correlation coefficients, to assess inter-rater reliability, and Cohen's kappa, to assess agreement regarding possible ADHD caseness. Correlations between informant ratings on the SWAN were moderate. Children with LL were rated as having increased inattention and hyperactivity relative to children with TL; teachers, however, rated children with LL as having more inattention than parents. Inter-rater reliability of the SWAN was good and there were no systematic differences between the LL and TL groups. Case agreement between parent and teachers was fair; this varied by language group with poorer case agreement for children with LL. Children's language abilities affect the discrepancy between informant ratings of ADHD symptomatology and the agreement between parents and teachers regarding potential ADHD caseness. The assessment of children's core language ability would be a beneficial addition to the ADHD diagnostic process.

Isometric deformations of planar quadrilaterals with constant index

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

Zaputryaeva, E S

We consider isometric deformations (motions) of polygons (so-called carpenter's rule problem) in the case of self-intersecting polygons with the additional condition that the index of the polygon is preserved by the motion. We provide general information about isometric deformations of planar polygons and give a complete solution of the carpenter's problem for quadrilaterals. Bibliography: 17 titles.

75 FR 71431 - Agency Information Collection Activities: Final Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-23

... use only in those cases where the company chooses to make use of some aspects of the additional... the option of ``Ex-Im Bank Sole Risk'' as an obligor type; added the option ``CAD or SDDP'' to the... Payable for Financial Institutions Only. OMB Number: 3048-0021. Type of Review: Regular. Need and Use: The...

Meaningful Learning from Practice: Web-Based Video in Professional Preparation Programmes in University

ERIC Educational Resources Information Center

Admiraal, Wilfried

2014-01-01

Web-based video is one of the technologies which can support meaningful learning from practice--in addition to practical benefits such as accessibility of practices, flexibility in updating information, and incorporating video into multimedia resources. A multiple case study was set up on the use of a web-based video learning environment in two…

Developing Cross-Cultural Competence: A Guide for Working with Children and Their Families, Third Edition

ERIC Educational Resources Information Center

Lynch, Eleanor W.; Hanson, Marci J.

2004-01-01

The third edition of this bestselling text brings together detailed, accurate information on working with families and children with disabilities from specific cultural, ethnic, and language groups. Filled with timely new additions such as a chapter on South Asian roots, open-ended case studies on ethical dilemmas, and an expanded discussion on…

[Development method of healthcare information system integration based on business collaboration model].

PubMed

Li, Shasha; Nie, Hongchao; Lu, Xudong; Duan, Huilong

2015-02-01

Integration of heterogeneous systems is the key to hospital information construction due to complexity of the healthcare environment. Currently, during the process of healthcare information system integration, people participating in integration project usually communicate by free-format document, which impairs the efficiency and adaptability of integration. A method utilizing business process model and notation (BPMN) to model integration requirement and automatically transforming it to executable integration configuration was proposed in this paper. Based on the method, a tool was developed to model integration requirement and transform it to integration configuration. In addition, an integration case in radiology scenario was used to verify the method.

When is enough evidence enough? - Using systematic decision analysis and value-of-information analysis to determine the need for further evidence.

PubMed

Siebert, Uwe; Rochau, Ursula; Claxton, Karl

2013-01-01

Decision analysis (DA) and value-of-information (VOI) analysis provide a systematic, quantitative methodological framework that explicitly considers the uncertainty surrounding the currently available evidence to guide healthcare decisions. In medical decision making under uncertainty, there are two fundamental questions: 1) What decision should be made now given the best available evidence (and its uncertainty)?; 2) Subsequent to the current decision and given the magnitude of the remaining uncertainty, should we gather further evidence (i.e., perform additional studies), and if yes, which studies should be undertaken (e.g., efficacy, side effects, quality of life, costs), and what sample sizes are needed? Using the currently best available evidence, VoI analysis focuses on the likelihood of making a wrong decision if the new intervention is adopted. The value of performing further studies and gathering additional evidence is based on the extent to which the additional information will reduce this uncertainty. A quantitative framework allows for the valuation of the additional information that is generated by further research, and considers the decision maker's objectives and resource constraints. Claxton et al. summarise: "Value of information analysis can be used to inform a range of policy questions including whether a new technology should be approved based on existing evidence, whether it should be approved but additional research conducted or whether approval should be withheld until the additional evidence becomes available." [Claxton K. Value of information entry in Encyclopaedia of Health Economics, Elsevier, forthcoming 2014.] The purpose of this tutorial is to introduce the framework of systematic VoI analysis to guide further research. In our tutorial article, we explain the theoretical foundations and practical methods of decision analysis and value-of-information analysis. To illustrate, we use a simple case example of a foot ulcer (e.g., with diabetes) as well as key references from the literature, including examples for the use of the decision-analytic VoI framework by health technology assessment agencies to guide further research. These concepts may guide stakeholders involved or interested in how to determine whether or not and, if so, which additional evidence is needed to make decisions. Copyright © 2013. Published by Elsevier GmbH.

Performance assessment and beamline diagnostics based on evaluation of temporal information from infrared spectral datasets by means of R Environment for statistical analysis.

PubMed

Banas, Krzysztof; Banas, Agnieszka; Gajda, Mariusz; Kwiatek, Wojciech M; Pawlicki, Bohdan; Breese, Mark B H

2014-07-15

Assessment of the performance and up-to-date diagnostics of scientific equipment is one of the key components in contemporary laboratories. Most reliable checks are performed by real test experiments while varying the experimental conditions (typically, in the case of infrared spectroscopic measurements, the size of the beam aperture, the duration of the experiment, the spectral range, the scanner velocity, etc.). On the other hand, the stability of the instrument response in time is another key element of the great value. Source stability (or easy predictable temporal changes, similar to those observed in the case of synchrotron radiation-based sources working in non top-up mode), detector stability (especially in the case of liquid nitrogen- or liquid helium-cooled detectors) should be monitored. In these cases, recorded datasets (spectra) include additional variables such as time stamp when a particular spectrum was recorded (in the case of time trial experiments). A favorable approach in evaluating these data is building hyperspectral object that consist of all spectra and all additional parameters at which these spectra were recorded. Taking into account that these datasets could be considerably large in size, there is a need for the tools for semiautomatic data evaluation and information extraction. A comprehensive R archive network--the open-source R Environment--with its flexibility and growing potential, fits these requirements nicely. In this paper, examples of practical implementation of methods available in R for real-life Fourier transform infrared (FTIR) spectroscopic data problems are presented. However, this approach could easily be adopted to many various laboratory scenarios with other spectroscopic techniques.

The potential application of European market research data in dietary exposure modelling of food additives.

PubMed

Tennant, David Robin; Bruyninckx, Chris

2018-03-01

Consumer exposure assessments for food additives are incomplete without information about the proportions of foods in each authorised category that contain the additive. Such information has been difficult to obtain but the Mintel Global New Products Database (GNPD) provides information about product launches across Europe over the past 20 years. These data can be searched to identify products with specific additives listed on product labels and the numbers compared with total product launches for food and drink categories in the same database to determine the frequency of occurrence. There are uncertainties associated with the data but these can be managed by adopting a cautious and conservative approach. GNPD data can be mapped with authorised food categories and with food descriptions used in the EFSA Comprehensive European Food Consumption Surveys Database for exposure modelling. The data, when presented as percent occurrence, could be incorporated into the EFSA ANS Panel's 'brand-loyal/non-brand loyal exposure model in a quantitative way. Case studies of preservative, antioxidant, colour and sweetener additives showed that the impact of including occurrence data is greatest in the non-brand loyal scenario. Recommendations for future research include identifying occurrence data for alcoholic beverages, linking regulatory food codes, FoodEx and GNPD product descriptions, developing the use of occurrence data for carry-over foods and improving understanding of brand loyalty in consumer exposure models.

Application of Text Information Extraction System for Real-Time Cancer Case Identification in an Integrated Healthcare Organization.

PubMed

Xie, Fagen; Lee, Janet; Munoz-Plaza, Corrine E; Hahn, Erin E; Chen, Wansu

2017-01-01

Surgical pathology reports (SPR) contain rich clinical diagnosis information. The text information extraction system (TIES) is an end-to-end application leveraging natural language processing technologies and focused on the processing of pathology and/or radiology reports. We deployed the TIES system and integrated SPRs into the TIES system on a daily basis at Kaiser Permanente Southern California. The breast cancer cases diagnosed in December 2013 from the Cancer Registry (CANREG) were used to validate the performance of the TIES system. The National Cancer Institute Metathesaurus (NCIM) concept terms and codes to describe breast cancer were identified through the Unified Medical Language System Terminology Service (UTS) application. The identified NCIM codes were used to search for the coded SPRs in the back-end datastore directly. The identified cases were then compared with the breast cancer patients pulled from CANREG. A total of 437 breast cancer concept terms and 14 combinations of "breast"and "cancer" terms were identified from the UTS application. A total of 249 breast cancer cases diagnosed in December 2013 was pulled from CANREG. Out of these 249 cases, 241 were successfully identified by the TIES system from a total of 457 reports. The TIES system also identified an additional 277 cases that were not part of the validation sample. Out of the 277 cases, 11% were determined as highly likely to be cases after manual examinations, and 86% were in CANREG but were diagnosed in months other than December of 2013. The study demonstrated that the TIES system can effectively identify potential breast cancer cases in our care setting. Identified potential cases can be easily confirmed by reviewing the corresponding annotated reports through the front-end visualization interface. The TIES system is a great tool for identifying potential various cancer cases in a timely manner and on a regular basis in support of clinical research studies.

The reconstruction of atomic co-ordinates from a protein stereo ribbon diagram when additional information for sufficient sidechain positions is available

NASA Astrophysics Data System (ADS)

Lopes de Oliveira, Paulo Sérgio; Garratt, Richard Charles

1998-11-01

We describe the application of a method for the reconstruction of three-dimensional atomic co-ordinates from a stereo ribbon diagram of a protein when additional information for some of the sidechain positions is available. The method has applications in cases where the 3D co-ordinates have not been made available by any means other than the original publication and are of interest as models for molecular replacement, homology modelling etc. The approach is, on the one hand, more general than other methods which are based on stereo figures which present specific atomic positions, but on the other hand relies on input from a specialist. Its exact implementation will depend on the figure of interest. We have applied the method to the case of the α-d-galactose-binding lectin jacalin with a resultant RMS deviation, compared to the crystal structure, of 1.5 Å for the 133 Cα positions of the α-chain and 2.6 Å for the less regular β-chain. The success of the method depends on the secondary structure of the protein under consideration and the orientation of the stereo diagram itself but can be expected to reproduce the mainchain co-ordinates more accurately than the sidechains. Some ways in which the method may be generalised to other cases are discussed.

Automatic seizure detection based on the combination of newborn multi-channel EEG and HRV information

NASA Astrophysics Data System (ADS)

Mesbah, Mostefa; Balakrishnan, Malarvili; Colditz, Paul B.; Boashash, Boualem

2012-12-01

This article proposes a new method for newborn seizure detection that uses information extracted from both multi-channel electroencephalogram (EEG) and a single channel electrocardiogram (ECG). The aim of the study is to assess whether additional information extracted from ECG can improve the performance of seizure detectors based solely on EEG. Two different approaches were used to combine this extracted information. The first approach, known as feature fusion, involves combining features extracted from EEG and heart rate variability (HRV) into a single feature vector prior to feeding it to a classifier. The second approach, called classifier or decision fusion, is achieved by combining the independent decisions of the EEG and the HRV-based classifiers. Tested on recordings obtained from eight newborns with identified EEG seizures, the proposed neonatal seizure detection algorithms achieved 95.20% sensitivity and 88.60% specificity for the feature fusion case and 95.20% sensitivity and 94.30% specificity for the classifier fusion case. These results are considerably better than those involving classifiers using EEG only (80.90%, 86.50%) or HRV only (85.70%, 84.60%).

[Obligation to report occupational diseases. Importance of external post-mortem examinations before cremation].

PubMed

Verhoff, M A; Risse, M; Alles, J-U; Müller, K-M; Stachetzki, U

2004-05-01

The practical use of the legally required documentation of occupational diseases is demonstrated by a case of asbestos-related pleural mesothelioma. During the mandatory inquest before cremation, information of manifest pleural mesothelioma had been relayed to the widow of the patient, and an investigation for a possible occupational disease was performed. Reconstruction of the case showed that in the course of 3 months at least 13 physicians had been involved in in-hospital as well as ambulatory therapeutic measures. Until death, none of them informed the trade association about a suspected occupational disease in accordance with BK 4105 of the codex of occupational diseases, although the diagnosis of manifest pleural mesothelioma had been histologically confirmed already 10 weeks prior to the death of the patient. This case demonstrates obvious and evident deficiencies in applying the Code of Social Law VII, which requires physicians to report occupational diseases. In addition, it shows the importance of the post-mortem examination as a control function before cremation.

The Extent of Consumer Product Involvement in Paediatric Injuries

PubMed Central

Catchpoole, Jesani; Walker, Sue; Vallmuur, Kirsten

2016-01-01

A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases. PMID:27399744

The Extent of Consumer Product Involvement in Paediatric Injuries.

PubMed

Catchpoole, Jesani; Walker, Sue; Vallmuur, Kirsten

2016-07-07

A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases.

[Fatal occupational accidents: estimates based on more data sources].

PubMed

Baldasseroni, A; Chellini, E; Zoppi, O; Giovannetti, L

2001-01-01

The data reported by INAIL (Istituto Nazionale Assicurazione Infortuni sul Lavoro) on fatal occupational injuries have always been considered complete and reliable. The authors of this article verified the completeness of this information source crossing it with data bases existing in different registration systems (Regional Mortality Registry of Tuscany--RMR; registers and data of the Operative Units of Prevention, Hygiene and Safety in the Workplace--UOPISLL) for the period between 1992 and 1996. In the five years concerned, a total of 458 cases were reported. These cases could be considered fatal injuries at work without taking into account traffic accidents, which were not included in the present study. The results show that the most complete information source was RMR, reporting 80% of the total data, while INAIL reports only 62.2% of the total cases. On the contrary, the UOPISLL source is the least reliable. Using the capture/recapture method, the estimate of events in the period concerned (1992-1996) amounts to nearly 500 (499.8 LC 475.9-523.7), while the three sources systematically explored for the whole period (INAIL, RMR, UOSPILL) report 458 cases. An additional information source, the daily press, which could be systematically tested only two months for each of the five years, reports 10 additional cases, which were ignored by the 3 other sources, indirectly confirming in this way how reliable the performed estimate was. The main cases among the 157 fatal accidents reported by RMR, but not by INAIL, occurred among farmers (70), most of them already retired, but there were several fatal accidents reported in the construction sector (30). Other categories were included only in the RMR data because, in the period concerned, they were not covered by INAIL insurance (18 cases in the Army and Police, 7 on the railways). The survey that was carried out confirms the essential importance of INAIL data for the surveillance system applied to this phenomenon. This also confirms the need--which has been already stressed in the scientific literature--to combine INAIL's registration system at least with the mortality registries. In this way the knowledge and comprehension of the phenomenon could be integrated and completed especially for marginal work areas, where obligatory insurance may be evaded; and for groups of workers not covered by insurance. The relevance of an integrated system of registration of occupational fatal accidents is discussed.

An Innovative Approach to Improve Completeness of Treatment and Other Key Data Elements in a Population-Based Cancer Registry: A15-Month Data Submission.

PubMed

Hsieh, Mei-Chin; Mumphrey, Brent; Pareti, Lisa; Yi, Yong; Wu, Xiao-Cheng

2017-01-01

BACKGROUND: In order to comply with the Louisiana legislative obligation and meet funding agencies’ requirement of case completeness for 12-month data submission, hospital cancer registries are mandated to submit cancer incidence data to the Louisiana Tumor Registry (LTR) within 6 months of diagnosis. However, enforcing compliance with timely reporting may result in incomplete data on adjuvant treatment received by the LTR. Although additional treatment information can be obtained via retransmission of the North American Association of Central Cancer Registries (NAACCR)–modified abstracts, consolidating multiple NAACCR-modified abstracts for the same case is extremely time consuming. To avoid a huge amount of work while obtaining timely and complete data, the LTR has requested hospital cancer registries resubmit their data 15 months after the close of the diagnosis year. The purpose of this report is to assess the improvement in the completeness of data items related to treatment, staging and site specific factors. METHODS: The LTR requested that hospital cancer registries resubmit 15-month data between April 1, 2016 and April 15, 2016 for cases diagnosed in 2014. Microsoft Visual Studio Visual Basic script was used to link and compare resubmitted data with existing data in the LTR database. Data elements used for matching same patient/tumor were name, Social Security number, date of birth, primary site, laterality, and hospital identifier number. Treatment data items were compared as known vs none/ unknown and known vs known with different code. Matched records with updated information were imported into the LTR database and flagged as modified abstract records for manual consolidation. Nonmatched records were also loaded in the LTR database as potential new cases for further investigation. RESULTS: A total of 25,207 resubmitted NAACCR abstracts were received from 38 hospitals and freestanding radiation centers. About 11.1% had at least 1 update related to treatment and/or other data item; an average of 3.3 updates per updated abstract. The majority of the updates (45.7%) for treatment were changes from none/unknown to known value and 42.6% of the updates were related to radiation treatment fields. In addition, 172 potential new cases were identified. Approximately 10.5% (18 cases) of these new cases were confirmed to be truly missed cases after investigation. CONCLUSION: The 15-month data resubmission is a cost-effective approach to obtaining complete information on treatment and other key data items from reporting facilities and can also be used to identify potential missed cases.

Vitamin D toxicity of dietary origin in cats fed a natural complementary kitten food

PubMed Central

Crossley, Victoria J; Bovens, Catherine PV; Pineda, Carmen; Hibbert, Angie; Finch, Natalie C

2017-01-01

Case series summary This case series describes two young sibling cats and an additional unrelated cat, from two separate households, that developed hypercalcaemia associated with hypervitaminosis D. Excessive vitamin D concentrations were identified in a natural complementary tinned kitten food that was fed to all three cats as part of their diet. In one of the cases, there was clinical evidence of soft tissue mineralisation. The hypercalcaemia and soft tissue mineralisation resolved following withdrawal of the affected food and medical management of the hypercalcaemia. Relevance and novel information This case series demonstrates the importance of obtaining a thorough dietary history in patients presenting with hypercalcaemia and the measurement of vitamin D metabolites when investigating such cases. Complementary foods may have the potential to induce nutritional toxicity even when fed with complete, nutritionally balanced diets. PMID:29270305

Uncovering malpractice in appendectomies: a review of 234 cases.

PubMed

Choudhry, Amad J; Anandalwar, Seema P; Choudhry, Asad J; Svider, Peter F; Oliver, Joseph O; Eloy, Jean Anderson; Chokshi, Ravi J

2013-10-01

General surgery is a "high-risk specialty" with respect to medical malpractice rates, and appendicitis is one of the most common diagnoses encountered by practitioners. Our objectives were to detail issues affecting malpractice litigation regarding appendicitis and appendectomies, including outcomes, awards, alleged causes of malpractice, and other factors instrumental in determining legal responsibility and increasing patient safety. Publically available federal and state court records were examined for pertinent jury verdict and settlement reports. Information from 234 pertinent cases was collected, including alleged causes of malpractice and outcomes. Of the 234 cases included in this study, the most common factor noted was an alleged delay in diagnosis (67.1%), followed by intraoperative negligence (16.2%). Alleged deficits in informed consent, although only specifically cited as a cause of malpractice in 1.3% of cases, were found to be an important aspect of many cases. In total, 59.8% of cases were ruled in favor of the physician, 23.7% in favor of the plaintiff, and 5.5% reached a settlement. The average plaintiff award was US $794,152, and the average settlement award was US $1,434,286. An important strategy to decrease liability in a physician's practice is prompt evaluation of an appendicitis patient. An integral part of this is efficient communication between physicians practicing a wide variety of specialties, especially including practitioners in emergency medicine and general surgery. Additionally, completing a thorough informed consent explaining all aspects of the procedure including the factors we outline will not only increase patient awareness of potential risks but also protect the physician in the face of litigation.

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017.

PubMed

Neal, Joseph M; Barrington, Michael J; Fettiplace, Michael R; Gitman, Marina; Memtsoudis, Stavros G; Mörwald, Eva E; Rubin, Daniel S; Weinberg, Guy

2018-02-01

The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. WHAT'S NEW IN THIS UPDATE?: This interim update summarizes recent scientific findings that have enhanced our understanding of the mechanisms that lead to lipid emulsion reversal of LAST, including rapid partitioning, direct inotropy, and post-conditioning. Since the previous practice advisory, epidemiological data have emerged that suggest a lower frequency of LAST as reported by single institutions and some registries, nevertheless a considerable number of events still occur within the general community. Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.

Postmortem computed tomography and magnetic resonance imaging facilitates forensic autopsy in a fatal case of poisoning with formic acid, diphenhydramine, and ethanol.

PubMed

Berger, Florian; Steuer, Andrea E; Rentsch, Katharina; Gascho, Dominic; Stamou, Stamatios; Schärli, Sarah; Thali, Michael J; Krämer, Thomas; Flach, Patricia M

2016-09-01

A case of fatal poisoning by ingesting formic acid, diphenhydramine, and ethanol by a 25-year-old woman who committed suicide is presented. Prior to autopsy, postmortem computed tomography and postmortem magnetic resonance tomography were performed and revealed severe damage to the stomach, the left thoracic wall, and parts of the liver. Imaging detected acid-induced fluid-fluid level within the thoracic cavity (fat-equivalent fluid and necrotic pleural effusion). This case report illustrates that postmortem cross-sectional imaging may facilitate dissection of severely damaged or complex regions, and may provide additional information compared to autopsy and toxicological examinations alone.

Different EGFR gene mutations in two patients with synchronous multiple lung cancers: A case report

PubMed Central

Sakai, Hiroki; Kimura, Hiroyuki; Tsuda, Masataka; Wakiyama, Yoichi; Miyazawa, Tomoyuki; Marushima, Hideki; Kojima, Koji; Hoshikawa, Masahiro; Takagi, Masayuki; Nakamura, Haruhiko

2017-01-01

Routine clinical and pathological evaluations to determine the relationship between different lesions are often not completely conclusive. Interestingly, detailed genetic analysis of tumor samples may provide important additional information and identify second primary lung cancers. In the present study, we report cases of two synchronous lung adenocarcinomas composed of two distinct pathological subtypes with different EGFR gene mutations: a homozygous deletion in exon 19 of the papillary adenocarcinoma subtype and a point mutation of L858R in exon 21 of the tubular adenocarcinoma. The present report highlights the clinical importance of molecular cancer biomarkers to guide management decisions in cases involving multiple lung tumors. PMID:29090842

Implementation failures in the use of two New Zealand laws to control the tobacco industry: 1989–2005

PubMed Central

Thomson, George; Wilson, Nick

2005-01-01

Background We reviewed the implementation of New Zealand laws in relation to the activities of the tobacco industry and their allies. Material for two brief case studies was obtained from correspondence with official agencies, official information requests, internet searches (tobacco industry documents and official government sites), and interviews with 12 key informants. Results The first case study identified four occasions over a period of 14 years where New Zealand Government agencies appeared to fail to enforce consumer protection law, although apparent breaches by the tobacco industry and their allies had occurred in relation to statements on the relative safety of secondhand smoke. The second case study examined responses to a legal requirement for the tobacco industry to provide information on tobacco additives. There was failure to enforce the law, and a failure of the political process for at least 13 years to clarify and strengthen the law. Relevant factors in both these cases of 'policy slippage' appear to have been financial and opportunity costs of taking legal action, political difficulties and the fragmented nature of government structures. Conclusion Considered together, these case studies suggest the need for governments to: (i) make better use of national consumer laws (with proper monitoring and enforcement) in relation to tobacco; and (ii) to strengthen international law and resources around tobacco-related consumer protection. A number of options for achieving these aims are available to governments. PMID:16354296

Development of an online incident-reporting system for management of medical risks at hospital.

PubMed

Kanda, Hirohito

2011-01-01

  To minimize their occurrence, it is important to gather and analyze data regarding cases of not only medical accidents but also of incidents involving potential harm to patients. In gathering data, we have separated reporting between the details of such incidents and information about their occurrence. We have implemented a system involving a first report to achieve prompt notification and a second report to provide details. An online report input system has been established taking into consideration both ease of input and promptness of information sharing. We discuss the input of the first and second reports in a total of 951 cases over a period of 6 months. From the data regarding the timing of the first report, 307 and 789 cases were reported within 24 h and 48 h, respectively, indicating that the first report was input mostly without delay in accordance with the operational guidelines. On the other hand, it took 14 days to surpass a second report rate of 80%. Cases that took more than 2 weeks to be reported would likely have gone unreported had there not been a first report to indicate and confirm that an incident had even occurred. Investigation is needed, especially for problematic cases, so we assume that discovering important incidents via the first report has been successful. In addition, details of incidents can be input into this system in free-text, yielding information that cannot be acquired with multiple choice input as in standard reporting systems.

A 3-Component Mixture of Rayleigh Distributions: Properties and Estimation in Bayesian Framework

PubMed Central

Aslam, Muhammad; Tahir, Muhammad; Hussain, Zawar; Al-Zahrani, Bander

2015-01-01

To study lifetimes of certain engineering processes, a lifetime model which can accommodate the nature of such processes is desired. The mixture models of underlying lifetime distributions are intuitively more appropriate and appealing to model the heterogeneous nature of process as compared to simple models. This paper is about studying a 3-component mixture of the Rayleigh distributionsin Bayesian perspective. The censored sampling environment is considered due to its popularity in reliability theory and survival analysis. The expressions for the Bayes estimators and their posterior risks are derived under different scenarios. In case the case that no or little prior information is available, elicitation of hyperparameters is given. To examine, numerically, the performance of the Bayes estimators using non-informative and informative priors under different loss functions, we have simulated their statistical properties for different sample sizes and test termination times. In addition, to highlight the practical significance, an illustrative example based on a real-life engineering data is also given. PMID:25993475

Unattractive consequences: litigation from facial dermabrasion and chemical peels.

PubMed

Svider, Peter F; Jiron, Jose; Zuliani, Giancarlo; Shkoukani, Mahdi A; Folbe, Adam J; Carron, Michael

2014-11-01

Facial dermabrasion and chemical peel are common cosmetic procedures that are generally safe yet do possess inherent risks. The patient's expectations, formed well in advance of treatment, strongly correlate with overall satisfaction. The authors reviewed and analyzed litigation related to the performance of facial dermabrasion and chemical peel. The authors searched the WestlawNext legal database for relevant litigation and examined factors such as allegations raised, patient demographics, defendant specialties, final outcomes, and payments. Proceedings from 25 cases were analyzed, involving 22 female and 2 male plaintiffs; in 1 case, sex was not specified. Sixteen cases (64%) resulted in a decision for the defendant and 9 (36%) were resolved with payments. The median difference between out-of-court settlements (median, $940 000) and jury-awarded damages (median, $535 000) was not statistically significant. Factors raised in litigation included poor cosmetic outcome (80%), alleged intratreatment negligence (68%), permanent injury (64%), informed-consent deficits (60%), emotional/psychological injury (44%), posttreatment negligence (32%), and the need for additional treatment/surgery (32%). Out-of-court settlements and jury-awarded damages were considerable in cases where physicians practicing various (or multiple) specialties were named as defendants. These findings emphasize the need for physicians to thoroughly document potential complications prior to treatment, during the informed-consent process. Additionally, general considerations should be taken into account, such as patient expectations and the potential need for other procedures, which may enhance pretreatment communication and ultimately minimize liability. Finally, it is important to stress that physicians may be held liable for procedures performed by nonphysician ancillary staff. © 2014 The American Society for Aesthetic Plastic Surgery, Inc.

Virtual patient simulation at US and Canadian medical schools.

PubMed

Huang, Grace; Reynolds, Robby; Candler, Chris

2007-05-01

"Virtual patients" are computer-based simulations designed to complement clinical training. These applications possess numerous educational benefits but are costly to develop. Few medical schools can afford to create them. The purpose of this inventory was to gather information regarding in-house virtual patient development at U.S. and Canadian medical schools to promote the sharing of existing cases and future collaboration. From February to September 2005, the authors contacted 142 U.S. and Canadian medical schools and requested that they report on virtual patient simulation activities at their respective institutions. The inventory elicited information regarding the pedagogic and technical characteristics of each virtual patient application. The schools were also asked to report on their willingness to share virtual patients. Twenty-six out of 108 responding schools reported that they were producing virtual patients. Twelve schools provided additional data on 103 cases and 111 virtual patients. The vast majority of virtual patients were media rich and were associated with significant production costs and time. The reported virtual patient cases tended to focus on primary care disciplines and did not as a whole exhibit racial or ethnic diversity. Funding sources, production costs, and production duration influenced the extent of schools' willingness to share. Broader access to and cooperative development of these resources would allow medical schools to enhance their clinical curricula. Virtual patient development should include basic science objectives for more integrative learning, simulate the consequences of clinical decision making, and include additional cases in cultural competency. Together, these efforts can enhance medical education despite external constraints on clinical training.

Deriving a no expected sensitization induction level for fragrance ingredients without animal testing: An integrated approach applied to specific case studies.

PubMed

Natsch, Andreas; Emter, Roger; Haupt, Tina; Ellis, Graham

2018-06-01

Cosmetic regulations prohibit animal testing for the purpose of safety assessment and recent REACH guidance states that the local lymph node assay (LLNA) in mice shall only be conducted if in vitro data cannot give sufficient information for classification and labelling. However, Quantitative Risk Assessment (QRA) for fragrance ingredients requires a NESIL, a dose not expected to cause induction of skin sensitization in humans. In absence of human data, this is derived from the LLNA and it remains a key challenge for risk assessors to derive this value from non-animal data. Here we present a workflow using structural information, reactivity data and KeratinoSens results to predict a LLNA result as a point of departure. Specific additional tests (metabolic activation, complementary reactivity tests) are applied in selected cases depending on the chemical domain of a molecule. Finally, in vitro and in vivo data on close analogues are used to estimate uncertainty of the prediction in the specific chemical domain. This approach was applied to three molecules which were subsequently tested in the LLNA and 22 molecules with available and sometimes discordant human and LLNA data. Four additional case studies illustrate how this approach is being applied to recently developed molecules in the absence of animal data. Estimation of uncertainty and how this can be applied to determine a final NESIL for risk assessment is discussed. We conclude that, in the data-rich domain of fragrance ingredients, sensitization risk assessment without animal testing is possible in most cases by this integrated approach.

Identifying Challenges to the Integration of Computer-Based Surveillance Information Systems in a Large City Health Department: A Case Study.

PubMed

Jennings, Jacky M; Stover, Jeffrey A; Bair-Merritt, Megan H; Fichtenberg, Caroline; Munoz, Mary Grace; Maziad, Rafiq; Ketemepi, Sherry Johnson; Zenilman, Jonathan

2009-01-01

Integrated infectious disease surveillance information systems have the potential to provide important new surveillance capacities and business efficiencies for local health departments. We conducted a case study at a large city health department of the primary computer-based infectious disease surveillance information systems during a 10-year period to identify the major challenges for information integration across the systems. The assessment included key informant interviews and evaluations of the computer-based surveillance information systems used for acute communicable diseases, human immunodeficiency virus/acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis. Assessments were conducted in 1998 with a follow-up in 2008. Assessments specifically identified and described the primary computer-based surveillance information system, any duplicative information systems, and selected variables collected. Persistent challenges to information integration across the information systems included the existence of duplicative data systems, differences in the variables used to collect similar information, and differences in basic architecture. The assessments identified a number of challenges for information integration across the infectious disease surveillance information systems at this city health department. The results suggest that local disease control programs use computer-based surveillance information systems that were not designed for data integration. To the extent that integration provides important new surveillance capacities and business efficiencies, we recommend that patient-centric information systems be designed that provide all the epidemiologic, clinical, and research needs in one system. In addition, the systems should include a standard system of elements and fields across similar surveillance systems.

Evaluation of National Tsutsugamushi Disease Surveillance--Japan, 2000.

PubMed

Matsui, Tamano; Kramer, Michael H; Mendlein, James M; Osaka, Ken; Ohyama, Takaaki; Takahashi, Hiroshi; Ono, Tomomichi; Okabe, Nobuhiko

2002-12-01

In Japan, Tsutsugamushi disease, which is caused by Orientia tsutsugamushi, is re-emerging with newly recognized strains and is now endemic in all prefectures except Hokkaido and Okinawa. We analyzed recent surveillance data to describe the epidemiology of Tsutsugamushi disease and to evaluate the newly implemented national surveillance system according to the CDC guidelines for evaluating surveillance systems. In 2000, 756 cases of Tsutsugamushi disease were reported from 37 of 47 prefectures; two of these cases were fatal. The median age of case-patients was 64 years (range: 2 - 94 years); 414 (54.8%) were male. In northern Japan, most cases were diagnosed in the months of May through July and in the months of October through December, and in southern Japan, cases were diagnosed almost year-round with a peak from October through December and in January. Reporting and transfer of surveillance information from the prefecture to the national level was effective and timely, but the completeness and quality of case reporting could still be improved. The current system for Tsutsugamushi disease surveillance is useful for describing epidemiologic patterns by time, prefecture, and demographic characteristics. However, collection of additional information on suspected place of transmission, activity performed at the place of transmission, or the case-patient's profession would likely make the system more valuable for outbreak detection and for better defining populations at risk.

[Actual circumstances of suicides and related factors according to newspaper coverage of television programs].

PubMed

Takamura, Soichi; Shimizu, Takahiro; Nekoda, Yasutoshi

2015-01-01

This study investigated the actual circumstances of suicides and related factors based on TV program pages in newspapers. Information was extracted from the television schedule columns of one major newspaper introducing programs from 2004 to June 2009. During information extraction, reliability was maintained by having 2 researchers specializing in mental health make determinations independently. We examined the column for program names and introductions of 6 broadcast TV channels within the television schedule for data analysis. After information was extracted using the established selection criteria regarding suicide and related information, information extraction was performed for sub-themes in the TV programs. Information was also classified with regard to specialization and program genre or other related context as well as the presence or absence of an experiential narrative. In addition to carrying out the qualitative classification of these collected information data, we compared the numbers and proportion (%) in chronological order and context. Moreover, programs dealing repeatedly with one case were analyzed for trends in the contents of program introductions and in the media. Depending on the season, some programs constantly broadcast about suicides, mainly in spring and autumn. Most of these programs air on Tuesday and Wednesday. We also analyzed programs that repeatedly discussed the same case and identified eight cases repeatedly discussed by more than ten different programs. We also considered bullying, homicide, and depression, which appeared most frequently as subthemes of suicide. An unprofessional approach was observed in 504 programs (81%), whereas only 47 (7.6%) showed expertise. Depending on the season and day of the week, suicide is constantly broadcasted on TV programs. We also considered mental health because bullying was a common subtheme in this context. An unprofessional approach was seen in most programs. We also studied programs that repeatedly discussed the same case because overexposure of offenders in programs can lead to secondary suicides.

Decision support using anesthesia information management system records and accreditation council for graduate medical education case logs for resident operating room assignments.

PubMed

Wanderer, Jonathan P; Charnin, Jonathan; Driscoll, William D; Bailin, Michael T; Baker, Keith

2013-08-01

Our goal in this study was to develop decision support systems for resident operating room (OR) assignments using anesthesia information management system (AIMS) records and Accreditation Council for Graduate Medical Education (ACGME) case logs and evaluate the implementations. We developed 2 Web-based systems: an ACGME case-log visualization tool, and Residents Helping in Navigating OR Scheduling (Rhinos), an interactive system that solicits OR assignment requests from residents and creates resident profiles. Resident profiles are snapshots of the cases and procedures each resident has done and were derived from AIMS records and ACGME case logs. A Rhinos pilot was performed for 6 weeks on 2 clinical services. One hundred sixty-five requests were entered and used in OR assignment decisions by a single attending anesthesiologist. Each request consisted of a rank ordered list of up to 3 ORs. Residents had access to detailed information about these cases including surgeon and patient name, age, procedure type, and admission status. Success rates at matching resident requests were determined by comparing requests with AIMS records. Of the 165 requests, 87 first-choice matches (52.7%), 27 second-choice matches (16.4%), and 8 third-choice matches (4.8%) were made. Forty-three requests were unmatched (26.1%). Thirty-nine first-choice requests overlapped (23.6%). Full implementation followed on 8 clinical services for 8 weeks. Seven hundred fifty-four requests were reviewed by 15 attending anesthesiologists, with 339 first-choice matches (45.0%), 122 second-choice matches (16.2%), 55 third-choice matches (7.3%), and 238 unmatched (31.5%). There were 279 overlapping first-choice requests (37.0%). The overall combined match success rate was 69.4%. Separately, we developed an ACGME case-log visualization tool that allows individual resident experiences to be compared against case minimums as well as resident peer groups. We conclude that it is feasible to use ACGME case-log data in decision support systems for informing resident OR assignments. Additional analysis will be necessary to assess the educational impact of these systems.

Content Analysis of Standardized-Patients' Descriptive Feedback on Student Performance on the CPX.

PubMed

Lee, Young Hee; Lee, Young-Mee; Kim, Byung Soo

2010-12-01

The goal of this study was to explore what kind of additional information is provided by the descriptive comments other than the rating scales, on the physician-patient interaction (PPI) in the clinical performance examination (CPX) and its feedback role in identifying students' strengths and weaknesses in communication skills. The data were collected from 18 medical schools in Seoul and Gyeonggi region, which participated in the CPX for fourth-year medical students in 2006 and 2007. In total 12,650 examination cases in 2006 and 12,814 cases in 2007 were analyzed. Descriptive comments from the standardized patients (SPs) were analyzed by content analysis, which includes a 4-step process: coding, conceptualizing, categorizing and explanation. Ten categories (41 concepts) for 'strength' and 11 for 'weakness' (40 concepts) in the PPI were extracted. Among them, 10 categories were the same in both strength and weakness: providing adequate interview atmosphere, attentive listening, providing emotional support, non-verbal behaviors, professional attitude, questioning, explanation, reaching agreement, counseling & education and conducting adequate physical examination. For the 'structured and organized interview', only weakness was described. In 'providing emotional support' and 'adequate interview atmosphere', comments on strengths were more frequently mentioned than weaknesses. However, communication skills that were related to non-verbal behaviors were more frequently considered weaknesses rather than strengths. The numbers and content of the SP's comments on students' strengths and weaknesses in the PPI varied depending on the case specificities. The results suggest that the SPs' descriptive comments on student' performance on the CPX can provide additional information versus structured quantitative assessment tools such as performance checklists and rating scales. In particular, this information can be used as valuable feedback to identify the advantages and dicadvantages of the PPI and to enhance students' communication skills.

Coherent state coding approaches the capacity of non-Gaussian bosonic channels

NASA Astrophysics Data System (ADS)

Huber, Stefan; König, Robert

2018-05-01

The additivity problem asks if the use of entanglement can boost the information-carrying capacity of a given channel beyond what is achievable by coding with simple product states only. This has recently been shown not to be the case for phase-insensitive one-mode Gaussian channels, but remains unresolved in general. Here we consider two general classes of bosonic noise channels, which include phase-insensitive Gaussian channels as special cases: these are attenuators with general, potentially non-Gaussian environment states and classical noise channels with general probabilistic noise. We show that additivity violations, if existent, are rather minor for all these channels: the maximal gain in classical capacity is bounded by a constant independent of the input energy. Our proof shows that coding by simple classical modulation of coherent states is close to optimal.

CONTROL FUNCTION ASSISTED IPW ESTIMATION WITH A SECONDARY OUTCOME IN CASE-CONTROL STUDIES.

PubMed

Sofer, Tamar; Cornelis, Marilyn C; Kraft, Peter; Tchetgen Tchetgen, Eric J

2017-04-01

Case-control studies are designed towards studying associations between risk factors and a single, primary outcome. Information about additional, secondary outcomes is also collected, but association studies targeting such secondary outcomes should account for the case-control sampling scheme, or otherwise results may be biased. Often, one uses inverse probability weighted (IPW) estimators to estimate population effects in such studies. IPW estimators are robust, as they only require correct specification of the mean regression model of the secondary outcome on covariates, and knowledge of the disease prevalence. However, IPW estimators are inefficient relative to estimators that make additional assumptions about the data generating mechanism. We propose a class of estimators for the effect of risk factors on a secondary outcome in case-control studies that combine IPW with an additional modeling assumption: specification of the disease outcome probability model. We incorporate this model via a mean zero control function. We derive the class of all regular and asymptotically linear estimators corresponding to our modeling assumption, when the secondary outcome mean is modeled using either the identity or the log link. We find the efficient estimator in our class of estimators and show that it reduces to standard IPW when the model for the primary disease outcome is unrestricted, and is more efficient than standard IPW when the model is either parametric or semiparametric.

Engineering 2.0: Exploring Lightweight Technologies for the Virtual Enterprise

NASA Astrophysics Data System (ADS)

Larsson, Andreas; Ericson, Åsa; Larsson, Tobias; Isaksson, Ola; Bertoni, Marco

In a traditional business partnership, the partner companies are under contractual obligation to share data, information, and knowledge through one or several information systems that the leading firm decides. In such a case, the issue of sharing "whatever needs to be shared" is settled in contracts before any action is taken, however, also giving the implications that sharing expertise becomes a heavy and time-consuming activity. In turn, it can be argued that the heavy administration affects the lead time of product development negatively since the necessary input flows are delayed. In addition, the adaptation to certain predefined collaborative information systems is both expensive and resource-consuming (e.g., educating staff to use them). Also, the system might not be adaptable to the existing internal technology structure, causing a "translation" procedure, again taking up resources. Another structure for collaboration is a network or alliance of independent partner companies. One motivation for a network structure is that the partners can join or leave it more easily. A reason for joining and staying is an implicit sense of knowledge sharing (Tomkins 2001) and access to a "win-win" environment. Furthermore, the partners can be linked by information technology, i.e., forming a virtual ­structure rather than a physical one. The technologies provide the channels with additional knowledge. In a best-case scenario, a company would get access to a wide range of useful competences, and in a worst-case scenario the company would be drained of its core competences. Accordingly, at least two considerations for joining a partner network can be considered. First, the resources needed to couple the technologies have to be reasonable, due to the underpinning logic of going in and out of more than one network. Second, the company has to identify its knowledge base and evaluate the prospective gains and losses of sharing its expertise.

When knowledge activated from memory intrudes on probabilistic inferences from description - the case of stereotypes.

PubMed

Dorrough, Angela R; Glöckner, Andreas; Betsch, Tilmann; Wille, Anika

2017-10-01

To make decisions in probabilistic inference tasks, individuals integrate relevant information partly in an automatic manner. Thereby, potentially irrelevant stimuli that are additionally presented can intrude on the decision process (e.g., Söllner, Bröder, Glöckner, & Betsch, 2014). We investigate whether such an intrusion effect can also be caused by potentially irrelevant or even misleading knowledge activated from memory. In four studies that combine a standard information board paradigm from decision research with a standard manipulation from social psychology, we investigate the case of stereotypes and demonstrate that stereotype knowledge can yield intrusion biases in probabilistic inferences from description. The magnitude of these biases increases with stereotype accessibility and decreases with a clarification of the rational solution. Copyright © 2017 Elsevier B.V. All rights reserved.

From orientation to magnitudes in paleostress determinations using fault slip data

NASA Astrophysics Data System (ADS)

Angelier, Jacques

Determinations of reduced stress tensors using fault slip data yield the orientation of principal stress axes and the ratio Φ of the differences between principal stress magnitudes. The use of rupture and friction laws allows determination of the two remaining unknowns, that is, the reconstruction of the complete stress tensor. Taking into account the depth of overburden brings an additional constraint. The method is applied and discussed in the case of the Hoover Dam site (western U.S.A.), where large data sets and rock mechanics information are available. Differences between intact sample and rock mass properties account for apparent disagreements between paleostress levels determined in similar tectonic environments. Pore pressure plays an important role; where information about pore pressure is absent, zero and hydrostatic pore pressure cases should be considered as limits.

Improving end of life care: an information systems approach to reducing medical errors.

PubMed

Tamang, S; Kopec, D; Shagas, G; Levy, K

2005-01-01

Chronic and terminally ill patients are disproportionately affected by medical errors. In addition, the elderly suffer more preventable adverse events than younger patients. Targeting system wide "error-reducing" reforms to vulnerable populations can significantly reduce the incidence and prevalence of human error in medical practice. Recent developments in health informatics, particularly the application of artificial intelligence (AI) techniques such as data mining, neural networks, and case-based reasoning (CBR), presents tremendous opportunities for mitigating error in disease diagnosis and patient management. Additionally, the ubiquity of the Internet creates the possibility of an almost ideal network for the dissemination of medical information. We explore the capacity and limitations of web-based palliative information systems (IS) to transform the delivery of care, streamline processes and improve the efficiency and appropriateness of medical treatment. As a result, medical error(s) that occur with patients dealing with severe, chronic illness and the frail elderly can be reduced.The palliative model grew out of the need for pain relief and comfort measures for patients diagnosed with cancer. Applied definitions of palliative care extend this convention, but there is no widely accepted definition. This research will discuss the development life cycle of two palliative information systems: the CONFER QOLP management information system (MIS), currently used by a community-based palliative care program in Brooklyn, New York, and the CAREN case-based reasoning prototype. CONFER is a web platform based on the idea of "eCare". CONFER uses XML (extensible mark-up language), a W3C-endorced standard mark up to define systems data. The second system, CAREN, is a CBR prototype designed for palliative care patients in the cancer trajectory. CBR is a technique, which tries to exploit the similarities of two situations and match decision-making to the best-known precedent cases. The prototype uses the opensource CASPIAN shell developed by the University of Aberystwyth, Wales and is available by anonymous FTP. We will discuss and analyze the preliminary results we have obtained using this CBR tool. Our research suggests that automated information systems can be used to improve the quality of care at the end of life and disseminate expert level 'know how' to palliative care clinicians. We will present how our CBR prototype can be successfully deployed, capable of securely transferring information using a Secure File Transfer Protocol (SFTP) and using a JAVA CBR engine.

Fallon, Nevada FORGE Thermal-Hydrological-Mechanical Models

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

Blankenship, Doug; Sonnenthal, Eric

Archive contains thermal-mechanical simulation input/output files. Included are files which fall into the following categories: ( 1 ) Spreadsheets with various input parameter calculations ( 2 ) Final Simulation Inputs ( 3 ) Native-State Thermal-Hydrological Model Input File Folders ( 4 ) Native-State Thermal-Hydrological-Mechanical Model Input Files ( 5 ) THM Model Stimulation Cases See 'File Descriptions.xlsx' resource below for additional information on individual files.

76 FR 72769 - National Emissions Standards for Hazardous Air Pollutants: Mineral Wool Production and Wool...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-25

...-2010-1041 and EPA-HQ-OAR-2010-1042, by one of the following methods: http://www.regulations.gov... units: a cupola furnace for melting the mineral charge; a blow chamber in which air and, in some cases... addition to one complete version of the comment that includes information claimed as CBI, a copy of the...

Primary and Secondary Teachers' Ideas on School Visits to Science Centres in the Basque Country

ERIC Educational Resources Information Center

Morentin, Maite; Guisasola, Jenaro

2015-01-01

In recent decades, research has shown the challenge posed to teachers by science education in informal contexts such as science museums or centres. In addition, there is consensus that in the case of pupils visiting a science centre, learning improves when the visit is connected to the classroom curriculum, so the teachers' involvement in…

HowTo - Easy use of global unique identifier

NASA Astrophysics Data System (ADS)

Czerniak, A.; Fleischer, D.; Schirnick, C.

2013-12-01

The GEOMAR sample- and core repository covers several thousands of samples and cores and was collected over the last decades. In the actual project, we bring this collection up to the new generation and tag every sample and core with a unique identifier, in our case the International Geo Sample Number (ISGN). This work is done with our digital Ink and hand writing recognition implementation. The Smart Pen technology was save time and resources to record the information on every sample or core. In the procedure of recording, there are several steps systematical are done: 1. Getting all information about the core or sample, such as cruise number, responsible person and so on. 2. Tag with unique identifiers, in our case a QR-Code. 3. Wrote down the location of sample or core. After transmitting the information from Smart Pen, actually via USB but wireless is a choice too, into our server infrastructure the link to other information began. As it linked in our Virtual Research Environment (VRE) with the unique identifier (ISGN) sample or core can be located and the QR-Code was simply linked back from core or sample to ISGN with additional scientific information. On the QR-Code all important information are on it and it was simple to produce thousand of it.

Actual Time Required for Dynamic Fluoroscopic Intraoperative Cholangiography

PubMed Central

Whitwam, Paul; Turner, David; Kennedy, Kathy; Hashmi, Syed

2005-01-01

Objectives: This study was undertaken to determine the actual amount of time a dynamic fluoroscopic intraoperative cholangiogram adds to a laparoscopic cholecystectomy. A secondary objective was to define the information gained from this procedure. Methods: A consecutive case study of 52 patients undergoing laparoscopic cholecystectomy was used. Time was recorded from placement of a laparoscopic hemoclip across the cystic duct at its junction with the gallbladder until successful completion of the intraoperative cholangiogram. The mean, median, and range of times for these cases, as well as the results and false-negative rates, were determined. Results: Cholangiography was successfully completed in 96% of patients. The mean time added to laparoscopic cholecystectomy by the addition of dynamic fluoroscopic intraoperative cholangiography was 4.3 minutes. The median time was 3.0 minutes. The times ranged from 2.0 minutes to 16.0 minutes. Choledocholithiasis was present in 15.4% of these patients. The false-positive rate was zero in this study. Conclusions: Dynamic fluoroscopic intraoperative cholangiogram was fast and efficient. The information gained was significant in that 15% of patients proceeded on to laparoscopic common bile duct exploration. We conclude that intraoperative cholangiography should be a routine addition to laparoscopic cholecystectomy. PMID:15984705

Medical applications of shortwave FM radar: remote monitoring of cardiac and respiratory motion.

PubMed

Mostov, K; Liptsen, E; Boutchko, R

2010-03-01

This article introduces the use of low power continuous wave frequency modulated radar for medical applications, specifically for remote monitoring of vital signs in patients. Gigahertz frequency radar measures the electromagnetic wave signal reflected from the surface of a human body and from tissue boundaries. Time series analysis of the measured signal provides simultaneous information on range, size, and reflective properties of multiple targets in the field of view of the radar. This information is used to extract the respiratory and cardiac rates of the patient in real time. The results from several preliminary human subject experiments are provided. The heart and respiration rate frequencies extracted from the radar signal match those measured independently for all the experiments, including a case when additional targets are simultaneously resolved in the field of view and a case when only the patient's extremity is visible to the radar antennas. Micropower continuous wave FM radar is a reliable, robust, inexpensive, and harmless tool for real-time monitoring of the cardiac and respiratory rates. Additionally, it opens a range of new and exciting opportunities in diagnostic and critical care medicine. Differences between the presented approach and other types of radars used for biomedical applications are discussed.

Exploring relations between task conflict and informational conflict in the Stroop task.

PubMed

Entel, Olga; Tzelgov, Joseph; Bereby-Meyer, Yoella; Shahar, Nitzan

2015-11-01

In this study, we tested the proposal that the Stroop task involves two conflicts--task conflict and informational conflict. Task conflict was defined as the latency difference between color words and non-letter neutrals, and manipulated by varying the proportion of color words versus non-letter neutrals. Informational conflict was defined as the latency difference between incongruent and congruent trials and manipulated by varying the congruent-to-incongruent trial ratio. We replicated previous findings showing that increasing the ratio of incongruent-to-congruent trials reduces the latency difference between the incongruent and congruent condition (i.e., informational conflict), as does increasing the proportion of color words (i.e., task conflict). A significant under-additive interaction between the two proportion manipulations (congruent vs. incongruent and color words vs. neutrals) indicated that the effects of task conflict and informational conflict were not additive. By assessing task conflict as the contrast between color words and neutrals, we found that task conflict existed in all of our experimental conditions. Under specific conditions, when task conflict dominated behavior by explaining most of the variability between congruency conditions, we also found negative facilitation, thus demonstrating that this effect is a special case of task conflict.

An automated database case definition for serious bleeding related to oral anticoagulant use.

PubMed

Cunningham, Andrew; Stein, C Michael; Chung, Cecilia P; Daugherty, James R; Smalley, Walter E; Ray, Wayne A

2011-06-01

Bleeding complications are a serious adverse effect of medications that prevent abnormal blood clotting. To facilitate epidemiologic investigations of bleeding complications, we developed and validated an automated database case definition for bleeding-related hospitalizations. The case definition utilized information from an in-progress retrospective cohort study of warfarin-related bleeding in Tennessee Medicaid enrollees 30 years of age or older. It identified inpatient stays during the study period of January 1990 to December 2005 with diagnoses and/or procedures that indicated a current episode of bleeding. The definition was validated by medical record review for a sample of 236 hospitalizations. We reviewed 186 hospitalizations that had medical records with sufficient information for adjudication. Of these, 165 (89%, 95%CI: 83-92%) were clinically confirmed bleeding-related hospitalizations. An additional 19 hospitalizations (10%, 7-15%) were adjudicated as possibly bleeding-related. Of the 165 clinically confirmed bleeding-related hospitalizations, the automated database and clinical definitions had concordant anatomical sites (gastrointestinal, cerebral, genitourinary, other) for 163 (99%, 96-100%). For those hospitalizations with sufficient information to distinguish between upper/lower gastrointestinal bleeding, the concordance was 89% (76-96%) for upper gastrointestinal sites and 91% (77-97%) for lower gastrointestinal sites. A case definition for bleeding-related hospitalizations suitable for automated databases had a positive predictive value of between 89% and 99% and could distinguish specific bleeding sites. Copyright © 2011 John Wiley & Sons, Ltd.

Less is often more, but not always: additional evidence that familiarity breeds contempt and a call for future research.

PubMed

Norton, Michael I; Frost, Jeana H; Ariely, Dan

2013-12-01

Ullrich, Krueger, Brod, and Groschupf (2013)-using a replication of the trait paradigm from Norton, Frost, and Ariely (2007)-suggest that less information does not always equal greater liking. We first ground the current debate in a larger historical debate in social psychology regarding the merits of configural versus algebraic models of person perception. We next review (a) related research that has suggested that more information can in some cases lead to more liking and (b) a large body of "real world" data-from friendships, daters, married couples, employment, celebrities, and politics-that suggests that more information often leads to less liking. We then provide an additional replication of our "less is more" effect, using a slight variation of the trait-list paradigm. The existing data suggest a need for further integrative explorations of when familiarity leads to contempt or liking or has no effect. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Analyzing partially missing confounder information in comparative effectiveness and safety research of therapeutics.

PubMed

Toh, Sengwee; García Rodríguez, Luis A; Hernán, Miguel A

2012-05-01

Electronic healthcare databases are commonly used in comparative effectiveness and safety research of therapeutics. Many databases now include additional confounder information in a subset of the study population through data linkage or data collection. We described and compared existing methods for analyzing such datasets. Using data from The Health Improvement Network and the relation between non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding as an example, we employed several methods to handle partially missing confounder information. The crude odds ratio (OR) of upper gastrointestinal bleeding was 1.50 (95% confidence interval: 0.98, 2.28) among selective cyclo-oxygenase-2 inhibitor initiators (n = 43 569) compared with traditional non-steroidal anti-inflammatory drug initiators (n = 411 616). The OR dropped to 0.81 (0.52, 1.27) upon adjustment for confounders recorded for all patients. When further considering three additional variables missing in 22% of the study population (smoking, alcohol consumption, body mass index), the OR was between 0.80 and 0.83 for the missing-category approach, the missing-indicator approach, single imputation by the most common category, multiple imputation by chained equations, and propensity score calibration. The OR was 0.65 (0.39, 1.09) and 0.67 (0.38, 1.16) for the unweighted and the inverse probability weighted complete-case analysis, respectively. Existing methods for handling partially missing confounder data require different assumptions and may produce different results. The unweighted complete-case analysis, the missing-category/indicator approach, and single imputation require often unrealistic assumptions and should be avoided. In this study, differences across methods were not substantial, likely due to relatively low proportion of missingness and weak confounding effect by the three additional variables upon adjustment for other variables. Copyright © 2012 John Wiley & Sons, Ltd.

EXAMINING THE ROLE AND RESEARCH CHALLENGES OF SOCIAL MEDIA AS A TOOL FOR NONPROLIFERATION AND ARMS CONTROL TREATY VERIFICATION

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

Henry, Michael J.; Cramer, Nicholas O.; Benz, Jacob M.

Traditional arms control treaty verification activities typically involve a combination of technical measurements via physical and chemical sensors, state declarations, political agreements, and on-site inspections involving international subject matter experts. However, the ubiquity of the internet, and the electronic sharing of data that it enables, has made available a wealth of open source information with the potential to benefit verification efforts. Open source information is already being used by organizations such as the International Atomic Energy Agency to support the verification of state-declared information, prepare inspectors for in-field activities, and to maintain situational awareness . The recent explosion in socialmore » media use has opened new doors to exploring the attitudes, moods, and activities around a given topic. Social media platforms, such as Twitter, Facebook, and YouTube, offer an opportunity for individuals, as well as institutions, to participate in a global conversation at minimal cost. Social media data can also provide a more data-rich environment, with text data being augmented with images, videos, and location data. The research described in this paper investigates the utility of applying social media signatures as potential arms control and nonproliferation treaty verification tools and technologies, as determined through a series of case studies. The treaty relevant events that these case studies touch upon include detection of undeclared facilities or activities, determination of unknown events recorded by the International Monitoring System (IMS), and the global media response to the occurrence of an Indian missile launch. The case studies examine how social media can be used to fill an information gap and provide additional confidence to a verification activity. The case studies represent, either directly or through a proxy, instances where social media information may be available that could potentially augment the evaluation of an event. The goal of this paper is to instigate a discussion within the verification community as to where and how social media can be effectively utilized to complement and enhance traditional treaty verification efforts. In addition, this paper seeks to identify areas of future research and development necessary to adapt social media analytic tools and techniques, and to form the seed for social media analytics to aid and inform arms control and nonproliferation policymakers and analysts. While social media analysis (as well as open source analysis as a whole) will not ever be able to replace traditional arms control verification measures, they do supply unique signatures that can augment existing analysis.« less

Opinion Dynamics with Disagreement and Modulated Information

NASA Astrophysics Data System (ADS)

Sîrbu, Alina; Loreto, Vittorio; Servedio, Vito D. P.; Tria, Francesca

2013-04-01

Opinion dynamics concerns social processes through which populations or groups of individuals agree or disagree on specific issues. As such, modelling opinion dynamics represents an important research area that has been progressively acquiring relevance in many different domains. Existing approaches have mostly represented opinions through discrete binary or continuous variables by exploring a whole panoply of cases: e.g. independence, noise, external effects, multiple issues. In most of these cases the crucial ingredient is an attractive dynamics through which similar or similar enough agents get closer. Only rarely the possibility of explicit disagreement has been taken into account (i.e., the possibility for a repulsive interaction among individuals' opinions), and mostly for discrete or 1-dimensional opinions, through the introduction of additional model parameters. Here we introduce a new model of opinion formation, which focuses on the interplay between the possibility of explicit disagreement, modulated in a self-consistent way by the existing opinions' overlaps between the interacting individuals, and the effect of external information on the system. Opinions are modelled as a vector of continuous variables related to multiple possible choices for an issue. Information can be modulated to account for promoting multiple possible choices. Numerical results show that extreme information results in segregation and has a limited effect on the population, while milder messages have better success and a cohesion effect. Additionally, the initial condition plays an important role, with the population forming one or multiple clusters based on the initial average similarity between individuals, with a transition point depending on the number of opinion choices.

First confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States, updated information on the epidemiology of MERS-CoV infection, and guidance for the public, clinicians, and public health authorities - May 2014.

PubMed

Bialek, Stephanie R; Allen, Donna; Alvarado-Ramy, Francisco; Arthur, Ray; Balajee, Arunmozhi; Bell, David; Best, Susan; Blackmore, Carina; Breakwell, Lucy; Cannons, Andrew; Brown, Clive; Cetron, Martin; Chea, Nora; Chommanard, Christina; Cohen, Nicole; Conover, Craig; Crespo, Antonio; Creviston, Jeanean; Curns, Aaron T; Dahl, Rebecca; Dearth, Stephanie; DeMaria, Alfred; Echols, Fred; Erdman, Dean D; Feikin, Daniel; Frias, Mabel; Gerber, Susan I; Gulati, Reena; Hale, Christa; Haynes, Lia M; Heberlein-Larson, Lea; Holton, Kelly; Ijaz, Kashef; Kapoor, Minal; Kohl, Katrin; Kuhar, David T; Kumar, Alan M; Kundich, Marianne; Lippold, Susan; Liu, Lixia; Lovchik, Judith C; Madoff, Larry; Martell, Sandra; Matthews, Sarah; Moore, Jessica; Murray, Linda R; Onofrey, Shauna; Pallansch, Mark A; Pesik, Nicki; Pham, Huong; Pillai, Satish; Pontones, Pam; Pringle, Kimberly; Pritchard, Scott; Rasmussen, Sonja; Richards, Shawn; Sandoval, Michelle; Schneider, Eileen; Schuchat, Anne; Sheedy, Kristine; Sherin, Kevin; Swerdlow, David L; Tappero, Jordan W; Vernon, Michael O; Watkins, Sharon; Watson, John

2014-05-16

Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula. This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014.

Ultrasound-guided needle EMG of the diaphragm: technique description and case report.

PubMed

Boon, Andrea J; Alsharif, Kais I; Harper, C Michel; Smith, Jay

2008-12-01

We describe an ultrasound (US)-guided technique for needle examination of the diaphragm and report a case in which the adjuvant use of diagnostic US in conjunction with electrophysiologic studies provided additional information regarding the motion of the diaphragm in a patient who was a potential candidate for phrenic nerve pacing. US imaging provides excellent direct and real-time visualization of soft tissue, anatomic landmarks, fascial planes, and neurovascular structures. It thereby enhances safety by avoiding accidental needle puncture of vital organs, and it also increases the diagnostic utility of the needle examination.

Smart Grid Information Clearinghouse (SGIC)

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

Rahman, Saifur

Since the Energy Independence and Security Act of 2007 was enacted, there has been a large number of websites that discusses smart grid and relevant information, including those from government, academia, industry, private sector and regulatory. These websites collect information independently. Therefore, smart grid information was quite scattered and dispersed. The objective of this work was to develop, populate, manage and maintain the public Smart Grid Information Clearinghouse (SGIC) web portal. The information in the SGIC website is comprehensive that includes smart grid information, research & development, demonstration projects, technical standards, costs & benefit analyses, business cases, legislation, policy &more » regulation, and other information on lesson learned and best practices. The content in the SGIC website is logically grouped to allow easily browse, search and sort. In addition to providing the browse and search feature, the SGIC web portal also allow users to share their smart grid information with others though our online content submission platform. The Clearinghouse web portal, therefore, serves as the first stop shop for smart grid information that collects smart grid information in a non-bias, non-promotional manner and can provide a missing link from information sources to end users and better serve users’ needs. The web portal is available at www.sgiclearinghouse.org. This report summarizes the work performed during the course of the project (September 2009 – August 2014). Section 2.0 lists SGIC Advisory Committee and User Group members. Section 3.0 discusses SGIC information architecture and web-based database application functionalities. Section 4.0 summarizes SGIC features and functionalities, including its search, browse and sort capabilities, web portal social networking, online content submission platform and security measures implemented. Section 5.0 discusses SGIC web portal contents, including smart grid 101, smart grid projects, deployment experience (i.e., use cases, lessons learned, cost-benefit analyses and business cases), in-depth information (i.e., standards, technology, cyber security, legislation, education and training and demand response), as well as international information. Section 6.0 summarizes SGIC statistics from the launch of the portal on July 07, 2010 to August 31, 2014. Section 7.0 summarizes publicly available information as a result of this work.« less

Petri net modeling of encrypted information flow in federated cloud

NASA Astrophysics Data System (ADS)

Khushk, Abdul Rauf; Li, Xiaozhong

2017-08-01

Solutions proposed and developed for the cost-effective cloud systems suffer from a combination of secure private clouds and less secure public clouds. Need to locate applications within different clouds poses a security risk to the information flow of the entire system. This study addresses this by assigning security levels of a given lattice to the entities of a federated cloud system. A dynamic flow sensitive security model featuring Bell-LaPadula procedures is explored that tracks and authenticates the secure information flow in federated clouds. Additionally, a Petri net model is considered as a case study to represent the proposed system and further validate the performance of the said system.

Second-Order Asymptotics for the Classical Capacity of Image-Additive Quantum Channels

NASA Astrophysics Data System (ADS)

Tomamichel, Marco; Tan, Vincent Y. F.

2015-08-01

We study non-asymptotic fundamental limits for transmitting classical information over memoryless quantum channels, i.e. we investigate the amount of classical information that can be transmitted when a quantum channel is used a finite number of times and a fixed, non-vanishing average error is permissible. In this work we consider the classical capacity of quantum channels that are image-additive, including all classical to quantum channels, as well as the product state capacity of arbitrary quantum channels. In both cases we show that the non-asymptotic fundamental limit admits a second-order approximation that illustrates the speed at which the rate of optimal codes converges to the Holevo capacity as the blocklength tends to infinity. The behavior is governed by a new channel parameter, called channel dispersion, for which we provide a geometrical interpretation.

Chemical Leukoderma Associated with Methylphenidate Transdermal System: Data From the US Food and Drug Administration Adverse Event Reporting System.

PubMed

Cheng, Carmen; La Grenade, Lois; Diak, Ida-Lina; Brinker, Allen; Levin, Robert L

2017-01-01

To identify and characterize cases of chemical leukoderma, an underrecognized adverse event, associated with the methylphenidate transdermal system (MTS) reported to the US Food and Drug Administration Adverse Event Reporting System (FAERS). We searched the Food and Drug Administration Adverse Event Reporting System for reports of chemical leukoderma associated with MTS, received by the Food and Drug Administration from April 6, 2006 to December 23, 2014. We identified 51 cases of chemical leukoderma reported with the use of MTS. The median age was 11 years; 43 cases reported leukoderma at or near the application site only, and 7 reported leukoderma at other parts of the body in addition to the application site; 1 case did not provide enough information to confirm the affected site. The time to onset ranged from 2 months to 4 years after the initiation of MTS. MTS was discontinued in 31 cases. Thirteen patients were prescribed treatment for repigmentation. Three cases reported continued spread of leukoderma after MTS was discontinued. Nineteen cases were diagnosed as vitiligo, including 5 cases reporting histologic features consistent with vitiligo. Leukoderma was persistent in all cases. The median follow-up interval after the discontinuation of MTS in 23 cases was 14 months. As outlined in recent changes to the prescribing information for MTS, health care professionals need to be aware of the potential risk of chemical leukoderma caused by MTS, especially given that chemical leukoderma is often misdiagnosed as idiopathic vitiligo. MTS should be discontinued at the earliest sign of pigment loss and other treatment options considered. Published by Elsevier Inc.

An overview of the use of Facebook in National Weather Services

NASA Astrophysics Data System (ADS)

Palacio, Virginia; Principe, Olatz; Martija, Maialen; Gaztelumendi, Santiago

2016-10-01

National Meteorological Services (NMSs) use different "classical" tools in order to diffuse meteorological information, including television, radio, newspaper, phone, e-mail and websites. In recent years, new communication technologies and, in particular, the rapid expansion of Facebook allows users to efficiently exchange information and to easily share it with a large part of the population. Facebook is one of the most used social networks and it represents a perfect virtual platform to share information and to promote active and immediate interaction amongst users. This is why many NMSs develop new communication strategies and incorporate this tool for different purposes. Some NMSs not only provide forecast, real-time observed data and other routine information, but they also upload videos (for example, with the weatherperson explaining the forecast or short reports) and amazing pictures taken by followers. In addition, they also give educational and didactic information (above all about climatic issues) and organize photographic competitions. In this paper, firstly, we investigate when Facebook was introduced in different NMSs worldwide as an additional tool for the diffusion of meteorological information. Then, we propose a classification of these NMSs based on the success of their Facebook page, i.e. on the number of followers. Finally, we select some representative cases of NMSs and we analyze how Facebook is used to improve their services.

Lyme Disease Surveillance in New York State: an Assessment of Case Underreporting.

PubMed

White, J; Noonan-Toly, C; Lukacik, G; Thomas, N; Hinckley, A; Hook, S; Backenson, P B

2018-03-01

Despite the mandatory nature of Lyme disease (LD) reporting in New York State (NYS), it is believed that only a fraction of the LD cases diagnosed annually are reported to public health authorities. Lack of complete LD case reporting generally stems from (i) lack of report of provider-diagnosed cases where supportive laboratory testing is not ordered or results are negative (i.e. provider underreporting) and (ii) incomplete case information (clinical laboratory reporting only with no accompanying clinical information) such that cases are considered 'suspect' and not included in national and statewide case counts (i.e. case misclassification). In an attempt to better understand LD underreporting in NYS, a two-part study was conducted in 2011 using surveillance data from three counties. Case misclassification was assessed by obtaining medical records on suspect cases and reclassifying according to the surveillance case definition. To assess provider underreporting, lists of patients for whom ICD-9-CM code 088.81 (LD) had been used were reported to NYS Department of Health (NYSDOH). These lists were matched to the NYSDOH case reporting system, and medical records were requested on patients not previously reported; cases were then classified according to the case definition. When including both provider underreporting and case misclassification, approximately 20% (range 18.4-24.6%) more LD cases were identified in the three-county study area than were originally reported through standard surveillance. The additional cases represent a minimum percentage of unreported cases; the true percentage of unreported cases is likely higher. Unreported cases were more likely to have a history of erythema migrans (EM) rash and were more likely to be young paediatric cases. Results of the study support the assertion that LD cases are underreported in NYS. Initiatives to increase reporting should highlight the importance of reporting clinically diagnosed EM and be targeted to those providers most likely to diagnose LD, specifically providers treating paediatric patients. © 2016 Blackwell Verlag GmbH.

Resolution of Probabilistic Weather Forecasts with Application in Disease Management.

PubMed

Hughes, G; McRoberts, N; Burnett, F J

2017-02-01

Predictive systems in disease management often incorporate weather data among the disease risk factors, and sometimes this comes in the form of forecast weather data rather than observed weather data. In such cases, it is useful to have an evaluation of the operational weather forecast, in addition to the evaluation of the disease forecasts provided by the predictive system. Typically, weather forecasts and disease forecasts are evaluated using different methodologies. However, the information theoretic quantity expected mutual information provides a basis for evaluating both kinds of forecast. Expected mutual information is an appropriate metric for the average performance of a predictive system over a set of forecasts. Both relative entropy (a divergence, measuring information gain) and specific information (an entropy difference, measuring change in uncertainty) provide a basis for the assessment of individual forecasts.

Using National Health Care Databases and Problem-Based Practice Analysis to Inform Integrated Curriculum Development.

PubMed

Baker, Amy J; Raymond, Mark R; Haist, Steven A; Boulet, John R

2017-04-01

One challenge when implementing case-based learning, and other approaches to contextualized learning, is determining which clinical problems to include. This article illustrates how health care utilization data, readily available from the National Center for Health Statistics (NCHS), can be incorporated into an educational needs assessment to identify medical problems physicians are likely to encounter in clinical practice. The NCHS survey data summarize patient demographics, diagnoses, and interventions for tens of thousands of patients seen in various settings, including emergency departments (EDs), clinics, and hospitals.Selected data from the National Hospital Ambulatory Medical Care Survey: Emergency Department illustrate how instructional materials can be derived from the results of such public-use health care data. Using fever as the reason for visit to the ED, the patient management path is depicted in the form of a case drill-down by exploring the most common diagnoses, blood tests, diagnostic studies, procedures, and medications associated with fever.Although these types of data are quite useful, they should not serve as the sole basis for determining which instructional cases to include. Additional sources of information should be considered to ensure the inclusion of cases that represent infrequent but high-impact problems and those that illustrate fundamental principles that generalize to other cases.

Augmenting superpopulation capture-recapture models with population assignment data

USGS Publications Warehouse

Wen, Zhi; Pollock, Kenneth; Nichols, James; Waser, Peter

2011-01-01

Ecologists applying capture-recapture models to animal populations sometimes have access to additional information about individuals' populations of origin (e.g., information about genetics, stable isotopes, etc.). Tests that assign an individual's genotype to its most likely source population are increasingly used. Here we show how to augment a superpopulation capture-recapture model with such information. We consider a single superpopulation model without age structure, and split each entry probability into separate components due to births in situ and immigration. We show that it is possible to estimate these two probabilities separately. We first consider the case of perfect information about population of origin, where we can distinguish individuals born in situ from immigrants with certainty. Then we consider the more realistic case of imperfect information, where we use genetic or other information to assign probabilities to each individual's origin as in situ or outside the population. We use a resampling approach to impute the true population of origin from imperfect assignment information. The integration of data on population of origin with capture-recapture data allows us to determine the contributions of immigration and in situ reproduction to the growth of the population, an issue of importance to ecologists. We illustrate our new models with capture-recapture and genetic assignment data from a population of banner-tailed kangaroo rats Dipodomys spectabilis in Arizona.

The impact of 18 F-FET PET-CT on target definition in image-guided stereotactic radiotherapy in patients with skull base lesions.

PubMed

Badakhshi, Harun; Graf, Reinhold; Prasad, Vikas; Budach, Volker

2014-06-25

18 F-fluoro-ethyl-tyrosine PET is gaining more indications in the field of oncology. We investigated the potentials of usage of FET-PET/CT in addition to MRI for definition of gross tumor volume (GTV) in stereotactic radiotherapy of lesions of skull base. We included in a prospective setting 21 cases. An MRI was performed, completed by FET PET/CT. Different GTV's were defined based on respective imaging tools: 1. GTVMRI, 2. GTV MRI /CT, 3. GTV composit (1 + 2), and GTVPET = GTV Boost. Lesions could be visualised by MRI and FET-PET/CT in all patients. FET tracer enhancement was found in all cases. Skull base infiltration by these lesions was observed by MRI, CT (PET/CT) and FET-PET (PET/CT) in all patients. Totally, brain tissue infiltration was seen in 10 patients. While, in 7 (out 10) cases, MRI and CT (from PET/CT) were indicating brain infiltration, FET-PET could add additional information regarding infiltrative behaviour: in 3 (out 10) patients, infiltration of the brain was displayed merely in FET-PET. An enlargement of GTVMRI/CT due to the FET-PET driven information, which revealed GTVcomposite , was necessary in 7 cases,. This enlargement was significant by definition (> 10% of GTVMRI/CT). The mean PET-effect on GTV counted for 1 ± 4 cm3. The restricted boost fields were based mainly on the GTVPET volume. In mean, about 8.5 cm3 of GTVMRI/CT, which showed no FET uptake, were excluded from target volume. GTV boost driven by only-PET-activity, was in mean by 33% smaller than the initial large treatment field, GTV composite, for those cases received boost treatment. FET-PET lead to significant (>10%) changes in the initial treatment fields in 11/21 patients and showed additional tumour volume relevant for radiation planning in 6/21 cases, and led to a subsequent decrease of more than 10% of the initial volumes for the boost fields. The implementation of FET PET into the planning procedures showed a benefit in terms of accurate definition of skull base lesions as targets for Image-guided stereotactic Radiotherapy. This has to be investigated prospectively in larger cohorts.

Exploring the Potential of Smartphones and Tablets for Performance Support in Food Chemistry Laboratory Classes

NASA Astrophysics Data System (ADS)

van der Kolk, Koos; Hartog, Rob; Beldman, Gerrit; Gruppen, Harry

2013-12-01

Increasingly, mobile applications appear on the market that can support students in chemistry laboratory classes. In a multiple app-supported laboratory, each of these applications covers one use-case. In practice, this leads to situations in which information is scattered over different screens and written materials. Such a multiple app-supported laboratory will become awkward with the growth of the number of applications and use cases. In particular, using and switching between applications is likely to induce extraneous cognitive load that can easily be avoided. The manuscript describes the design of a prototype smartphone web app (LabBuddy) designed to support students in food chemistry laboratory classes. The manuscript describes a case study ( n = 26) of the use of a LabBuddy prototype in such a laboratory class. Based on the evaluation of this case study, design requirements for LabBuddy were articulated. LabBuddy should work on HTML5 capable devices, independent of screen size, by having a responsive layout. In addition, LabBuddy should enable a student using LabBuddy to switch between devices without much effort. Finally, LabBuddy should offer an integrated representation of information.

Investigating a tuberculosis cluster among Filipino health care workers in a low-incidence country.

PubMed

Davidson, J A; Fulton, N; Thomas, H L; Lalor, M K; Zenner, D; Brown, T; Murphy, S; Anderson, L F

2018-03-01

Nearly 8% of adult tuberculosis (TB) cases in England, Wales and Northern Ireland (EW&NI) occur among health care workers (HCWs), the majority of whom are from high TB incidence countries. To determine if a TB cluster containing multiple HCWs was due to nosocomial transmission. A cluster of TB cases notified in EW&NI from 2009 to 2014, with indistinguishable 24-locus mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) profiles, was identified through routine national cluster review. Cases were investigated to identify epidemiological links, and occupational health (OH) information was collected for HCW cases. To further discriminate strains, typing of eight additional loci was conducted. Of the 53 cases identified, 22 were HCWs. The majority (n = 43), including 21 HCWs, were born in the Philippines. Additional typing split the cluster into three subclusters and seven unique strains. No epidemiological links were identified beyond one household and a common residential area. HCWs in this cluster received no or inadequate OH assessment. The MIRU-VNTR profile of this cluster probably reflects common endemic strains circulating in the Philippines, with reactivation occurring in the UK. Furthermore, 32-locus typing showed that 24-locus MIRU-VNTR failed to distinguish strain diversity. The lack of OH assessment indicates that latent tuberculous infection could have been identified and treated, thereby preventing active cases from occurring.

A cooperative model for IS security risk management in distributed environment.

PubMed

Feng, Nan; Zheng, Chundong

2014-01-01

Given the increasing cooperation between organizations, the flexible exchange of security information across the allied organizations is critical to effectively manage information systems (IS) security in a distributed environment. In this paper, we develop a cooperative model for IS security risk management in a distributed environment. In the proposed model, the exchange of security information among the interconnected IS under distributed environment is supported by Bayesian networks (BNs). In addition, for an organization's IS, a BN is utilized to represent its security environment and dynamically predict its security risk level, by which the security manager can select an optimal action to safeguard the firm's information resources. The actual case studied illustrates the cooperative model presented in this paper and how it can be exploited to manage the distributed IS security risk effectively.

Big data, little security: Addressing security issues in your platform

NASA Astrophysics Data System (ADS)

Macklin, Thomas; Mathews, Joseph

2017-05-01

This paper describes some patterns for information security problems that consistently emerge among traditional enterprise networks and applications, both with respect to cyber threats and data sensitivity. We draw upon cases from qualitative studies and interviews of system developers, network operators, and certifiers of military applications. Specifically, the problems discussed involve sensitivity of data aggregates, training efficacy, and security decision support in the human machine interface. While proven techniques can address many enterprise security challenges, we provide additional recommendations on how to further improve overall security posture, and suggest additional research thrusts to address areas where known gaps remain.

MHD Advanced Power Train Phase I, Final Report, Volume 7

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

A. R. Jones

This appendix provides additional data in support of the MHD/Steam Power Plant Analyses reported in report Volume 5. The data is in the form of 3PA/SUMARY computer code printouts. The order of presentation in all four cases is as follows: (1) Overall Performance; (2) Component/Subsystem Information; (3) Plant Cost Accounts Summary; and (4) Plant Costing Details and Cost of Electricity.

Report on New Methods for Representing and Interacting with Qualitative Geographic Information, Stage 2: Task Group 1 Core Re-engineering and Place-based Use Case

DTIC Science & Technology

2013-06-30

Void, Behind you, Quantum Leaping, The space between spaces  when a geographic reference is provided, we identified several categories of challenges to... consciously opt-in to include geolocation in times of crisis. In addition, 10% of tweets in our sample included place references in the text and that

Advice on Life? Online Fan Forums as a Space for Peer-to-Peer Sex and Relationships Education

ERIC Educational Resources Information Center

Masanet, Maria-Jose; Buckingham, David

2015-01-01

Previous research has pointed to the potential of entertainment media as a source of informal sex education for young people. New social media may offer additional potential in this respect. In this paper, we consider the pedagogical possibilities and limitations of online fan forums, via a case study of the forums of the controversial British…

Connecting non-timber forest products stakeholders to information and knowledge: A case study of an Internet web site

Treesearch

James Chamberlain; Matt Winn; A.L. Hammett

2009-01-01

Many products are harvested from forests that are not timber-based but are based on plant materials. These non-timber forest products (NTFPs) have not been fully incorporated into economic development programs, yet they provide significant monetary benefits for rural entrepreneurs. Interest in NTFPs as alternative forest enterprises and sources of additional income has...

A Use Case for implementing Earth observation (EO) to avoid regional groundwater contamination in the Midwest US

NASA Astrophysics Data System (ADS)

Bernknopf, R.; Pearlman, J.

2016-12-01

A use case to implement Landsat data for application in decisions in the agricultural sector is being developed. Stakeholders are at both the farm level and regional level. Decisions by individual farmers and communities about the intensity of use of agrochemicals on crops can affect the future quality of the groundwater in Iowa. An initial case study was completed to examine some of the technical perspectives of adapting and coupling satellite imagery and in situ water quality measurements to forecast changes in groundwater quality. This analysis was conducted to identify the benefits of EO to assist in specific decisions to improve agricultural land management and regulation of groundwater contamination. Results demonstrated that Landsat information facilitates spatiotemporal analysis of the impact of nitrates on groundwater resources. Value is dependent on whether additional information reduces the variance (uncertainty) in outcomes. The use case ultimately involves scientific experts, farmers and their representatives, and the Government. Decisions involve some level of uncertainty in scientific measurement and statistical variability affects its informational value. These issues are concerns with implementing remote sensing technology and must be examined with end users and their impact discussed and understood. Thus, the study team held meetings with subject experts from Iowa State University and the Iowa Farm Bureau to explore the next steps in developing the use case. Discussion with the subject experts focused on more detail to capture new agricultural science advances and engineering options that could be linked in a multi-scale approach. A second meeting between the study and the Iowa Farm Bureau centered on the need for efficient regulation of land use and regulation of agrochemical application in the Midwest. The impacts of these discussions and other user inputs on the directions of the use case will be presented.

Distribution of maternal age and birth order groups in cases with unclassified multiple congenital abnormalities according to the number of component abnormalities: a national population-based case-control study.

PubMed

Csermely, Gyula; Czeizel, Andrew E; Veszprémi, Béla

2015-02-01

Multiple congenital abnormalities are caused by chromosomal aberrations, mutant major genes and teratogens. A minor proportion of these patients are identified as syndromes but the major part belonging to the group of unclassified multiple CAs (UMCAs). The main objective of this study was to evaluate the maternal age and birth order in pregnant women who had offspring affected with UMCA. The strong association between numerical chromosomal aberrations, e.g., Down syndrome and advanced maternal age is well-known and tested here. The Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980 to 1996, yielded a large population-based national data set with 22,843 malformed newborns or fetuses ("informative cases") included 1349 UMCA cases with their 2407 matched controls. Case-control comparison of maternal age and birth order was made for cases with UMCA, stratified by component numbers and their controls. In addition, 834 cases with Down syndrome were compared to 1432 matched controls. The well-known advanced maternal age with the higher risk for Down syndrome was confirmed. The findings of the study suggest that the young age of mothers associates with the higher risk of UMCA, in addition birth order 4 or more associates with the higher risk for UMCA with 2 and 3 component CAs. This study was the first to analyze the possible maternal and birth order effect for cases with UMCA, and the young age and higher birth order associated with a higher risk for UMCA. © 2014 Wiley Periodicals, Inc.

Meningitis and legal liability: an otolaryngology perspective.

PubMed

Svider, Peter F; Blake, Danielle M; Sahni, Kiren P; Folbe, Adam J; Liu, James K; Baredes, Soly; Eloy, Jean Anderson

2014-01-01

Meningitis is a potential complication in otolaryngologic procedures and conditions. Severe sequelae make understanding factors involved in relevant malpractice litigation critical. We analyze pertinent litigation for awards, outcomes, patient demographic factors, and other alleged causes of malpractice. Pertinent jury verdict and settlement reports were examined using the Westlaw legal database (Thomson Reuters, New York, NY). Twenty-three cases (60.5%) involved non-iatrogenic injuries, including inadequate treatment or failure to diagnose sinusitis or otitis media, while 15 (39.5%) involved iatrogenic cases, mostly rhinologic procedures. 36.8% of cases were resolved for the defendant, 28.9% with juries awarding damages, and 34.2% with settlements. Although not statistically significant, mean damages awarded were higher than settlements ($2.1 vs. 1.5M, p=0.056), and cases involving pediatric patients were more likely to be resolved with payment than those with adult litigants (80.0% vs. 52.2%, p=0.08 respectively). Other frequent alleged factors included permanent deficits (63.2%), requiring additional surgery (41.1%), death (34.2%), cognitive deficits (21.2%), deafness (15.8%), and inadequate informed consent (33.0% of iatrogenic cases). Practitioners facing litigation related to meningitis may wish to consider these findings, notably for cases involving death or permanent functional deficits, as cases with out of court settlements tended to be resolved with lower payments. Cases involving misdiagnosis may be more likely to be resolved with payment compared with iatrogenic cases. By understanding the issues detailed in this analysis and including them in the informed consent process for patients undergoing rhinologic and otologic procedures, otolaryngologists may potentially improve patient safety and decrease liability. © 2014.

Space benefits: The secondary application of aerospace technology in other sectors of the economy

NASA Technical Reports Server (NTRS)

1976-01-01

A 'Benefit Briefing Notebook' was prepared for the NASA Technology Utilization Office to provide accurate, convenient, and integrated resource information on the transfer of aerospace technology to other sectors of the U.S. economy. The contents are divided into three sections: (1) transfer overview, (2) benefit cases, and (3) indexes. The transfer overview section provides a general perspective for technology transfer from NASA to other organizations. In addition to a description of the basic transfer modes, the selection criteria for notebook examples and the kinds of benefit data they contain are also presented. The benefits section is subdivided into nineteen subject areas. Each subsection presents one or more key issues of current interest, with discrete transfer cases related to each key issue. Additional transfer examples relevant to each subject area are then presented. Pertinent transfer data are given at the end of each example.

The 2014 Sandia Verification and Validation Challenge: Problem statement

DOE PAGES

Hu, Kenneth; Orient, George

2016-01-18

This paper presents a case study in utilizing information from experiments, models, and verification and validation (V&V) to support a decision. It consists of a simple system with data and models provided, plus a safety requirement to assess. The goal is to pose a problem that is flexible enough to allow challengers to demonstrate a variety of approaches, but constrained enough to focus attention on a theme. This was accomplished by providing a good deal of background information in addition to the data, models, and code, but directing the participants' activities with specific deliverables. In this challenge, the theme ismore » how to gather and present evidence about the quality of model predictions, in order to support a decision. This case study formed the basis of the 2014 Sandia V&V Challenge Workshop and this resulting special edition of the ASME Journal of Verification, Validation, and Uncertainty Quantification.« less

Automated interferometric alignment system for paraboloidal mirrors

DOEpatents

Maxey, L. Curtis

1993-01-01

A method is described for a systematic method of interpreting interference fringes obtained by using a corner cube retroreflector as an alignment aid when aigning a paraboloid to a spherical wavefront. This is applicable to any general case where such alignment is required, but is specifically applicable in the case of aligning an autocollimating test using a diverging beam wavefront. In addition, the method provides information which can be systematically interpreted such that independent information about pitch, yaw and focus errors can be obtained. Thus, the system lends itself readily to automation. Finally, although the method is developed specifically for paraboloids, it can be seen to be applicable to a variety of other aspheric optics when applied in combination with a wavefront corrector that produces a wavefront which, when reflected from the correctly aligned aspheric surface will produce a collimated wavefront like that obtained from the paraboloid when it is correctly aligned to a spherical wavefront.

Automated interferometric alignment system for paraboloidal mirrors

DOEpatents

Maxey, L.C.

1993-09-28

A method is described for a systematic method of interpreting interference fringes obtained by using a corner cube retroreflector as an alignment aid when aligning a paraboloid to a spherical wavefront. This is applicable to any general case where such alignment is required, but is specifically applicable in the case of aligning an autocollimating test using a diverging beam wavefront. In addition, the method provides information which can be systematically interpreted such that independent information about pitch, yaw and focus errors can be obtained. Thus, the system lends itself readily to automation. Finally, although the method is developed specifically for paraboloids, it can be seen to be applicable to a variety of other aspheric optics when applied in combination with a wavefront corrector that produces a wavefront which, when reflected from the correctly aligned aspheric surface will produce a collimated wavefront like that obtained from the paraboloid when it is correctly aligned to a spherical wavefront. 14 figures.

Malpractice in otology.

PubMed

Blake, Danielle M; Svider, Peter F; Carniol, Eric T; Mauro, Andrew C; Eloy, Jean Anderson; Jyung, Robert W

2013-10-01

(1) Analyze otologic procedural malpractice litigation in the United States of America. (2) Discuss ways to prevent future malpractice litigation. Case series with record review. The study is a case series with review of court records pertaining to otologic procedures using the Westlaw legal database. The phrase medical malpractice was searched with terms related to otology and neurotology obtained from the AAO-HNS website. Of the 47 claims that met inclusion criteria, 63.8% were decided in the physician's favor, 25.5% were decided in the plaintiff's favor (average payment $446,697), and 10.6% were settled out of court (average payment $372,607). Cerumen removal was the most common procedure leading to complaint (21.3%) and the most likely procedure to lead to payment (50.0%). Hearing loss was the most common injury claimed among all cases (53.2%) and resulted in a high proportion of cases that led to payment (40.0%). Other common alleged injuries were facial nerve injury (27.7%), tympanic membrane perforation (23.4%), need for additional surgery (42.6%), and lack of informed consent (31.9%). In addition, cases resulting from acoustic neuroma or stapedectomy resulted in higher payments to the plaintiffs (average $3,498,597 and $2,733,000, respectively). Malpractice trials were resolved in the defendant's favor in the majority of cases. Cerumen removal was the most common procedure leading to complaint and the procedure most likely to result in payment. Hearing loss was the most common injury cited. Payment was highest in acoustic neuroma and stapedectomy cases.

A new disaster victim identification management strategy targeting "near identification-threshold" cases: Experiences from the Boxing Day tsunami.

PubMed

Wright, Kirsty; Mundorff, Amy; Chaseling, Janet; Forrest, Alexander; Maguire, Christopher; Crane, Denis I

2015-05-01

The international disaster victim identification (DVI) response to the Boxing Day tsunami, led by the Royal Thai Police in Phuket, Thailand, was one of the largest and most complex in DVI history. Referred to as the Thai Tsunami Victim Identification operation, the group comprised a multi-national, multi-agency, and multi-disciplinary team. The traditional DVI approach proved successful in identifying a large number of victims quickly. However, the team struggled to identify certain victims due to incomplete or poor quality ante-mortem and post-mortem data. In response to these challenges, a new 'near-threshold' DVI management strategy was implemented to target presumptive identifications and improve operational efficiency. The strategy was implemented by the DNA Team, therefore DNA kinship matches that just failed to reach the reporting threshold of 99.9% were prioritized, however the same approach could be taken by targeting, for example, cases with partial fingerprint matches. The presumptive DNA identifications were progressively filtered through the Investigation, Dental and Fingerprint Teams to add additional information necessary to either strengthen or conclusively exclude the identification. Over a five-month period 111 victims from ten countries were identified using this targeted approach. The new identifications comprised 87 adults, 24 children and included 97 Thai locals. New data from the Fingerprint Team established nearly 60% of the total near-threshold identifications and the combined DNA/Physical method was responsible for over 30%. Implementing the new strategy, targeting near-threshold cases, had positive management implications. The process initiated additional ante-mortem information collections, and established a much-needed, distinct "end-point" for unresolved cases. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Is all co-production created equal? Understanding drivers and outcomes across different users and forms of engagement

NASA Astrophysics Data System (ADS)

Browne, K.; Lemos, M. C.

2017-12-01

Despite a growing recognition of the importance of coproduced information in networks of decision-makers facing climate change, relatively little attention has been paid to how different types of users and forms of engagement (e.g. brokering and bridging of climate information) may yield different coproduction outcomes. In this study, we compare drivers and outcomes of co-production of a large network (twenty-five cases) of users within the scope of the Great Lakes Integrated Sciences and Assessments (GLISA), a boundary organization whose mission is to disseminate climate information in the Great Lakes Region. We focus especially on drivers of co-production within boundary organizations (e.g. embeddness, complementarity, financial and human resources and trust building and legitimacy) to explore different forms of engagement and models of brokering and bridging information. Our case studies span a wide range of users, including cities, businesses, academic and professional organizations and governmental agencies. We find that different kinds of resources and engagement matter in terms of desirable outcomes. In addition, while the supply of resources by boundary organizations is necessary to foster co-production, effective use and stable networks are often not achieved in the absence of sustained engagement and support.

How to Fully Represent Expert Information about Imprecise Properties in a Computer System – Random Sets, Fuzzy Sets, and Beyond: An Overview

PubMed Central

Nguyen, Hung T.; Kreinovich, Vladik

2014-01-01

To help computers make better decisions, it is desirable to describe all our knowledge in computer-understandable terms. This is easy for knowledge described in terms on numerical values: we simply store the corresponding numbers in the computer. This is also easy for knowledge about precise (well-defined) properties which are either true or false for each object: we simply store the corresponding “true” and “false” values in the computer. The challenge is how to store information about imprecise properties. In this paper, we overview different ways to fully store the expert information about imprecise properties. We show that in the simplest case, when the only source of imprecision is disagreement between different experts, a natural way to store all the expert information is to use random sets; we also show how fuzzy sets naturally appear in such random-set representation. We then show how the random-set representation can be extended to the general (“fuzzy”) case when, in addition to disagreements, experts are also unsure whether some objects satisfy certain properties or not. PMID:25386045

Involvement of Thalamus in Initiation of Epileptic Seizures Induced by Pilocarpine in Mice

PubMed Central

Li, Yong-Hua; Li, Jia-Jia; Lu, Qin-Chi; Gong, Hai-Qing; Liang, Pei-Ji

2014-01-01

Studies have suggested that thalamus is involved in temporal lobe epilepsy, but the role of thalamus is still unclear. We obtained local filed potentials (LFPs) and single-unit activities from CA1 of hippocampus and parafascicular nucleus of thalamus during the development of epileptic seizures induced by pilocarpine in mice. Two measures, redundancy and directionality index, were used to analyze the electrophysiological characters of neuronal activities and the information flow between thalamus and hippocampus. We found that LFPs became more regular during the seizure in both hippocampus and thalamus, and in some cases LFPs showed a transient disorder at seizure onset. The variation tendency of the peak values of cross-correlation function between neurons matched the variation tendency of the redundancy of LFPs. The information tended to flow from thalamus to hippocampus during seizure initiation period no matter what the information flow direction was before the seizure. In some cases the information flow was symmetrically bidirectional, but none was found in which the information flowed from hippocampus to thalamus during the seizure initiation period. In addition, inactivation of thalamus by tetrodotoxin (TTX) resulted in a suppression of seizures. These results suggest that thalamus may play an important role in the initiation of epileptic seizures. PMID:24778885

Information spreading in Delay Tolerant Networks based on nodes' behaviors

NASA Astrophysics Data System (ADS)

Wu, Yahui; Deng, Su; Huang, Hongbin

2014-07-01

Information spreading in DTNs (Delay Tolerant Networks) adopts a store-carry-forward method, and nodes receive the message from others directly. However, it is hard to judge whether the information is safe in this communication mode. In this case, a node may observe other nodes' behaviors. At present, there is no theoretical model to describe the varying rule of the nodes' trusting level. In addition, due to the uncertainty of the connectivity in DTN, a node is hard to get the global state of the network. Therefore, a rational model about the node's trusting level should be a function of the node's own observing result. For example, if a node finds k nodes carrying a message, it may trust the information with probability p(k). This paper does not explore the real distribution of p(k), but instead presents a unifying theoretical framework to evaluate the performance of the information spreading in above case. This framework is an extension of the traditional SI (susceptible-infected) model, and is useful when p(k) conforms to any distribution. Simulations based on both synthetic and real motion traces show the accuracy of the framework. Finally, we explore the impact of the nodes' behaviors based on certain special distributions through numerical results.

A path towards uncertainty assignment in an operational cloud-phase algorithm from ARM vertically pointing active sensors

NASA Astrophysics Data System (ADS)

Riihimaki, Laura D.; Comstock, Jennifer M.; Anderson, Kevin K.; Holmes, Aimee; Luke, Edward

2016-06-01

Knowledge of cloud phase (liquid, ice, mixed, etc.) is necessary to describe the radiative impact of clouds and their lifetimes, but is a property that is difficult to simulate correctly in climate models. One step towards improving those simulations is to make observations of cloud phase with sufficient accuracy to help constrain model representations of cloud processes. In this study, we outline a methodology using a basic Bayesian classifier to estimate the probabilities of cloud-phase class from Atmospheric Radiation Measurement (ARM) vertically pointing active remote sensors. The advantage of this method over previous ones is that it provides uncertainty information on the phase classification. We also test the value of including higher moments of the cloud radar Doppler spectrum than are traditionally used operationally. Using training data of known phase from the Mixed-Phase Arctic Cloud Experiment (M-PACE) field campaign, we demonstrate a proof of concept for how the method can be used to train an algorithm that identifies ice, liquid, mixed phase, and snow. Over 95 % of data are identified correctly for pure ice and liquid cases used in this study. Mixed-phase and snow cases are more problematic to identify correctly. When lidar data are not available, including additional information from the Doppler spectrum provides substantial improvement to the algorithm. This is a first step towards an operational algorithm and can be expanded to include additional categories such as drizzle with additional training data.

SU-F-E-15: Initial Experience Implementing a Case Method Teaching Approach to Radiation Oncology Physics Residents, Graduate Students and Doctorate of Medical Physics Students

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

Gutierrez, A

Purpose: Case Method Teaching approach is a teaching tool used commonly in business school to challenge students with real-world situations—i.e. cases. The students are placed in the role of the decision maker and have to provide a solution based on the multitude of information provided. Specifically, students must develop an ability to quickly make sense of a complex problem, provide a solution incorporating all of the objectives (at time conflicting) and constraints, and communicate that solution in a succinct, professional and effective manner. The validity of the solution is highly dependent on the auxiliary information provided in the case andmore » the basic didactic knowledge of the student. A Case Method Teaching approach was developed and implemented into an on-going course focused on AAPM Task Group reports at UTHSCSA. Methods: A current course at UTHSCSA reviews and discusses 15 AAPM Task Group reports per semester. The course is structured into three topic modules: Imaging QA, Stereotactic Radiotherapy, and Special Patient Measurements—i.e. pacemakers, fetal dose. After a topic module is complete, the students are divided into groups (2–3 people) and are asked to review a case study related to the module topic. Students then provide a solution presented in an executive summary and class presentation. Results: Case studies were created to address each module topic. Through team work and whole-class discussion, a collaborative learning environment was established. Students additionally learned concepts such vendor relations, financial negotiations, capital project management, and competitive strategy. Conclusion: Case Method Teaching approach is an effective teaching tool to further enhance the learning experience of radiation oncology physics students by presenting them with though-provoking dilemmas that require students to distinguish pertinent from peripheral information, formulate strategies and recommendations for action, and confront obstacles to implementation.« less

Analysis of Internet Information on Lateral Lumbar Interbody Fusion.

PubMed

Belayneh, Rebekah; Mesfin, Addisu

2016-07-01

Lateral lumbar interbody fusion (LLIF) is a surgical technique that is being increasingly used. The authors' objective was to examine information on the Internet pertaining to the LLIF technique. An analysis was conducted of publicly accessible websites pertaining to LLIF. The following search engines were used: Google (www.google.com), Bing (www.bing.com), and Yahoo (www.yahoo.com). DuckDuckGo (www.duckduckgo.com) was an additional search engine used due to its emphasis on generating accurate and consistent results while protecting searchers' privacy and reducing advertisements. The top 35 websites providing information on LLIF from the 4 search engines were identified. A total of 140 websites were evaluated. Each web-site was categorized based on authorship (academic, private, medical industry, insurance company, other) and content of information. Using the search term lateral lumbar interbody fusion, 174,000 Google results, 112,000 Yahoo results, and 112,000 Bing results were obtained. DuckDuckGo does not display the number of results found for a search. From the top 140 websites collected from each website, 78 unique websites were identified. Websites were authored by a private medical group in 46.2% of the cases, an academic medical group in 26.9% of the cases, and the biomedical industry in 5.1% of the cases. Sixty-eight percent of websites reported indications, and 24.4% reported contraindications. Benefits of LLIF were reported by 69.2% of websites. Thirty-six percent of websites reported complications of LLIF. Overall, the quality of information regarding LLIF on the Internet is poor. Spine surgeons and spine societies can assist in improving the quality of the information on the Internet regarding LLIF. [Orthopedics. 2016; 39(4):e701-e707.]. Copyright 2016, SLACK Incorporated.

Cumulative Review of Thrombotic Microangiopathy, Thrombotic Thrombocytopenic Purpura, and Hemolytic Uremic Syndrome Reports with Subcutaneous Interferon β-1a.

PubMed

Ben-Amor, Ali-Frédéric; Trochanov, Anton; Fischer, Tanya Z

2015-05-01

Rare cases of thrombotic microangiopathy (TMA), manifested as thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS), have been reported with interferon β products. We performed a cumulative review of TMA cases recorded in a Global Safety Database for patients with multiple sclerosis who received subcutaneous interferon β-1a treatment. Search criteria were: all reported cases, serious and non-serious, from all sources (including non-health care professionals and clinical trial reports), regardless of event ranking and causality assessment by reporter or company. Data lock was May 3, 2014, with additional analysis of cases reported between August 1, 2014-November 30, 2014. Ninety-one patient cases (76.9% female) with 105 events were retrieved. Time to onset varied from 2 months to 14 years, and in 31.9% of patients the event occurred within 2 years of treatment initiation. Seven patients had a fatal outcome (five were secondary to other causes and two reported insufficient information). Forty-four patients recovered, 32 patients had not recovered at the time of the report, and in eight cases outcome was either not reported or unknown. Treatment was discontinued in 84.6% (77/91) of patients. In 67% (61/91) of patients, the reporter suspected a causal association between treatment and TMA/TTP-HUS. Risk factors and/or confounding factors were present in 45.1% (41/91) of patients. Early prodromal syndrome or specific patterns were not detected, although 54.9% (50/91) of cases contained insufficient information. Overall reporting rate of TMA/TTP-HUS was estimated as 7.2 per 100,000 patient-years. Reporting rates for human serum album (HSA)-containing and HSA-free formulations were 5.72 and 7.68 per 100,000 patient-years, respectively. No new signal relating specifically to increased frequency of TMA/TTP-HUS with HSA-free subcutaneous interferon β-1a was detected and no additional risk mitigation measures are required regarding the different formulations. The benefit-risk balance of subcutaneous interferon β-1a remains positive, and routine pharmacovigilance monitoring is appropriate. Ares Trading SA, Aubonne, Switzerland, a subsidiary of Merck Serono SA.

Utility of three-dimensional and multiplanar reformatted computed tomography for evaluation of pediatric congenital spine abnormalities.

PubMed

Newton, Peter O; Hahn, Gregory W; Fricka, Kevin B; Wenger, Dennis R

2002-04-15

A retrospective radiographic review of 31 patients with congenital spine abnormalities who underwent conventional radiography and advanced imaging studies was conducted. To analyze the utility of three-dimensional computed tomography with multiplanar reformatted images for congenital spine anomalies, as compared with plain radiographs and axial two-dimensional computed tomography imaging. Conventional radiographic imaging for congenital spine disorders often are difficult to interpret because of the patient's small size, the complexity of the disorder, a deformity not in the plane of the radiographs, superimposed structures, and difficulty in forming a mental three-dimensional image. Multiplanar reformatted and three-dimensional computed tomographic imaging offers many potential advantages for defining congenital spine anomalies including visualization of the deformity in any plane, from any angle, with the overlying structures subtracted. The imaging studies of patients who had undergone a three-dimensional computed tomography for congenital deformities of the spine between 1992 and 1998 were reviewed (31 cases). All plain radiographs and axial two-dimensional computed tomography images performed before the three-dimensional computed tomography were reviewed and the findings documented. This was repeated for the three-dimensional reconstructions and, when available, the multiplanar reformatted images (15 cases). In each case, the utility of the advanced imaging was graded as one of the following: Grade A (substantial new information obtained), Grade B (confirmatory with improved visualization and understanding of the deformity), and Grade C (no added useful information obtained). In 17 of 31 cases, the multiplanar reformatted and three-dimensional images allowed identification of unrecognized malformations. In nine additional cases, the advanced imaging was helpful in better visualizing and understanding previously identified deformities. In five cases, no new information was gained. The standard and curved multiplanar reformatted images were best for defining the occiput-C1-C2 anatomy and the extent of segmentation defects. The curved multiplanar reformatted images were especially helpful in keeping the spine from "coming in" and "going out" of the plane of the image when there was significant spine deformity in the sagittal or coronal plane. The three-dimensional reconstructions proved valuable in defining failures of formation. Advanced computed tomography imaging (three-dimensional computed tomography and curved/standard multiplanar reformatted images) allows better definition of congenital spine anomalies. More than 50% of the cases showed additional abnormalities not appreciated on plain radiographs or axial two-dimensional computed tomography images. Curved multiplanar reformatted images allowed imaging in the coronal and sagittal planes of the entire deformity.

Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care

PubMed Central

van der Plas, Annicka G. M.; Vissers, Kris C.; Francke, Anneke L.; Donker, Gé A.; Jansen, Wim J. J.; Deliens, Luc; Onwuteaka-Philipsen, Bregje D.

2015-01-01

Background Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. Objectives To compare cancer patients with and without additional support from a case manager on: 1) the patients’ general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. Methods This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. Results The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Conclusions Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is ‘only’ advisory and he or she does not provide hands-on care or prescribe medication. PMID:26208099

Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care.

PubMed

van der Plas, Annicka G M; Vissers, Kris C; Francke, Anneke L; Donker, Gé A; Jansen, Wim J J; Deliens, Luc; Onwuteaka-Philipsen, Bregje D

2015-01-01

Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. To compare cancer patients with and without additional support from a case manager on: 1) the patients' general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is 'only' advisory and he or she does not provide hands-on care or prescribe medication.

Myopericytoma of skin and soft tissues: clinicopathologic and immunohistochemical study of 54 cases.

PubMed

Mentzel, Thomas; Dei Tos, Angelo P; Sapi, Zoltan; Kutzner, Heinz

2006-01-01

Perivascular neoplasms comprise traditionally glomus tumor and hemangiopericytoma (HPC). Whereas glomus tumor represents a well-defined entity, the existence of HPC as a separate entity has been questioned because a number of neoplasms of different lines of differentiation are characterized by a HPC-like vascular growth pattern. Myopericytoma represents a recently delineated entity showing a HPC-like vascular pattern. A large series of myopericytoma of skin and soft tissues has been analyzed to further characterize the clinicopathologic spectrum of this entity. Fifty-four cases of myopericytoma of skin and soft tissues were retrieved and the histology reviewed. Immunohistochemical stainings using alpha-smooth muscle actin (ASMA), desmin, and h-caldesmon antibodies were performed, and clinical data and follow-up information were obtained from referring pathologists. Thirty-four patients were male and 18 were female (gender was unknown in 2 cases). Patient age ranged from 13 to 87 years (median, 52 years). The lower extremities were most commonly affected (26 cases) followed by the upper extremities (16 cases), the head and neck region (4 cases), and the trunk (2 cases); exact location was unknown in 5 cases. In 20 cases, the neoplasms were confined to the dermis, in 6 cases an extension into the subcutis was seen, and 24 as well as 4 cases arose in subcutaneous and deep soft tissue, respectively. Two cases were multicentric; and in 1 of these patients, multiple anatomic regions were involved. Histologically, in all cases, numerous thin-walled vessels and a concentric, perivascular arrangement of ovoid, plump spindled to round myoid tumor cells was seen. However, a broad morphologic spectrum ranging from hypocellular, fibroma-like (3 cases), myofibroma-like (2 cases), angioleiomyoma-like (12 cases), and HPC-like neoplasms (13 cases) to classic myopericytomas (14 cases) and immature, cellular lesions (2 cases) was noted. In addition, 2 neoplasms with focal glomoid features, 5 intravascular, and 1 malignant myopericytomas were found. Prominent cytologic atypia and increased proliferative activity (>3 mitoses/10 high power fields) was seen in 4 and 2 cases, respectively. Immunohistochemically, all cases tested stained positively for ASMA. In addition, 29 of 32 cases tested stained positively for h-caldesmon, whereas desmin was only focally positive in 3 of 33 cases. Follow-up information was available in 46 cases (range, 7-168 months; median, 48 months). Despite marginal or incomplete excision in 23 of 46 cases, only 2 neoplasms (1 malignant and 1 intravascular myopericytoma) recurred locally (within 1 and 4 years, respectively). Despite overlapping morphologic features to angioleiomyoma and myofibroma, myopericytoma represents a distinct perivascular, myoid neoplasm of skin and soft tissues, characterized by a broad morphologic spectrum of concentrically, perivascularly growing myoid tumor cells that stain positively for ASMA and often for h-caldesmon, whereas desmin is usually negative. Most cases of myopericytoma behave in a benign fashion, but local recurrences and rarely metastases may occur in atypical and malignant neoplasms.

Investigation of display issues relevant to the presentation of aircraft fault information

NASA Technical Reports Server (NTRS)

Allen, Donald M.

1989-01-01

This research, performed as a part of NASA Langley's Faultfinder project, investigated display implementation issues related to the introduction of real time fault diagnostic systems into next generation commercial aircraft. Three major issues were investigated: visual display styles for presenting fault related information to the crew, the form the output from the expert system should take, and methods for filtering fault related information for presentation to the crew. Twenty-four flight familiar male volunteers participated as subjects. Five subjects were NASA test pilots, six were Commercial Airline Pilots, seven were Air Force Lear Jet pilots, and six were NASA personnel familiar with flight (non-pilots). Subjects were presented with aircraft subsystem information on a CRT screen. They were required to identify the subsystems presented in a display and to remember the state (normal or abnormal) of subsystem parameter information contained in the display. The results of the study indicated that in the simpler experimental test cases (i.e., those involving single subsystem failures and composite hypothesis displays) subjects' performance did not differ across the different display formats. However, for the more complex cases (i.e., those involving multiple subsystem faults and multiple hypotheses displays), subjects' performance was superior in the text- and picture-based display formats compared to the symbol-based format. In addition, the findings suggest that a layered approached to information display is appropriate.

Comparative risk for cardiovascular diseases of dipeptidyl peptidase-4 inhibitors vs. sulfonylureas in combination with metformin: Results of a two-phase study.

PubMed

Enders, Dirk; Kollhorst, Bianca; Engel, Susanne; Linder, Roland; Verheyen, Frank; Pigeot, Iris

2016-01-01

The aim was to assess whether the use of additional data from the Disease Management Program (DMP) diabetes mellitus type 2 to minimize the potential for residual confounding will alter the estimated risk of either myocardial infarction, ischemic stroke or heart failure in patients with type 2 diabetes using sulfonylureas compared to dipeptidyl peptidase-4 (DPP-4) inhibitors in addition to metformin based on routine health care data. We conducted a nested two-phase case-control study using claims data of one German health insurance from 2004 to 2013 (phase 1) and data of the DMP from 2010 to 2013 (phase 2). Adjusted odds ratios (ORs) for the combined cardiovascular event myocardial infarction, ischemic stroke or heart failure were calculated using a two-phase logistic regression. Phase 1 comprised 3179 patients (289 cases; 2890 controls) and phase 2 comprised 1968 patients (168 cases; 1800 controls). We observed an adjusted OR of 0.83 for the combined cardiovascular event (95% CI: 0.61-1.13). We observed a non-significantly reduced risk for cardiovascular diseases in patients using DPP-4 inhibitors compared to sulfonylureas in addition to metformin. This finding was not altered by the inclusion of additional information of the DMP in the analysis. However, due to the low power of this study, further studies are needed to reproduce our findings. Copyright © 2016 Elsevier Inc. All rights reserved.

Advances in magnetic resonance neuroimaging techniques in the evaluation of neonatal encephalopathy.

PubMed

Panigrahy, Ashok; Blüml, Stefan

2007-02-01

Magnetic resonance (MR) imaging has become an essential tool in the evaluation of neonatal encephalopathy. Magnetic resonance-compatible neonatal incubators allow sick neonates to be transported to the MR scanner, and neonatal head coils can improve signal-to-noise ratio, critical for advanced MR imaging techniques. Refinement of conventional imaging techniques include the use of PROPELLER techniques for motion correction. Magnetic resonance spectroscopic imaging and diffusion tensor imaging provide quantitative assessment of both brain development and brain injury in the newborn with respect to metabolite abnormalities and hypoxic-ischemic injury. Knowledge of normal developmental changes in MR spectroscopy metabolite concentration and diffusion tensor metrics is essential to interpret pathological cases. Perfusion MR and functional MR can provide additional physiological information. Both MR spectroscopy and diffusion tensor imaging can provide additional information in the differential of neonatal encephalopathy, including perinatal white matter injury, hypoxic-ischemic brain injury, metabolic disease, infection, and birth injury.

Randomized pilot study and qualitative evaluation of a clinical decision support system for brain tumour diagnosis based on SV ¹H MRS: evaluation as an additional information procedure for novice radiologists.

PubMed

Sáez, Carlos; Martí-Bonmatí, Luis; Alberich-Bayarri, Angel; Robles, Montserrat; García-Gómez, Juan M

2014-02-01

The results of a randomized pilot study and qualitative evaluation of the clinical decision support system Curiam BT are reported. We evaluated the system's feasibility and potential value as a radiological information procedure complementary to magnetic resonance (MR) imaging to assist novice radiologists in diagnosing brain tumours using MR spectroscopy (1.5 and 3.0T). Fifty-five cases were analysed at three hospitals according to four non-exclusive diagnostic questions. Our results show that Curiam BT improved the diagnostic accuracy in all the four questions. Additionally, we discuss the findings of the users' feedback about the system, and the further work to optimize it for real environments and to conduct a large clinical trial. © 2013 Published by Elsevier Ltd.

MS-Electronic Nose Performance Improvement Using GC Retention Times And 2-Way And 3-Way Data Processing Methods

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

Burian, Cosmin; Llobet, Eduard; Vilanova, Xavier

We have designed a challenging experimental sample set in the form of 20 solutions with a high degree of similarity in order to study whether the addition of chromatographic separation information improves the performance of regular MS based electronic noses. In order to make an initial study of the approach, two different chromatographic methods were used. By processing the data of these experiments with 2 and 3-way algorithms, we have shown that the addition of chromatographic separation information improves the results compared to the 2-way analysis of mass spectra or total ion chromatogram treated separately. Our findings show that whenmore » the chromatographic peaks are resolved (longer measurement times), 2-way methods work better than 3-way methods, whereas in the case of a more challenging measurement (more coeluted chromatograms, much faster GC-MS measurements) 3-way methods work better.« less

Image denoising and deblurring using multispectral data

NASA Astrophysics Data System (ADS)

Semenishchev, E. A.; Voronin, V. V.; Marchuk, V. I.

2017-05-01

Currently decision-making systems get widespread. These systems are based on the analysis video sequences and also additional data. They are volume, change size, the behavior of one or a group of objects, temperature gradient, the presence of local areas with strong differences, and others. Security and control system are main areas of application. A noise on the images strongly influences the subsequent processing and decision making. This paper considers the problem of primary signal processing for solving the tasks of image denoising and deblurring of multispectral data. The additional information from multispectral channels can improve the efficiency of object classification. In this paper we use method of combining information about the objects obtained by the cameras in different frequency bands. We apply method based on simultaneous minimization L2 and the first order square difference sequence of estimates to denoising and restoring the blur on the edges. In case of loss of the information will be applied an approach based on the interpolation of data taken from the analysis of objects located in other areas and information obtained from multispectral camera. The effectiveness of the proposed approach is shown in a set of test images.

Identifying a National Death Index Match

PubMed Central

Burchett, Bruce M.; Blazer, Dan G.

2009-01-01

Data from the National Death Index (NDI) are frequently used to determine survival status in epidemiologic or clinical studies. On the basis of selected information submitted by the investigator, NDI returns a file containing a set of candidate matches. Although NDI deems some matches as perfect, multiple candidate matches may be available for other cases. Working across data from the Duke University site of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), NDI, and the Social Security Death Index (SSDI), the authors found that, for this Established Populations for Epidemiologic Studies of the Elderly cohort of 1,896 cases born before 1922 and alive as of January 1, 1999, a match on Social Security number plus additional personal information (specific combinations of last name, first name, month of birth, day of birth) resulted in agreement between NDI and Social Security Death Index dates of death 94.7% of the time, while comparable agreement was found for only 12.3% of candidate decedents who did not have the required combination of information. Thus, an easy to apply algorithm facilitates accurate identification of NDI matches. PMID:19567777

Results of Studying Astronomy Students’ Science Literacy, Quantitative Literacy, and Information Literacy

NASA Astrophysics Data System (ADS)

Buxner, Sanlyn; Impey, Chris David; Follette, Katherine B.; Dokter, Erin F.; McCarthy, Don; Vezino, Beau; Formanek, Martin; Romine, James M.; Brock, Laci; Neiberding, Megan; Prather, Edward E.

2017-01-01

Introductory astronomy courses often serve as terminal science courses for non-science majors and present an opportunity to assess non future scientists’ attitudes towards science as well as basic scientific knowledge and scientific analysis skills that may remain unchanged after college. Through a series of studies, we have been able to evaluate students’ basic science knowledge, attitudes towards science, quantitative literacy, and informational literacy. In the Fall of 2015, we conducted a case study of a single class administering all relevant surveys to an undergraduate class of 20 students. We will present our analysis of trends of each of these studies as well as the comparison case study. In general we have found that students basic scientific knowledge has remained stable over the past quarter century. In all of our studies, there is a strong relationship between student attitudes and their science and quantitative knowledge and skills. Additionally, students’ information literacy is strongly connected to their attitudes and basic scientific knowledge. We are currently expanding these studies to include new audiences and will discuss the implications of our findings for instructors.

Battery electric vehicles - implications for the driver interface.

PubMed

Neumann, Isabel; Krems, Josef F

2016-03-01

The current study examines the human-machine interface of a battery electric vehicle (BEV) from a user-perspective, focussing on the evaluation of BEV-specific displays, the relevance of provided information and challenges for drivers due to the concept of electricity in a road vehicle. A sample of 40 users drove a BEV for 6 months. Data were gathered at three points of data collection. Participants perceived the BEV-specific displays as only moderately reliable and helpful for estimating the displayed parameters. This was even less the case after driving the BEV for 3 months. A taxonomy of user requirements was compiled revealing the need for improved and additional information, especially regarding energy consumption and efficiency. Drivers had difficulty understanding electrical units and the energy consumption of the BEV. On the background of general principles for display design, results provide implications how to display relevant information and how to facilitate drivers' understanding of energy consumption in BEVs. Practitioner Summary: Battery electric vehicle (BEV) displays need to incorporate new information. A taxonomy of user requirements was compiled revealing the need for improved and additional information in the BEV interface. Furthermore, drivers had trouble understanding electrical units and energy consumption; therefore, appropriate assistance is required. Design principles which are specifically important in the BEV context are discussed.

In the eyes of the law: malpractice litigation in oculoplastic surgery.

PubMed

Svider, Peter F; Blake, Danielle M; Husain, Qasim; Mauro, Andrew C; Turbin, Roger E; Eloy, Jean Anderson; Langer, Paul D

2014-01-01

To assess characteristics associated with various outcomes of malpractice litigation, resulting from injuries sustained during oculoplastic procedures. The Westlaw legal database (Thomson Reuters, New York, NY, U.S.A.) was used to obtain jury verdicts and settlements. Pertinent data were extracted from 69 malpractice cases litigated from 1988 to 2012 involving oculoplastic procedures, including alleged cause of malpractice, outcome, and defendant specialty. The most commonly litigated surgical procedures were blepharoplasty (63.8% of total) and brow lift surgery (11.6%). The most commonly alleged complications included excessive scarring (24.6%), lagophthalmos (24.6%), visual defects (23.2%), and exposure keratitis (21.7%). Plastic surgeons were the most commonly named defendants (46.4%), followed by both comprehensive ophthalmologists and fellowship-trained ophthalmic plastic surgeons (17.3% each). A defense verdict was held in 60.9% of cases, a plaintiff verdict in 31.9% of cases, and a settlement was reached in 7.2% of cases. Blindness, cranial nerve injury, and the allegation of a permanent deficit increased the likelihood of a case being resolved with payment to the plaintiff (Fisher exact tests, p < 0.05). Most litigated oculoplastic malpractice cases were resolved in favor of the defendant, while settlements and plaintiff decisions averaged $455,703. Blepharoplasty constituted two-thirds of cases, with the most frequently cited associated complications being unsightly scarring, lagophthalmos, and visual deficits. An alleged lack of informed consent (30.4%) or the need for additional surgery (39.1%) was present in a considerable proportion of cases, emphasizing the importance of a detailed informed consent and clear communication preoperatively regarding patient expectations.

Formulating qualitative features using interactive visualization for analysis of multivariate spatiotemporal data

NASA Astrophysics Data System (ADS)

Porter, M.; Hill, M. C.; Pierce, S. A.; Gil, Y.; Pennington, D. D.

2017-12-01

DiscoverWater is a web-based visualization tool developed to enable the visual representation of data, and thus, aid scientific and societal understanding of hydrologic systems. Open data sources are coalesced to, for example, illustrate the impacts on streamflow of irrigation withdrawals. Scientists and stakeholders are informed through synchronized time-series data plots that correlate multiple spatiotemporal datasets and an interactive time-evolving map that provides a spatial analytical context. Together, these components elucidate trends so that the user can try to envision the relations between groundwater-surface water interactions, the impacts of pumping on these interactions, and the interplay of climate. Aligning data in this manner has the capacity for interdisciplinary knowledge discovery and motivates dialogue about system processes that we seek to enhance through qualitative features informed through quantitative models. DiscoverWater and its connection is demonstrated using two field cases. First, it is used to visualize data sets from the High Plains aquifer, where reservoir- and groundwater-supported irrigation has affected the Arkansas River in western Kansas. Second, data and model results from Barton Springs segment of the Edwards aquifer in Texas reveal the effects of regional pumping on this important urbanizing aquifer system. Identifying what is interesting about the data and the modeled system in the two different case studies is a step towards moving typically static visualization capabilities to an adaptive framework. Additionally, the dashboard interface incorporates both quantitative and qualitative information about distinctive case studies in a machine-readable form, such that a catalog of qualitative models can capture subject matter expertise alongside associated datasets. As the catalog is expanded to include other case studies, the collection has potential to establish a standard framework able to inform intelligent system reasoning.

Basic haemoglobinopathy diagnostics in Dutch laboratories; providing an informative test result.

PubMed

Kaufmann, J O; Smit, J W; Huisman, W; Idema, R N; Bakker, E; Giordano, P C

2013-08-01

After a first survey in 2001, the Dutch Association of Hematological Laboratory Research (VHL) advised its members to adopt a basic protocol for haemoglobinopathy carrier detection and to provide genetic information with all positive results to allow health-care professionals to inform carriers about potential genetic risks. This article reports on the compliance with these recommendations and their consequences. Clinical chemists of all 106 Dutch laboratories were invited to answer a survey on patient population, diagnostic techniques used, (self-reported) knowledge, use and effect of the additional information. The average increase in diagnostic output was over 60% and the recommended basic protocol was applied by 65% of the laboratories. Over 84% of the laboratories reported to be aware of the additional recommendations and 77% to be using them. Most laboratories with limited diagnostic requests were still sending their cases to other laboratories and included the genetic information received from these laboratories in their diagnostic reports. The effect of information on subsequent 'family analysis' was estimated to be between 26 and 50%. The present study shows an increase in diagnostic potential for haemoglobinopathy over the last decade, especially in the larger cities. Low 'family testing' rates were mostly found in areas with lower carrier prevalence or associated with local reluctance to pass the information to carriers. In spite of a dramatic improvement, too many carriers are still not informed because of lack of awareness among health-care providers and more education is needed. © 2012 John Wiley & Sons Ltd.

A diagnostic expert system for structured reports, quality assessment, and training of residents in sonography.

PubMed

Huettig, Matthias; Buscher, Georg; Menzel, Thomas; Scheppach, Wolfgang; Puppe, Frank; Buscher, Hans-Peter

2004-03-15

The quality of medical reports on diagnostic procedures has a considerable impact on the quality of medical care. Handwritten or otherwise unstructured reports tend to be incomplete, whereas structured questionnaires are of limited flexibility and not considered case-adequate. Thus, medical reports of this kind may promote an incomplete and misleading documentation and, therefore, be problematic with respect to their reliability. SonoConsult (SC), an expert system for structured and case-adequate documentation of sonographic findings with an additional diagnostic component, was evaluated with respect to user acceptance and suitability for enhancing the quality of reports and supporting sonographic beginners. The expectations and the attitudes of the users toward the program were evaluated by anonymous questionnaires. The documentation of findings and the diagnostic conclusions in 103 free text reports made by experienced examiners were evaluated by subjecting their information to a subsequent input into SC. Free text reports were checked for information that was asked by SC but not mentioned in the reports. In a series of 150 cases, the system diagnoses were blinded during input of findings into SC-questionnaires and the examiners' diagnostic conclusions were compared with the uncovered SC-diagnoses with respect to forgotten diagnoses. The structured and data-driven acquisition of information by the program was well accepted by the users. However, only a medium interest in the system-delivered diagnoses was noted. The program-generated reports were characterized by a more detailed description of the findings and a higher number of diagnoses in comparison to the unstructured reports before introduction of SC as the only documentation system. When unaware of the system diagnoses, information was entered into the questionnaires, and SC generated some diagnoses which were not mentioned by the examiners in their conclusions. The possibility to inspect the system diagnoses led to an enhancement of the number of diagnoses the examiners mentioned in their conclusions. By contrast, the examiners meant that the influence of the program on their conclusions was minimal or dispensable. Beginners in sonography acknowledged that the program led them to perform a complete examination in an adequate sequence. An expert system for the data-driven, case-adequate information acquisition of abdominal ultrasound examinations may enhance the quality of the reports and, potentially, of the examinations at the same time. In addition, it may help beginners to learn a structured problem- and finding-adequate examination sequence.

Effect of information literacy training course on information literacy skills of undergraduate students of Isfahan University of Medical Sciences based on ACRL standards.

PubMed

Karimi, Zohreh; Ashrafi-Rizi, Hasan; Papi, Ahmad; Shahrzadi, Leila; Hassanzadeh, Akbar

2015-01-01

Information literacy is the basis for lifelong learning. Information literacy skills, especially for student in an environment that is full of information from multiple technologies are being developed is equally important. Information literacy is a set of cognitive and practical skills and like any other science, proper training is needed, and standard-based education is definitely better and evaluation would be easier. This study aimed to determine the impact of information literacy training course on information literacy skills of Isfahan University of Medical Sciences students based on ACRL standard in 2012. The study method is semi-experience with two group design (with pre-test and post-test) and applied. The data collection toll was a questionnaire assessing student's information literacy that developed by Davarpanah and Siamak and validity was confirmed by professional librarians and reliability as measured by Cronbach's alpha, was 0.83. The sample consisted of 50 undergraduate students from Isfahan University of Medical Sciences that by random sampling method was perch in both case and control groups. Before and after the training (once a week), a questionnaire was distributed between the two groups. This training was held in a classroom equipped with computers with internet access and in addition to training using brochures and librarian presentation, interactive methods such as discussion and exercises were used. The data were analyzed using SPSS version 20 software and two level of descriptive (mean and SD) and inferential statistics (t-test and t-paired). The results showed that the students' information literacy scores before the training was lower than average, so that in the control group was 32.96 and in the case group was 33.24; while information literacy scores in the case group significantly increased after the training (46.68). Also, the effect of education, respectively had a greater impact on the ability to access information (the second standard), ethics and legal use of information (the third standard), effective use of information (the fourth standard), critically evaluate information and its sources (the fifth standard). This study showed that the training was effective on enhancing students' information literacy skills as the greatest impact was on increasing the ability to access information. Due to low mean score information literacy in the context of object recognition, there is a need for more training in this area.

Evaluation of forensic medical history taking from the child in cases of child physical and sexual abuse and neglect.

PubMed

Drummond, Rachel; Gall, John A M

2017-02-01

Suspected child physical abuse, sexual abuse and neglect are not uncommon presentations. As part of the assessment of these cases, a forensic medical history may be taken. This forensic history is used not only to determine the steps necessary to address the child's wellbeing but also to direct the forensic examination. Currently, there is no clear consensus on whether or not a forensic medical history should consistently be considered an integral element within the paediatric forensic evaluation. This study examines the value derived by the medical practitioner taking a forensic medical history rather than relying on hearsay evidence when a child presents for an assessment. A retrospective review of paediatric cases seen by the Victorian Forensic Paediatric Medical Service (VFPMS) between 2014 and 2015 was undertaken. 274 forensic case reports were reviewed and the data was entered into an Excel spread sheet and analysed using chi squared tests within STATA ® . With increasing age of the child, a forensic medical history is significantly more likely to be taken. Additional information is made available to the medical practitioner what would otherwise have been provided if the medical practitioner relied only on the interview conducted by the police. Discrepancies observed between the official third parties (police or child protection) report of what a child has said and what the child says to the medical practitioner decrease with age, as do discrepancies observed between the child's version of events and a third party's (eg. parents, caregivers, friends) version of events. The study showed that by taking a forensic medical history from the child additional information can be obtained. Further, that there is a value in the examining medical practitioner taking a forensic medical history from children in cases of child physical and sexual abuse and neglect. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Malaria elimination in Haiti by the year 2020: an achievable goal?

PubMed

Boncy, Paul Jacques; Adrien, Paul; Lemoine, Jean Frantz; Existe, Alexandre; Henry, Patricia Jean; Raccurt, Christian; Brasseur, Philippe; Fenelon, Natael; Dame, John B; Okech, Bernard A; Kaljee, Linda; Baxa, Dwayne; Prieur, Eric; El Badry, Maha A; Tagliamonte, Massimiliano S; Mulligan, Connie J; Carter, Tamar E; Beau de Rochars, V Madsen; Lutz, Chelsea; Parke, Dana M; Zervos, Marcus J

2015-06-05

Haiti and the Dominican Republic, which share the island of Hispaniola, are the last locations in the Caribbean where malaria still persists. Malaria is an important public health concern in Haiti with 17,094 reported cases in 2014. Further, on January 12, 2010, a record earthquake devastated densely populated areas in Haiti including many healthcare and laboratory facilities. Weakened infrastructure provided fertile reservoirs for uncontrolled transmission of infectious pathogens. This situation results in unique challenges for malaria epidemiology and elimination efforts. To help Haiti achieve its malaria elimination goals by year 2020, the Laboratoire National de Santé Publique and Henry Ford Health System, in close collaboration with the Direction d'Épidémiologie, de Laboratoire et de Recherches and the Programme National de Contrôle de la Malaria, hosted a scientific meeting on "Elimination Strategies for Malaria in Haiti" on January 29-30, 2015 at the National Laboratory in Port-au-Prince, Haiti. The meeting brought together laboratory personnel, researchers, clinicians, academics, public health professionals, and other stakeholders to discuss main stakes and perspectives on malaria elimination. Several themes and recommendations emerged during discussions at this meeting. First, more information and research on malaria transmission in Haiti are needed including information from active surveillance of cases and vectors. Second, many healthcare personnel need additional training and critical resources on how to properly identify malaria cases so as to improve accurate and timely case reporting. Third, it is necessary to continue studies genotyping strains of Plasmodium falciparum in different sites with active transmission to evaluate for drug resistance and impacts on health. Fourth, elimination strategies outlined in this report will continue to incorporate use of primaquine in addition to chloroquine and active surveillance of cases. Elimination of malaria in Haiti will require collaborative multidisciplinary approaches, sound strategic planning, and strong ownership of strategies by the Haiti Ministère de la Santé Publique et de la Population.

Response Surface Methodology: 1966-1986

DTIC Science & Technology

1986-09-01

reviews criteria from which choices of design parameters in (i) can be made; for example, the choice of a composite...fact that, in ý13 this case, all design points are at a distance p = - from the design center, and no control is ex- erted on Var y(,k) at a distance...interactions in the second order model. The notion of "small’ composite results from the fact that additional information on

[Urologists in National Socialism: persecuted, displaced and murdered urologists: list of persons and overview of sources used].

PubMed

Bellmann, J

2012-07-01

The names of 247 urologists or physicians working in the field of urology are mentioned, including their biographical data und the sources used to compile their biographies. Each name represents an individual experience of persecution, displacement and in some cases deliberate murder. Investigating these life histories has not yet been completed, as in the course of time additional information becomes available.

Think Global, Document Local: Using Data and Information Technologies To Move the Early Childhood Agenda. Starting Points: Meeting the Needs of Our Youngest Children.

ERIC Educational Resources Information Center

Watson, Sara; Squires, Barbara; Schafer, Peter

Child advocacy groups have become increasingly sophisticated about using data to mobilize public opinion and motivate greater public investment in young children and their families. The lesson emerging from this work is that state and local data are needed in addition to national data to build a more powerful case for change. This policy brief…

Extending Case-Based Reasoning (CBR) Approaches to Semi-automated Network Alert Reporting

DTIC Science & Technology

2013-04-01

connecting to the domain is likely infected with malware, or may have been exposed to malicious code. -- Detailed Information: The Sourcefire VRT ...to be generated by malware. After applying an extensive whitelist, the VRT pulls out the most commonly visited domains and adds them to its...malicious software. The VRT recommends ClamAV for Windows 3.0. 39 -- Contributors: Sourcefire Vulnerability Research Team -- Additional

Endodontic treatment of a mandibular first molar with three mesial canals and broken instrument removal.

PubMed

Faramarzi, Farhad; Fakhri, Hamidreza; Fakri, Hamidreza; Javaheri, Homan H

2010-04-01

To succeed in any dental procedure, the clinician's awareness of the patient's dental anatomy and its variations is crucial. In endodontic therapy, obtaining full information about the root canals' variations can affect the outcome substantially. This case report presents the endodontic treatment of a mandibular first molar exhibiting three mesial root canals with 4 mm of a separated K-file in the coronal third of the mesiolingual canal on an 18-year-old female patient. This case demonstrates the importance of locating additional canals in any roots undergoing endodontic treatment and how the clinician's awareness of aberrant internal anatomy may change the treatment results.

Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia.

PubMed

McCarthy, Caroline; Brady, Paul; O'Halloran, Ken D; McCreary, Christine

2016-01-01

Hyperventilation can be a manifestation of anxiety that involves abnormally fast breathing (tachypnea) and an elevated minute ventilation that exceeds metabolic demand. This report describes a case of hyperventilation-induced hypocapnia resulting in tetany in a 16-year-old girl undergoing orthodontic extractions under intravenous conscious sedation. Pulse oximetry is the gold standard respiratory-related index in conscious sedation. Although the parameter has great utility in determining oxygen desaturation, it provides no additional information on respiratory function, including, for example, respiratory rate. In this case, we found capnography to be a very useful aid to monitor respiration in this patient and also to treat the hypocapnia.

Are There Frame-Distortion Contributions to Collision-Induced Absorption and Collision-Induced Light Scattering?

NASA Astrophysics Data System (ADS)

Hohm, Uwe

2007-12-01

Collision-induced spectroscopy, such as collision-induced absorption (CIA) and collision-induced light scattering (CILS), can give valuable information on permanent electric moments, polarizabilities and intermolecular-interaction potentials. In general the collision-induced spectra of the pure rare-gases and their binary mixtures are understood fairly well. However if at least one of the collision partners is a molecule then in some cases the spectra show features which can hardly be explained by current theories which deal with the case of undistorted molecules. Here we discuss the possibility of collision-induced frame distortion as an additional effect to be considered in collision-induced spectroscopy.

Retrospective comparison of abdominal ultrasonography and radiography in the investigation of feline abdominal disease

PubMed Central

Won, Wylen Wade; Sharma, Ajay; Wu, Wenbo

2015-01-01

Abdominal radiography and ultrasonography are commonly used as part of the initial diagnostic plan for cats with nonspecific signs of abdominal disease. This retrospective study compared the clinical usefulness of abdominal radiography and ultrasonography in 105 feline patients with signs of abdominal disease. The final diagnosis was determined more commonly with ultrasonography (59%) compared to radiography (25.7%). Ultrasonography was also able to provide additional clinically relevant information in 76% of cases, and changed or refined the diagnosis in 47% of cases. Based on these findings, ultrasonography may be sufficient as an initial diagnostic test for the investigation of feline abdominal disease. PMID:26483582

A study of information flow in hospice interdisciplinary team meetings

PubMed Central

DEMIRIS, GEORGE; WASHINGTON, KARLA; OLIVER, DEBRA PARKER; WITTENBERG-LYLES, ELAINE

2009-01-01

The aim of this study was to explore the information flow of hospice interdisciplinary meetings focusing on information access, exchange and documentation. The study participants were members of four hospice interdisciplinary teams in the Midwestern United States. Team members included a diverse range of professionals including physicians, nurses, social workers, bereavement counselors, and others. A total of 81 patient care discussions were videotaped and transcribed. A content analysis revealed several themes that needed to be addressed to improve the overall information flow, such as access to and recording of information, documentation of services, obtaining information from absent team members, data redundancy and updating of recorded information. On average, 5% of all utterances when discussing a patient case were focused on soliciting information from the member who had access to the patient chart. In 12.3% of all discussions, members referred to an absent member who could have provided additional information. In 8.6% of all discussions the same facts were repeated three times or more. Based on the findings we propose guidelines that can address potential informational gaps and enhance team communication in hospice. PMID:19012142

A Cooperative Model for IS Security Risk Management in Distributed Environment

PubMed Central

Zheng, Chundong

2014-01-01

Given the increasing cooperation between organizations, the flexible exchange of security information across the allied organizations is critical to effectively manage information systems (IS) security in a distributed environment. In this paper, we develop a cooperative model for IS security risk management in a distributed environment. In the proposed model, the exchange of security information among the interconnected IS under distributed environment is supported by Bayesian networks (BNs). In addition, for an organization's IS, a BN is utilized to represent its security environment and dynamically predict its security risk level, by which the security manager can select an optimal action to safeguard the firm's information resources. The actual case studied illustrates the cooperative model presented in this paper and how it can be exploited to manage the distributed IS security risk effectively. PMID:24563626

On the security of a dynamic ID-based authentication scheme for telecare medical information systems.

PubMed

Lin, Han-Yu

2013-04-01

Telecare medical information systems (TMISs) are increasingly popular technologies for healthcare applications. Using TMISs, physicians and caregivers can monitor the vital signs of patients remotely. Since the database of TMISs stores patients' electronic medical records (EMRs), only authorized users should be granted the access to this information for the privacy concern. To keep the user anonymity, recently, Chen et al. proposed a dynamic ID-based authentication scheme for telecare medical information system. They claimed that their scheme is more secure and robust for use in a TMIS. However, we will demonstrate that their scheme fails to satisfy the user anonymity due to the dictionary attacks. It is also possible to derive a user password in case of smart card loss attacks. Additionally, an improved scheme eliminating these weaknesses is also presented.

Nurses' Information Seeking Behavior for Clinical Practice: A Case Study in a Developing Country.

PubMed

Sarbaz, Masoumeh; Kimiafar, Khalil; Sheikhtaheri, Abbas; Taherzadeh, Zhila; Eslami, Saeid

2016-01-01

We used a valid questionnaire to survey Iranian nurses' seeking information behavior and their confidence on different information sources. The frequently used sources were Internet" and "personal experiences" (54.8% and 48.2% respectively). "English medical journals" (61.9%) and "English textbooks" (41.3%) were the least frequently used sources. Nurses felt high confidence in sources such as "International instructions/guidelines" (58.6%) and "English medical textbooks" (50.4%). The main reasons for selecting sources were easy accessibility, being up to date and reliability. Google, Pubmed and Up to Date were the most used electronic sources. In addition, there were differences in terms of using some of these resources and nurse' age and gender. In developing information sources for nurses, factors such as reliability level, availability, and updatedness of resources should be more emphasized.

Impact of quarantine on the 2003 SARS outbreak: a retrospective modeling study.

PubMed

Hsieh, Ying-Hen; King, Chwan-Chuan; Chen, Cathy W S; Ho, Mei-Shang; Hsu, Sze-Bi; Wu, Yi-Chun

2007-02-21

During the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, traditional intervention measures such as quarantine and border control were found to be useful in containing the outbreak. We used laboratory verified SARS case data and the detailed quarantine data in Taiwan, where over 150,000 people were quarantined during the 2003 outbreak, to formulate a mathematical model which incorporates Level A quarantine (of potentially exposed contacts of suspected SARS patients) and Level B quarantine (of travelers arriving at borders from SARS affected areas) implemented in Taiwan during the outbreak. We obtain the average case fatality ratio and the daily quarantine rate for the Taiwan outbreak. Model simulations is utilized to show that Level A quarantine prevented approximately 461 additional SARS cases and 62 additional deaths, while the effect of Level B quarantine was comparatively minor, yielding only around 5% reduction of cases and deaths. The combined impact of the two levels of quarantine had reduced the case number and deaths by almost a half. The results demonstrate how modeling can be useful in qualitative evaluation of the impact of traditional intervention measures for newly emerging infectious diseases outbreak when there is inadequate information on the characteristics and clinical features of the new disease-measures which could become particularly important with the looming threat of global flu pandemic possibly caused by a novel mutating flu strain, including that of avian variety.

A Case of Suspicious Gangliocytoma with Heterogeneously Distributed Lesions in the Thalamus and Basal Ganglia.

PubMed

Miyake, Yohei; Mishima, Kazuhiko; Suzuki, Tomonari; Adachi, Jun-Ichi; Sasaki, Atsushi; Nishikawa, Ryo

2018-04-01

We report a case of a 24-year-old woman who presented with an uncomfortable feeling in her right foot with a 6-month history of slight weakness in her right hand. Neuroimaging demonstrated irregular shaped lesions in the left thalamus and basal ganglia in addition to spotty lesions in the contralateral thalamus. The MRI showed high-intensity signals on T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted images. The lesions demonstrated low-intensity signaling on T1-weighted images and were slightly enhanced with gadolinium. Other examinations including positron emission tomography, MR spectroscopy, and laboratory tests did not reveal any specific information regarding the lesions. The biopsied specimens, from the left basal ganglia, revealed proliferation of dysplastic neuronal cells without any neoplastic glial elements; thus, gangliocytoma (WHO grade I) was the most likely diagnosis. The patient was further observed based on this diagnosis of suspicious gangliocytoma, and the follow-up MRI, performed a year after the biopsy, revealed that the disease was stable. To our knowledge, gangliocytoma in the thalamus and basal ganglia have not been reported. Additionally, the findings of the magnetic resonance imaging (MRI) in this case were unique and different from those previously reported in cases of gangliocytoma. The authors report this unique case and discuss the radiological, pathological, and genetic findings.

A Case of Suspicious Gangliocytoma with Heterogeneously Distributed Lesions in the Thalamus and Basal Ganglia

PubMed Central

Miyake, Yohei; Mishima, Kazuhiko; Suzuki, Tomonari; Adachi, Jun-ichi; Sasaki, Atsushi; Nishikawa, Ryo

2018-01-01

We report a case of a 24-year-old woman who presented with an uncomfortable feeling in her right foot with a 6-month history of slight weakness in her right hand. Neuroimaging demonstrated irregular shaped lesions in the left thalamus and basal ganglia in addition to spotty lesions in the contralateral thalamus. The MRI showed high-intensity signals on T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted images. The lesions demonstrated low-intensity signaling on T1-weighted images and were slightly enhanced with gadolinium. Other examinations including positron emission tomography, MR spectroscopy, and laboratory tests did not reveal any specific information regarding the lesions. The biopsied specimens, from the left basal ganglia, revealed proliferation of dysplastic neuronal cells without any neoplastic glial elements; thus, gangliocytoma (WHO grade I) was the most likely diagnosis. The patient was further observed based on this diagnosis of suspicious gangliocytoma, and the follow-up MRI, performed a year after the biopsy, revealed that the disease was stable. To our knowledge, gangliocytoma in the thalamus and basal ganglia have not been reported. Additionally, the findings of the magnetic resonance imaging (MRI) in this case were unique and different from those previously reported in cases of gangliocytoma. The authors report this unique case and discuss the radiological, pathological, and genetic findings. PMID:29725570

Narrative research methods in palliative care contexts: two case studies.

PubMed

Thomas, Carol; Reeve, Joanne; Bingley, Amanda; Brown, Janice; Payne, Sheila; Lynch, Tom

2009-05-01

Narrative methods have played a minor role in research with dying patients to date, and deserve to be more widely understood. This article illustrates the utility and value of these methods through the narrative analysis of semi-structured interview data gathered in a series of interviews with two terminally ill cancer patients and their spouses. The methods and findings associated with these two case studies are outlined and discussed. The authors' contention is that an analytical focus on the naturalistic storytelling of patients and informal carers can throw new light on individuals' perceived illness states and symptoms, care-related needs, behaviors, and desires. In addition, the juxtaposition of two cases that share a number of markers of risk and need at the end of life illustrates how the narrative analysis of patients' experiential accounts can assist in uncovering important distinctions between cases that are of relevance to care management.

New variant of Creutzfeldt-Jakob (vCJD) disease and other human prion diseases under epidemiological surveillance in Brazil.

PubMed

Gattás, Vera Lúcia; Lima Neto, Antonio Silva; Dimech, George Santiago; Mancini, Denise; Cantarino, Ligia Maria; Marins, José Ricardo Pio; Luna, Expedito José Albuquerque

2007-01-01

To increase the timeliness of detection of human cases of the new variant of Creutzfeldt-Jakob disease (vCJD) and to reduce the risk of transmission, the Brazilian Ministry of Health has established and standardized rules and control measures. These include the definition of criteria for suspect cases, reporting, monitoring, and control measures for illness prevention and transmission. Guidelines to be used by the team of health care staff were published and distributed to health workers. A detailed proposal for a simplified system of surveillance for prion diseases was developed and mandatory reporting introduced. Additional effort is necessary to increase vCJD case detection, thus making it necessary to establish a partnership with health care services for best identification of suspected cases and dissemination of information to all involved in the service dealing with vCJD investigation.

Measuring Workload Demand of Informatics Systems with the Clinical Case Demand Index

PubMed Central

Iyengar, M. Sriram; Rogith, Deevakar; Florez-Arango, Jose F

2017-01-01

Introduction: The increasing use of Health Information Technology (HIT) can add substantially to workload on clinical providers. Current methods for assessing workload do not take into account the nature of clinical cases and the use of HIT tools while solving them. Methods: The Clinical Case Demand Index (CCDI), consisting of a summary score and visual representation, was developed to meet this need. Consistency with current perceived workload measures was evaluated in a Randomized Control Trial of a mobile health system. Results: CCDI is significantly correlated with existing workload measures and inversely related to provider performance. Discussion: CCDI combines subjective and objective characteristics of clinical cases along with cognitive and clinical dimensions. Applications include evaluation of HIT tools, clinician scheduling, medical education. Conclusion: CCDI supports comparative effectiveness research of HIT tools. In addition, CCDI could have numerous applications including training, clinical trials, design of clinical workflows, and others. PMID:29854166

New variant of Creutzfeldt-Jakob (vCJD) disease and other human prion diseases under epidemiological surveillance in Brazil

PubMed Central

Gattás, Vera Lúcia; Lima Neto, Antonio Silva; Dimech, George Santiago; Mancini, Denise; Cantarino, Ligia Maria; Marins, José Ricardo Pio; Luna, Expedito José Albuquerque

2007-01-01

To increase the timeliness of detection of human cases of the new variant of Creutzfeldt-Jakob disease (vCJD) and to reduce the risk of transmission, the Brazilian Ministry of Health has established and standardized rules and control measures. These include the definition of criteria for suspect cases, reporting, monitoring, and control measures for illness prevention and transmission. Guidelines to be used by the team of health care staff were published and distributed to health workers. A detailed proposal for a simplified system of surveillance for prion diseases was developed and mandatory reporting introduced. Additional effort is necessary to increase vCJD case detection, thus making it necessary to establish a partnership with health care services for best identification of suspected cases and dissemination of information to all involved in the service dealing with vCJD investigation. PMID:29213409

Classification of hyperspectral imagery using MapReduce on a NVIDIA graphics processing unit (Conference Presentation)

NASA Astrophysics Data System (ADS)

Ramirez, Andres; Rahnemoonfar, Maryam

2017-04-01

A hyperspectral image provides multidimensional figure rich in data consisting of hundreds of spectral dimensions. Analyzing the spectral and spatial information of such image with linear and non-linear algorithms will result in high computational time. In order to overcome this problem, this research presents a system using a MapReduce-Graphics Processing Unit (GPU) model that can help analyzing a hyperspectral image through the usage of parallel hardware and a parallel programming model, which will be simpler to handle compared to other low-level parallel programming models. Additionally, Hadoop was used as an open-source version of the MapReduce parallel programming model. This research compared classification accuracy results and timing results between the Hadoop and GPU system and tested it against the following test cases: the CPU and GPU test case, a CPU test case and a test case where no dimensional reduction was applied.

Measles outbreak--California, December 2014-February 2015.

PubMed

Zipprich, Jennifer; Winter, Kathleen; Hacker, Jill; Xia, Dongxiang; Watt, James; Harriman, Kathleen

2015-02-20

On January 5, 2015, the California Department of Public Health (CDPH) was notified about a suspected measles case. The patient was a hospitalized, unvaccinated child, aged 11 years with rash onset on December 28. The only notable travel history during the exposure period was a visit to one of two adjacent Disney theme parks located in Orange County, California. On the same day, CDPH received reports of four additional suspected measles cases in California residents and two in Utah residents, all of whom reported visiting one or both Disney theme parks during December 17-20. By January 7,seven California measles cases had been confirmed, and CDPH issued a press release and an Epidemic Information Exchange (Epi-X) notification to other states regarding this outbreak. Measles transmission is ongoing.

Electromagnetic Field Assessment as a Smart City Service: The SmartSantander Use-Case

PubMed Central

Diez, Luis; Agüero, Ramón; Muñoz, Luis

2017-01-01

Despite the increasing presence of wireless communications in everyday life, there exist some voices raising concerns about their adverse effects. One particularly relevant example is the potential impact of the electromagnetic field they induce on the population’s health. Traditionally, very specialized methods and devices (dosimetry) have been used to assess the strength of the E-field, with the main objective of checking whether it respects the corresponding regulations. In this paper, we propose a complete novel approach, which exploits the functionality leveraged by a smart city platform. We deploy a number of measuring probes, integrated as sensing devices, to carry out a characterization embracing large areas, as well as long periods of time. This unique platform has been active for more than one year, generating a vast amount of information. We process such information, and the obtained results validate the whole methodology. In addition, we discuss the variation of the E-field caused by cellular networks, considering additional information, such as usage statistics. Finally, we establish the exposure that can be attributed to the base stations within the scenario under analysis. PMID:28561783

Electromagnetic Field Assessment as a Smart City Service: The SmartSantander Use-Case.

PubMed

Diez, Luis; Agüero, Ramón; Muñoz, Luis

2017-05-31

Despite the increasing presence of wireless communications in everyday life, there exist some voices raising concerns about their adverse effects. One particularly relevant example is the potential impact of the electromagnetic field they induce on the population's health. Traditionally, very specialized methods and devices (dosimetry) have been used to assess the strength of the E-field, with the main objective of checking whether it respects the corresponding regulations. In this paper, we propose a complete novel approach, which exploits the functionality leveraged by a smart city platform. We deploy a number of measuring probes, integrated as sensing devices, to carry out a characterization embracing large areas, as well as long periods of time. This unique platform has been active for more than one year, generating a vast amount of information. We process such information, and the obtained results validate the whole methodology. In addition, we discuss the variation of the E-field caused by cellular networks, considering additional information, such as usage statistics. Finally, we establish the exposure that can be attributed to the base stations within the scenario under analysis.

Impact of clinical history on chest radiograph interpretation.

PubMed

Test, Matthew; Shah, Samir S; Monuteaux, Michael; Ambroggio, Lilliam; Lee, Edward Y; Markowitz, Richard I; Bixby, Sarah; Diperna, Stephanie; Servaes, Sabah; Hellinger, Jeffrey C; Neuman, Mark I

2013-07-01

The inclusion of clinical information may have unrecognized influence in the interpretation of diagnostic testing. The objective of the study was to determine the impact of clinical history on chest radiograph interpretation in the diagnosis of pneumonia. Prospective case-based study. Radiologists interpreted 110 radiographs of children evaluated for suspicion of pneumonia. Clinical information was withheld during the first interpretation. After 6 months the radiographs were reviewed with clinical information. Radiologists reported on pneumonia indicators described by the World Health Organization (ie, any infiltrate, alveolar infiltrate, interstitial infiltrate, air bronchograms, hilar adenopathy, pleural effusion). Children's Hospital of Philadelphia and Boston Children's Hospital. Six board-certified radiologists. Inter- and inter-rater reliability were assessed using the kappa statistic. The addition of clinical history did not have a substantial impact on the inter-rater reliability in the identification of any infiltrate, alveolar infiltrate, interstitial infiltrate, pleural effusion, or hilar adenopathy. Inter-rater reliability in the identification of air bronchograms improved from fair (k = 0.32) to moderate (k = 0.53). Intra-rater reliability for the identification of alveolar infiltrate remained substantial to almost perfect for all 6 raters with and without clinical information. One rater had a decrease in inter-rater reliability from almost perfect (k = 1.0) to fair (k = 0.21) in the identification of interstitial infiltrate with the addition of clinical history. Alveolar infiltrate and pleural effusion are findings with high intra- and inter-rater reliability in the diagnosis of bacterial pneumonia. The addition of clinical information did not have a substantial impact on the reliability of these findings. © 2012 Society of Hospital Medicine.

Bayesian network interface for assisting radiology interpretation and education

NASA Astrophysics Data System (ADS)

Duda, Jeffrey; Botzolakis, Emmanuel; Chen, Po-Hao; Mohan, Suyash; Nasrallah, Ilya; Rauschecker, Andreas; Rudie, Jeffrey; Bryan, R. Nick; Gee, James; Cook, Tessa

2018-03-01

In this work, we present the use of Bayesian networks for radiologist decision support during clinical interpretation. This computational approach has the advantage of avoiding incorrect diagnoses that result from known human cognitive biases such as anchoring bias, framing effect, availability bias, and premature closure. To integrate Bayesian networks into clinical practice, we developed an open-source web application that provides diagnostic support for a variety of radiology disease entities (e.g., basal ganglia diseases, bone lesions). The Clinical tool presents the user with a set of buttons representing clinical and imaging features of interest. These buttons are used to set the value for each observed feature. As features are identified, the conditional probabilities for each possible diagnosis are updated in real time. Additionally, using sensitivity analysis, the interface may be set to inform the user which remaining imaging features provide maximum discriminatory information to choose the most likely diagnosis. The Case Submission tools allow the user to submit a validated case and the associated imaging features to a database, which can then be used for future tuning/testing of the Bayesian networks. These submitted cases are then reviewed by an assigned expert using the provided QC tool. The Research tool presents users with cases with previously labeled features and a chosen diagnosis, for the purpose of performance evaluation. Similarly, the Education page presents cases with known features, but provides real time feedback on feature selection.

Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study

PubMed Central

Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke JAH; Schoonhoven, Lisette; Koopmans, Raymond TCM; Laurant, Miranda GH

2017-01-01

Introduction In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. Methods and analysis This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context–mechanism–outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. Ethics and dissemination The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. PMID:28600370

Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study.

PubMed

Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke J A H; Schoonhoven, Lisette; Koopmans, Raymond T C M; Laurant, Miranda G H

2017-06-08

In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. © 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.

Imaging pigment chemistry in melanocytic conjunctival lesions with pump-probe microscopy

NASA Astrophysics Data System (ADS)

Wilson, Jesse W.; Vajzovic, Lejla; Robles, Francisco E.; Cummings, Thomas J.; Mruthyunjaya, Prithvi; Warren, Warren S.

2013-03-01

We extend nonlinear pump-probe microscopy, recently demonstrated to image the microscopic distribution of eumelanin and pheomelanin in unstained skin biopsy sections, to the case of melanocytic conjunctival lesions. The microscopic distribution of pigmentation chemistry serves as a functional indicator of melanocyte activity. In these conjunctival specimens (benign nevi, primary acquired melanoses, and conjunctival melanoma), we have observed pump-probe spectroscopic signatures of eumelanin, pheomelanin, hemoglobin, and surgical ink, in addition to important structural features that differentiate benign from malignant lesions. We will also discuss prospects for an in vivo `optical biopsy' to provide additional information before having to perform invasive procedures.

Using MicroCT to Assess Periodontal Regeneration Outcomes-Comparison of Image-Based and Histologic Results: A Case Report.

PubMed

Rebaudi, Alberto; Trisi, Paolo; Pagni, Giorgio; Wang, Hom-Lay

The purpose of this study was to compare microcomputed tomography (microCT) and histologic analysis outcomes of a periodontal regeneration of a human defect treated with a polylactic- and polyglycolic-acid copolymer. At 11 months following the grafting procedure, the root with the surrounding periodontal tissues was removed and analyzed using microCT and histologic techniques. The results suggest that microCT three-dimensional analysis may be used in synergy with two-dimensional histologic sections to provide additional information for studying the regeneration outcomes normally reported by histologic biopsies in humans. Additional data is needed to validate these findings.

Legal liability in iatrogenic orbital injury.

PubMed

Svider, Peter F; Kovalerchik, Olga; Mauro, Andrew C; Baredes, Soly; Eloy, Jean Anderson

2013-09-01

In this study, we detailed factors governing legal outcomes in iatrogenic orbital injury, with the purpose of discussing strategies to minimize liability and enhance patient safety. Retrospective analysis. Jury verdict and settlement reports were searched from publically available federal and state court records using the Westlaw database (Thomson Reuters, New York, NY). After exclusion of nonrelevant cases, 20 cases of iatrogenic orbital injuries were examined for factors such as legal outcome, damages awarded, defendant specialty, alleged causes of malpractice, and patient demographic information. The majority (60.0%) of cases were resolved in the defendant's favor. Payment was considerable for the cases decided in support of the plaintiff, averaging $1.13 million. Out-of-court settlements averaged $1.78 million (range, $487,500-$3.9 million), whereas jury-awarded damages averaged $472,661 (range, $75,000-$763,214). Complications stemming from endoscopic sinus surgery were most common (50.0%). Diplopia was the most common medical complaint (50.0%), whereas permanent deficits and having to undergo additional surgery were each present in 65.0% of cases. The potential for permanent sequelae of iatrogenic orbital injury makes this complication susceptible to malpractice litigation. Otolaryngologists were the most common defendants. Although cases were resolved in the defendant's favor 60% of the time, payments made were considerable, averaging $1.13 million. Steps to minimize liability and improve patient safety include an informed consent process explicitly listing risks, including diplopia and blindness, and obtaining timely ophthalmology consultation when a complication is recognized. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Investigation of cancer incidence and mortality at a Scottish semiconductor manufacturing facility.

PubMed

McElvenny, Damien M; Darnton, Andrew J; Hodgson, John T; Clarke, Simon D; Elliott, Richard C; Osman, John

2003-10-01

We became aware of concern about cancer at a Scottish semiconductor manufacturing facility in 1998. Aim To compare cancer experience among current and former workers at the facility, with an appropriate comparison population, making use of any readily available exposure information. We obtained personnel and employment episode information from four sources within the company. Workers were flagged for death and cancer registrations at the National Health Service Central Register in Edinburgh. We constructed standardized registration and mortality ratios (SRRs and SMRs), using Scotland as the comparison, with and without an adjustment for deprivation. The main mortality analysis included 4388 workers, with a mean length of follow-up of 12.5 years. Overall mortality was substantially below that expected for men, and for women was slightly below expected. Total cancer registrations were close to expected levels for men and women. Four cancers produced noteworthy findings: malignant neoplasm of the trachea, bronchus and lung in women-deprivation adjusted SRR [95% confidence interval (CI), number of cases] 273 (136-488, 11 cases); malignant neoplasm of the stomach in women-adjusted SRR 438 (90-1281, three cases); and malignant neoplasm of the female breast-adjusted SRR 134 (82-206, 20 cases). The unadjusted SMR for male brain cancer was 401 (83-1172, three cases) and there was an additional non-fatal case. These findings, particularly those relating to lung cancer, though inconclusive, point to the possibility of a work-related risk of cancer that justifies further investigation.

Exome-based analysis of cardiac arrhythmia, respiratory control, and epilepsy genes in sudden unexpected death in epilepsy.

PubMed

Bagnall, Richard D; Crompton, Douglas E; Petrovski, Slavé; Lam, Lien; Cutmore, Carina; Garry, Sarah I; Sadleir, Lynette G; Dibbens, Leanne M; Cairns, Anita; Kivity, Sara; Afawi, Zaid; Regan, Brigid M; Duflou, Johan; Berkovic, Samuel F; Scheffer, Ingrid E; Semsarian, Christopher

2016-04-01

The leading cause of epilepsy-related premature mortality is sudden unexpected death in epilepsy (SUDEP). The cause of SUDEP remains unknown. To search for genetic risk factors in SUDEP cases, we performed an exome-based analysis of rare variants. Demographic and clinical information of 61 SUDEP cases were collected. Exome sequencing and rare variant collapsing analysis with 2,936 control exomes were performed to test for genes enriched with damaging variants. Additionally, cardiac arrhythmia, respiratory control, and epilepsy genes were screened for variants with frequency of <0.1% and predicted to be pathogenic with multiple in silico tools. The 61 SUDEP cases were categorized as definite SUDEP (n = 54), probable SUDEP (n = 5), and definite SUDEP plus (n = 2). We identified de novo mutations, previously reported pathogenic mutations, or candidate pathogenic variants in 28 of 61 (46%) cases. Four SUDEP cases (7%) had mutations in common genes responsible for the cardiac arrhythmia disease, long QT syndrome (LQTS). Nine cases (15%) had candidate pathogenic variants in dominant cardiac arrhythmia genes. Fifteen cases (25%) had mutations or candidate pathogenic variants in dominant epilepsy genes. No gene reached genome-wide significance with rare variant collapsing analysis; however, DEPDC5 (p = 0.00015) and KCNH2 (p = 0.0037) were among the top 30 genes, genome-wide. A sizeable proportion of SUDEP cases have clinically relevant mutations in cardiac arrhythmia and epilepsy genes. In cases with an LQTS gene mutation, SUDEP may occur as a result of a predictable and preventable cause. Understanding the genetic basis of SUDEP may inform cascade testing of at-risk family members. © 2016 American Neurological Association.

[Analysis of mitochondrial SNPs in addition to conventional STR-typing in a case of aggravated theft].

PubMed

Röper, Andrea; Reichert, Walter; Mattern, Rainer

2007-01-01

In the field of forensic DNA typing, the analysis of Short Tandem Repeats (STRs) can fail in cases of degraded DNA. The typing of coding region Single Nucleotide Polymorphisms (SNPs) of the mitochondrial genome provides an approach to acquire additional information. In the examined case of aggravated theft, both suspects could be excluded of having left the analyzed hair on the crime scene by SNP typing. This conclusion was not possible subsequent to STR typing. SNP typing of the trace on the torch light left on the crime scene increased the likelihood for suspect no. 2 to be the origin of this trace. This finding was already indicated by STR analysis. Suspect no. 1 was excluded for being the origin of this trace by SNP typing which was also indicated by STR analysis. A limiting factor for the analysis of SNPs is the maternal inheritance of mitochondrial DNA. Individualisation is not possible. In conclusion, it can be said that in the case of traces which cause problems with conventional STR typing the supplementary analysis of coding region SNPs from the mitochondrial genome is very reasonable and greatly contributes to the refinement of analysis methods in the field of forensic genetics.

Awareness and uptake of direct-to-consumer genetic testing among cancer cases, their relatives, and controls: the Northwest Cancer Genetics Network.

PubMed

Hall, Taryn O; Renz, Anne D; Snapinn, Katherine W; Bowen, Deborah J; Edwards, Karen L

2012-07-01

To determine if awareness of, interest in, and use of direct-to-consumer (DTC) genetic testing is greater in a sample of high-risk individuals (cancer cases and their relatives), compared to controls. Participants were recruited from the Northwest Cancer Genetics Network. A follow-up survey was mailed to participants to assess DTC genetic testing awareness, interest, and use. One thousand two hundred sixty-seven participants responded to the survey. Forty-nine percent of respondents were aware of DTC genetic testing. Of those aware, 19% indicated interest in obtaining and <1% reported having used DTC genetic testing. Additional information supplied by respondents who reported use of DTC genetic tests indicated that 55% of these respondents likely engaged in clinical genetic testing, rather than DTC genetic testing. Awareness of DTC genetic testing was greater in our sample of high-risk individuals than in controls and population-based studies. Although interest in and use of these tests among cases in our sample were equivalent to other population-based studies, interest in testing was higher among relatives and people who self-referred for a registry focused on cancer than among cases and controls. Additionally, our results suggest that there may be some confusion about what constitutes DTC genetic testing.

Model-based Assessment for Balancing Privacy Requirements and Operational Capabilities

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

Knirsch, Fabian; Engel, Dominik; Frincu, Marc

2015-02-17

The smart grid changes the way energy is produced and distributed. In addition both, energy and information is exchanged bidirectionally among participating parties. Therefore heterogeneous systems have to cooperate effectively in order to achieve a common high-level use case, such as smart metering for billing or demand response for load curtailment. Furthermore, a substantial amount of personal data is often needed for achieving that goal. Capturing and processing personal data in the smart grid increases customer concerns about privacy and in addition, certain statutory and operational requirements regarding privacy aware data processing and storage have to be met. An increasemore » of privacy constraints, however, often limits the operational capabilities of the system. In this paper, we present an approach that automates the process of finding an optimal balance between privacy requirements and operational requirements in a smart grid use case and application scenario. This is achieved by formally describing use cases in an abstract model and by finding an algorithm that determines the optimum balance by forward mapping privacy and operational impacts. For this optimal balancing algorithm both, a numeric approximation and – if feasible – an analytic assessment are presented and investigated. The system is evaluated by applying the tool to a real-world use case from the University of Southern California (USC) microgrid.« less

The impact of CMSA's case management adherence guidelines and guidelines training on case manager-reported behavior change.

PubMed

Aliotta, Sherry L; Boling, Jeanne; Commander, Connie; Day, David; Greenberg, Liza; Lattimer, Cheri; Marshall, Danielle; Rogers, Susan A

2007-01-01

The Case Management Society of America (CMSA) developed evidence-based guidelines (Case Management Adherence Guidelines, CMAG) for case managers to support increased efficacy of case managers in helping patients become more adherent to medication regimens. The effort was in response to documented high levels of nonadherence, and evidence demonstrating that lack of adherence negatively impacts patient health status. The CMSA engaged in a massive training program to support case manager adoption of the CMAG tools and approaches to improve patient knowledge and motivation. This article reports on findings of a follow-up survey that evaluated case manager's use of the tools and strategies discussed in the CMAG. Seven hundred fifty case managers from all settings were trained in the use of the CMAG. In a follow-up survey, 42% of respondents reported that there has been a very, or fairly, significant impact of using their new skills to increase their effectiveness in helping patients reach their outcome improvement goals. In addition, 43% reported that there has been a very, or fairly, big improvement in patient adherence since they took the training, while 39% did not see a major impact. At the time of the survey (up to 1 year after training), 43% of respondents indicated that the training was very valuable; another 39% reported that it was fairly valuable. Participants continue to use the skills and information adopted in the training sessions: 26% report that they currently use at least some of the information and skills very often, while another 49% use them fairly often. Sixty-six percent of respondents indicated that they specifically use motivational interviewing to help address patient knowledge and motivation regarding medication adherence. Medication adherence is a key issue in case management practice; efforts to positively impact low patient knowledge and motivation can be frustration for case managers. The CMAG offer evidence-based assessment tools to evaluate patient knowledge of medications and their motivation to adhere, and recommend the strategy of motivational interviewing to help case managers address adherence more effectively with patients. A 1-time training on the CMAG and motivational interviewing had some effect on self-reported case manager effectiveness in addressing medication adherence. Case managers appreciated the training; many reported that they continue to use skills and that they have observed changes in patient outcomes. Additional training, skill building, and reinforcement may help case managers apply CMAG and motivational interviewing effectively to support patients' adherence to medication regimens. The CMSA may continue to evaluate the impact of the CMAG and CMAG training to refine the tools and the training approach.

Beyond PubMed: Searching the "Grey Literature" for Clinical Trial Results.

PubMed

Citrome, Leslie

2014-07-01

Clinical trial results have been traditionally communicated through the publication of scholarly reports and reviews in biomedical journals. However, this dissemination of information can be delayed or incomplete, making it difficult to appraise new treatments, or in the case of missing data, evaluate older interventions. Going beyond the routine search of PubMed, it is possible to discover additional information in the "grey literature." Examples of the grey literature include clinical trial registries, patent databases, company and industrywide repositories, regulatory agency digital archives, abstracts of paper and poster presentations on meeting/congress websites, industry investor reports and press releases, and institutional and personal websites.

Hedgehogs and sugar gliders: respiratory anatomy, physiology, and disease.

PubMed

Johnson, Dan H

2011-05-01

This article discusses the respiratory anatomy, physiology, and disease of African pygmy hedgehogs (Atelerix albiventris) and sugar gliders (Petaurus breviceps), two species commonly seen in exotic animal practice. Where appropriate, information from closely related species is mentioned because cross-susceptibility is likely and because these additional species may also be encountered in practice. Other body systems and processes are discussed insofar as they relate to or affect respiratory function. Although some topics, such as special senses, hibernation, or vocalization, may seem out of place, in each case the information relates back to respiration in some important way. Copyright © 2011 Elsevier Inc. All rights reserved.

Dual-energy contrast-enhanced mammography.

PubMed

Travieso Aja, M M; Rodríguez Rodríguez, M; Alayón Hernández, S; Vega Benítez, V; Luzardo, O P

2014-01-01

The degree of vascularization in breast lesions is related to their malignancy. For this reason, functional diagnostic imaging techniques have become important in recent years. Dual-energy contrast-enhanced mammography is a new, apparently promising technique in breast cancer that provides information about the degree of vascularization of the lesion in addition to the morphological information provided by conventional mammography. This article describes the state of the art for dual-energy contrast-enhanced mammography. Based on 15 months' clinical experience, we illustrate this review with clinical cases that allow us to discuss the advantages and limitations of this technique. Copyright © 2014 SERAM. Published by Elsevier Espana. All rights reserved.

[Forensic Analysis of 6 Cases of Sudden Death due to Hyperthyroid Heart Disease].

PubMed

Zhang, M Z; Li, B X; Zhao, R; Guan, D W; Zhang, G H; Wu, X; Zhu, B L; Li, R B

2017-10-01

To analyse the cases of sudden death due to hyperthyroid heart disease, and explore the general information of deaths and the forensic pathological characteristics to provide reference evidence for forensic identification of such cases. Six cases of sudden death due to hyperthyroid heart disease between 2001 and 2016 were selected from School of Forensic Medicine, China Medical University. The general information （gender and age）, clinical manifestations, medical history, anatomical and histopathological findings, biochemical parameters and cause of death were analysed retrospectively. Most of the 6 patients had definite history of hyperthyroidism, and they all showed certain degrees of symptoms of cardiovascular disease; had obvious incentive factors of death; histopathological examination of thyroid conformed to the performances of diffuse toxic goiter; with increase of cardiac weight, dilatation of cardiac chambers, myocardial hypertrophy and focal necrosis; postmortem biochemical analyses of pericardial fluid could be used as an additional method for diagnostic of sudden death due to hyperthyroid heart disease. The identification of death due to hyperthyroid heart disease should be based on the clinical history and the results of autopsy, histopathological examination, postmortem toxicology tests. The postmortem biochemical detection of thyroid and cardiac function should be performed if necessary. Copyright© by the Editorial Department of Journal of Forensic Medicine

A qualitative study of the prodrome to first-episode major depressive disorder in adolescents.

PubMed

Syed Sheriff, Rebecca J; McGorry, Patrick D; Cotton, Sue; Yung, Alison R

2015-01-01

Currently, we lack a clear picture of the evolution of major depressive disorder (MDD) in adolescents. The period of disturbance preceding MDD can be conceptualised as the prodrome. The aim of the study was to explore the prodrome of first-episode MDD retrospectively in a group of help-seeking adolescents using qualitative methodologies. Consecutively referred adolescents (15-18 years of age) with first-episode MDD were recruited for this study from Orygen Youth Health, Melbourne, Vic., Australia. After using quantitative methodologies to confirm the index episode of MDD and measure the extent of recovery, the prodrome was investigated in depth using qualitative techniques. Twenty-nine adolescents (20 females and 9 males) and 7 informants (6 mothers and 1 grandmother) participated. All 29 participants had a prodrome of varying lengths (between 6 days and 4 years). The most noticeable symptoms initially were perplexity and confusion and, thereafter, sadness and irritability. A common pattern was a reduction in their ability to fulfil their role accompanied by guilt, self-blame and reduced self-esteem. Around half of the participants had increased thoughts of suicide and increased anxiety. There were gender differences in the patterns of symptoms noticed, with males more commonly noticing a change in how they related to the world and females more commonly noticing a change in the way that they related to others. All informants noticed a prodrome of varying lengths; in 2 cases longer, in 2 cases shorter and in 3 cases around the same time period as that noticed by the participant. The changes most commonly noticed by informants were sadness, upset, irritability and reduced self-esteem. The symptoms were fewer in number and sometimes varied from those noticed by the adolescents themselves. Whilst we recognise that this study is vulnerable to autobiographical bias, we took all reasonable measures to minimise this. Symptoms not included in the diagnostic criteria for depression were the earliest changes noticed by the adolescents themselves and are, therefore, potentially important in informing prevention strategies, as is the finding that there are gender differences in the patterns of changes noticed. In addition, parents may provide an additional avenue to help seeking.

Informed consent comprehension and recollection in adult dental patients: A systematic review.

PubMed

Moreira, Narjara Conduru Fernandes; Pachêco-Pereira, Camila; Keenan, Louanne; Cummings, Greta; Flores-Mir, Carlos

2016-08-01

Patients' ability to recollect and comprehend treatment information plays a fundamental role in their decision making. The authors considered original studies assessing recollection or comprehension of dental informed consent in adults. The authors searched 6 electronic databases and partial gray literature and hand searched and cross-checked reference lists published through April 2015. The authors assessed the risk of bias in the included studies via different validated tools according to the study design. Nineteen studies were included: 5 randomized clinical trials, 8 cross-sectional studies, 3 qualitative studies, 2 mixed-methods studies, and 1 case series. Conventional informed consent processes yielded comprehension results of 27% to 85% and recollection of 20% to 86%, whereas informed consent processes enhanced by additional media ranged from 44% to 93% for comprehension and from 30% to 94% for recollection. Patient self-reported understanding ranged positively, with most patients feeling that they understood all or almost all the information presented. Results of qualitative data analyses indicated that patients did not always understand explanations, although dentists thought they did. Some patients firmly stated that they did not receive any related information. Only a few patients were able to remember complications related to their treatment options. Results of this systematic review should alert dentists that although patients in general report that they understand information given to them, they may have limited comprehension. Additional media may improve conventional informed consent processes in dentistry in a meaningful way. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

Optimal management program for asbestos containing building materials to be available in the event of a disaster.

PubMed

Kim, Young-Chan; Hong, Won-Hwa

2017-06-01

The safe management and disposal of asbestos is a matter of considerable importance. A large number of studies have been undertaken to quantify the issue of waste management following a disaster. Nevertheless, there have been few (if any) studies concerning asbestos waste, covering the amount generated, the cost of disposal, and the degree of hazard incurred. Thus, the current study focuses on developing a program for the management of Asbestos Containing Building Materials (ACBMs), which form the source of asbestos waste in the event of a disaster. The study will also discuss a case study undertaken in a specific region in Korea in terms of: (1) the location of ACBM-containing buildings; (2) types and quantities of ACBMs; (3) the cost of ACBM disposal; (4) the amount of asbestos fiber present during normal times and during post-disaster periods; (5) the required order in which ACBM-containing buildings should be dismantled; and (6) additional greenhouse gases generated during ACBM removal. The case study will focus on a specific building, with an area of 35.34m 2 , and will analyze information concerning the abovementioned points. In addition, the case study will focus on a selected area (108 buildings) and the administrative district (21,063 buildings). The significance of the program can be established by the fact that it visibly transmits information concerning ACBM management. It is a highly promising program, with a widespread application for the safe management and optimal disposal of asbestos in terms of technology, policy, and methodology. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prediction of true test scores from observed item scores and ancillary data.

PubMed

Haberman, Shelby J; Yao, Lili; Sinharay, Sandip

2015-05-01

In many educational tests which involve constructed responses, a traditional test score is obtained by adding together item scores obtained through holistic scoring by trained human raters. For example, this practice was used until 2008 in the case of GRE(®) General Analytical Writing and until 2009 in the case of TOEFL(®) iBT Writing. With use of natural language processing, it is possible to obtain additional information concerning item responses from computer programs such as e-rater(®). In addition, available information relevant to examinee performance may include scores on related tests. We suggest application of standard results from classical test theory to the available data to obtain best linear predictors of true traditional test scores. In performing such analysis, we require estimation of variances and covariances of measurement errors, a task which can be quite difficult in the case of tests with limited numbers of items and with multiple measurements per item. As a consequence, a new estimation method is suggested based on samples of examinees who have taken an assessment more than once. Such samples are typically not random samples of the general population of examinees, so that we apply statistical adjustment methods to obtain the needed estimated variances and covariances of measurement errors. To examine practical implications of the suggested methods of analysis, applications are made to GRE General Analytical Writing and TOEFL iBT Writing. Results obtained indicate that substantial improvements are possible both in terms of reliability of scoring and in terms of assessment reliability. © 2015 The British Psychological Society.

Maximum likelihood estimation for Cox's regression model under nested case-control sampling.

PubMed

Scheike, Thomas H; Juul, Anders

2004-04-01

Nested case-control sampling is designed to reduce the costs of large cohort studies. It is important to estimate the parameters of interest as efficiently as possible. We present a new maximum likelihood estimator (MLE) for nested case-control sampling in the context of Cox's proportional hazards model. The MLE is computed by the EM-algorithm, which is easy to implement in the proportional hazards setting. Standard errors are estimated by a numerical profile likelihood approach based on EM aided differentiation. The work was motivated by a nested case-control study that hypothesized that insulin-like growth factor I was associated with ischemic heart disease. The study was based on a population of 3784 Danes and 231 cases of ischemic heart disease where controls were matched on age and gender. We illustrate the use of the MLE for these data and show how the maximum likelihood framework can be used to obtain information additional to the relative risk estimates of covariates.

Invasive Group A Streptococcal Infection in Older Adults in Long-term Care Facilities and the Community, United States, 1998–20031

PubMed Central

Richards, Chesley L.; Lynfield, Ruth; Barrett, Nancy L.; Harrison, Lee H.; Arnold, Kathryn E.; Reingold, Arthur; Bennett, Nancy M.; Craig, Allen S.; Gershman, Ken; Cieslak, Paul R.; Lewis, Paige; Greene, Carolyn M.; Beall, Bernard; Van Beneden, Chris A.

2007-01-01

Limited information exists on the incidence and characteristics of invasive group A streptococcal (GAS) infections among residents of long-term care facilities (LTCFs). We reviewed cases of invasive GAS infections occurring among persons >65 years of age identified through active, population-based surveillance from 1998 through 2003. We identified 1,762 invasive GAS cases among persons >65 years, including 1,662 with known residence type (LTCF or community). Incidence of invasive GAS infection among LTCF residents compared to community-based elderly was 41.0 versus 6.9 cases per 100,000 population. LTCF case-patients were 1.5 times as likely to die from the infection as community-based case-patients (33% vs. 21%, p<0.01) but were less often hospitalized (90% vs. 95%, p<0.01). In multivariate logistic regression modeling, LTCF residence remained an independent predictor of death. Additional prevention strategies against GAS infection in this high-risk population are urgently needed. PMID:18258035

Simpson-Golabi-Behmel syndrome in a female: A case report and an unsolved issue.

PubMed

Vaisfeld, Alessandro; Pomponi, Maria Grazia; Pietrobono, Roberta; Tabolacci, Elisabetta; Neri, Giovanni

2017-01-01

Simpson-Golabi-Behmel syndrome is an X-linked recessive overgrowth condition caused by alterations in GPC3 gene, encoding for the cell surface receptor glypican 3, whose clinical manifestations in affected males are well known. Conversely, there is little information regarding affected females, with very few reported cases, and a clinical definition of this phenotype is still lacking. In the present report we describe an additional case, the first to receive a primary molecular diagnosis based on strong clinical suspicion. Possible explanations for full clinical expression of X-linked recessive conditions in females include several mechanisms, such as skewed X inactivation or homozygosity/compound heterozygosity of the causal mutation. Both of these were excluded in our case. Given that the possibility of full expression of SGBS in females is now firmly established, we recommend that GPC3 analysis be performed in all suggestive female cases. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

An 'inflammatory' variant of solar purpura: a simulant of leukocytoclastic vasculitis and neutrophilic dermatoses.

PubMed

Wood, Benjamin A; LeBoit, Philip E

2013-08-01

To study the clinical and pathological features of cases of apparent solar purpura, with attention to the recently described phenomenon of inflammatory changes within otherwise typical lesions. We studied 95 cases diagnosed as solar purpura and identified 10 cases (10.5%) in which significant neutrophilic inflammation was present, potentially simulating a leukocytoclastic vasculitis or neutrophilic dermatosis. An additional three cases were identified in subsequent routine practice. The clinical features, including follow-up for subsequent development of vasculitis and histological features were studied. In all cases the histological features were typical of solar purpura, with the exception of inflammatory changes, typically associated with clefting of elastotic stroma. Clinical follow-up information was available for all patients and none developed subsequent evidence of a cutaneous or systemic vasculitis or neutrophilic dermatosis. Inflammatory changes appear to be more frequent in solar purpura than is generally recognised. Awareness of this histological variation and correlation with the clinical findings and evolution is important in avoiding misdiagnosis.

[Managing and identifying the causes of IUGR].

PubMed

Salomon, L J; Malan, V

2013-12-01

The management and identification of the causes for a small for gestational age (SGA) and/or an intrauterine growth restriction (IUGR) fetus is a common but complex problem in Obstetrics. The Medline, Embase and the Cochrane Library databases were examined over the last 15 years, with no language restrictions, using a combination of the words PAG (SGA), IUGR (IUGR), fetal weight (Fetal weight), sonography (ultrasound), management, cause (etiology), examinations (examinations). Some references not selected by this strategy, but associated with these publications or suggested by members of the working group were also added. The relevant articles were used to establish the text of recommendation following discussion between experts of the working group. Once the diagnosis of SGA is raised (whether on clinical, echocardiographic or Doppler), a management strategy to look for potential causes must be proposed and discussed with parents (Expert reviews). The extent of additional explorations varies depending on the exact presentation of the case (term at diagnosis, severity of anomalies). Additional explorations only make sense if they are likely to change the management of the current pregnancy and particularly to reduce perinatal morbidity and mortality. Explorations have two main objectives: (i) assess fetal vitality and possibilities for continuing the pregnancy in terms of safety for the mother and the foetus; (ii) establish the origin of SGA. The latter is detailed in this chapter recommendation. The earlier and the more severe the biometric anomalies, the more comprehensive the investigations. Maternal symptoms or fetal Doppler anomalies also require urgent management. Explorations to establish the origin of SGA and/or IUGR must follow a rigorous and systematic approach. In all cases, the practitioner will provide clear information to parents and collect information including detailed clinical and ultrasound examinations. Additional tests and in particular fetal invasive testing must be performed in some cases after parental consent and according to clinical and sonographic guidance elements. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Computer-Aided System Engineering and Analysis (CASE/A) Programmer's Manual, Version 5.0

NASA Technical Reports Server (NTRS)

Knox, J. C.

1996-01-01

The Computer Aided System Engineering and Analysis (CASE/A) Version 5.0 Programmer's Manual provides the programmer and user with information regarding the internal structure of the CASE/A 5.0 software system. CASE/A 5.0 is a trade study tool that provides modeling/simulation capabilities for analyzing environmental control and life support systems and active thermal control systems. CASE/A has been successfully used in studies such as the evaluation of carbon dioxide removal in the space station. CASE/A modeling provides a graphical and command-driven interface for the user. This interface allows the user to construct a model by placing equipment components in a graphical layout of the system hardware, then connect the components via flow streams and define their operating parameters. Once the equipment is placed, the simulation time and other control parameters can be set to run the simulation based on the model constructed. After completion of the simulation, graphical plots or text files can be obtained for evaluation of the simulation results over time. Additionally, users have the capability to control the simulation and extract information at various times in the simulation (e.g., control equipment operating parameters over the simulation time or extract plot data) by using "User Operations (OPS) Code." This OPS code is written in FORTRAN with a canned set of utility subroutines for performing common tasks. CASE/A version 5.0 software runs under the VAX VMS(Trademark) environment. It utilizes the Tektronics 4014(Trademark) graphics display system and the VTIOO(Trademark) text manipulation/display system.

Ranking streamflow model performance based on Information theory metrics

NASA Astrophysics Data System (ADS)

Martinez, Gonzalo; Pachepsky, Yakov; Pan, Feng; Wagener, Thorsten; Nicholson, Thomas

2016-04-01

The accuracy-based model performance metrics not necessarily reflect the qualitative correspondence between simulated and measured streamflow time series. The objective of this work was to use the information theory-based metrics to see whether they can be used as complementary tool for hydrologic model evaluation and selection. We simulated 10-year streamflow time series in five watersheds located in Texas, North Carolina, Mississippi, and West Virginia. Eight model of different complexity were applied. The information-theory based metrics were obtained after representing the time series as strings of symbols where different symbols corresponded to different quantiles of the probability distribution of streamflow. The symbol alphabet was used. Three metrics were computed for those strings - mean information gain that measures the randomness of the signal, effective measure complexity that characterizes predictability and fluctuation complexity that characterizes the presence of a pattern in the signal. The observed streamflow time series has smaller information content and larger complexity metrics than the precipitation time series. Watersheds served as information filters and and streamflow time series were less random and more complex than the ones of precipitation. This is reflected the fact that the watershed acts as the information filter in the hydrologic conversion process from precipitation to streamflow. The Nash Sutcliffe efficiency metric increased as the complexity of models increased, but in many cases several model had this efficiency values not statistically significant from each other. In such cases, ranking models by the closeness of the information-theory based parameters in simulated and measured streamflow time series can provide an additional criterion for the evaluation of hydrologic model performance.

Geostatistical interpolation of hourly precipitation from rain gauges and radar for a large-scale extreme rainfall event

NASA Astrophysics Data System (ADS)

Haberlandt, Uwe

2007-01-01

SummaryThe methods kriging with external drift (KED) and indicator kriging with external drift (IKED) are used for the spatial interpolation of hourly rainfall from rain gauges using additional information from radar, daily precipitation of a denser network, and elevation. The techniques are illustrated using data from the storm period of the 10th to the 13th of August 2002 that led to the extreme flood event in the Elbe river basin in Germany. Cross-validation is applied to compare the interpolation performance of the KED and IKED methods using different additional information with the univariate reference methods nearest neighbour (NN) or Thiessen polygons, inverse square distance weighting (IDW), ordinary kriging (OK) and ordinary indicator kriging (IK). Special attention is given to the analysis of the impact of the semivariogram estimation on the interpolation performance. Hourly and average semivariograms are inferred from daily, hourly and radar data considering either isotropic or anisotropic behaviour using automatic and manual fitting procedures. The multivariate methods KED and IKED clearly outperform the univariate ones with the most important additional information being radar, followed by precipitation from the daily network and elevation, which plays only a secondary role here. The best performance is achieved when all additional information are used simultaneously with KED. The indicator-based kriging methods provide, in some cases, smaller root mean square errors than the methods, which use the original data, but at the expense of a significant loss of variance. The impact of the semivariogram on interpolation performance is not very high. The best results are obtained using an automatic fitting procedure with isotropic variograms either from hourly or radar data.

From climate model ensembles to climate change impacts and adaptation: A case study of water resource management in the southwest of England

NASA Astrophysics Data System (ADS)

Lopez, Ana; Fung, Fai; New, Mark; Watts, Glenn; Weston, Alan; Wilby, Robert L.

2009-08-01

The majority of climate change impacts and adaptation studies so far have been based on at most a few deterministic realizations of future climate, usually representing different emissions scenarios. Large ensembles of climate models are increasingly available either as ensembles of opportunity or perturbed physics ensembles, providing a wealth of additional data that is potentially useful for improving adaptation strategies to climate change. Because of the novelty of this ensemble information, there is little previous experience of practical applications or of the added value of this information for impacts and adaptation decision making. This paper evaluates the value of perturbed physics ensembles of climate models for understanding and planning public water supply under climate change. We deliberately select water resource models that are already used by water supply companies and regulators on the assumption that uptake of information from large ensembles of climate models will be more likely if it does not involve significant investment in new modeling tools and methods. We illustrate the methods with a case study on the Wimbleball water resource zone in the southwest of England. This zone is sufficiently simple to demonstrate the utility of the approach but with enough complexity to allow a variety of different decisions to be made. Our research shows that the additional information contained in the climate model ensemble provides a better understanding of the possible ranges of future conditions, compared to the use of single-model scenarios. Furthermore, with careful presentation, decision makers will find the results from large ensembles of models more accessible and be able to more easily compare the merits of different management options and the timing of different adaptation. The overhead in additional time and expertise for carrying out the impacts analysis will be justified by the increased quality of the decision-making process. We remark that even though we have focused our study on a water resource system in the United Kingdom, our conclusions about the added value of climate model ensembles in guiding adaptation decisions can be generalized to other sectors and geographical regions.

Methodologies for the Statistical Analysis of Memory Response to Radiation

NASA Astrophysics Data System (ADS)

Bosser, Alexandre L.; Gupta, Viyas; Tsiligiannis, Georgios; Frost, Christopher D.; Zadeh, Ali; Jaatinen, Jukka; Javanainen, Arto; Puchner, Helmut; Saigné, Frédéric; Virtanen, Ari; Wrobel, Frédéric; Dilillo, Luigi

2016-08-01

Methodologies are proposed for in-depth statistical analysis of Single Event Upset data. The motivation for using these methodologies is to obtain precise information on the intrinsic defects and weaknesses of the tested devices, and to gain insight on their failure mechanisms, at no additional cost. The case study is a 65 nm SRAM irradiated with neutrons, protons and heavy ions. This publication is an extended version of a previous study [1].

Community Relations Plan: Galena Airport and Campion Air Force Station, Alaska

DTIC Science & Technology

1994-11-11

toxic 0k Corporations that are not wastes at any facility listed or proposed for incorporated for the specific listing on the NPL and where site work ... working toward for awarding a TAG, and how to obtain incorporation under state laws. additional information are described. The Applications are...for similar work in the area. Notification Procedures and In special cases, where an applicant Evaluation Criteria group intends to apply for a single

Outsourcing Human Security: The Pros and Cons of Private Security Companies in Peacekeeping

DTIC Science & Technology

2013-03-01

collection of information is estimated to average 1 hour per response, including the time for reviewing instruction, searching existing data sources ... heavy economic reliance on the UN to pay these troop contributing countries (TCCs) for their troops.38 Additionally, states such as India and...review primary and secondary source data developed and acquired through case studies, government and UN records, and research on PSCs and their shifting

Transforming Executive Fire Officers-A Paradigm Shift to Meet the Intelligence Needs of the 21st Century Fire Service

DTIC Science & Technology

2010-09-01

the non-police public. Additionally, inclusion will have positive returns by generating political support in the best- case scenario. Conversely, an...is challenged to adapt its practices, policies and strategic objectives if it is to maintain the highest state of operational readiness. Inclusion of...readiness. Inclusion of firefighters into the information and intelligence- sharing framework will require a systemic transformation by both the fire

Foxfire 2: Ghost Stories, Spring Wild Plant Foods, Spinning and Weaving, Midwifing, Burial Customs, Corn Shuckin's, Wagon Making and More Affairs of Plain Living.

ERIC Educational Resources Information Center

Wigginton, Eliot, Ed.

Information about the rural Appalachian culture as told by longtime residents of Rabun Gap County, Georgia, is presented in this book. In many cases the material is in the words of the resident and additional commentary is provided by the high school student conducting the interview. Instructions are given for making items often made at home when…

Public Perception on Disaster Management Using Volunteered Geographic Information (vgi): Case of Uae

NASA Astrophysics Data System (ADS)

Yagoub, M. M.

2015-10-01

The number of smart phones that are supported by location facility like Global Positioning System (GPS), Camera and connected to the internet has increased sharply in UAE during the last five years. This increase offers a chance to capitalize on using these devices as resources for data collection, therefore reducing cost. In many cases specific events may happen in areas or at time where there may be no governmental departments to collect such unrepeated events. The current research will showcase various studies that had been conducted on Volunteered Geographic Information (VGI) debating various aspects such as accuracy, legal issues, and privacy. This research will also integrate Geographic Information System (GIS), VGI, social media tools, data mining, and mobile technology to design a conceptual framework for promoting public participation in UAE. The data gathered through survey will be helpful in correlating various aspects of VGI. Since there are diverse views about these aspects, policy makers are left undecided in many countries about how to deal with VGI. The assessment of the UAE case will contribute to the age-long debate by examining the willingness of the public to participate. The result will show the public perception to be as sensors for data collection. Additionally, the potential of citizen involvement in the risk and disaster management process by providing voluntary data collected for VGI applications will also be explored in the paper.

Flexible patient information search and retrieval framework: pilot implementation

NASA Astrophysics Data System (ADS)

Erdal, Selnur; Catalyurek, Umit V.; Saltz, Joel; Kamal, Jyoti; Gurcan, Metin N.

2007-03-01

Medical centers collect and store significant amount of valuable data pertaining to patients' visit in the form of medical free-text. In addition, standardized diagnosis codes (International Classification of Diseases, Ninth Revision, Clinical Modification: ICD9-CM) related to those dictated reports are usually available. In this work, we have created a framework where image searches could be initiated through a combination of free-text reports as well as ICD9 codes. This framework enables more comprehensive search on existing large sets of patient data in a systematic way. The free text search is enriched by computer-aided inclusion of additional search terms enhanced by a thesaurus. This combination of enriched search allows users to access to a larger set of relevant results from a patient-centric PACS in a simpler way. Therefore, such framework is of particular use in tasks such as gathering images for desired patient populations, building disease models, and so on. As the motivating application of our framework, we implemented a search engine. This search engine processed two years of patient data from the OSU Medical Center's Information Warehouse and identified lung nodule location information using a combination of UMLS Meta-Thesaurus enhanced text report searches along with ICD9 code searches on patients that have been discharged. Five different queries with various ICD9 codes involving lung cancer were carried out on 172552 cases. Each search was completed under a minute on average per ICD9 code and the inclusion of UMLS thesaurus increased the number of relevant cases by 45% on average.

Business logic for geoprocessing of distributed geodata

NASA Astrophysics Data System (ADS)

Kiehle, Christian

2006-12-01

This paper describes the development of a business-logic component for the geoprocessing of distributed geodata. The business logic acts as a mediator between the data and the user, therefore playing a central role in any spatial information system. The component is used in service-oriented architectures to foster the reuse of existing geodata inventories. Based on a geoscientific case study of groundwater vulnerability assessment and mapping, the demands for such architectures are identified with special regard to software engineering tasks. Methods are derived from the field of applied Geosciences (Hydrogeology), Geoinformatics, and Software Engineering. In addition to the development of a business logic component, a forthcoming Open Geospatial Consortium (OGC) specification is introduced: the OGC Web Processing Service (WPS) specification. A sample application is introduced to demonstrate the potential of WPS for future information systems. The sample application Geoservice Groundwater Vulnerability is described in detail to provide insight into the business logic component, and demonstrate how information can be generated out of distributed geodata. This has the potential to significantly accelerate the assessment and mapping of groundwater vulnerability. The presented concept is easily transferable to other geoscientific use cases dealing with distributed data inventories. Potential application fields include web-based geoinformation systems operating on distributed data (e.g. environmental planning systems, cadastral information systems, and others).

[Pathological form in breast cancer: setting and evaluation of a professional pratice].

PubMed

Barré, Maxime; Classe, Jean-Marc; Dravet, François; Dupré, Pierre-François; Loussouarn, Delphine; Toquet, Claire; Sagan, Christine

2009-06-01

According to national recommendations, the surgical oncologic specimens addressed to a pathology department must have the required clinical information. The objectives of this study are to evaluate the quality of filling out a pathology form used in breast pathology, to specify the nonconformity consequences on breast management, on histology report and to define modes of action in order to obtain an increase in the number of correct pathology forms. It is a prospective study on pathology forms transmitted with tumorectomy for cancers or microcalcifications filled out by three surgeons from the 1st October, 2004 to the 31st April, 2005. Two hundred and fifty-nine pathology forms were analyzed. There were not correctly filled out in a third of the cases. Nonconformity concerns only one preset information in 69% of pathology forms and is variable according to the surgeons (14 to 31%). The chapters least informed are "lesion" and "type of surgery". These nonconformities involve additional work for the pathologist either because the missing information must be found or because the specimen management must be modified. The prefilled pathology form is a guarantee of quality control. In our study, in 70% of cases, they are accurate. To improve this conformity rate, quality improvement plans must be implemented.

Resolving the Azimuthal Ambiguity in Vector Magnetogram Data with the Divergence-Free Condition: Theoretical Examination

NASA Technical Reports Server (NTRS)

Crouch, A.; Barnes, G.

2008-01-01

We demonstrate that the azimuthal ambiguity that is present in solar vector magnetogram data can be resolved with line-of-sight and horizontal heliographic derivative information by using the divergence-free property of magnetic fields without additional assumptions. We discuss the specific derivative information that is sufficient to resolve the ambiguity away from disk center, with particular emphasis on the line-of-sight derivative of the various components of the magnetic field. Conversely, we also show cases where ambiguity resolution fails because sufficient line-of-sight derivative information is not available. For example, knowledge of only the line-of-sight derivative of the line-of-sight component of the field is not sufficient to resolve the ambiguity away from disk center.

Thermal Injuries in Veterinary Forensic Pathology.

PubMed

Wohlsein, P; Peters, M; Schulze, C; Baumgärtner, W

2016-09-01

Localized thermal injuries in animals may be caused by exposure to fire and radiant heat, contact with hot items including hot liquids or steam, inhalation of hot air, and exposure to cold temperatures. In addition, animal fire victims may have intoxications caused by smoke gas. This article reviews the causes, pathogenetic aspects, morphological findings, additional investigations, differential diagnoses, and causes of death in various forms of thermal injuries. Since these cases do not occur frequently in diagnostic pathology, they represent a challenging task in general but also with respect to forensic or criminal aspects, such as whether a lesion represents an accidental or nonaccidental effect. Besides detailed information about the circumstances at the location, thermal injuries in animals require a thorough morphological evaluation, including additional investigations in conjunction with a profound knowledge about the possible lesion spectrum and suitable additional investigations. © The Author(s) 2016.

Mumps Outbreak in a Highly Vaccinated University-Affiliated Setting Before and After a Measles-Mumps-Rubella Vaccination Campaign-Iowa, July 2015-May 2016.

PubMed

Shah, Minesh; Quinlisk, Patricia; Weigel, Andrew; Riley, Jacob; James, Lisa; Patterson, James; Hickman, Carole; Rota, Paul A; Stewart, Rebekah; Clemmons, Nakia; Kalas, Nicholas; Cardemil, Cristina

2018-01-06

In response to a mumps outbreak at the University of Iowa and surrounding community, university, state, and local health officials implemented a vaccination campaign targeting students <25 years of age with an additional dose of measles-mumps-rubella (MMR) vaccine. More than 4700 vaccine campaign doses were administered; 97% were documented third doses. We describe the epidemiology of the outbreak before and after the campaign, focusing on cases in university students. Mumps cases were identified from reportable disease databases and university health system records. Detailed information on student cases was obtained from interviews, medical chart abstractions, university and state vaccination records, and state public health laboratory results. Pre- and postcampaign incidence among students, university faculty/staff, and community members <25 vs ≥25 years old were compared using Fisher exact test. Multivariable regression modeling was performed to identify variables associated with a positive mumps polymerase chain reaction test. Of 453 cases in the county, 301 (66%) occurred in university students. Student cases were primarily undergraduates (90%) and highly vaccinated (86% had 2 MMR doses, and 12% had 3 MMR doses). Fewer cases occurred in students after the campaign (75 [25%]) than before (226 [75%]). Cases in the target group (students <25 years of age) declined 9% postcampaign (P=.01). A positive mumps polymerase chain reaction test was associated with the presence of parotitis and early sample collection, and inversely associated with recent receipt of MMR vaccine. Following a large additional dose MMR vaccination campaign, fewer mumps cases occurred overall and in the target population. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Is the biggest security threat to medical information simply a lack of understanding?

PubMed

Williams, Patricia A H

2011-01-01

Connecting Australian health services and the e-health initiative is a major focus in the current health environment. Many issues are presented as key to its success including solving issues with confidentiality and privacy. However, the main problem may not be these issues in sharing information but the fact that the point of origin of such records is still relatively insecure. This paper highlights why this may be the case. Research into the security of medical information has shown that many primary healthcare providers are unable to create an environment with effective information security. Numerous factors contribute to this complex situation including a trustful environment, the resultant security culture and the capability of individual healthcare organisations. Further, the growing importance of new directions in the use of patient information is considered. This paper discusses these issues and positions them within the complex environment that is healthcare. In our current health system infrastructure, the points of origin of patient information are our most vulnerable. This entwined with progressively new uses of this information expose additional security concerns, such as re-identification of information, that require attention.

Factors leading to the involvement of Forensic Advisors in the Belgian criminal justice system.

PubMed

Bitzer, Sonja

2018-04-01

Forensic Advisors at the National Institute for Criminalistics and Criminology in Brussels act as advising body to the magistrate regarding analytical possibilities and the usefulness of trace analysis in a case. Initially, their function was devised to assist in complex murder cases with unknown offender. However, in a previous study, the increasing diversity of the cases they are requested for has been observed (Bitzer et al., in press). In order to deepen our understanding of the decision steps in the criminal investigation process, the decision to involve a Forensic Advisor and the factors leading to their involvement were evaluated. The study focused on homicide, robbery and burglary cases with and without requests for a Forensic Advisor between January 2014 and June 2016. The factors were categorised into five knowledge dimensions: strategic, immediate, physical, criminal and utility. Decision tree modelling was carried out in order to identify the factors influencing the request for a Forensic Advisor in the case. The decision to request a Forensic Advisor differs between different types of offences. It also depends on the complexity of the case in terms of the number of traces and objects collected at the crime scene, and the availability of witness reports. Indeed, Forensic Advisors take the role of trace analysis coordinator by providing an overview of all available traces, objects, analyses and results. According to the principal implication factors and the performed case study, the contribution of Forensic Advisors consists mainly in summarising all information and advise on potential additional analyses. This might be explained by a loss of overview of the information and the possibilities regarding trace analysis by the magistrate responsible of the case. Copyright © 2018 Elsevier B.V. All rights reserved.

Contrast-enhanced postmortem computed tomography in clinical pathology: enhanced value of 20 clinical autopsies.

PubMed

Westphal, Saskia E; Apitzsch, Jonas C; Penzkofer, Tobias; Kuhl, Christiane K; Mahnken, Andreas H; Knüchel, Ruth

2014-09-01

Postmortem computed tomography (PMCT) is a modern tool that complements autopsy diagnostics. In clinical autopsies, a major cause of death is cardiovascular disease. To improve the performance of PMCT in cardiovascular disease, full body angiography was developed (PMCT angiography [PMCTA]). Twenty PMCTA scans generated before autopsy were compared with native PMCT and clinical autopsy. The objective of the study was to quantify the additional diagnostic value of adding angiography to native imaging and to compare PMCT and PMCTA findings to autopsy findings. The diagnosis of the cause of death was identical or overlapped in 80% of the cases that used PMCTA and 70% that used PMCT. The additional diagnostic yield given by PMCT and PMCTA in combination with autopsy was 55%. PMCT yielded additional diagnoses in the musculoskeletal system. The greatest additional diagnostic value of PMCTA was in association with cardiovascular diagnoses. The accuracy of PMCTA for cardiac causes of death was 80%, and the positive predictive value was 90%. The findings indicate that native PMCT cannot display the cardiovascular system sufficiently clearly for high-quality diagnostic assessment. However, PMCTA is a powerful tool in autopsy cases with a history of cardiovascular disease and/or a suspected cardiovascular cause of death. The combination of PMCTA and clinical autopsy enhances diagnostic quality and completeness of the autopsy report. Furthermore, in cases without consent or with a restricted consent for clinical autopsy, PMCTA has the potential to provide information on cardiovascular causes of death. Copyright © 2014 Elsevier Inc. All rights reserved.

Data Albums: An Event Driven Search, Aggregation and Curation Tool for Earth Science

NASA Technical Reports Server (NTRS)

Ramachandran, Rahul; Kulkarni, Ajinkya; Maskey, Manil; Bakare, Rohan; Basyal, Sabin; Li, Xiang; Flynn, Shannon

2014-01-01

One of the largest continuing challenges in any Earth science investigation is the discovery and access of useful science content from the increasingly large volumes of Earth science data and related information available. Approaches used in Earth science research such as case study analysis and climatology studies involve gathering discovering and gathering diverse data sets and information to support the research goals. Research based on case studies involves a detailed description of specific weather events using data from different sources, to characterize physical processes in play for a specific event. Climatology-based research tends to focus on the representativeness of a given event, by studying the characteristics and distribution of a large number of events. This allows researchers to generalize characteristics such as spatio-temporal distribution, intensity, annual cycle, duration, etc. To gather relevant data and information for case studies and climatology analysis is both tedious and time consuming. Current Earth science data systems are designed with the assumption that researchers access data primarily by instrument or geophysical parameter. Those who know exactly the datasets of interest can obtain the specific files they need using these systems. However, in cases where researchers are interested in studying a significant event, they have to manually assemble a variety of datasets relevant to it by searching the different distributed data systems. In these cases, a search process needs to be organized around the event rather than observing instruments. In addition, the existing data systems assume users have sufficient knowledge regarding the domain vocabulary to be able to effectively utilize their catalogs. These systems do not support new or interdisciplinary researchers who may be unfamiliar with the domain terminology. This paper presents a specialized search, aggregation and curation tool for Earth science to address these existing challenges. The search tool automatically creates curated "Data Albums", aggregated collections of information related to a specific science topic or event, containing links to relevant data files (granules) from different instruments; tools and services for visualization and analysis; and information about the event contained in news reports, images or videos to supplement research analysis. Curation in the tool is driven via an ontology based relevancy ranking algorithm to filter out non-relevant information and data.

Performance Measurement of Location Enabled e-Government Processes: A Use Case on Traffic Safety Monitoring

NASA Astrophysics Data System (ADS)

Vandenbroucke, D.; Vancauwenberghe, G.

2016-12-01

The European Union Location Framework (EULF), as part of the Interoperable Solutions for European Public Administrations (ISA) Programme of the EU (EC DG DIGIT), aims to enhance the interactions between governments, businesses and citizens by embedding location information into e-Government processes. The challenge remains to find scientific sound and at the same time practicable approaches to estimate or measure the impact of location enablement of e-Government processes on the performance of the processes. A method has been defined to estimate process performance in terms of variables describing the efficiency, effectiveness, as well as the quality of the output of the work processes. A series of use cases have been identified, corresponding to existing e-Government work processes in which location information could bring added value. In a first step, the processes are described by means of BPMN (Business Process Model and Notation) to better understand the process steps, the actors involved, the spatial data flows, as well as the required input and the generated output. In a second step the processes are assessed in terms of the (sub-optimal) use of location information and the potential enhancement of the process by better integrating location information and services. The process performance is measured ex ante (before using location enabled e-Government services) and ex-post (after the integration of such services) in order to estimate and measure the impact of location information. The paper describes the method for performance measurement and highlights how the method is applied to one use case, i.e. the process of traffic safety monitoring. The use case is analysed and assessed in terms of location enablement and its potential impact on process performance. The results of applying the methodology on the use case revealed that performance is highly impacted by factors such as the way location information is collected, managed and shared throughout the process, and the degree to which spatial data are harmonized. The work led also to the formulation of some recommendations to enrich the BPMN standard with additional methods for annotating processes, and to the proposal of the development of some tools for automatic process performance. In that context some planned future work is highlighted as well.

ERP implementation in rural health care.

PubMed

Trimmer, Kenneth J; Pumphrey, Lela D; Wiggins, Carla

2002-01-01

Enterprise resource planning (ERP) systems provide organizations with the opportunity to integrate individual, functionally-oriented information systems. Although much of the focus in the popular press has been placed on ERP systems in large for-profit organizations, small hospitals and clinics are candidates for ERP systems. Focusing information systems on critical success factors (CSFs) allows the organization to address a limited number of areas associated with performance. This limited number of factors can provide management with an insight into dimensions of information that must be addressed by a system. Focuses on CSFs for small health-care organizations. In addition, also considers factors critical to the implementation of health-care information systems. Presents two cases. The results indicate support for the continuing use of CSFs to help focus on the benefits of ERPs. Focusing on groups of tangible and intangible benefits can also assist the rural health-care organization in the use of ERPs.

Ethical principles of informed consent: exploring nurses' dual role of care provider and researcher.

PubMed

Judkins-Cohn, Tanya M; Kielwasser-Withrow, Kiersten; Owen, Melissa; Ward, Jessica

2014-01-01

This article describes the ethical principles of autonomy, beneficence, and justice within the nurse researcher-participant relationship as these principles relate to the informed consent process for research. Within this process, the nurse is confronted with a dual role. This article describes how nurses, who are in the dual role of care provider and researcher, can apply these ethical principles to their practice in conjunction with the American Nurses Association's code of ethics for nurses. This article also describes, as an element of ethical practice, the importance of using participant-centered quality measures to aid informed decision making of participants in research. In addition, the article provides strategies for improving the informed consent process in nursing research. Finally, case scenarios are discussed, along with the application of ethical principles within the awareness of the dual role of the nurse as care provider and researcher. Copyright 2014, SLACK Incorporated.

Value of Flat-detector Computed Tomography Angiography with Intravenous Contrast Media Injection in the Evaluation and Treatment of Acutely Ruptured Aneurysms of the AcomA complex: A Single Center Experience in 15 Cases.

PubMed

Rösch, Julie; Lang, Stefan; Gölitz, Philipp; Kallmünzer, Bernd; Rössler, Karl; Doerfler, Arnd; Struffert, Tobias

2017-05-05

To illustrate the added value of flat-detector computed tomography angiography with intravenous contrast media injection (intravenous FDCTA) in the evaluation of complex A1/A2/AcomA aneurysms. We retrospectively reviewed 15 patients with ruptured aneurysms. In each patient, an intravenous FDCTA was performed and its diagnostic value investigated. In all patients, FDCTA contributed relevant additional information concerning the anatomy of the A1/A2/AcomA complex and the relationship of the aneurysm neck to these vascular structures, which could not be gained by 2D- and 3D-DSA, and changed the management in 33% of the patients (5 out of 15). In an additional 5 cases, knowledge of the detailed anatomy was helpful to plan the exact stent position. In case of complex A1/A2/AcomA aneurysms, intravenous FDCTA is an effective option to visualize the exact location of the aneurysm neck and the relationship between the aneurysm and the adjacent vessels. Thus, it is of significant added value in the precise planning of a therapeutic strategy.

A parametric shell analysis of the shuttle 51-L SRB AFT field joint

NASA Technical Reports Server (NTRS)

Davis, Randall C.; Bowman, Lynn M.; Hughes, Robert M., IV; Jackson, Brian J.

1990-01-01

Following the Shuttle 51-L accident, an investigation was conducted to determine the cause of the failure. Investigators at the Langley Research Center focused attention on the structural behavior of the field joints with O-ring seals in the steel solid rocket booster (SRB) cases. The shell-of-revolution computer program BOSOR4 was used to model the aft field joint of the solid rocket booster case. The shell model consisted of the SRB wall and joint geometry present during the Shuttle 51-L flight. A parametric study of the joint was performed on the geometry, including joint clearances, contact between the joint components, and on the loads, induced and applied. In addition combinations of geometry and loads were evaluated. The analytical results from the parametric study showed that contact between the joint components was a primary contributor to allowing hot gases to blow by the O-rings. Based upon understanding the original joint behavior, various proposed joint modifications are shown and analyzed in order to provide additional insight and information. Finally, experimental results from a hydro-static pressurization of a test rocket booster case to study joint motion are presented and verified analytically.

Economic impact of stimulated technological activity. Part 3: Case study, knowledge additions and earth links from space crew systems

NASA Technical Reports Server (NTRS)

1971-01-01

A case study of knowledge contributions from the crew life support aspect of the manned space program is reported. The new information needed to be learned, the solutions developed, and the relation of new knowledge gained to earthly problems were investigated. Illustrations are given in the following categories: supplying atmosphere for spacecraft; providing carbon dioxide removal and recycling; providing contaminant control and removal; maintaining the body's thermal balance; protecting against the space hazards of decompression, radiation, and meteorites; minimizing fire and blast hazards; providing adequate light and conditions for adequate visual performance; providing mobility and work physiology; and providing adequate habitability.

Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia

PubMed Central

McCarthy, Caroline; Brady, Paul; O'Halloran, Ken D.; McCreary, Christine

2016-01-01

Hyperventilation can be a manifestation of anxiety that involves abnormally fast breathing (tachypnea) and an elevated minute ventilation that exceeds metabolic demand. This report describes a case of hyperventilation-induced hypocapnia resulting in tetany in a 16-year-old girl undergoing orthodontic extractions under intravenous conscious sedation. Pulse oximetry is the gold standard respiratory-related index in conscious sedation. Although the parameter has great utility in determining oxygen desaturation, it provides no additional information on respiratory function, including, for example, respiratory rate. In this case, we found capnography to be a very useful aid to monitor respiration in this patient and also to treat the hypocapnia. PMID:26866408

A case of pulmonary and hepatic cystic Echinococcosis of CE1 stage in a healthy Japanese female that was suspected to have been acquired during her stay in the United Kingdom.

PubMed

Nakamura, Kiwamu; Ito, Akira; Yara, Satomi; Haranaga, Shusaku; Hibiya, Kenji; Hirayasu, Tsuneo; Sako, Yasuhito; Fujita, Jiro

2011-09-01

We herein report a case of a young Japanese female who was confirmed to have cystic echinococcosis (CE) 1 stage based on the World Health Organization Informal Working Group on Echinococcosis pathological classification of CE, and she was also suspected to be infected with eggs of the G1 Echinococcus granulosus sensu stricto during her stay in the United Kingdom and therefore, suffered from synchronous pulmonary and hepatic CE. Oral albendazole was administered initially, but rupture of a lung hydatid cyst was observed. To avoid additional rupture, we performed two surgeries. CE is very rare in Japan; all CE cases in Japan during the past two decades have been confirmed to be imported, and almost all cases are hepatic CE. This case is the first case report of a Japanese patient who had concomitant giant lung and liver CE with early-stage CE1 and was successfully treated by surgery and pharmacotherapy with a serological follow-up.

Investigation of crew performance in a multi-vehicle supervisory control task

NASA Technical Reports Server (NTRS)

Miller, R. A.; Plamondon, B. D.; Jagacinski, R. J.; Kirlik, A. C.

1986-01-01

Crew information processing and decision making in a supervisory control task which is loosely based on the mission of future generation helicopters is measured and represented. Subjects control the motion and activities of their own vehicle and direct the activities of four additional craft. The task involves searching an uncertain environment for cargo and enemies, returning cargo to home base and destroying enemies while attempting to avoid destruction of the scout and the supervised vehicles. A series of experiments with two-person crews and one-person crews were performed. Resulting crew performance was modeled with the objective of describing and understanding the information processing strategies utilized. Of particular interest are problem simplification strategies under time stress and high work load, simplification and compensation in the one-person cases, crew coordination in the two-person cases, and the relationship between strategy and errors in all cases. The results should provide some insight into the effective use of aids, particularly aids based on artificial intelligence, for similar tasks. The simulation is described which is used for the study and some preliminary results from the first two-person crew study are discussed.

Twelve tips for creating trigger images for problem-based learning cases.

PubMed

Azer, Samy A

2007-03-01

A trigger is the starting point of problem-based learning (PBL) cases. It is usually in the form of 5-6 text lines that provide the key information about the main character (usually the patient), including 3-4 of patient's presenting problems. In addition to the trigger text, most programs using PBL include a visual trigger. This might be in the form of a single image, a series of images, a video clip, a cartoon, or even one of the patient's investigation results (e.g. chest X-ray, pathology report, or urine sample analysis). The main educational objectives of the trigger image are as follows: (1) to introduce the patient to the students; (2) to enhance students' observation skills; (3) to provide them with new information to add to the cues obtained from the trigger text; and (4) to stimulate students to ask questions as they develop their enquiry plan. When planned and delivered effectively, trigger images should be engaging and stimulate group discussion. Understanding the educational objectives of using trigger images and choosing appropriate images are the keys for constructing successful PBL cases. These twelve tips highlight the key steps in the successful creation of trigger images.

[Increased incidence of mumps orchitis in adolescence and adulthood--sequelae of low vaccination rate?].

PubMed

Siemer, S W; Uder, M; Scholz, M; Steffens, J; Jeanelle, J P; Humke, U

1997-09-01

In recent years, mumps orchitis has become a rarely reported disease. However, since October 1994 a clear increase in the incidence of this disease has been observed. At four hospitals in the Saarland, Germany, 45 cases of mumps orchitis in adolescents and adults were diagnosed in this period. In addition to the case history and clinical findings, the diagnosis was confirmed by an increased IgM titer. None of the patients had been previously vaccinated. The main reason for this was a lack of parental knowledge of the necessity for this vaccination, one which has almost no side effects. The goal of this study is to describe the disease, present our own results, and indicate the need for vaccination. In addition to providing information, a further aim of the study is to increase the motivation of adolescents and adults for vaccination. Although many treatments for mumps have been published in recent years, the most successful therapy is still prophylactic vaccination.

Pathogenic Germline Variants in 10,389 Adult Cancers.

PubMed

Huang, Kuan-Lin; Mashl, R Jay; Wu, Yige; Ritter, Deborah I; Wang, Jiayin; Oh, Clara; Paczkowska, Marta; Reynolds, Sheila; Wyczalkowski, Matthew A; Oak, Ninad; Scott, Adam D; Krassowski, Michal; Cherniack, Andrew D; Houlahan, Kathleen E; Jayasinghe, Reyka; Wang, Liang-Bo; Zhou, Daniel Cui; Liu, Di; Cao, Song; Kim, Young Won; Koire, Amanda; McMichael, Joshua F; Hucthagowder, Vishwanathan; Kim, Tae-Beom; Hahn, Abigail; Wang, Chen; McLellan, Michael D; Al-Mulla, Fahd; Johnson, Kimberly J; Lichtarge, Olivier; Boutros, Paul C; Raphael, Benjamin; Lazar, Alexander J; Zhang, Wei; Wendl, Michael C; Govindan, Ramaswamy; Jain, Sanjay; Wheeler, David; Kulkarni, Shashikant; Dipersio, John F; Reimand, Jüri; Meric-Bernstam, Funda; Chen, Ken; Shmulevich, Ilya; Plon, Sharon E; Chen, Feng; Ding, Li

2018-04-05

We conducted the largest investigation of predisposition variants in cancer to date, discovering 853 pathogenic or likely pathogenic variants in 8% of 10,389 cases from 33 cancer types. Twenty-one genes showed single or cross-cancer associations, including novel associations of SDHA in melanoma and PALB2 in stomach adenocarcinoma. The 659 predisposition variants and 18 additional large deletions in tumor suppressors, including ATM, BRCA1, and NF1, showed low gene expression and frequent (43%) loss of heterozygosity or biallelic two-hit events. We also discovered 33 such variants in oncogenes, including missenses in MET, RET, and PTPN11 associated with high gene expression. We nominated 47 additional predisposition variants from prioritized VUSs supported by multiple evidences involving case-control frequency, loss of heterozygosity, expression effect, and co-localization with mutations and modified residues. Our integrative approach links rare predisposition variants to functional consequences, informing future guidelines of variant classification and germline genetic testing in cancer. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Under which conditions, additional monitoring data are worth gathering for improving decision making? Application of the VOI theory in the Bayesian Event Tree eruption forecasting framework

NASA Astrophysics Data System (ADS)

Loschetter, Annick; Rohmer, Jérémy

2016-04-01

Standard and new generation of monitoring observations provide in almost real-time important information about the evolution of the volcanic system. These observations are used to update the model and contribute to a better hazard assessment and to support decision making concerning potential evacuation. The framework BET_EF (based on Bayesian Event Tree) developed by INGV enables dealing with the integration of information from monitoring with the prospect of decision making. Using this framework, the objectives of the present work are i. to propose a method to assess the added value of information (within the Value Of Information (VOI) theory) from monitoring; ii. to perform sensitivity analysis on the different parameters that influence the VOI from monitoring. VOI consists in assessing the possible increase in expected value provided by gathering information, for instance through monitoring. Basically, the VOI is the difference between the value with information and the value without additional information in a Cost-Benefit approach. This theory is well suited to deal with situations that can be represented in the form of a decision tree such as the BET_EF tool. Reference values and ranges of variation (for sensitivity analysis) were defined for input parameters, based on data from the MESIMEX exercise (performed at Vesuvio volcano in 2006). Complementary methods for sensitivity analyses were implemented: local, global using Sobol' indices and regional using Contribution to Sample Mean and Variance plots. The results (specific to the case considered) obtained with the different techniques are in good agreement and enable answering the following questions: i. Which characteristics of monitoring are important for early warning (reliability)? ii. How do experts' opinions influence the hazard assessment and thus the decision? Concerning the characteristics of monitoring, the more influent parameters are the means rather than the variances for the case considered. For the parameters that concern expert setting, the weight attributed to monitoring measurement ω, the mean of thresholds, the economic context and the setting of the decision threshold are very influential. The interest of applying the VOI theory (more precisely the value of imperfect information) in the BET framework was demonstrated as support for helping experts in the setting of the monitoring system or for helping managers to decide the installation of additional monitoring systems. Acknowledgments: This work was carried out in the framework of the project MEDSUV. This project is funded under the call FP7 ENV.2012.6.4-2: Long-term monitoring experiment in geologically active regions of Europe prone to natural hazards: the Supersite concept. Grant agreement n°308665.

Discriminative analysis of lip motion features for speaker identification and speech-reading.

PubMed

Cetingül, H Ertan; Yemez, Yücel; Erzin, Engin; Tekalp, A Murat

2006-10-01

There have been several studies that jointly use audio, lip intensity, and lip geometry information for speaker identification and speech-reading applications. This paper proposes using explicit lip motion information, instead of or in addition to lip intensity and/or geometry information, for speaker identification and speech-reading within a unified feature selection and discrimination analysis framework, and addresses two important issues: 1) Is using explicit lip motion information useful, and, 2) if so, what are the best lip motion features for these two applications? The best lip motion features for speaker identification are considered to be those that result in the highest discrimination of individual speakers in a population, whereas for speech-reading, the best features are those providing the highest phoneme/word/phrase recognition rate. Several lip motion feature candidates have been considered including dense motion features within a bounding box about the lip, lip contour motion features, and combination of these with lip shape features. Furthermore, a novel two-stage, spatial, and temporal discrimination analysis is introduced to select the best lip motion features for speaker identification and speech-reading applications. Experimental results using an hidden-Markov-model-based recognition system indicate that using explicit lip motion information provides additional performance gains in both applications, and lip motion features prove more valuable in the case of speech-reading application.

Act No. 89-487 of 10 July 1989 relating to the prevention of the mistreatment of minors and protection of childhood.

PubMed

1989-01-01

This Act amends the French Family and Social Aid Code to insert provisions designed to prevent the mistreatment of minors. It provides that childhood social aid services are to have the additional objectives of preventing mistreatment and collecting information on the mistreatment of minors and are to inform and sensitize the public at large, as well as concerned persons, about the conditions of mistreated minors. The Act requires the president of each local general council to establish a system for collection of information, require the collaboration of professionals and associations dealing with the protection of the family and children, and notify legal authorities when a minor has or appears to have been mistreated and it is impossible to evaluate the situation or the family refuses to cooperate. The Act also creates a free telephone service to respond at any time of the day to requests for information or advice on minors who are or appear to be mistreated and to convey to the presidents of local general councils information and recommendations about these minors. In addition, all physicians, medical and paramedical personnel, magistrates, teachers, and police are to receive initial and continuing training to allow them to respond to cases of mistreated children and take actions necessary to prevent mistreatment and protect children.

Peril in the market-classification and dosage of species used as anti-diabetics in Lima, Peru

PubMed Central

2013-01-01

Background Peru is what Peruvian anthropologist Lupe Camino calls the “health axis” of the old Central Andean culture area stretching from Ecuador to Bolivia. In particular in the North of the country the traditional use of medicinal dates back as far as the first millennium B.C. Both healers, and the wider population, often buy their medicinal plants in local markets, but there is very little comparative information available about which plants are sold under which vernacular name at any given time, for which indication, and which dosage information and information about side effects is given by vendors. For this study we used two traditionally used species groups “Hercampuri” Gentianella spec. (Gentianaceae) and “Pasuchaca” Geranium spec. (Geraniaceae.), found in the Mercado Aviación in Lima, as small, clearly circumscribed plant group frequently used to treat symptoms of diabetes as a test case to study the taxonomy, indications, dosage, indicated side effects, and additional species used as admixtures and hypothesized that: 1. A wide variety of different species is sold under the same common name, and often several common names exist for one species. 2. There is no consistency in the dosage, or a relationship between dosage and species marketed under one name. 3. However, there is consistency in the knowledge about usage and side effects. Methods Surveys focusing on medicinal plants sold and their properties were conducted at the Mercado Aviación in Lima in December 2012. Vouchers of all specimens were deposited at the National Herbarium of Peru. Results and conclusions Our surveys in Mercado Aviación in Lima yielded four species of Gentianella, two of Geranium, and three additional species from three genera used as common additives that were sold as anti-diabetic. These results indicate that even in case of only a few plant species, used for a very clearly circumscribed application, patients run a considerable risk when purchasing their remedies in the market. The possible side effects in this case are the more serious because diabetes has to be treated long term, and as such the patients are ingesting possible toxic remedies over a long period of time. Much more control, and a much more stringent identification of the material sold in public markets, and entering the global supply chain via internet sales, would be needed. PMID:23718140

Peril in the market-classification and dosage of species used as anti-diabetics in Lima, Peru.

PubMed

Bussmann, Rainer W; Paniagua-Zambrana, Narel; Chamorro, Marinoli Rivas; Moreira, Natalia Molina; del Rosario Cuadros Negri, María Luisa; Olivera, Jose

2013-05-30

Peru is what Peruvian anthropologist Lupe Camino calls the “health axis” of the old Central Andean culture area stretching from Ecuador to Bolivia. In particular in the North of the country the traditional use of medicinal dates back as far as the first millennium B.C. Both healers, and the wider population, often buy their medicinal plants in local markets, but there is very little comparative information available about which plants are sold under which vernacular name at any given time, for which indication, and which dosage information and information about side effects is given by vendors. For this study we used two traditionally used species groups “Hercampuri” Gentianella spec. (Gentianaceae) and “Pasuchaca” Geranium spec. (Geraniaceae.), found in the Mercado Aviación in Lima, as small, clearly circumscribed plant group frequently used to treat symptoms of diabetes as a test case to study the taxonomy, indications, dosage, indicated side effects, and additional species used as admixtures and hypothesized that: 1. A wide variety of different species is sold under the same common name, and often several common names exist for one species. 2. There is no consistency in the dosage, or a relationship between dosage and species marketed under one name. 3. However, there is consistency in the knowledge about usage and side effects. Surveys focusing on medicinal plants sold and their properties were conducted at the Mercado Aviaciónin Lima in December 2012. Vouchers of all specimens were deposited at the National Herbarium of Peru. Our surveys in Mercado Aviación in Lima yielded four species of Gentianella, two of Geranium, and three additional species from three genera used as common additives that were sold as anti-diabetic. These results indicate that even in case of only a few plant species, used for a very clearly circumscribed application, patients run a considerable risk when purchasing their remedies in the market. The possible side effects in this case are the more serious because diabetes has to be treated long term, and as such the patients are ingesting possible toxic remedies over a long period of time. Much more control, and a much more stringent identification of the material sold in public markets, and entering the global supply chain via internet sales, would be needed.

Practical Stereology Applications for the Pathologist.

PubMed

Brown, Danielle L

2017-05-01

Qualitative histopathology is the gold standard for routine examination of morphological tissue changes in the regulatory or academic environment. The human eye is exceptional for pattern recognition but often cannot detect small changes in quantity. In cases where detection of subtle quantitative changes is critical, more sensitive methods are required. Two-dimensional histomorphometry can provide additional quantitative information and is quite useful in many cases. However, the provided data may not be referent to the entire tissue and, as such, it makes several assumptions, which are sources of bias. In contrast, stereology is design based rather than assumption based and uses stringent sampling methods to obtain accurate and precise 3-dimensional information using geometrical and statistical principles. Recent advances in technology have made stereology more approachable and practical for the pathologist in both regulatory and academic environments. This review introduces pathologists to the basic principles of stereology and walks the reader through some real-world examples for the application of these principles in the workplace.

Use of the Adult Attachment Projective Picture System in an assessment of an adolescent in foster care.

PubMed

Webster, Linda; Joubert, David

2011-01-01

Child maltreatment has been associated with a host of negative outcomes including impaired social relationships (Rogosch, Cicchetti, & Aber, 1995), depression (Toth, Manly, & Cicchetti, 1992), poor self-concept and motivation (Vondra, Barnett, & Cicchetti, 1990), and delinquency and conduct problems (Cook et al., 2005; Grotevant et al., 2006; McCabe, Lucchini, Hough, Yeh, & Hazen, 2005; Ryan & Testa, 2005). An assessment of the mental representation of attachment relationships could offer additional relevant and useful information to the evaluation of youth in foster care, and could inform treatment and placement considerations. The Adult Attachment Projective Picture System (AAP) is a relatively new measure of internal representations of attachment based on the analysis of a set of stimuli designed to systematically activate the attachment system (George, West, & Pettem, 1997). This article considers the use of the AAP with a maltreated adolescent in a clinical setting and uses a case study to illustrate the components of the AAP that are particularly relevant to case conceptualization and interventions.

Bayesian inference for dynamic transcriptional regulation; the Hes1 system as a case study.

PubMed

Heron, Elizabeth A; Finkenstädt, Bärbel; Rand, David A

2007-10-01

In this study, we address the problem of estimating the parameters of regulatory networks and provide the first application of Markov chain Monte Carlo (MCMC) methods to experimental data. As a case study, we consider a stochastic model of the Hes1 system expressed in terms of stochastic differential equations (SDEs) to which rigorous likelihood methods of inference can be applied. When fitting continuous-time stochastic models to discretely observed time series the lengths of the sampling intervals are important, and much of our study addresses the problem when the data are sparse. We estimate the parameters of an autoregulatory network providing results both for simulated and real experimental data from the Hes1 system. We develop an estimation algorithm using MCMC techniques which are flexible enough to allow for the imputation of latent data on a finer time scale and the presence of prior information about parameters which may be informed from other experiments as well as additional measurement error.

Level II scour analysis for Bridge 37, (BRNETH00740037) on Town Highway 74, crossing South Peacham Brook, Barnet, Vermont

USGS Publications Warehouse

Burns, Ronda L.; Severance, Timothy

1997-01-01

Contraction scour for all modelled flows ranged from 15.8 to 22.5 ft. The worst-case contraction scour occurred at the 500-year discharge. Abutment scour ranged from 6.7 to 11.1 ft. The worst-case abutment scour also occurred at the 500-year discharge. Additional information on scour depths and depths to armoring are included in the section titled “Scour Results”. Scoured-streambed elevations, based on the calculated scour depths, are presented in Tables 1 and 2. A cross-section of the scour computed at the bridge is presented in Figure 8. Scour depths were calculated assuming an infinite depth of erosive material and a homogeneous particle-size distribution. Usually, computed scour depths are evaluated in combination with other information including (but not limited to) historical performance during flood events, the geomorphic stability assessment, existing scour protection measures, and the results of the hydraulic analyses. Therefore, scour depths adopted by VTAOT may differ from the computed values documented herein.

Analysis of Factors Associated With Rhytidectomy Malpractice Litigation Cases.

PubMed

Kandinov, Aron; Mutchnick, Sean; Nangia, Vaibhuv; Svider, Peter F; Zuliani, Giancarlo F; Shkoukani, Mahdi A; Carron, Michael A

2017-07-01

This study investigates the financial burden of medical malpractice litigation associated with rhytidectomies, as well as factors that contribute to litigation and poor defendant outcomes, which can help guide physician practices. To comprehensively evaluate rhytidectomy malpractice litigation. Jury verdict and settlement reports related to rhytidectomy malpractice litigations were obtained using the Westlaw Next database. Use of medical malpractice in conjunction with several terms for rhytidectomy, to account for the various procedure names associated with the procedure, yielded 155 court cases. Duplicate and nonrelevant cases were removed, and 89 cases were included in the analysis and reviewed for outcomes, defendant specialty, payments, and other allegations raised in proceedings. Data were collected from November 21, 2015, to December 25, 2015. Data analysis took place from December 25, 2015, to January 20, 2016. A total of 89 cases met our inclusion criteria. Most plaintiffs were female (81 of 88 with known sex [92%]), and patient age ranged from 40 to 76 years (median age, 56 years). Fifty-three (60%) were resolved in the defendant's favor, while the remaining 36 cases (40%) were resolved with either a settlement or a plaintiff verdict payment. The mean payment was $1.4 million. A greater proportion of cases involving plastic surgeon defendants were resolved with payment compared with cases involving defendants with ear, nose, and throat specialty (15 [36%] vs 4 [24%]). The most common allegations raised in litigation were intraoperative negligence (61 [69%]), poor cosmesis or disfigurement (57 [64%]), inadequate informed consent (30 [34%]), additional procedures required (14 [16%]), postoperative negligence (12 [14%]), and facial nerve injury (10 [11%]). Six cases (7%) involved alleged negligence surrounding a "lifestyle-lift" procedure, which tightens or oversews the superficial muscular aponeurosis system layer. In this study, although most cases of rhytidectomy malpractice litigation were resolved in the defendant's favor, cases resulting in payments created substantial financial burden for the defendants. Common factors cited by plaintiffs for pursuing litigation included dissatisfaction with cosmetic outcomes and perceived deficits in informed consent. These factors reinforce the importance of a comprehensive, preoperative informed consent process in which the specific potential risks and outcomes are presented by the surgeon to the patient to limit or avoid postsurgical allegations. Intraoperative negligence and facial nerve injury were significantly more likely to result in poor defendant outcomes. NA.

Using routine diagnostic data as a method of surveillance of arboviral infection in travellers: a comparative analysis with a focus on dengue.

PubMed

Cleton, Natalie; Reusken, Chantal; Murk, Jean-Luc; de Jong, Menno; Reimerink, Johan; van der Eijk, Annemiek; Koopmans, Marion

2014-01-01

In a large part of the developing world, limited infectious disease surveillance is performed. In laboratory information management systems data on diagnostic requests is available and may be amenable to trend analyses. We explored this potential, using DENV diagnostic requests as a model. Test results and anonymised information provided by clinicians were received for 8942 patients from diagnostic centres in the Netherlands from January 2000 to May 2011. The data were evaluated for completeness of a predefined minimal dataset and trends in DENV positive results by travel destination. Population travel data were obtained from a commercial registry, and dengue case notification data by country from WHO DengueNet. Vaccination history was rarely reported (0.4%); travel destination was completed for 42% of requests; trends in diagnostic requests and IgM positive tests for this subset correlated to the WHO DENV notifications for the three main travel destinations, with some discrepancies. Additionally, this approach may provide information on disease outbreaks with other pathogens causing diseases clinically similar to DENV. PCR data proved to be insufficient for trend monitoring by country. This approach is not straightforward, but shows potential for use as a source of additional information for surveillance of disease. Copyright © 2013 Elsevier Ltd. All rights reserved.

An ancestry informative marker set for determining continental origin: validation and extension using human genome diversity panels

PubMed Central

Nassir, Rami; Kosoy, Roman; Tian, Chao; White, Phoebe A; Butler, Lesley M; Silva, Gabriel; Kittles, Rick; Alarcon-Riquelme, Marta E; Gregersen, Peter K; Belmont, John W; De La Vega, Francisco M; Seldin, Michael F

2009-01-01

Background Case-control genetic studies of complex human diseases can be confounded by population stratification. This issue can be addressed using panels of ancestry informative markers (AIMs) that can provide substantial population substructure information. Previously, we described a panel of 128 SNP AIMs that were designed as a tool for ascertaining the origins of subjects from Europe, Sub-Saharan Africa, Americas, and East Asia. Results In this study, genotypes from Human Genome Diversity Panel populations were used to further evaluate a 93 SNP AIM panel, a subset of the 128 AIMS set, for distinguishing continental origins. Using both model-based and relatively model-independent methods, we here confirm the ability of this AIM set to distinguish diverse population groups that were not previously evaluated. This study included multiple population groups from Oceana, South Asia, East Asia, Sub-Saharan Africa, North and South America, and Europe. In addition, the 93 AIM set provides population substructure information that can, for example, distinguish Arab and Ashkenazi from Northern European population groups and Pygmy from other Sub-Saharan African population groups. Conclusion These data provide additional support for using the 93 AIM set to efficiently identify continental subject groups for genetic studies, to identify study population outliers, and to control for admixture in association studies. PMID:19630973

Sharing information among existing data sources

NASA Astrophysics Data System (ADS)

Ashley, W. R., III

1999-01-01

The sharing of information between law enforcement agencies is a premise for the success of all jurisdictions. A wealth of information resides in both the databases and infrastructures of local, state, and regional agencies. However, this information is often not available to the law enforcement professionals who require it. When the information is, available, individual investigators must not only know that it exists, but where it resides, and how to retrieve it. In many cases, these types of cross-jurisdictional communications are limited to personal relationships that result from telephone calls, faxes, and in some cases, e-mail. As criminal elements become more sophisticated and distributed, law enforcement agencies must begin to develop infrastructures and common sharing mechanisms that address a constantly evolving criminal threat. Historically, criminals have taken advantage of the lack of communication between law enforcement agencies. Examples of this are evident in the search for stolen property and monetary dealings. Pawned property, cash transactions, and failure to supply child support are three common cross- jurisdictional crimes that could be better enforced by strengthening the lines of communication. Criminal behavior demonstrates that it is easier to profit from their actions by dealing in separate jurisdictions. For example, stolen property is sold outside of the jurisdiction of its origin. In most cases, simply traveling a short distance to the adjoining county or municipality is sufficient to ensure that apprehension of the criminal or seizure of the stolen property is highly unlikely. In addition to the traditional burglar, fugitives often sell or pawn property to finance their continued evasion from the law. Sharing of information in a rapid manner would increase the ability of law enforcement personnel to track and capture fugitives, as well as criminals. In an example to combat this threat, the State of Florida recently acted on the need to share crucial investigative information across jurisdictional bounds by establishing a communications infrastructure for all of its law enforcement jurisdictions. The Criminal Justice Network (CJ-Net) is a statewide TCP/IP network, dedicated to the sharing of law enforcement information. CJ-Net is managed and maintained by the Florida Department of Law Enforcement (FDLE) and provides open access and privileges to any criminal justice agency, including the state court and penitentiary systems. In addition to Florida, other states, such as North Carolina, are also beginning to implement common protocol communication infrastructures and architectures in order to link local jurisdictions together throughout the state. The law enforcement domain in an optimum situation for information-sharing technologies. Communication infrastructures are continually established, and as such, action is required to effectively use these networks to their full potential. Information technologies that are best suited for the law enforcement domain, must be evaluated and implemented in a cost-effective manner. Unlike the Defense Department and other large federal agencies, individual jurisdictions at both the local and state level cannot afford to expend limited resources on research and development of prototype systems. Therefore, we must identify enabling technologies that have matured in related domains and transition them into law enforcement at a minimum cost. Crucial to this measure, is the selection of the appropriate levels of information-sharing technologies to be inserted. Information-sharing technologies that are unproven or have extensive recurring costs are not suitable for this domain. Information-sharing technologies traditionally exist between two distinct polar bounds: the data warehousing approach and mediation across distributed heterogeneous data sources. These two ends of the spectrum represent extremely different philosophies in accomplishing the same goal. In the following sections of this paper, discussions of information-sharing mechanisms will be addressed and the effectiveness of each is examined for the law enforcement domain. In each case, it is the opinion of the author as to which approach would lend itself to the most appropriate solution to the problem of effectively sharing criminal justice information.

Model Scramjet Inlet Unstart Induced by Mass Addition and Heat Release

NASA Astrophysics Data System (ADS)

Im, Seong-Kyun; Baccarella, Damiano; McGann, Brendan; Liu, Qili; Wermer, Lydiy; Do, Hyungrok

2015-11-01

The inlet unstart phenomena in a model scramjet are investigated at an arc-heated hypersonic wind tunnel. The unstart induced by nitrogen or ethylene jets at low or high enthalpy Mach 4.5 freestream flow conditions are compared. The jet injection pressurizes the downstream flow by mass addition and flow blockage. In case of the ethylene jet injection, heat release from combustion increases the backpressure further. Time-resolved schlieren imaging is performed at the jet and the lip of the model inlet to visualize the flow features during unstart. High frequency pressure measurements are used to provide information on pressure fluctuation at the scramjet wall. In both of the mass and heat release driven unstart cases, it is observed that there are similar flow transient and quasi-steady behaviors of unstart shockwave system during the unstart processes. Combustion driven unstart induces severe oscillatory flow motions of the jet and the unstart shock at the lip of the scramjet inlet after the completion of the unstart process, while the unstarted flow induced by solely mass addition remains relatively steady. The discrepancies between the processes of mass and heat release driven unstart are explained by flow choking mechanism.

Additional Samples: Where They Should Be Located

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

Pilger, G. G., E-mail: jfelipe@ufrgs.br; Costa, J. F. C. L.; Koppe, J. C.

2001-09-15

Information for mine planning requires to be close spaced, if compared to the grid used for exploration and resource assessment. The additional samples collected during quasimining usually are located in the same pattern of the original diamond drillholes net but closer spaced. This procedure is not the best in mathematical sense for selecting a location. The impact of an additional information to reduce the uncertainty about the parameter been modeled is not the same everywhere within the deposit. Some locations are more sensitive in reducing the local and global uncertainty than others. This study introduces a methodology to select additionalmore » sample locations based on stochastic simulation. The procedure takes into account data variability and their spatial location. Multiple equally probable models representing a geological attribute are generated via geostatistical simulation. These models share basically the same histogram and the same variogram obtained from the original data set. At each block belonging to the model a value is obtained from the n simulations and their combination allows one to access local variability. Variability is measured using an uncertainty index proposed. This index was used to map zones of high variability. A value extracted from a given simulation is added to the original data set from a zone identified as erratic in the previous maps. The process of adding samples and simulation is repeated and the benefit of the additional sample is evaluated. The benefit in terms of uncertainty reduction is measure locally and globally. The procedure showed to be robust and theoretically sound, mapping zones where the additional information is most beneficial. A case study in a coal mine using coal seam thickness illustrates the method.« less

Use of retailer fidelity card schemes in the assessment of food additive intake: Sunset Yellow a case study.

PubMed

Sardi, M; Haldemann, Y; Nordmann, H; Bottex, B; Safford, B; Smith, B; Tennant, D; Howlett, J; Jasti, P R

2010-11-01

The feasibility of using a retailer fidelity card scheme to estimate food additive intake was investigated using the Swiss retailer MIGROS's Cumulus Card and the example of the food colour Sunset Yellow (E 110). Information held within the card scheme was used to identify a sample of households purchasing foods containing Sunset Yellow over a 15 day period. A sample of 1204 households was selected for interview, of which 830 households were retained in the study following interview. Interviews were conducted to establish household structure, patterns of consumption by different individuals within the household, and the proportion of foods containing Sunset Yellow habitually purchased at the retailer and/or consumed outside the home. Information provided by the retailer on levels of Sunset Yellow in the foods was combined with the information obtained at interview to calculate the per-capita intake of Sunset Yellow by members of participating households. More than 99% of consumers (n = 1902) of foods containing Sunset Yellow were estimated to consume less than 1 mg Sunset Yellow kg(-1) body weight day(-1). The method proved to be a simple and resource-efficient approach to estimate food additive intake on the basis of actual consumer behaviour and thus reports results more closely related to the actual consumption of foods by individuals.

[Using value of information analysis in decision making about applied research. The case of genetic screening for hemochromatosis in Germany].

PubMed

Rogowski, W H; Grosse, S D; Meyer, E; John, J; Palmer, S

2012-05-01

Public decision makers face demands to invest in applied research in order to accelerate the adoption of new genetic tests. However, such an investment is profitable only if the results gained from further investigations have a significant impact on health care practice. An upper limit for the value of additional information aimed at improving the basis for reimbursement decisions is given by the expected value of perfect information (EVPI). This study illustrates the significance of the concept of EVPI on the basis of a probabilistic cost-effectiveness model of screening for hereditary hemochromatosis among German men. In the present example, population-based screening can barely be recommended at threshold values of 50,000 or 100,000 Euro per life year gained and also the value of additional research which might cause this decision to be overturned is small: At the mentioned threshold values, the EVPI in the German public health care system was ca. 500,000 and 2,200,000 Euro, respectively. An analysis of EVPI by individual parameters or groups of parameters shows that additional research about adherence to preventive phlebotomy could potentially provide the highest benefit. The potential value of further research also depends on methodological assumptions regarding the decision maker's time horizon as well as on scenarios with an impact on the number of affected patients and the cost-effectiveness of screening.

Rare Diseases on the Internet: An Assessment of the Quality of Online Information.

PubMed

Pauer, Frédéric; Litzkendorf, Svenja; Göbel, Jens; Storf, Holger; Zeidler, Jan; Graf von der Schulenburg, Johann-Matthias

2017-01-18

The importance of the Internet as a medium for publishing and sharing health and medical information has increased considerably during the last decade. Nonetheless, comprehensive knowledge and information are scarce and difficult to find, especially for rare diseases. Additionally, the quality of health or medical information about rare diseases is frequently difficult to assess for the patients and their family members. The aim of this study is to assess the quality of information on the Internet about rare diseases. Additionally, the study aims to evaluate if the quality of information on rare diseases varies between different information supplier categories. A total of 13 quality criteria for websites providing medical information about rare diseases were transferred to a self-disclosure questionnaire. Identified providers of information on the Internet about rare diseases were invited to fill out the questionnaire. The questionnaire contained questions about the information provider in general (eg, supplier category, information category, language, use of quality certificates, and target group) and about quality aspects that reflect the 13 quality criteria. Differences in subgroup analyses were performed using t tests. We identified 693 websites containing information about rare diseases. A total of 123 questionnaires (17.7%) were completely filled out by the information suppliers. For the remaining identified suppliers (570/693, 82.3%), the questionnaires were filled out by the authors based on the information available on their website. In many cases, the quality of websites was proportionally low. Furthermore, subgroup analysis showed no statistically significant differences between the quality of information provided by support group/patient organization compared to medical institution (P=.19). The quality of information by individuals (patient/relative) was significantly lower compared to information provided by support group/patient organization (P=.001), medical institution (P=.009), and other associations and sponsoring bodies (P=.001) as well. Overall, the quality of information on the Internet about rare diseases is low. Quality certificates are rarely used and important quality criteria are often not fulfilled completely. Additionally, some information categories are underrepresented (eg, information about psychosocial counseling, social-legal advice, and family planning). Nevertheless, due to the high amount of information provided by support groups, this study shows that these are extremely valuable sources of information for patients suffering from a rare disease and their relatives. ©Frédéric Pauer, Svenja Litzkendorf, Jens Göbel, Holger Storf, Jan Zeidler, Johann-Matthias Graf von der Schulenburg. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.01.2017.

Surgical pathology extradepartmental consultation practices.

PubMed

Azam, Muhammad; Nakhleh, Raouf E

2002-04-01

To document the practice parameters and case characteristics associated with personal (expert) consultations. We also examine the value, level of participant (customer) satisfaction, turnaround time, and rate of personal consultations. We asked participants in the College of American Pathologists' Q-Probes program to document cases sent for consultation during 4 months or up to 20 cases. They documented patient and specimen characteristics, the turnaround times, and the participants' levels of satisfaction with the consultation experience. One hundred eighty laboratories/surgical pathology practices. One hundred seventy-two (95.6%) were from the United States; the remainder were located in Canada and Australia. Rate and turnaround time of consultations and participant level of satisfaction. A total of 2746 consultation cases were examined for an aggregate consultation rate of 0.5% (median, 0.7%). Institutions with a higher occupied bed size and a greater number of surgical pathology cases both had lower consultation rates (P < or =.05). The median turnaround time (defined as the interval from the date on which the case was sent to the date on which the diagnosis was received) was 6 days. Twenty-nine percent and 68% of cases had a turnaround time within 3 and 7 days, respectively. Fifty-two percent of cases were sent to nationally known experts, and 32% were sent to local experts. Skin (18.0%), hematolymphoid (11.6%), and breast (9.6%) specimens were most commonly sent for consultation. In 70.5% of cases, the consultant confirmed the referring pathologist's original diagnosis, but in 15.9% of cases, the consultant also added significant information. Satisfaction rates were higher with faster turnaround times and verbal reporting. Satisfaction rates were lower for cases in which the patient or the clinician requested the consultation and in which the consultant's diagnosis was ambiguous. This study establishes a multi-institutional consultation rate of 0.5%, defines the nature of surgical pathology consultations, and demonstrates that satisfaction with consultations is associated with a faster turnaround time and receipt of additional, clinically meaningful information.

dCITE: Measuring Necessary Cladistic Information Can Help You Reduce Polytomy Artefacts in Trees.

PubMed

Wise, Michael J

2016-01-01

Biologists regularly create phylogenetic trees to better understand the evolutionary origins of their species of interest, and often use genomes as their data source. However, as more and more incomplete genomes are published, in many cases it may not be possible to compute genome-based phylogenetic trees due to large gaps in the assembled sequences. In addition, comparison of complete genomes may not even be desirable due to the presence of horizontally acquired and homologous genes. A decision must therefore be made about which gene, or gene combinations, should be used to compute a tree. Deflated Cladistic Information based on Total Entropy (dCITE) is proposed as an easily computed metric for measuring the cladistic information in multiple sequence alignments representing a range of taxa, without the need to first compute the corresponding trees. dCITE scores can be used to rank candidate genes or decide whether input sequences provide insufficient cladistic information, making artefactual polytomies more likely. The dCITE method can be applied to protein, nucleotide or encoded phenotypic data, so can be used to select which data-type is most appropriate, given the choice. In a series of experiments the dCITE method was compared with related measures. Then, as a practical demonstration, the ideas developed in the paper were applied to a dataset representing species from the order Campylobacterales; trees based on sequence combinations, selected on the basis of their dCITE scores, were compared with a tree constructed to mimic Multi-Locus Sequence Typing (MLST) combinations of fragments. We see that the greater the dCITE score the more likely it is that the computed phylogenetic tree will be free of artefactual polytomies. Secondly, cladistic information saturates, beyond which little additional cladistic information can be obtained by adding additional sequences. Finally, sequences with high cladistic information produce more consistent trees for the same taxa.

dCITE: Measuring Necessary Cladistic Information Can Help You Reduce Polytomy Artefacts in Trees

PubMed Central

2016-01-01

Biologists regularly create phylogenetic trees to better understand the evolutionary origins of their species of interest, and often use genomes as their data source. However, as more and more incomplete genomes are published, in many cases it may not be possible to compute genome-based phylogenetic trees due to large gaps in the assembled sequences. In addition, comparison of complete genomes may not even be desirable due to the presence of horizontally acquired and homologous genes. A decision must therefore be made about which gene, or gene combinations, should be used to compute a tree. Deflated Cladistic Information based on Total Entropy (dCITE) is proposed as an easily computed metric for measuring the cladistic information in multiple sequence alignments representing a range of taxa, without the need to first compute the corresponding trees. dCITE scores can be used to rank candidate genes or decide whether input sequences provide insufficient cladistic information, making artefactual polytomies more likely. The dCITE method can be applied to protein, nucleotide or encoded phenotypic data, so can be used to select which data-type is most appropriate, given the choice. In a series of experiments the dCITE method was compared with related measures. Then, as a practical demonstration, the ideas developed in the paper were applied to a dataset representing species from the order Campylobacterales; trees based on sequence combinations, selected on the basis of their dCITE scores, were compared with a tree constructed to mimic Multi-Locus Sequence Typing (MLST) combinations of fragments. We see that the greater the dCITE score the more likely it is that the computed phylogenetic tree will be free of artefactual polytomies. Secondly, cladistic information saturates, beyond which little additional cladistic information can be obtained by adding additional sequences. Finally, sequences with high cladistic information produce more consistent trees for the same taxa. PMID:27898695

INDUSTRIE 4.0 - Automation in weft knitting technology

NASA Astrophysics Data System (ADS)

Simonis, K.; Gloy, Y.-S.; Gries, T.

2016-07-01

Industry 4.0 applies to the knitting industry. Regarding the knitting process retrofitting activities are executed mostly manually by an operator on the basis on the operator's experience. In doing so, the knitted fabric is not necessarily produced in the most efficient way regarding process speed and fabric quality aspects. The knitting division at ITA is concentrating on project activities regarding automation and Industry 4.0. ITA is working on analysing the correspondences of the knitting process parameters and their influence on the fabric quality. By using e.g. the augmented reality technology, the operator will be supported when setting up the knitting machine in case of product or pattern change - or in case of an intervention when production errors occur. Furthermore, the RFID-Technology offers great possibilities to ensure information flow between sub-processes of the fragmented textile process chain. ITA is using RFID-chips to save yarn production information and connect the information to the fabric producing machine control. In addition, ITA is currently working on integrating image processing systems into the large circular knitting machine in order to ensure online-quality measurement of the knitted fabrics. This will lead to a self-optimizing and selflearning knitting machine.

Effect of information literacy training course on information literacy skills of undergraduate students of Isfahan University of Medical Sciences based on ACRL standards

PubMed Central

Karimi, Zohreh; Ashrafi-rizi, Hasan; Papi, Ahmad; Shahrzadi, Leila; Hassanzadeh, Akbar

2015-01-01

Background: Information literacy is the basis for lifelong learning. Information literacy skills, especially for student in an environment that is full of information from multiple technologies are being developed is equally important. Information literacy is a set of cognitive and practical skills and like any other science, proper training is needed, and standard-based education is definitely better and evaluation would be easier. This study aimed to determine the impact of information literacy training course on information literacy skills of Isfahan University of Medical Sciences students based on ACRL standard in 2012. Materials and Methods: The study method is semi-experience with two group design (with pre-test and post-test) and applied. The data collection toll was a questionnaire assessing student's information literacy that developed by Davarpanah and Siamak and validity was confirmed by professional librarians and reliability as measured by Cronbach's alpha, was 0.83. The sample consisted of 50 undergraduate students from Isfahan University of Medical Sciences that by random sampling method was perch in both case and control groups. Before and after the training (once a week), a questionnaire was distributed between the two groups. This training was held in a classroom equipped with computers with internet access and in addition to training using brochures and librarian presentation, interactive methods such as discussion and exercises were used. The data were analyzed using SPSS version 20 software and two level of descriptive (mean and SD) and inferential statistics (t-test and t-paired). Results: The results showed that the students’ information literacy scores before the training was lower than average, so that in the control group was 32.96 and in the case group was 33.24; while information literacy scores in the case group significantly increased after the training (46.68). Also, the effect of education, respectively had a greater impact on the ability to access information (the second standard), ethics and legal use of information (the third standard), effective use of information (the fourth standard), critically evaluate information and its sources (the fifth standard). Conclusion: This study showed that the training was effective on enhancing students’ information literacy skills as the greatest impact was on increasing the ability to access information. Due to low mean score information literacy in the context of object recognition, there is a need for more training in this area. PMID:27462618

Annual Report to Congress on Foreign Economic Collection and Industrial Espionage, FY 2008

DTIC Science & Technology

2009-07-23

Warcraft —could offer access to information that would be valuable to economic collectors or industrial espionage in the future. The virtual world ...Industrial Espionage, 2007. Economic espionage cases went up slightly and nearly every day brought reports—in the press and in the classified world —of...reports—in the press and in the classified world —of new cyber attacks against US Government and business entities. Additionally, the increasing use of

Military Dog Training Aids: Toxicity and Treatment

DTIC Science & Technology

1989-11-10

current literature may provide additional toxicity information. 7. Treatment Humans: Treatment of the rare case of acute overdose or toxic psychosis from...substitute for heroin and is fentanyl or one of it derivatives. 2. Chemical And Physical Properties Molecular wt. 369.42 Boiling pt. 272 0 C Melting pt...coaiscious, give gastric lavage or emetic. Treat with antidote, Narcan at 0.01 mg/kg IV, in massive overdose of heroin use up to 0.2 mg/kg. 8

Models of Government Blogging: Design Tradeoffs in Civic Engagement

NASA Astrophysics Data System (ADS)

Kavanaugh, Andrea; Kim, Hyung Nam; Pérez-Quiñones, Manuel; Isenhour, Philip

Some local government officials and staff have been experimenting with emerging technologies as part of a broad suite of media used for informing and communicating with their constituencies. In addition to the typical government website and, for some, email exchange with citizens, some town and municipal governments are using blogs, video streaming, pod- casting, and Real Simple Syndication (RSS) to reach constituencies with updates and, in some cases, interaction and discussion between citizens and government.

The Fourth Factor: The Case for Parity of Information as an Operational Factor With Space, Time & Force

DTIC Science & Technology

2008-10-31

problem is devoid of a factor, it incurs additional (and sometimes unacceptable) risk. Operational art exists in an area that inter mingles science ...Operational Art as defined in U.S. Joint Doctrine is an accepted process for use by operational commanders to visualize how to most efficiently and...effectively employ military capabilities to achieve a desired objective. Within Operational Art are three accepted factors in which all other

Remote Sensing of Chaparral Fire Potential: Case Study in Topanga Canyon, California.

DTIC Science & Technology

Remote sensing techniques, especially the use of color infrared aerial photography, provide a useful tool for fire hazard analysis, including interpetive information about fuel volumes, physiognomic plant groupings, the relationships of buildings to both natural and planted vegetation, and fire vulnerability of roofing materials. In addition, the behavior of the September, 1970 Wright Fire in the Topanga study area suggested the validity of the fire potential analysis which had been made prior to that conflagration.

Comparative Study on High-Order Positivity-preserving WENO Schemes

NASA Technical Reports Server (NTRS)

Kotov, Dmitry V.; Yee, Helen M.; Sjogreen, Bjorn Axel

2013-01-01

The goal of this study is to compare the results obtained by non-positivity-preserving methods with the recently developed positivity-preserving schemes for representative test cases. In particular the more di cult 3D Noh and Sedov problems are considered. These test cases are chosen because of the negative pressure/density most often exhibited by standard high-order shock-capturing schemes. The simulation of a hypersonic nonequilibrium viscous shock tube that is related to the NASA Electric Arc Shock Tube (EAST) is also included. EAST is a high-temperature and high Mach number viscous nonequilibrium ow consisting of 13 species. In addition, as most common shock-capturing schemes have been developed for problems without source terms, when applied to problems with nonlinear and/or sti source terms these methods can result in spurious solutions, even when solving a conservative system of equations with a conservative scheme. This kind of behavior can be observed even for a scalar case (LeVeque & Yee 1990) as well as for the case consisting of two species and one reaction (Wang et al. 2012). For further information concerning this issue see (LeVeque & Yee 1990; Griffiths et al. 1992; Lafon & Yee 1996; Yee et al. 2012). This EAST example indicated that standard high-order shock-capturing methods exhibit instability of density/pressure in addition to grid-dependent discontinuity locations with insufficient grid points. The evaluation of these test cases is based on the stability of the numerical schemes together with the accuracy of the obtained solutions.

CardioClassifier: disease- and gene-specific computational decision support for clinical genome interpretation.

PubMed

Whiffin, Nicola; Walsh, Roddy; Govind, Risha; Edwards, Matthew; Ahmad, Mian; Zhang, Xiaolei; Tayal, Upasana; Buchan, Rachel; Midwinter, William; Wilk, Alicja E; Najgebauer, Hanna; Francis, Catherine; Wilkinson, Sam; Monk, Thomas; Brett, Laura; O'Regan, Declan P; Prasad, Sanjay K; Morris-Rosendahl, Deborah J; Barton, Paul J R; Edwards, Elizabeth; Ware, James S; Cook, Stuart A

2018-01-25

PurposeInternationally adopted variant interpretation guidelines from the American College of Medical Genetics and Genomics (ACMG) are generic and require disease-specific refinement. Here we developed CardioClassifier (http://www.cardioclassifier.org), a semiautomated decision-support tool for inherited cardiac conditions (ICCs).MethodsCardioClassifier integrates data retrieved from multiple sources with user-input case-specific information, through an interactive interface, to support variant interpretation. Combining disease- and gene-specific knowledge with variant observations in large cohorts of cases and controls, we refined 14 computational ACMG criteria and created three ICC-specific rules.ResultsWe benchmarked CardioClassifier on 57 expertly curated variants and show full retrieval of all computational data, concordantly activating 87.3% of rules. A generic annotation tool identified fewer than half as many clinically actionable variants (64/219 vs. 156/219, Fisher's P = 1.1  ×  10 -18 ), with important false positives, illustrating the critical importance of disease and gene-specific annotations. CardioClassifier identified putatively disease-causing variants in 33.7% of 327 cardiomyopathy cases, comparable with leading ICC laboratories. Through addition of manually curated data, variants found in over 40% of cardiomyopathy cases are fully annotated, without requiring additional user-input data.ConclusionCardioClassifier is an ICC-specific decision-support tool that integrates expertly curated computational annotations with case-specific data to generate fast, reproducible, and interactive variant pathogenicity reports, according to best practice guidelines.GENETICS in MEDICINE advance online publication, 25 January 2018; doi:10.1038/gim.2017.258.

The incidence and nature of complaints against dentists for the treatment of children in Israel from 1992-2011.

PubMed

Givol, N; Frenkel, T; Tickotsky, N; Moskovitz, M

2015-03-01

Medical literature lacks information about complaints against dentists who treat children. The present study aimed to evaluate the reports filed to Medical Consultant International (MCI) regarding paediatric dentistry in 1992-2011. Most dentists in Israel (85%) are obliged by their professional liability insurance policy to report adverse events to MCI. Reports were analysed using a structured form that included demographic details of the treating dentist, patients and parents, type of treatment, the result and the dentist's attitude. MCI dental consultants' decisions were evaluated by two specialists in paediatric dentistry. The number of complaints per year is increasing. Complaints involved maltreatment (33%), case mismanagement (25%) and complications that required additional treatment (26%). Communication was problematic in 60% of cases. Only 16.7% of complaints developed into an actual lawsuit. Most complaints were against female general practitioners and against dentists who worked in community dental clinics located in peripheral areas. Treating permanent teeth increased to 3.6 times the probability of developing into a lawsuit. 59% of event records had missing data. Seventy-five percent of the cases rose from elective treatments while 25% concerned emergency treatments. One third of the cases required additional treatment in a hospital i.e. abscess drainage, foreign body swallowing or other physical damages. Better case selection and documentation, better training of dentists who treat children and more appropriate attitude toward patients and parents, are likely to reduce the number of complaints.

Asymptomatic and sub-microscopic malaria infection in Kayah State, eastern Myanmar.

PubMed

Zaw, Myo Thiha; Thant, Myo; Hlaing, Tin Maung; Aung, Naing Zin; Thu, Min; Phumchuea, Kanit; Phusri, Kanokwan; Saeseu, Teerawat; Yorsaeng, Ritthideach; Nguitragool, Wang; Felger, Ingrid; Kaewkungwal, Jaranit; Cui, Liwang; Sattabongkot, Jetsumon

2017-04-04

Myanmar has the heaviest burden of malaria in the Greater Mekong Sub-region. Asymptomatic Plasmodium spp. infections are common in this region and may represent an important reservoir of transmission that must be targeted for malaria elimination. A mass blood survey was conducted among 485 individuals from six villages in Kayah State, an area of endemic but low transmission malaria in eastern Myanmar. Malaria infection was screened by rapid diagnostic test (RDT), light microscopy and real-time polymerase chain reaction (PCR), and its association with demographic factors was explored. The prevalence of asymptomatic Plasmodium spp. infection was 2.3% (11/485) by real-time PCR. Plasmodium vivax accounted for 72.7% (8/11) and Plasmodium falciparum for 27.3% (3/11) of infections. Men were at greater risk of infection by Plasmodium spp. than women. Individuals who worked as farmers or wood and bamboo cutters had an increased risk of infection. A combination of RDT, light microscopy and PCR diagnostics were used to identify asymptomatic malaria infection, providing additional information on asymptomatic cases in addition to the routine statistics on symptomatic cases, so as to determine the true burden of disease in the area. Such information and risk factors can improve malaria risk stratification and guide decision-makers towards better design and delivery of targeted interventions in small villages, representative of Kayah State.

Public Attitudes Toward Expanded Newborn Screening.

PubMed

DeLuca, Jane M

There is limited research available on public knowledge and understanding of expanded newborn screening (NBS). The aims of this study were to assess current public knowledge and understanding of newborn screening disorders and procedures, perceived education needs, and preferences for the delivery of NBS information and education. An additional aim was to develop a beginning understanding of public attitudes toward screening for complex, severe, and in some cases untreatable disorders. In this preliminary descriptive study, eighty-eight participants completed surveys querying their general knowledge of NBS, preferred means of receiving NBS information and education, and their opinions about screening for severe disorders such as lysosomal storage diseases (LSD). Most study participants lacked general knowledge about current NBS practices, however, they supported expanding screening for severe and in some cases untreatable conditions. Most participants were enthusiastic about expanding NBS; however, those with more years of education were cautious regarding extensive costs of diagnosing and treating rare disorders. Newborn screening continues to evolve through new technological developments and the addition of more disorders to screening panels. More research of into public acceptance of newborn screening is needed. Addressing the educational needs of the public is important for improving their understanding of NBS and promoting patient-centered care in the era of genomic screening. Enhanced educational efforts are necessary for improving public understanding of newborn screening. Copyright © 2017 Elsevier Inc. All rights reserved.

Great apes are sensitive to prior reliability of an informant in a gaze following task.

PubMed

Schmid, Benjamin; Karg, Katja; Perner, Josef; Tomasello, Michael

2017-01-01

Social animals frequently rely on information from other individuals. This can be costly in case the other individual is mistaken or even deceptive. Human infants below 4 years of age show proficiency in their reliance on differently reliable informants. They can infer the reliability of an informant from few interactions and use that assessment in later interactions with the same informant in a different context. To explore whether great apes share that ability, in our study we confronted great apes with a reliable or unreliable informant in an object choice task, to see whether that would in a subsequent task affect their gaze following behaviour in response to the same informant. In our study, prior reliability of the informant and habituation during the gaze following task affected both great apes' automatic gaze following response and their more deliberate response of gaze following behind barriers. As habituation is very context specific, it is unlikely that habituation in the reliability task affected the gaze following task. Rather it seems that apes employ a reliability tracking strategy that results in a general avoidance of additional information from an unreliable informant.

Availability of information on renal function in Dutch community pharmacies.

PubMed

Koster, Ellen S; Philbert, Daphne; Noordam, Michelle; Winters, Nina A; Blom, Lyda; Bouvy, Marcel L

2016-08-01

Background Early detection and monitoring of impaired renal function may prevent drug related problems. Objective To assess the availability of information on patient's renal function in Dutch community pharmacies, for patients using medication that might need monitoring in case of renal impairment. Methods Per pharmacy, 25 patients aged ≥65 years using at least one drug that requires monitoring, were randomly selected from the pharmacy information system. For these patients, information on renal function [estimated glomerular filtration rate (eGFR)], was obtained from the pharmacy information system. When absent, this information was obtained from the general practitioner (GP). Results Data were collected for 1632 patients. For 1201 patients (74 %) eGFR values were not directly available in the pharmacy, for another 194 patients (12 %) the eGFR value was not up-to-date. For 1082 patients information could be obtained from the GP, resulting in 942 additional recent eGFR values. Finally, recent information on renal function was available for 72 % (n = 1179) of selected patients. Conclusion In patients using drugs that require renal monitoring, information on renal function is often unknown in the pharmacy. For the majority of patients this information can be retrieved from the GP.

Systems biology: the case for a systems science approach to diabetes.

PubMed

Petrasek, Danny

2008-01-01

The unprecedented accumulation of biological data in recent decades has underscored the need to organize and integrate the massive collection of information. In addition, there is rising agreement among biologists that a complete understanding of a single cell will not lead directly to a complete understanding of a system of cells. The success of a systems science approach in engineering and physics may be of great value in the evolution of biological science. This article reviews some examples that suggest the importance of a systems biology approach and, in addition, advance one specific systems science principle, the conservation of uncertainty, which may give insight into the emergent behavior of numerous biological and physiological phenomena.

Cultural Heritage Documentation in SIS Environment: AN Application for "PORTA SIRENA" in the Archaeological Site of Paestum

NASA Astrophysics Data System (ADS)

Pepe, M.; Parente, C.

2017-05-01

The Heritage Documentation allows the monitoring, maintenance and conservation by the most recent, efficient investigation techniques and storage of data. A key role in Heritage Documentation is represented by the Geographic Information Systems (GIS) and Spatial Information System (SIS), thanks to the possibility offered by this instrument not only to connect spatial elements (geographical features) to attribute tables, but also manage various information in the form of raster (terrestrial, aerial and satellite imagery), 3D point clouds, 3D models and other vector data. The paper describes all the activities that lead to the construction of a SIS, especially in relation to the new survey technologies with particular focus at survey performed by Close Range Photogrammetry (CRP). In addition, after explaining the relationships between the different information systems that contribute towards creating of a SIS and the various professions involved, a case study in Paestum area (Italy), showing the efficiency of Spatial Information System (SIS) technology, is discussed.

Qualitative analysis of round-table discussions on the business case and procurement challenges for hospital electronic prescribing systems.

PubMed

Cresswell, Kathrin M; Slee, Ann; Coleman, Jamie; Williams, Robin; Bates, David W; Sheikh, Aziz

2013-01-01

There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making. We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9. We drew on data from 17 participants (approximately eight per roundtable), six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing "wants" and aspirations from organizational "needs". Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management.

Validation of a combined autosomal/Y-chromosomal STR approach for analyzing typical biological stains in sexual-assault cases.

PubMed

Purps, Josephine; Geppert, Maria; Nagy, Marion; Roewer, Lutz

2015-11-01

DNA testing is an established part of the investigation and prosecution of sexual assault. The primary purpose of DNA evidence is to identify a suspect and/or to demonstrate sexual contact. However, due to highly uneven proportions of female and male DNA in typical stains, routine autosomal analysis often fails to detect the DNA of the assailant. To evaluate the forensic efficiency of the combined application of autosomal and Y-chromosomal short tandem repeat (STR) markers, we present a large retrospective casework study of probative evidence collected in sexual-assault cases. We investigated up to 39 STR markers by testing combinations of the 16-locus NGMSElect kit with both the 23-locus PowerPlex Y23 and the 17-locus Yfiler kit. Using this dual approach we analyzed DNA extracts from 2077 biological stains collected in 287 cases over 30 months. To assess the outcome of the combined approach in comparison to stand-alone autosomal analysis we evaluated informative DNA profiles. Our investigation revealed that Y-STR analysis added up to 21% additional, highly informative (complete, single-source) profiles to the set of reportable autosomal STR profiles for typical stains collected in sexual-assault cases. Detection of multiple male contributors was approximately three times more likely with Y-chromosomal profiling than with autosomal STR profiling. In summary, 1/10 cases would have remained inconclusive (and could have been dismissed) if Y-STR analysis had been omitted from DNA profiling in sexual-assault cases. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Multinational outbreak of travel-related Salmonella Chester infections in Europe, summers 2014 and 2015.

PubMed

Fonteneau, Laure; Jourdan Da Silva, Nathalie; Fabre, Laetitia; Ashton, Philip; Torpdahl, Mia; Müller, Luise; Bouchrif, Brahim; El Boulani, Abdellah; Valkanou, Eleni; Mattheus, Wesley; Friesema, Ingrid; Herrera Leon, Silvia; Varela Martínez, Carmen; Mossong, Joël; Severi, Ettore; Grant, Kathie; Weill, François-Xavier; Gossner, Céline M; Bertrand, Sophie; Dallman, Tim; Le Hello, Simon

2017-02-16

Between 2014 and 2015, the European Centre for Disease Prevention and Control was informed of an increase in numbers of Salmonella enterica serotype Chester cases with travel to Morocco occurring in six European countries. Epidemiological and microbiological investigations were conducted. In addition to gathering information on the characteristics of cases from the different countries in 2014, the epidemiological investigation comprised a matched case-case study involving French patients with salmonellosis who travelled to Morocco that year. A univariate conditional logistic regression was performed to quantify associations. The microbiological study included a whole genome sequencing (WGS) analysis of clinical and non-human isolates of S. Chester of varied place and year of isolation. A total of 162 cases, mostly from France, followed by Belgium, the Netherlands, Spain, Denmark and Sweden were reported, including 86 (53%) women. The median age per country ranged from 3 to 38 years. Cases of S. Chester were more likely to have eaten in a restaurant and visited the coast of Morocco. The results of WGS showed five multilocus sequence types (ST), with 96 of 153 isolates analysed clustering into a tight group that corresponded to a novel ST, ST1954. Of these 96 isolates, 46 (48%) were derived from food or patients returning from Morocco and carried two types of plasmids containing either qnrS1 or qnrB19 genes. This European-wide outbreak associated with travel to Morocco was likely a multi-source outbreak with several food vehicles contaminated by multidrug-resistant S. Chester strains. This article is copyright of The Authors, 2017.

Occupational health impact of the 2009 H1N1 flu pandemic: surveillance of sickness absence.

PubMed

Torá-Rocamora, Isabel; Delclos, George L; Martínez, José Miguel; Jardí, Josefina; Alberti, Constança; Manzanera, Rafael; Yasui, Yutaka; Clèries, Ramón; Tobías, Aurelio; Benavides, Fernando G

2012-03-01

Workplace absences due to illness can disrupt usual operations and increase costs for businesses. This study of sickness absence due to influenza and influenza-related illness presents a unique opportunity to characterise and measure the impact of the 2009 (H1N1) pandemic, by comparing trends during the pandemic to those of previous years, and adding this information to that obtained by traditional epidemiological surveillance systems. We compared the numbers of cases of sickness absence due to illness caused by influenza and influenza-related illness in 2007-2009, and in the first 3 months of 2010 in Catalonia (n=811 940) using a time series approach. Trends were examined by economic activity, age and gender. The weekly endemic-epidemic index (EEI) was calculated and its 95% CI obtained with the delta method, with observed and expected cases considered as independent random variables. Influenza activity peaked earlier in 2009 and yielded more cases than in previous years. Week 46 (in November 2009) had the highest number of new cases resulting in sickness absence (EEI 20.99; 95% CI 9.44 to 46.69). Women and the 'education, health and other social activities' sector were the most affected. Results indicate that the new H1N1 pandemic had a significant impact on business, with shifts in the timing of peak incidence, a doubling in the number of cases, and changes in the distribution of cases by economic activity sector and gender. Traditional epidemiological surveillance systems could benefit from the addition of information based on sickness absence data.

Teacher learning from girls' informal science experiences

NASA Astrophysics Data System (ADS)

Birmingham, Daniel J.

School science continues to fail to engage youth from non-dominant communities (Carlone, Huan-Frank & Webb, 2011). However, recent research demonstrates that informal science learning settings support both knowledge gains and increased participation in science among youth from non-dominant communities (Dierking, 2007; Falk et al., 2007; HFRP, 2010). Despite the success, little is known about how teachers can learn from informal science practices to support student engagement in science. In this study, I examine the impact informal science experiences has for the teaching and learning of science in school contexts. This study is focused on eliciting girls' stories of informal science learning experiences and sharing these stories with science teachers to examine what they notice and make meaning of in connection with their classroom practices (van Es & Sherin, 2002). I co-constructed cases of informal science experiences with middle school females who participate in an after school science program in an urban area. These cases consisted of the girls' written stories, their explicit messages to science teachers, examples of actions taken when investigating community based science issues and transcripts of conversations between the girls and researchers. These cases were shared with local science teachers in order to investigate what they "notice" (van Es & Sherin, 2002) regarding girls' participation in informal science learning, how they make meaning of youths' stories and whether the stories influence their classroom practices. I found that the girls' use their cases to share experiences of how, where and why science matters, to express hope for school science and to critique stereotypical views that young, female, students of color from lower SES backgrounds are not interested or capable of making contributions to scientific investigations. Additionally, I found that teachers noticed powerful messages within and across the girls' cases. The messages include; 1) students' desire to be active participants in science investigations, 2) the need to provide spaces for students to leverage their strengths when learning and doing science, 3) the importance of building connections between science and community, and 4) expanding the outcomes of scientific investigations beyond traditional school measures. However, their individual meaning making was influenced by tensions between what they found powerful in the cases, the institutional narratives that often guide practice in schools and the societal and personal narratives connected to participation of girls from non dominant communities in science. Thus, each of the three teachers took different pathways as they implemented new science learning experiences based upon what each found most salient in the girls' stories as well as the influence of institutional, societal and personal narratives, resulting in varied learning experiences for their students.

Beyond PubMed: Searching the “Grey Literature” for Clinical Trial Results

PubMed Central

2014-01-01

Clinical trial results have been traditionally communicated through the publication of scholarly reports and reviews in biomedical journals. However, this dissemination of information can be delayed or incomplete, making it difficult to appraise new treatments, or in the case of missing data, evaluate older interventions. Going beyond the routine search of PubMed, it is possible to discover additional information in the “grey literature.” Examples of the grey literature include clinical trial registries, patent databases, company and industrywide repositories, regulatory agency digital archives, abstracts of paper and poster presentations on meeting/congress websites, industry investor reports and press releases, and institutional and personal websites. PMID:25337445

Telemedicine in Anesthesiology and Reanimatology

PubMed Central

Tafro, Lejla; Masic, Izet

2010-01-01

Review SUMMARY In recent years impressive progress is happening in information and telecommunication technologies. The application of computers in medicine allows permanent data storage, data transfer from one place to another, retrieving and data processing, data availability at all times, monitoring of patients over time, etc. This can significantly improve the medical profession. Medicine is one of the most intensive users of all types of information and telecommunication technology. Quickly and reliably store and transfer data (text, images, sounds, etc.) provides significant assistance and improvement in almost all medical procedures. In addition, data in locations far from medical centers can be of invaluable benefit, especially in emergency cases in which the decisive role has anesthesiologists. PMID:24222933

HMI conventions for process control graphics.

PubMed

Pikaar, Ruud N

2012-01-01

Process operators supervise and control complex processes. To enable the operator to do an adequate job, instrumentation and process control engineers need to address several related topics, such as console design, information design, navigation, and alarm management. In process control upgrade projects, usually a 1:1 conversion of existing graphics is proposed. This paper suggests another approach, efficiently leading to a reduced number of new powerful process graphics, supported by a permanent process overview displays. In addition a road map for structuring content (process information) and conventions for the presentation of objects, symbols, and so on, has been developed. The impact of the human factors engineering approach on process control upgrade projects is illustrated by several cases.

Research participation experiences of informants of suicide and control cases: taken from a case-control psychological autopsy study of people who died by suicide.

PubMed

Wong, Paul W C; Chan, Wincy S C; Beh, Philip S L; Yau, Fiona W S; Yip, Paul S F; Hawton, Keith

2010-01-01

Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. (1) To investigate whether informants of suicide cases recruited by two approaches (coroners' court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. The acceptance rate for our original psychological autopsy study was modest. The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

Box Office Forecasting considering Competitive Environment and Word-of-Mouth in Social Networks: A Case Study of Korean Film Market.

PubMed

Kim, Taegu; Hong, Jungsik; Kang, Pilsung

2017-01-01

Accurate box office forecasting models are developed by considering competition and word-of-mouth (WOM) effects in addition to screening-related information. Nationality, genre, ratings, and distributors of motion pictures running concurrently with the target motion picture are used to describe the competition, whereas the numbers of informative, positive, and negative mentions posted on social network services (SNS) are used to gauge the atmosphere spread by WOM. Among these candidate variables, only significant variables are selected by genetic algorithm (GA), based on which machine learning algorithms are trained to build forecasting models. The forecasts are combined to improve forecasting performance. Experimental results on the Korean film market show that the forecasting accuracy in early screening periods can be significantly improved by considering competition. In addition, WOM has a stronger influence on total box office forecasting. Considering both competition and WOM improves forecasting performance to a larger extent than when only one of them is considered.

Box Office Forecasting considering Competitive Environment and Word-of-Mouth in Social Networks: A Case Study of Korean Film Market

PubMed Central

Kim, Taegu; Hong, Jungsik

2017-01-01

Accurate box office forecasting models are developed by considering competition and word-of-mouth (WOM) effects in addition to screening-related information. Nationality, genre, ratings, and distributors of motion pictures running concurrently with the target motion picture are used to describe the competition, whereas the numbers of informative, positive, and negative mentions posted on social network services (SNS) are used to gauge the atmosphere spread by WOM. Among these candidate variables, only significant variables are selected by genetic algorithm (GA), based on which machine learning algorithms are trained to build forecasting models. The forecasts are combined to improve forecasting performance. Experimental results on the Korean film market show that the forecasting accuracy in early screening periods can be significantly improved by considering competition. In addition, WOM has a stronger influence on total box office forecasting. Considering both competition and WOM improves forecasting performance to a larger extent than when only one of them is considered. PMID:28819355

Expansion Of Sugarcane Production In São Paulo, Brazil: Implications For Fire Occurrence And Respiratory Health

NASA Astrophysics Data System (ADS)

Uriarte, M.

2008-12-01

Recent increases in the price of oil have generated much interest in biofuel development. Despite the increasing demand, the social and environmental impacts of large scale adoption of biofuels at both regional and national scales remain understudied, especially in developing economies. Here we use municipality-level data for the state of São Paulo in Brasil to explore the effects of fires associated with sugarcane cultivation on respiratory health of elderly and children. We examined the effects of fires occurring in the same year in which respiratory cases were reported as well as chronic effects associated with long-term cultivation of sugarcane. Across the state, respiratory morbidity attributable to fires accounted for 113 elderly and 317 child cases, approximately 1.8% of total cases in each group. Although no chronic effects of fire were detected for the elderly group, an additional 650 child cases can be attributed to the long term cultivation of sugar cane increasing to 5.4% the percent of children cases that can be attributed to fire. For municipalities with greater than 50% of the land in sugarcane the percentage increased to 15% and 12 % respectively for elderly and children. An additional 209 child cases could also be attributed to past exposure to fires associated with sugarcane, suggesting that in total 38% of children respiratory cases could be attributed to current or chronic exposure to fires in these municipalities. The harmful effects of cane- associated fires on health are not only a burden for the public health system but also for household economies. This type of information should be incorporated into land use decisions and discussions of biofuel sustainability.

Geothermal Exploration Case Studies on OpenEI (Presentation)

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

Young, K.; Bennett, M.; Atkins, D.

2014-03-01

The U.S. Geological Survey (USGS) resource assessment (Williams et al., 2008) outlined a mean 30 GWe of undiscovered hydrothermal resource in the western United States. One goal of the U.S. Department of Energy's (DOE) Geothermal Technology Office (GTO) is to accelerate the development of this undiscovered resource. DOE has focused efforts on helping industry identify hidden geothermal resources to increase geothermal capacity in the near term. Increased exploration activity will produce more prospects, more discoveries, and more readily developable resources. Detailed exploration case studies akin to those found in oil and gas (e.g. Beaumont and Foster, 1990-1992) will give developersmore » central location for information gives models for identifying new geothermal areas, and guide efficient exploration and development of these areas. To support this effort, the National Renewable Energy Laboratory (NREL) has been working with GTO to develop a template for geothermal case studies on the Geothermal Gateway on OpenEI. In 2012, the template was developed and tested with two case studies: Raft River Geothermal Area (http://en.openei.org/wiki/Raft_River_Geothermal_Area) and Coso Geothermal Area (http://en.openei.org/wiki/Coso_Geothermal_Area). In 2013, ten additional case studies were completed, and Semantic MediaWiki features were developed to allow for more data and the direct citations of these data. These case studies are now in the process of external peer review. In 2014, NREL is working with universities and industry partners to populate additional case studies on OpenEI. The goal is to provide a large enough data set to start conducting analyses of exploration programs to identify correlations between successful exploration plans for areas with similar geologic occurrence models.« less

Bovine tuberculosis slaughter surveillance in the United States 2001–2010: assessment of its traceback investigation function

PubMed Central

2014-01-01

Background The success of tracing cattle to the herd of origin after the detection and confirmation of bovine tuberculosis (TB) lesions in cattle at slaughter is a critical component of the national bovine TB eradication program in the United States (U.S.). The aims of this study were to 1) quantify the number of bovine TB cases identified at slaughter that were successfully traced to their herd of origin in the U.S. during 2001–2010, 2) quantify the number of successful traceback investigations that found additional TB infected animals in the herd of origin or epidemiologically linked herds, and 3) describe the forms of animal identification present on domestic bovine TB cases and their association with traceback success. Results We analyzed 2001–2010 data in which 371 granulomatous lesions were confirmed as bovine TB. From these 114 bovine TB cases, 78 adults (i.e. sexually intact bovines greater than two years of age), and 36 fed (i.e. less than or equal to two years of age) were classified as domestic cattle (U.S. originated). Of these adults and fed cases, 83% and 13% were successfully traced, respectively. Of these traceback investigations, 70% of adult cases and 50% of fed cases identified additional bovine TB infected animals in the herd of origin or an epidemiologically linked herd. We found that the presence of various forms of animal identification on domestic bovine TB cases at slaughter may facilitate successful traceback investigations; however, they do not guarantee it. Conclusions These results provide valuable information with regard to epidemiological traceback investigations and serve as a baseline to aid U.S. officials when assessing the impact of newly implemented strategies as part of the national bovine TB eradication in the U.S. PMID:25123050

How to feed environmental studies with soil information to address SDG 'Zero hunger'

NASA Astrophysics Data System (ADS)

Hendriks, Chantal; Stoorvogel, Jetse; Claessens, Lieven

2017-04-01

As pledged by UN Sustainable Development Goal (SDG) 2, there should be zero hunger, food security, improved food nutrition and sustainable agriculture by 2030. Environmental studies are essential to reach SDG 2. Soils play a crucial role, especially in addressing 'Zero hunger'. This study aims to discuss the connection between the supply and demand of soil data for environmental studies and how this connection can be improved illustrating different methods. As many studies are resource constrained, the options to collect new soil data are limited. Therefore, it is essential to use existing soil information, auxiliary data and collected field data efficiently. Existing soil data are criticised in literature as i) being dominantly qualitative, ii) being often outdated, iii) being not spatially exhaustive, iv) being only available at general scales, v) being inconsistent, and vi) lacking quality assessments. Additional field data can help to overcome some of these problems. Outdated maps can, for example, be improved by collecting additional soil data in areas where changes in soil properties are expected. Existing soil data can also provide insight in the expected soil variability and, as such, these data can be used for the design of sampling schemes. Existing soil data are also crucial input for studies on digital soil mapping because they give information on parent material and the relative age of soils. Digital soil mapping is commonly applied as an efficient method to quantitatively predict the spatial variation of soil properties. However, the efficiency of digital soil mapping may increase if we look at functional soil properties (e.g. nutrient availability, available water capacity) for the soil profile that vary in a two-dimensional space rather than at basic soil properties of individual soil layers (e.g. texture, organic matter content, nitrogen content) that vary in a three-dimensional space. Digital soil mapping techniques are based on statistical relations between soil properties and environmental variables. However, in some cases a more mechanistic approach, based on pedological knowledge, might be more convincing to predict soil properties. This study showed that the soil science community is able to provide the required soil information for environmental studies. However, there is not a single solution that provides the required soil data. Case studies are needed to prove that certain methods meet the data requirements, whereafter these case studies function as a lighthouse to other studies. We illustrate data availability and methodological innovations for a case study in Kenya, where the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS) aims to contribute to SDG 2.

First contribution of mites (Acari) to the forensic analysis of hanged corpses: a case study from Spain.

PubMed

Saloña-Bordas, Marta I; Perotti, M Alejandra

2014-11-01

This case study from North Spain, highlights the importance of the collection of mites in addition to insects, from crime scenes or corpses subjected to environmental constraints that reduce or minimise insect activity, such as hanged corpses. In addition, this analysis highlights the relevance of arthropods' collection in the field, even after the corpse has been moved away for autopsy. Four species of mites, phoretic on carrion (Silphidae) and rove (Staphylinidae) beetles, complemented and reinforced the autopsy analysis as well as the scarce information provided by insect activity. Poecilochirus carabi Canestrini & Canestrini, 1882 and Poecilochirus (Physoparasitus) davydovae Hyatt, 1980 (Mesostigmata: Parasitidae) were found in association with two Silphidae, Nicrophorus Fabricius, 1775 and Necrodes Leach, 1815, only when sampled in the autopsy room; this is suggestive of host-switching of mites and was likely due to the lack of availability of specific carriers in the field. The interpretation of the activity of Parasitidae mites both in the field and the autopsy room allows a better understanding of the timing and circumstances of decomposition. Phoretic deutonymphs of Pelzneria Scheucher 1957 (Astigmata: Histiostomatidae) were highly abundant, mostly P. crenulata Oudemans, 1909 and are reported for the first time on a Staphylinidae rove beetle, Creophilus maxillosus (L., 1758). Surprisingly, in this case study no Pelzneria were associated with the Silphidae found, which are their most common hosts, such as Necrodes littoralis (L., 1758) and Nicrophorus interruptus (Stephens, 1830). All histiostomatids were removed from the staphylinid (rove beetle) collected from the soil, at the scene of death, suggesting a recent arrival of the beetle. The occurrence of Staphylinidae beetles and their associated mites, such as Parasitidae and Pelzneria, and the information they provided would have been easily overlooked or lost if only the autopsy sampling would have been considered in the analysis of the case. The four mite species are reported for the first time for the Iberian Peninsula. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Behavioral Monitoring of Sexual Offenders Against Children in Virtual Risk Situations: A Feasibility Study.

PubMed

Fromberger, Peter; Meyer, Sabrina; Jordan, Kirsten; Müller, Jürgen L

2018-01-01

The decision about unsupervised privileges for sexual offenders against children (SOC) is one of the most difficult decisions for practitioners in forensic high-security hospitals. Facing the possible consequences of the decision for the society, a valid and reliable risk management of SOCs is essential. Some risk management approaches provide frameworks for the construction of relevant future risk situations. Due to ethical reasons, it is not possible to evaluate the validity of constructed risk situations in reality. The aim of the study was to test if behavioral monitoring of SOCs in high-immersive virtual risk situations provides additional information for risk management. Six SOCs and seven non-offender controls (NOC) walked through three virtual risk situations, confronting the participant with a virtual child character. The participant had to choose between predefined answers representing approach or avoidance behavior. Frequency of chosen answers were analyzed in regards to knowledge of the participants about coping skills and coping skills focused during therapy. SOCs and NOCs behavior differed only in one risk scenario. Furthermore, SOCs showed in 89% of all cases a behavior not corresponding to their own belief about adequate behavior in comparable risk situations. In 62% of all cases, SOCs behaved not corresponding to coping skills they stated that therapists focused on during therapy. In 50% of all cases, SOCs behaved in correspondence to coping skills therapists stated that they focused on during therapy. Therapists predicted the behavior of SOCs in virtual risk situations incorrect in 25% of all cases. Thus, virtual risk scenarios provide the possibility for practitioners to monitor the behavior of SOCs and to test their decisions on unsupervised privileges without endangering the community. This may provide additional information for therapy progress. Further studies are necessary to evaluate the predictive and ecological validity of behavioral monitoring in virtual risk situations for real life situations.

Behavioral Monitoring of Sexual Offenders Against Children in Virtual Risk Situations: A Feasibility Study

PubMed Central

Fromberger, Peter; Meyer, Sabrina; Jordan, Kirsten; Müller, Jürgen L.

2018-01-01

The decision about unsupervised privileges for sexual offenders against children (SOC) is one of the most difficult decisions for practitioners in forensic high-security hospitals. Facing the possible consequences of the decision for the society, a valid and reliable risk management of SOCs is essential. Some risk management approaches provide frameworks for the construction of relevant future risk situations. Due to ethical reasons, it is not possible to evaluate the validity of constructed risk situations in reality. The aim of the study was to test if behavioral monitoring of SOCs in high-immersive virtual risk situations provides additional information for risk management. Six SOCs and seven non-offender controls (NOC) walked through three virtual risk situations, confronting the participant with a virtual child character. The participant had to choose between predefined answers representing approach or avoidance behavior. Frequency of chosen answers were analyzed in regards to knowledge of the participants about coping skills and coping skills focused during therapy. SOCs and NOCs behavior differed only in one risk scenario. Furthermore, SOCs showed in 89% of all cases a behavior not corresponding to their own belief about adequate behavior in comparable risk situations. In 62% of all cases, SOCs behaved not corresponding to coping skills they stated that therapists focused on during therapy. In 50% of all cases, SOCs behaved in correspondence to coping skills therapists stated that they focused on during therapy. Therapists predicted the behavior of SOCs in virtual risk situations incorrect in 25% of all cases. Thus, virtual risk scenarios provide the possibility for practitioners to monitor the behavior of SOCs and to test their decisions on unsupervised privileges without endangering the community. This may provide additional information for therapy progress. Further studies are necessary to evaluate the predictive and ecological validity of behavioral monitoring in virtual risk situations for real life situations. PMID:29559934

A comparative assessment of statistical methods for extreme weather analysis

NASA Astrophysics Data System (ADS)

Schlögl, Matthias; Laaha, Gregor

2017-04-01

Extreme weather exposure assessment is of major importance for scientists and practitioners alike. We compare different extreme value approaches and fitting methods with respect to their value for assessing extreme precipitation and temperature impacts. Based on an Austrian data set from 25 meteorological stations representing diverse meteorological conditions, we assess the added value of partial duration series over the standardly used annual maxima series in order to give recommendations for performing extreme value statistics of meteorological hazards. Results show the merits of the robust L-moment estimation, which yielded better results than maximum likelihood estimation in 62 % of all cases. At the same time, results question the general assumption of the threshold excess approach (employing partial duration series, PDS) being superior to the block maxima approach (employing annual maxima series, AMS) due to information gain. For low return periods (non-extreme events) the PDS approach tends to overestimate return levels as compared to the AMS approach, whereas an opposite behavior was found for high return levels (extreme events). In extreme cases, an inappropriate threshold was shown to lead to considerable biases that may outperform the possible gain of information from including additional extreme events by far. This effect was neither visible from the square-root criterion, nor from standardly used graphical diagnosis (mean residual life plot), but from a direct comparison of AMS and PDS in synoptic quantile plots. We therefore recommend performing AMS and PDS approaches simultaneously in order to select the best suited approach. This will make the analyses more robust, in cases where threshold selection and dependency introduces biases to the PDS approach, but also in cases where the AMS contains non-extreme events that may introduce similar biases. For assessing the performance of extreme events we recommend conditional performance measures that focus on rare events only in addition to standardly used unconditional indicators. The findings of this study are of relevance for a broad range of environmental variables, including meteorological and hydrological quantities.

Evaluating Health Information Systems Using Ontologies

PubMed Central

Anderberg, Peter; Larsson, Tobias C; Fricker, Samuel A; Berglund, Johan

2016-01-01

Background There are several frameworks that attempt to address the challenges of evaluation of health information systems by offering models, methods, and guidelines about what to evaluate, how to evaluate, and how to report the evaluation results. Model-based evaluation frameworks usually suggest universally applicable evaluation aspects but do not consider case-specific aspects. On the other hand, evaluation frameworks that are case specific, by eliciting user requirements, limit their output to the evaluation aspects suggested by the users in the early phases of system development. In addition, these case-specific approaches extract different sets of evaluation aspects from each case, making it challenging to collectively compare, unify, or aggregate the evaluation of a set of heterogeneous health information systems. Objectives The aim of this paper is to find a method capable of suggesting evaluation aspects for a set of one or more health information systems—whether similar or heterogeneous—by organizing, unifying, and aggregating the quality attributes extracted from those systems and from an external evaluation framework. Methods On the basis of the available literature in semantic networks and ontologies, a method (called Unified eValuation using Ontology; UVON) was developed that can organize, unify, and aggregate the quality attributes of several health information systems into a tree-style ontology structure. The method was extended to integrate its generated ontology with the evaluation aspects suggested by model-based evaluation frameworks. An approach was developed to extract evaluation aspects from the ontology that also considers evaluation case practicalities such as the maximum number of evaluation aspects to be measured or their required degree of specificity. The method was applied and tested in Future Internet Social and Technological Alignment Research (FI-STAR), a project of 7 cloud-based eHealth applications that were developed and deployed across European Union countries. Results The relevance of the evaluation aspects created by the UVON method for the FI-STAR project was validated by the corresponding stakeholders of each case. These evaluation aspects were extracted from a UVON-generated ontology structure that reflects both the internally declared required quality attributes in the 7 eHealth applications of the FI-STAR project and the evaluation aspects recommended by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. The extracted evaluation aspects were used to create questionnaires (for the corresponding patients and health professionals) to evaluate each individual case and the whole of the FI-STAR project. Conclusions The UVON method can provide a relevant set of evaluation aspects for a heterogeneous set of health information systems by organizing, unifying, and aggregating the quality attributes through ontological structures. Those quality attributes can be either suggested by evaluation models or elicited from the stakeholders of those systems in the form of system requirements. The method continues to be systematic, context sensitive, and relevant across a heterogeneous set of health information systems. PMID:27311735

Evaluating Health Information Systems Using Ontologies.

PubMed

Eivazzadeh, Shahryar; Anderberg, Peter; Larsson, Tobias C; Fricker, Samuel A; Berglund, Johan

2016-06-16

There are several frameworks that attempt to address the challenges of evaluation of health information systems by offering models, methods, and guidelines about what to evaluate, how to evaluate, and how to report the evaluation results. Model-based evaluation frameworks usually suggest universally applicable evaluation aspects but do not consider case-specific aspects. On the other hand, evaluation frameworks that are case specific, by eliciting user requirements, limit their output to the evaluation aspects suggested by the users in the early phases of system development. In addition, these case-specific approaches extract different sets of evaluation aspects from each case, making it challenging to collectively compare, unify, or aggregate the evaluation of a set of heterogeneous health information systems. The aim of this paper is to find a method capable of suggesting evaluation aspects for a set of one or more health information systems-whether similar or heterogeneous-by organizing, unifying, and aggregating the quality attributes extracted from those systems and from an external evaluation framework. On the basis of the available literature in semantic networks and ontologies, a method (called Unified eValuation using Ontology; UVON) was developed that can organize, unify, and aggregate the quality attributes of several health information systems into a tree-style ontology structure. The method was extended to integrate its generated ontology with the evaluation aspects suggested by model-based evaluation frameworks. An approach was developed to extract evaluation aspects from the ontology that also considers evaluation case practicalities such as the maximum number of evaluation aspects to be measured or their required degree of specificity. The method was applied and tested in Future Internet Social and Technological Alignment Research (FI-STAR), a project of 7 cloud-based eHealth applications that were developed and deployed across European Union countries. The relevance of the evaluation aspects created by the UVON method for the FI-STAR project was validated by the corresponding stakeholders of each case. These evaluation aspects were extracted from a UVON-generated ontology structure that reflects both the internally declared required quality attributes in the 7 eHealth applications of the FI-STAR project and the evaluation aspects recommended by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. The extracted evaluation aspects were used to create questionnaires (for the corresponding patients and health professionals) to evaluate each individual case and the whole of the FI-STAR project. The UVON method can provide a relevant set of evaluation aspects for a heterogeneous set of health information systems by organizing, unifying, and aggregating the quality attributes through ontological structures. Those quality attributes can be either suggested by evaluation models or elicited from the stakeholders of those systems in the form of system requirements. The method continues to be systematic, context sensitive, and relevant across a heterogeneous set of health information systems.

What caused the outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit, Germany 2009 to 2012? Reconstructing transmission with epidemiological analysis and whole-genome sequencing

PubMed Central

Haller, Sebastian; Eller, Christoph; Hermes, Julia; Kaase, Martin; Steglich, Matthias; Radonić, Aleksandar; Dabrowski, Piotr Wojtek; Nitsche, Andreas; Pfeifer, Yvonne; Werner, Guido; Wunderle, Werner; Velasco, Edward; Abu Sin, Muna; Eckmanns, Tim; Nübel, Ulrich

2015-01-01

Objective We aimed to retrospectively reconstruct the timing of transmission events and pathways in order to understand why extensive preventive measures and investigations were not sufficient to prevent new cases. Methods We extracted available information from patient charts to describe cases and to compare them to the normal population of the ward. We conducted a cohort study to identify risk factors for pathogen acquisition. We sequenced the available isolates to determine the phylogenetic relatedness of Klebsiella pneumoniae isolates on the basis of their genome sequences. Results The investigation comprises 37 cases and the 10 cases with ESBL (extended-spectrum beta-lactamase)-producing K. pneumoniae bloodstream infection. Descriptive epidemiology indicated that a continuous transmission from person to person was most likely. Results from the cohort study showed that ‘frequent manipulation’ (a proxy for increased exposure to medical procedures) was significantly associated with being a case (RR 1.44, 95% CI 1.02 to 2.19). Genome sequences revealed that all 48 bacterial isolates available for sequencing from 31 cases were closely related (maximum genetic distance, 12 single nucleotide polymorphisms). Based on our calculation of evolutionary rate and sequence diversity, we estimate that the outbreak strain was endemic since 2008. Conclusions Epidemiological and phylogenetic analyses consistently indicated that there were additional, undiscovered cases prior to the onset of microbiological screening and that the spread of the pathogen remained undetected over several years, driven predominantly by person-to-person transmission. Whole-genome sequencing provided valuable information on the onset, course and size of the outbreak, and on possible ways of transmission. PMID:25967999

Polygenic dissection of diagnosis and clinical dimensions of bipolar disorder and schizophrenia.

PubMed

Ruderfer, Douglas M; Fanous, Ayman H; Ripke, Stephan; McQuillin, Andrew; Amdur, Richard L; Gejman, Pablo V; O'Donovan, Michael C; Andreassen, Ole A; Djurovic, Srdjan; Hultman, Christina M; Kelsoe, John R; Jamain, Stephane; Landén, Mikael; Leboyer, Marion; Nimgaonkar, Vishwajit; Nurnberger, John; Smoller, Jordan W; Craddock, Nick; Corvin, Aiden; Sullivan, Patrick F; Holmans, Peter; Sklar, Pamela; Kendler, Kenneth S

2014-09-01

Bipolar disorder and schizophrenia are two often severe disorders with high heritabilities. Recent studies have demonstrated a large overlap of genetic risk loci between these disorders but diagnostic and molecular distinctions still remain. Here, we perform a combined genome-wide association study (GWAS) of 19 779 bipolar disorder (BP) and schizophrenia (SCZ) cases versus 19 423 controls, in addition to a direct comparison GWAS of 7129 SCZ cases versus 9252 BP cases. In our case-control analysis, we identify five previously identified regions reaching genome-wide significance (CACNA1C, IFI44L, MHC, TRANK1 and MAD1L1) and a novel locus near PIK3C2A. We create a polygenic risk score that is significantly different between BP and SCZ and show a significant correlation between a BP polygenic risk score and the clinical dimension of mania in SCZ patients. Our results indicate that first, combining diseases with similar genetic risk profiles improves power to detect shared risk loci and second, that future direct comparisons of BP and SCZ are likely to identify loci with significant differential effects. Identifying these loci should aid in the fundamental understanding of how these diseases differ biologically. These findings also indicate that combining clinical symptom dimensions and polygenic signatures could provide additional information that may someday be used clinically.

Prenatally diagnosed de novo apparently balanced complex chromosome rearrangements: Two new cases and review of the literature

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

Ruiz, C.; Grubs, R.E.; Jewett, T.

Complex chromosome rearrangements (CCR) are rare structural rearrangements. Currently six cases of prenatally diagnosed balanced de novo CCR have been described. We present two new cases of prenatally ascertained balanced de novo CCR. In the first case, an amniocentesis revealed a balanced de novo three-way CCR involving chromosomes 5,6, and 11 with a pericentric inversion of chromosome 5 [four breaks]. In the second case a balanced de novo rearrangement was identified by amniocentesis which involved a reciprocal translocation between chromosomes 3 and 8 and a CCR involving chromosomes 6,7, and 18 [six breaks]. The use of whole chromosome painting helpedmore » elucidate the nature of these rearrangements. A review of the postnatally ascertained cases suggests that most patients have congenital anomalies, minor anomalies, and/or developmental delay/mental retardation. In addition, there appears to be a relationship between the number of chromosome breaks and the extent of phenotypic effects. The paucity of information regarding prenatally diagnosed CCR and the bias of ascertainment of postnatal CCR cases poses a problem in counseling families. 38 refs., 3 figs., 4 tabs.« less

Cross-border outbreak of extensively drug-resistant tuberculosis linked to a university in Romania.

PubMed

Popovici, O; Monk, Ph; Chemtob, D; Chiotan, D; Freidlin, P J; Groenheit, R; Haanperä, M; Homorodean, D; Mansjö, M; Robinson, E; Rorman, E; Smith, G; Soini, H; Van Der Werf, M J

2018-05-01

Extensively drug-resistant (XDR) tuberculosis (TB) poses a threat to public health due to its complicated, expensive and often unsuccessful treatment. A cluster of three XDR TB cases was detected among foreign medical students of a Romanian university. The contact investigations included tuberculin skin testing or interferon gamma release assay, chest X-ray, sputum smear microscopy, culture, drug susceptibility testing, genotyping and whole-genome sequencing (WGS), and were addressed to students, personnel of the university, family members or other close contacts of the cases. These investigations increased the total number of cases to seven. All confirmed cases shared a very similar WGS profile. Two more cases were epidemiologically linked, but no laboratory confirmation exists. Despite all the efforts done, the source of the outbreak was not identified, but the transmission was controlled. The investigation was conducted by a team including epidemiologists and microbiologists from five countries (Finland, Israel, Romania, Sweden and the UK) and from the European Centre for Disease Prevention and Control. Our report shows how countries can collaborate to control the spread of XDR TB by exchanging information about cases and their contacts to enable identification of additional cases and transmission and to perform the source investigation.

Level II scour analysis for Bridge 21 (MIDBTH00230021) on Town Highway 23, crossing the Middlebury River, Middlebury, Vermont

USGS Publications Warehouse

Boehmler, Erick M.; Degnan, James R.

1997-01-01

year discharges. In addition, the incipient roadway-overtopping discharge is determined and analyzed as another potential worst-case scour scenario. Total scour at a highway crossing is comprised of three components: 1) long-term streambed degradation; 2) contraction scour (due to accelerated flow caused by a reduction in flow area at a bridge) and; 3) local scour (caused by accelerated flow around piers and abutments). Total scour is the sum of the three components. Equations are available to compute depths for contraction and local scour and a summary of the results of these computations follows. Contraction scour for all modelled flows ranged from 1.2 to 1.8 feet. The worst-case contraction scour occurred at the incipient overtopping discharge, which is less than the 500-year discharge. Abutment scour ranged from 17.7 to 23.7 feet. The worst-case abutment scour occurred at the 500-year discharge. Additional information on scour depths and depths to armoring are included in the section titled “Scour Results”. Scoured-streambed elevations, based on the calculated scour depths, are presented in tables 1 and 2. A cross-section of the scour computed at the bridge is presented in figure 8. Scour depths were calculated assuming an infinite depth of erosive material and a homogeneous particle-size distribution. It is generally accepted that the Froehlich equation (abutment scour) gives “excessively conservative estimates of scour depths” (Richardson and others, 1995, p. 47). Usually, computed scour depths are evaluated in combination with other information including (but not limited to) historical performance during flood events, the geomorphic stability assessment, existing scour protection measures, and the results of the hydraulic analyses. Therefore, scour depths adopted by VTAOT may differ from the computed values documented herein.

Antitoxin Treatment of Inhalation Anthrax: A Systematic Review

PubMed Central

Huang, Eileen; Pillai, Satish K.; Bower, William A.; Hendricks, Katherine A.; Guarnizo, Julie T.; Hoyle, Jamechia D.; Gorman, Susan E.; Boyer, Anne E.; Quinn, Conrad P.; Meaney-Delman, Dana

2016-01-01

Concern about use of anthrax as a bioweapon prompted development of novel anthrax antitoxins for treatment. Clinical guidelines for the treatment of anthrax recommend antitoxin therapy in combination with intravenous antimicrobials; however, a large-scale or mass anthrax incident may exceed antitoxin availability and create a need for judicious antitoxin use. We conducted a systematic review of antitoxin treatment of inhalation anthrax in humans and experimental animals to inform antitoxin recommendations during a large-scale or mass anthrax incident. A comprehensive search of 11 databases and the FDA website was conducted to identify relevant animal studies and human reports: 28 animal studies and 3 human cases were identified. Antitoxin monotherapy at or shortly after symptom onset demonstrates increased survival compared to no treatment in animals. With early treatment, survival did not differ between antimicrobial monotherapy and antimicrobial-antitoxin therapy in nonhuman primates and rabbits. With delayed treatment, antitoxin-antimicrobial treatment increased rabbit survival. Among human cases, addition of antitoxin to combination antimicrobial treatment was associated with survival in 2 of the 3 cases treated. Despite the paucity of human data, limited animal data suggest that adjunctive antitoxin therapy may improve survival. Delayed treatment studies suggest improved survival with combined antitoxin-antimicrobial therapy, although a survival difference compared with antimicrobial therapy alone was not demonstrated statistically. In a mass anthrax incident with limited antitoxin supplies, antitoxin treatment of individuals who have not demonstrated a clinical benefit from antimicrobials, or those who present with more severe illness, may be warranted. Additional pathophysiology studies are needed, and a point-of-care assay correlating toxin levels with clinical status may provide important information to guide antitoxin use during a large-scale anthrax incident. PMID:26690378

Antitoxin Treatment of Inhalation Anthrax: A Systematic Review.

PubMed

Huang, Eileen; Pillai, Satish K; Bower, William A; Hendricks, Katherine A; Guarnizo, Julie T; Hoyle, Jamechia D; Gorman, Susan E; Boyer, Anne E; Quinn, Conrad P; Meaney-Delman, Dana

2015-01-01

Concern about use of anthrax as a bioweapon prompted development of novel anthrax antitoxins for treatment. Clinical guidelines for the treatment of anthrax recommend antitoxin therapy in combination with intravenous antimicrobials; however, a large-scale or mass anthrax incident may exceed antitoxin availability and create a need for judicious antitoxin use. We conducted a systematic review of antitoxin treatment of inhalation anthrax in humans and experimental animals to inform antitoxin recommendations during a large-scale or mass anthrax incident. A comprehensive search of 11 databases and the FDA website was conducted to identify relevant animal studies and human reports: 28 animal studies and 3 human cases were identified. Antitoxin monotherapy at or shortly after symptom onset demonstrates increased survival compared to no treatment in animals. With early treatment, survival did not differ between antimicrobial monotherapy and antimicrobial-antitoxin therapy in nonhuman primates and rabbits. With delayed treatment, antitoxin-antimicrobial treatment increased rabbit survival. Among human cases, addition of antitoxin to combination antimicrobial treatment was associated with survival in 2 of the 3 cases treated. Despite the paucity of human data, limited animal data suggest that adjunctive antitoxin therapy may improve survival. Delayed treatment studies suggest improved survival with combined antitoxin-antimicrobial therapy, although a survival difference compared with antimicrobial therapy alone was not demonstrated statistically. In a mass anthrax incident with limited antitoxin supplies, antitoxin treatment of individuals who have not demonstrated a clinical benefit from antimicrobials, or those who present with more severe illness, may be warranted. Additional pathophysiology studies are needed, and a point-of-care assay correlating toxin levels with clinical status may provide important information to guide antitoxin use during a large-scale anthrax incident.

Medical emergencies in children of orthodox Jehovah's Witness families: Three recent legal cases, ethical issues and proposals for management.

PubMed

Guichon, Juliet; Mitchell, Ian

2006-12-01

Three recent Canadian legal cases have dealt with the proposed blood transfusion of adolescent members of Jehovah's Witness (JW) families. In each case, the court permitted transfusions if medically necessary. Much critical analysis of the issue of forced treatment of decisionally competent adolescents focuses exclusively on competence and questions why mature minors may not decide for themselves. The authors argue that a focus on decision-making competence alone is too narrow. Before one may legally give or refuse consent to medical treatment, three conditions must be met: competence, adequate information and lack of coercion. In striving to find agreement on medical treatment, physicians, patients and JW family members seek and, in fact, often achieve mutual understanding and cooperation. Coercion by actual or threatened shunning and excommunication can occur, and these factors may affect adolescent decision-making. In this context, a court order authorizing medical treatment can, therefore, be seen as enhancing patient freedom. The authors suggest that, in addition to fulfilling existing statutory duties to report a child in need of protection, health care professionals caring for acute patients of JW families should actively look for evidence that the patient has accurate medical information and is acting without coercion. The authors also explore suggestions on how to deal with the unusual complexities of such cases.

A stress MRI of the shoulder for evaluation of ligamentous stabilizers in acute and chronic acromioclavicular joint instabilities.

PubMed

Izadpanah, Kaywan; Winterer, Jan; Vicari, Marco; Jaeger, Martin; Maier, Dirk; Eisebraun, Leonie; Ute Will, Jutta; Kotter, Elmar; Langer, Mathias; Südkamp, Norbert P; Hennig, Jürgen; Weigel, Mathias

2013-06-01

To show the feasibility of a stress magnetic resonance imaging (MRI) as a new method for simultaneous evaluation of the morphology and the functional integrity of the acromioclavicular joint (ACJ) ligamentous stabilizers. MRI of four volunteers, 10 patients with acute, and six with chronic ACJ injuries was performed using a 0.25 T open MRI scanner. A 2D-proton-density and a 3D-gradient-echo sequence at rest and under 6.5 kg shoulder traction were performed. Comparative measurements of the coracoclavicular and the acromioclavicular distance were performed. Additionally, the conoid and trapezoid ligament lengths were measured with multiplanar reconstructions. MRI at rest correctly identified tears of the coracoclavicular and the acromioclavicular ligaments in eight patients suffering acute ACJ injuries. Stress application helped to distinguish between partial and complete coracoclavicular ligament tears in two cases. Insufficiency of the ACJ ligaments was present in all acute and chronic ACJ injuries. Stress application in chronic ACJ ligaments revealed isolated insufficiency of the conoid ligament in three cases and of the trapezoid ligament in one case. Combined insufficiency was present in two cases. Stress MRI facilitates simultaneous acquisition of morphologic and functional information of the ACJ stabilizers. In acute ACJ injuries it helps to distinguish between partial and complete ligament tears. In chronic ACJ injuries it provides functional information of the ligament regrinds. Copyright © 2012 Wiley Periodicals, Inc.

Allegations of Failure to Obtain Informed Consent in Spinal Surgery Medical Malpractice Claims.

PubMed

Grauberger, Jennifer; Kerezoudis, Panagiotis; Choudhry, Asad J; Alvi, Mohammed Ali; Nassr, Ahmad; Currier, Bradford; Bydon, Mohamad

2017-06-21

Predictive factors associated with increased risk of medical malpractice litigation have been identified, including severity of injury, physician sex, and error in diagnosis. However, there is a paucity of literature investigating informed consent in spinal surgery malpractice. To investigate the failure to obtain informed consent as an allegation in medical malpractice claims for patients undergoing a spinal procedure. In this retrospective cohort study, a national medicolegal database was searched for malpractice claim cases related to spinal surgery for all years available (ie, January 1, 1980, through December 31, 2015). Failure to obtain informed consent and associated medical malpractice case verdict. A total of 233 patients (117 [50.4%] male and 116 [49.8%] female; 80 with no informed consent allegation and 153 who cited lack of informed consent) who underwent spinal surgery and filed a malpractice claim were studied (mean [SD] age, 47.1 [13.1] years in the total group, 45.8 [12.9] years in the control group, and 47.9 [13.3] years in the informed consent group). Median interval between year of surgery and year of verdict was 5.4 years (interquartile range, 4-7 years). The most common informed consent allegations were failure to explain risks and adverse effects of surgery (52 [30.4%]) and failure to explain alternative treatment options (17 [9.9%]). In bivariate analysis, patients in the control group were more likely to require additional surgery (45 [56.3%] vs 53 [34.6%], P = .002) and have more permanent injuries compared with the informed consent group (46 [57.5%] vs 63 [42.0%], P = .03). On multivariable regression analysis, permanent injuries were more often associated with indemnity payment after a plaintiff verdict (odds ratio [OR], 3.12; 95% CI, 1.46-6.65; P = .003) or a settlement (OR, 6.26; 95% CI, 1.06-36.70; P = .04). Informed consent allegations were significantly associated with less severe (temporary or emotional) injury (OR, 0.52; 95% CI, 0.28-0.97; P = .04). In addition, allegations of informed consent were found to be predictive of a defense verdict vs a plaintiff ruling (OR, 0.41; 95% CI, 0.17-0.98; P = .046) or settlement (OR, 0.01; 95% CI, 0.001-0.15; P < .001). Lack of informed consent is an important cause of medical malpractice litigation. Although associated with a lower rate of indemnity payments, malpractice lawsuits, including informed consent allegations, still present a time, money, and reputation toll for physicians. The findings of this study can therefore help to improve preoperative discussions to protect spinal surgeons from malpractice claims and ensure that patients are better informed.

The economics of biobanking and pharmacogenetics databasing: the case of an adaptive platform on breast cancer.

PubMed

Huttin, Christine C; Liebman, Michael N

2013-01-01

This paper aims to discuss the economics of biobanking. Among the critical issues in evaluating potential ROI for creation of a bio-bank are: scale (e.g. local, national, international), centralized versus virtual/distributed, degree of sample annotation/QC procedures, targeted end-users and uses, types of samples, potential characterization, both of samples and annotations. The paper presents a review on cost models for an economic analysis of biobanking for different steps: data collection (e.g. biospecimens in different types of sites, storage, transport and distribution, information management for the different types of information (e.g. biological information such as cell, gene, and protein)). It also provides additional concepts to process biospecimens from laboratory to clinical practice and will help to identify how changing paradigms in translational medicine affect the economic modeling.

Social Security and divorce or death benefits storyboard (S(2)D(2)BS): an interactive participant learning exercise.

PubMed

Brown, Pamela Pitman

2014-01-01

Using the concept of an interactive or living storyboard, the author discusses the use of seven case narratives constructed for the sole purpose of teaching introductory gerontology or geriatric students about the distribution of Social Security benefits after spousal death. Additional information is included pertaining to Social Security benefits payable to divorced persons after the death of the former spouse, including the status of married same-sex couples. Narratives include representations of a male breadwinner model couple, a two-earner couple who have similar/dissimilar earnings prior to retirement, a divorced couple with a remarriage after a death, a gay couple with and without children, and a female primary breadwinner couple. Updated information from the Social Security Administration, as well as information on game preparation, scripts, and debriefing questions are included.

Superfund Training/Tech Transfer

EPA Pesticide Factsheets

This asset includes a collection of information resources, training, and other media related to hazardous waste site cleanup and characterization. A major part of this asset is the CLU-IN System, which is a collection of websites designed to be the central reference library for the development, collection, evaluation, coordination, and dissemination of information relating to the utilization of alternative or innovative treatment technologies... for cleaning up hazardous waste sites (Title 42 Section 9660 (b)(8)). Information includes Best Practices for using innovative technologies, case studies and focus areas about characterization and remediation technologies, emerging issues, optimization, and green(ing) remediation. CLU-IN is available via web-based documentation, live events, podcasts, and videos. Additionally, the Technology Innovation and Field Services Division (TIFSD) supports both classroom and online training registration through Trainex.org. All EPA content is also posted on EPA's website.

An update on zolpidem abuse and dependence.

PubMed

Victorri-Vigneau, Caroline; Gérardin, Marie; Rousselet, Morgane; Guerlais, Marylène; Grall-Bronnec, Marie; Jolliet, Pascale

2014-01-01

In 2004, the health authorities (French National Agency for Medicines and Health Products Safety-ANSM) modified the summary of zolpidem characteristics. Particularly it now includes the sentence "a pharmacodependence may materialize." The current article aims to show that despite this modification, zolpidem continues to be associated with problematic drug use, as the official system (Center for Evaluation and Information on Pharmacodependence-Addictovigilance network) providing information on the abuse and dependence potential of drugs informs us. The authors reviewed the literature on this topic and analyzed French data from zolpidem's postmarketing period that were collected by the Addictovigilance network from 2003 to 2010. Postmarketing data and the 30 case reports yielded from the literature review highlight a significant dependence and abuse potential for zolpidem. This survey led to propose in stronger additional rules in France to try to mitigate the abuse potential of zolpidem.

WE-E-18C-01: Multi-Energy CT: Current Status and Recent Innovations

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

Pelc, N; McCollough, C; Yu, L

2014-06-15

Conventional computed tomography (CT) uses a single polychromatic x-ray spectrum and energy integrating detectors, and produces images whose contrast depends on the effective attenuation coefficient of the broad spectrum beam. This can introduce errors from beam hardening and does not produce the optimal contrast-to-noise ratio. In addition, multiple materials can have the same effective attenuation coefficient, causing different materials to be indistinguishable in conventional CT images. If transmission measurements at two or more energies are obtained, even with polychromatic beams, more specific information about the object can be obtained. If the object does not contain materials with k-edges in themore » spectrum, the x-ray attenuation can be well-approximated by a linear combination of two processes (photoelectric absorption and Compton scattering) or, equivalently, two basis materials. For such cases, two spectral measurements suffice, although additional measurements can provide higher precision. If K-edge materials are present, additional spectral measurements can allow these materials to be isolated. Current commercial implementations use varied approaches, including two sources operating a different kVp, one source whose kVp is rapidly switched in a single scan, and a dual layer detector that can provide spectral information in every reading. Processing of the spectral information can be performed in the raw data domain or in the image domain. The process of calculating the amount of the two basis functions implicitly corrects for beam hardening and therefore can lead to improvements in quantitative accuracy. Information can be extracted to provide material specific information beyond that of conventional CT. This additional information has been shown to be important in several clinical applications, and can also lead to more efficient clinical protocols. Recent innovations in x-ray sources, detectors, and systems have made multi-energy CT much more practical and improved its performance. In addition, this is a very active area of research and further improvements are expected through further technological improvements. Learning Objectives: Basic principles of multi-energy CT Current implementations of mutli-energy CT Data and image analysis methods in multi-energy CT Current clinical applications of dual energy CT5. recent innovations and anticipated advances in multi-energy CT.« less

Making the informal formal: An examination of why and how teachers and students leverage experiences in informal learning environments

NASA Astrophysics Data System (ADS)

Schneider, Barbara P.

This study was an effort to understand the impact of informal learning environments (museums, aquaria, nature centers, and outdoor education programs) on school groups by developing a picture of why and how teachers and their students leverage experiences in these settings. This work relied on the self-reported visions for science education of formal and informal teachers as a means of creating a portrait or profile of the teacher visitor thus providing a new way to assess the quality of informal visits based on vision elements. Multi-level, year long case studies at six school sites and their partnering informal centers that included multiple interviews, observations (250 hours) of both school based and field trip activities, as well as focus group interviews with students two months past their field trip experience comprised the bulk of data collection activities. In addition to this more intensive work with case study teachers data was gathered from a broader group of participants through surveys (n = 396) and one-time classroom teacher interviews (n = 36) in an effort to validate or confirm case study findings. I discovered that central to informal and formal teachers' visions was a view of education as empowerment. I explored such goals as empowering students to conceive of themselves and their worlds differently, empowering students by sharing responsibility for what and how they learn, and empowering students by creating environments where everyone can contribute meaningfully. Much of what classroom teachers did to leverage the informal experience in supporting their visions of education related to these goals. For example teachers used shared experiences in informal settings as a way for their students to gain better access to and understanding of the classroom curriculum thereby increasing student participation and allowing more students to be successful. They also changed their approach to content by basing the classroom curriculum on students' interests and questions raised during visits to informal settings. Consequently teachers noted their students were better able to connect to traditional elements of school as a result of their informal experiences. Personal growth of students was also a major area of change. Increases in self-esteem, fieldtrip and classroom participation, as well as improved classroom behavior were reported and observed and improved the way the classroom functioned.

Deposits in artificial corneas: risk factors and prevention.

PubMed

Hicks, Celia R; Chirila, Traian V; Werner, Liliana; Crawford, Geoffrey J; Apple, David J; Constable, Ian J

2004-04-01

To identify risk factors for calcium deposition and pigmented staining within AlphaCor artificial corneas. Retrospective analysis of data from 72 AlphaCor implantations was conducted. Histological analysis of explants was performed. Eight cases of either intraoptic calcium or pigment deposition occurred in AlphaCor patients between 2.5 and 21 months after implantation. Four cases had diffuse white deposits, confirmed to be calcium and associated with prior coadministration of topical steroids and beta-blockers. The other four cases had brown deposits, associated with cigarette smoking and topical levobunolol. These findings led to changes in patient management protocols, surgeon training and patient information so as to minimize the risk of further occurrences. No further cases of white deposition have occurred after warning surgeons of the risk associated with certain topical therapy combinations. The risk of brown staining may be difficult to remove completely as it appears that environmental exposure to chemicals may cause deposition in addition to personal smoking habits and topical medications.

Quality assurance in surgical practice through auditing.

PubMed

Wong, W T

1980-05-01

An efficient auditing method is presented which involves objective criteria-based numerical screening of medical process and treatment outcome by paramedical staff and detailed analysis of deviated cases by surgeons. If properly performed it requires the study of no more than 50 cases in a diagnostic category to provide sufficient information about the quality of care. Encouraging points as well as problems are communicated to the surgeons to induce the maintenance or improvement of the standard of care. Graphic documentation of case performance is possible, allowing surgeons to compare results with their colleagues. The general performance level of several consecutive studies can be compared at a glance. In addition, logical education programs to improve the medical process can be designed on the basis of the problems identified. As all the cases with an unacceptable outcome are traceable to inadequate medical process, improvement in this area will decrease outcome defects. With the use of auditing and the follow-up technique described, the quality of care in surgery may be assured.

Genotype-Based Association Mapping of Complex Diseases: Gene-Environment Interactions with Multiple Genetic Markers and Measurement Error in Environmental Exposures

PubMed Central

Lobach, Irvna; Fan, Ruzone; Carroll, Raymond T.

2011-01-01

With the advent of dense single nucleotide polymorphism genotyping, population-based association studies have become the major tools for identifying human disease genes and for fine gene mapping of complex traits. We develop a genotype-based approach for association analysis of case-control studies of gene-environment interactions in the case when environmental factors are measured with error and genotype data are available on multiple genetic markers. To directly use the observed genotype data, we propose two genotype-based models: genotype effect and additive effect models. Our approach offers several advantages. First, the proposed risk functions can directly incorporate the observed genotype data while modeling the linkage disequihbrium information in the regression coefficients, thus eliminating the need to infer haplotype phase. Compared with the haplotype-based approach, an estimating procedure based on the proposed methods can be much simpler and significantly faster. In addition, there is no potential risk due to haplotype phase estimation. Further, by fitting the proposed models, it is possible to analyze the risk alleles/variants of complex diseases, including their dominant or additive effects. To model measurement error, we adopt the pseudo-likelihood method by Lobach et al. [2008]. Performance of the proposed method is examined using simulation experiments. An application of our method is illustrated using a population-based case-control study of association between calcium intake with the risk of colorectal adenoma development. PMID:21031455

Attrition Bias Related to Missing Outcome Data: A Longitudinal Simulation Study.

PubMed

Lewin, Antoine; Brondeel, Ruben; Benmarhnia, Tarik; Thomas, Frédérique; Chaix, Basile

2018-01-01

Most longitudinal studies do not address potential selection biases due to selective attrition. Using empirical data and simulating additional attrition, we investigated the effectiveness of common approaches to handle missing outcome data from attrition in the association between individual education level and change in body mass index (BMI). Using data from the two waves of the French RECORD Cohort Study (N = 7,172), we first examined how inverse probability weighting (IPW) and multiple imputation handled missing outcome data from attrition in the observed data (stage 1). Second, simulating additional missing data in BMI at follow-up under various missing-at-random scenarios, we quantified the impact of attrition and assessed how multiple imputation performed compared to complete case analysis and to a perfectly specified IPW model as a gold standard (stage 2). With the observed data in stage 1, we found an inverse association between individual education and change in BMI, with complete case analysis, as well as with IPW and multiple imputation. When we simulated additional attrition under a missing-at-random pattern (stage 2), the bias increased with the magnitude of selective attrition, and multiple imputation was useless to address it. Our simulations revealed that selective attrition in the outcome heavily biased the association of interest. The present article contributes to raising awareness that for missing outcome data, multiple imputation does not do better than complete case analysis. More effort is thus needed during the design phase to understand attrition mechanisms by collecting information on the reasons for dropout.

The Impact of Multilocus Variable-Number Tandem-Repeat Analysis on PulseNet Canada Escherichia coli O157:H7 Laboratory Surveillance and Outbreak Support, 2008-2012.

PubMed

Rumore, Jillian Leigh; Tschetter, Lorelee; Nadon, Celine

2016-05-01

The lack of pattern diversity among pulsed-field gel electrophoresis (PFGE) profiles for Escherichia coli O157:H7 in Canada does not consistently provide optimal discrimination, and therefore, differentiating temporally and/or geographically associated sporadic cases from potential outbreak cases can at times impede investigations. To address this limitation, DNA sequence-based methods such as multilocus variable-number tandem-repeat analysis (MLVA) have been explored. To assess the performance of MLVA as a supplemental method to PFGE from the Canadian perspective, a retrospective analysis of all E. coli O157:H7 isolated in Canada from January 2008 to December 2012 (inclusive) was conducted. A total of 2285 E. coli O157:H7 isolates and 63 clusters of cases (by PFGE) were selected for the study. Based on the qualitative analysis, the addition of MLVA improved the categorization of cases for 60% of clusters and no change was observed for ∼40% of clusters investigated. In such situations, MLVA serves to confirm PFGE results, but may not add further information per se. The findings of this study demonstrate that MLVA data, when used in combination with PFGE-based analyses, provide additional resolution to the detection of clusters lacking PFGE diversity as well as demonstrate good epidemiological concordance. In addition, MLVA is able to identify cluster-associated isolates with variant PFGE pattern combinations that may have been previously missed by PFGE alone. Optimal laboratory surveillance in Canada is achieved with the application of PFGE and MLVA in tandem for routine surveillance, cluster detection, and outbreak response.

Crying and suicidal, but not depressed. Pseudobulbar affect in multiple sclerosis successfully treated with valproic acid: Case report and literature review.

PubMed

Johnson, Bridgette; Nichols, Scott

2015-12-01

Pseudobulbar affect/emotional incontinence is a potentially disabling condition characterized by expressions of affect or emotions out of context from the normal emotional basis for those expressions. This condition can result in diagnostic confusion and unrelieved suffering when clinicians interpret the emotional expressions at face value. In addition, the nomenclature, etiology, and treatment for this condition remain unclear in the medical literature. We report the case of a 60-year-old woman with multiple sclerosis who was referred to an inpatient psychiatry unit with complaints of worsening depression along with hopelessness, characterized by unrelenting crying. Our investigation showed that her symptoms were caused by pseudobulbar affect/emotional incontinence stemming from multiple sclerosis. The patient's history of multiple sclerosis and the fact that she identified herself as depressed only because of her incessant crying suggested that her symptoms might be due to the multiple sclerosis rather than to a depressive disorder. Magnetic resonance imaging demonstrated a new plaque consistent with multiple sclerosis lateral to her corpus callosum. Her symptoms resolved completely within three days on valproic acid but returned after she was cross-tapered to dextromethorphan plus quinidine, which is the FDA-approved treatment for this condition. This case provides important additional information to the current literature on pseudobulbar affect/emotional incontinence. The existing literature suggests a selective serotonin reuptake inhibitor (SSRI) and dextromethorphan/quinidine (Nuedexta) as first-line treatments; however, our patient was taking an SSRI at the time of presentation without appreciable benefit, and her symptoms responded to valproic acid but not to the dextromethorphan/quinidine. In addition, the case and the literature review suggest that the current nomenclature for this constellation of symptoms can be misleading.

ATLes: the strategic application of Web-based technology to address learning objectives and enhance classroom discussion in a veterinary pathology course.

PubMed

Hines, Stephen A; Collins, Peggy L; Quitadamo, Ian J; Brahler, C Jayne; Knudson, Cameron D; Crouch, Gregory J

2005-01-01

A case-based program called ATLes (Adaptive Teaching and Learning Environments) was designed for use in a systemic pathology course and implemented over a four-year period. Second-year veterinary students working in small collaborative learning groups used the program prior to their weekly pathology laboratory. The goals of ATLes were to better address specific learning objectives in the course (notably the appreciation of pathophysiology), to solve previously identified problems associated with information overload and information sorting that commonly occur as part of discovery-based processes, and to enhance classroom discussion. The program was also designed to model and allow students to practice the problem-oriented approach to clinical cases, thereby enabling them to study pathology in a relevant clinical context. Features included opportunities for students to obtain additional information on the case by requesting specific laboratory tests and/or diagnostic procedures. However, students were also required to justify their diagnostic plans and to provide mechanistic analyses. The use of ATLes met most of these objectives. Student acceptance was high, and students favorably reviewed the online ''Content Links'' that made useful information more readily accessible and level appropriate. Students came to the lab better prepared to engage in an in-depth and high-quality discussion and were better able to connect clinical problems to underlying changes in tissue (lesions). However, many students indicated that the required time on task prior to lab might have been excessive relative to what they thought they learned. The classroom discussion, although improved, was not elevated to the expected level-most likely reflecting other missing elements of the learning environment, including the existing student culture and the students' current discussion skills. This article briefly discusses the lessons learned from ATLes and how similar case-based exercises might be combined with other approaches to enhance and enliven classroom discussions in the veterinary curriculum.

Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction.

PubMed

de Nie, Karlijn F; Crama, N; Tilanus, Maurits A D; Klevering, B Jeroen; Boon, Camiel J F

2013-05-01

Primary vitreous floaters can be highly bothersome in some patients. In the case of persistently bothersome floaters, pars plana vitrectomy may be the most effective treatment. The aim of this study is to evaluate the incidence of complications, and patient satisfaction, after pars plana vitrectomy for disabling primary vitreous opacities. We included a total of 110 eyes that underwent pars plana vitrectomy between February 1998 and August 2010. Fifty-seven eyes (51.8%) underwent 20-gauge vitrectomy, whereas 53 eyes (48.2%) underwent 23-gauge vitrectomy. In a retrospective manner, we assessed intraoperative and postoperative complications. There was a considerable range of time between surgery and questionnaire (range: 4-136 months). Patient satisfaction was assessed by a questionnaire based on a modified NEI VFQ-25 questionnaire. A retinal detachment occurred in 10.9% of cases, and the incidence did not differ significantly between the 20-gauge and 23-gauge vitrectomy groups. In 4.5% of the eyes, a retinal detachment developed within the first 3 months, and 6.4% occurred later in the postoperative period. Cystoid macular edema occurred in 5.5%, and an epiretinal membrane was seen postoperatively in 3.6% of cases. Development of glaucoma requiring glaucoma surgery, a macular hole, and postoperative scotoma, each occurred in 0.9% of cases. No cases of endophthalmitis occurred. Eighty-five percent of patients were satisfied or very satisfied with the results of the vitrectomy. Eighty-four percent of all patients were completely cured from their troublesome vitreous floaters, and an additional 9.3% of patients were less troubled by vitreous floaters. Ten patients (9.3%) were dissatisfied, and six of these patients (5.6%) had a serious complication that resulted in permanent visual loss. Pars plana vitrectomy is an effective approach to treat primary vitreous floaters, resulting in a high rate of patient satisfaction. Postoperative complications may be more frequent than previously reported, so patients should be well-informed about the complication rate before reaching informed consent about this surgical intervention. Additional preventive measures should be considered to reduce this complication rate.

Electrophysiologic monitoring characteristics of the recurrent laryngeal nerve preoperatively paralyzed or invaded with malignancy.

PubMed

Kamani, Dipti; Darr, E Ashlie; Randolph, Gregory W

2013-11-01

To elucidate electrophysiologic responses of the recurrent laryngeal nerves that were preoperatively paralyzed or invaded by malignancy and to use this information as an added functional parameter for intraoperative management of recurrent laryngeal nerves with malignant invasion. Case series with chart review. Academic, tertiary care center. All consecutive neck surgeries with nerve monitoring performed by senior author (GWR) between December 1995 and January 2007 were reviewed after obtaining Institutional Review Board approval from Massachusetts Eye and Ear Infirmary Human Subjects Committee and the Partners Human Research Committee. Electrophysiologic parameters in all cases with preoperative vocal cord paralysis/paresis, and the recurrent laryngeal nerve invasion by cancer, were studied. Of the 1138 surgeries performed, 25 patients (2.1%) had preoperative vocal cord dysfunction. In patients with preoperative vocal cord dysfunction, recognizable recurrent laryngeal nerve electrophysiologic activity was preserved in over 50% of cases. Malignant invasion of the recurrent laryngeal nerve was found in 22 patients (1.9%). Neural invasion of the recurrent laryngeal nerve was associated with preoperative vocal cord paralysis in only 50% of these patients. In nerves invaded by malignancy, 60% maintained recognizable electrophysiologic activity, which was more commonly present and robust when vocal cord function was preserved. Knowledge of electrophysiologic intraoperative neural monitoring provides additional functional information and, along with preoperative vocal cord function information, aids in constructing decision algorithms regarding intraoperative management of the recurrent laryngeal nerve, in prognosticating postoperative outcomes, and in patient counseling regarding postoperative expectations.

Cutaneous drug reaction case reports: from the world literature.

PubMed

2003-01-01

Skin disorders are the most common adverse reactions attributed to drugs. Any skin disorder can be imitated, induced or aggravated by drugs. To help you keep up-to-date with the very latest skin reactions occurring with both new and established drugs, this section of the journal brings you information selected from the adverse drug reaction alerting service Reactions Weekly. Reactions Weekly is the complete drug safety alerting service and summarizes information selected from over 1600 biomedical journals. This newsletter is produced by Adis International and is available in a variety of formats. Please contact your nearest Adis office for subscription details. The use of tradenames, identified by ['~'] or the use of a registered ((R)) or trade mark ( trade mark ), is for product identification purposes only and does not imply endorsement. The following case reports are selected from the very latest to be published in the world dermatology literature. Any claim of a first report has been verified by a search of AdisBase (a proprietary database of Adis International) and Medline. In addition, the World Health Organization (WHO) Adverse Drug Reactions database is also searched. This database, maintained by the Uppsala Monitoring Centre in Sweden, is the largest and most comprehensive adverse drug reaction source in the world, with information obtained from National Centers of 65 affiliate countries. Each case report is assessed for seriousness using the FDA MedWatch definition of serious (patient outcome is: death; life-threatening; hospitalization; disability; congenital anomaly; or requires intervention to prevent permanent impairment or damage).

Insights from molecular dynamics simulations for computational protein design.

PubMed

Childers, Matthew Carter; Daggett, Valerie

2017-02-01

A grand challenge in the field of structural biology is to design and engineer proteins that exhibit targeted functions. Although much success on this front has been achieved, design success rates remain low, an ever-present reminder of our limited understanding of the relationship between amino acid sequences and the structures they adopt. In addition to experimental techniques and rational design strategies, computational methods have been employed to aid in the design and engineering of proteins. Molecular dynamics (MD) is one such method that simulates the motions of proteins according to classical dynamics. Here, we review how insights into protein dynamics derived from MD simulations have influenced the design of proteins. One of the greatest strengths of MD is its capacity to reveal information beyond what is available in the static structures deposited in the Protein Data Bank. In this regard simulations can be used to directly guide protein design by providing atomistic details of the dynamic molecular interactions contributing to protein stability and function. MD simulations can also be used as a virtual screening tool to rank, select, identify, and assess potential designs. MD is uniquely poised to inform protein design efforts where the application requires realistic models of protein dynamics and atomic level descriptions of the relationship between dynamics and function. Here, we review cases where MD simulations was used to modulate protein stability and protein function by providing information regarding the conformation(s), conformational transitions, interactions, and dynamics that govern stability and function. In addition, we discuss cases where conformations from protein folding/unfolding simulations have been exploited for protein design, yielding novel outcomes that could not be obtained from static structures.

Insights from molecular dynamics simulations for computational protein design

PubMed Central

Childers, Matthew Carter; Daggett, Valerie

2017-01-01

A grand challenge in the field of structural biology is to design and engineer proteins that exhibit targeted functions. Although much success on this front has been achieved, design success rates remain low, an ever-present reminder of our limited understanding of the relationship between amino acid sequences and the structures they adopt. In addition to experimental techniques and rational design strategies, computational methods have been employed to aid in the design and engineering of proteins. Molecular dynamics (MD) is one such method that simulates the motions of proteins according to classical dynamics. Here, we review how insights into protein dynamics derived from MD simulations have influenced the design of proteins. One of the greatest strengths of MD is its capacity to reveal information beyond what is available in the static structures deposited in the Protein Data Bank. In this regard simulations can be used to directly guide protein design by providing atomistic details of the dynamic molecular interactions contributing to protein stability and function. MD simulations can also be used as a virtual screening tool to rank, select, identify, and assess potential designs. MD is uniquely poised to inform protein design efforts where the application requires realistic models of protein dynamics and atomic level descriptions of the relationship between dynamics and function. Here, we review cases where MD simulations was used to modulate protein stability and protein function by providing information regarding the conformation(s), conformational transitions, interactions, and dynamics that govern stability and function. In addition, we discuss cases where conformations from protein folding/unfolding simulations have been exploited for protein design, yielding novel outcomes that could not be obtained from static structures. PMID:28239489

[Safe Use of Recent New Drugs-Current Status and Challenges].

PubMed

Ohashi, Yoshiaki

2018-01-01

　In Japan and overseas, Chugai Pharmaceutical Company handles numerous biopharmaceuticals, molecular targeted therapies and other pharmaceuticals with innovative modes of action. Expert safety evaluation is essential for promoting the appropriate use of these pharmaceuticals around the world and in gaining acceptance from patients and healthcare professionals (HCPs), while speedy decision-making is crucial for the timely collection and provision of safety information and thus ensuring safety. In 2015, we collected safety information on more than 180000 cases and evaluated it from a medical standpoint. We have established a system for recording the collected information in a global database, and are conducting signal detection of adverse drug reactions using this database. With this system, we promptly disclose information to regulatory authorities in Japan, the US, Europe and Asia. We have in-house medical doctors with abundant clinical experience who conduct expert safety evaluations. Many innovative drugs, such as anticancer drugs or biopharmaceuticals, require wider-ranging, more rigorous management, including the provision of appropriate safety information to HCPs, management of distribution through wholesalers and dispensing pharmacies, and confirmation of conditions of use, in addition to all-case registration surveillance. With progress in the development of individualized medicine and drugs with new modes of action, in order for HCPs to understand the characteristics of these new drugs and use them appropriately, pharmacists and pharmaceutical companies should cooperate in promoting their appropriate use in the spirit of 'All Pharmacists for Patients'.

The role of natural color additives in food allergy.

PubMed

Lucas, C D; Hallagan, J B; Taylor, S L

2001-01-01

A critical evaluation of the available information demonstrates that reactions to natural color additives are rare. Studies of turmeric and carotenoid pigments administered in mixtures with other food colorings failed to definitely identify reactions to either color additive. For carotenoids, the one case report of an adverse reaction was not conclusive. An anaphylactic reaction to saffron does suggest an IgE-mediated reaction, but the high use of saffron as compared with this single report of an adverse reaction suggests that sensitivity to saffron is extremely rare. Numerous reports of reactions to grapes or grape products have been reported in the literature, but no reports of sensitivities to grape skin extract or grape color extract were found. In rare cases, annatto dye may provoke a severe, adverse reaction in individuals with an uncommon hypersensitivity, and may aggravate the symptoms of patients suffering from recurrent urticaria. In its long history of use, there has been only one reported case of anaphylaxis resulting from the ingestion of annatto. Studies designed to investigate the role of annatto in recurrent urticaria sufferers were limited due to the absence of double-blind challenge and placebo controls. A number of cases of adverse reactions to carmine following ingestion have been reported in the literature. These adverse reactions suggest an IgE-mediated hypersensitivity. In many of the reported cases, the cause of sensitization to carmine was topical exposure from the use of carmine-containing cosmetics or occupational exposure to carmine and not from ingestion of carmine-containing foods and beverages. Following sensitization, affected individuals would be sensitive to carmine and the amounts present in foods and beverages could elicit allergic reactions. It is not known whether all individuals with carmine sensitivity induced through topical use are sensitive to the ingestion of carmine in foods. However, reactions to carmine solely because of ingestion are likely to be exceedingly rare due to the low use levels of carmine in foods and beverages. Despite their widespread use in food products, few reports of allergic reactions following ingestion have been reported for the majority of natural color additives. It is concluded that the ingestion of natural color additives presents a very low risk of provoking adverse reactions.

Spatio-temporal distribution of injured elephants in Masai Mara and the putative negative and positive roles of the local community.

PubMed

Mijele, Domnic; Obanda, Vincent; Omondi, Patrick; Soriguer, Ramón C; Gakuya, Francis; Otiende, Moses; Hongo, Peter; Alasaad, Samer

2013-01-01

Very few studies have ever focused on the elephants that are wounded or killed as local communities attempt to scare these animals away from their settlements and farms, or on the cases in which local people take revenge after elephants have killed or injured humans. On the other hand, local communities live in close proximity to elephants and hence can play a positive role in elephant conservation by informing the authorities of the presence of injured elephants. Between 2007 and 2011, 129 elephants were monitored in Masai Mara (Kenya), of which 54 had various types of active (intentionally caused) or passive (non-intentionally caused) injuries. Also studied were 75 random control samples of apparently unaffected animals. The observed active injuries were as expected biased by age, with adults suffering more harm; on the other hand, no such bias was observed in the case of passive injuries. Bias was also observed in elephant sex since more males than females were passively and actively injured. Cases of passive and active injuries in elephants were negatively related to the proximity to roads and farms; the distribution of injured elephants was not affected by the presence of either human settlements or water sources. Overall more elephants were actively injured during the dry season than the wet season as expected. Local communities play a positive role by informing KWS authorities of the presence of injured elephants and reported 43% of all cases of injured elephants. Our results suggest that the negative effect of local communities on elephants could be predicted by elephant proximity to farms and roads. In addition, local communities may be able to play a more positive role in elephant conservation given that they are key informants in the early detection of injured elephants.

Low-cost and no-cost practice to achieve energy efficiency of government office buildings: A case study in federal territory of Malaysia

NASA Astrophysics Data System (ADS)

Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Ibrahim, Amlus

2016-08-01

This paper presents the findings of a case study to achieve energy-efficient performance of conventional office buildings in Malaysia. Two multi-storey office buildings in Federal Territory of Malaysia have been selected. The aim is to study building energy saving potential then to highlight the appropriate measures that can be implemented. Data was collected using benchmarking method by comparing the measured consumption to other similar office buildings and a series of preliminary audit which involves interviews, a brief review of utility and operating data as well as a walkthrough in the buildings. Additionally, in order to get a better understanding of major energy consumption in the selected buildings, general audit have been conducted to collect more detailed information about building operation. In the end, this study emphasized low-cost and no-cost practice to achieve energy efficiency with significant results in some cases.

Age estimation by amino acid racemization in human teeth.

PubMed

Ohtani, Susumu; Yamamoto, Toshiharu

2010-11-01

When an unidentified body is found, it is essential to establish the personal identity of the body in addition to investigating the cause of death. Identification is one of the most important functions of forensic dentistry. Fingerprint, dental, and DNA analysis can be used to accurately identify a body. However, if no information is available for identification, age estimation can contribute to the resolution of a case. The authors have been using aspartic acid racemization rates in dentin (D-aspartic acid/L-aspartic acid: D/L Asp) as an index for age estimation and have obtained satisfactory results. We report five cases of age estimation using the racemization method. In all five cases, estimated ages were accurate within a range ±3 years. We conclude that the racemization method is a reliable and practical method for estimating age. © 2010 American Academy of Forensic Sciences.

[Assessment of SUSARs. Clinical evaluation of single cases in terms of regulatory requirements].

PubMed

Wroblewski, H; Schmickler, M

2005-04-01

In the course of implementing the European directives on pharmaceutical law, focus is set on suspected unexpected serious adverse reactions (SUSARs). SUSARs are essential for expedited reporting to authorities and ethics committees. During on-line monitoring of the study, the investigator documents all adverse events. Serious adverse events are forwarded to the sponsor in due time. The sponsor identifies SUSARs for expedited reporting. Clinical causality assessment between the investigational product and the adverse event is substantial in this process. This requires a balanced clinical assessment of all case relevant aspects and information available reflecting the complexity of the specific case, which cannot be covered by algorithms in general. In the setting of on-line monitoring, SUSARs ensure the safety of the patient and the study. In addition, SUSARs are relevant for generation of the safety profile of the substance.

Environmental surveillance during an outbreak of tularaemia in hares, the Netherlands, 2015

PubMed Central

Janse, Ingmar; Maas, Miriam; Rijks, Jolianne M; Koene, Miriam; van der Plaats, Rozemarijn QJ; Engelsma, Marc; van der Tas, Peter; Braks, Marieta; Stroo, Arjan; Notermans, Daan W; de Vries, Maaike C; Reubsaet, Frans; Fanoy, Ewout; Swaan, Corien; Kik, Marja JL; IJzer, Jooske; Jaarsma, Ryanne I; van Wieren, Sip; de Roda-Husman, Ana Maria; van Passel, Mark; Roest, Hendrik-Jan; van der Giessen, Joke

2017-01-01

Tularaemia, a disease caused by the bacterium Francisella tularensis, is a re-emerging zoonosis in the Netherlands. After sporadic human and hare cases occurred in the period 2011 to 2014, a cluster of F. tularensis-infected hares was recognised in a region in the north of the Netherlands from February to May 2015. No human cases were identified, including after active case finding. Presence of F. tularensis was investigated in potential reservoirs and transmission routes, including common voles, arthropod vectors and surface waters. F. tularensis was not detected in common voles, mosquito larvae or adults, tabanids or ticks. However, the bacterium was detected in water and sediment samples collected in a limited geographical area where infected hares had also been found. These results demonstrate that water monitoring could provide valuable information regarding F. tularensis spread and persistence, and should be used in addition to disease surveillance in wildlife. PMID:28877846

DORMAN computer program (study 2.5). Volume 3: Original data bank listing. [development of data bank for computerized information storage of NASA programs

NASA Technical Reports Server (NTRS)

Stricker, L. T.

1973-01-01

A number of analyses have been performed using the DORCA program for several NASA-funded Aerospace Corporation studies in the past few years. The data decks containing the input data for these analyses have been compiled and are submitted, under separate cover. A few of the data decks are full (basic) decks containing every data item and are used as reference decks in the data bank. The other data decks were obtained by differencing a full deck with respect to one of the reference decks. Using the DORMAN program, a full deck can be recreated from the modified deck and its reference deck when and if desired. The content and structure of the data bank are described. A description of each of these data decks is presented. Three of the cases that are included in this volume have become so widely recognized and accepted that additional descriptive material has been provided. The three cases are: Case 500 Costs, Case 506 Costs, and Case 403.

Developing High PV Penetration Cases for Frequency Response Study of U.S. Western Interconnection: Preprint

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

Tan, Jin; Zhang, Yingchen; Veda, Santosh

Recent large penetrations of solar photovoltaic (PV) generation and the inertial characteristics of inverter-based generation technologies have caught the attention of those in the electric power industry in the United States. This paper presents a systematic approach to developing test cases of high penetrations of PV for the Western Interconnection. First, to examine the accuracy of the base case model, the Western Electricity Coordinating Council (WECC) model is validated by using measurement data from synchronized phasor measurement units. Based on the 2022 Light Spring case, we developed four high PV penetration cases for the WECC system that are of interestmore » to the industry: 5% PV+15 % wind, 25% PV+15% wind, 45% PV+15% wind, 65% PV+15% wind). Additionally, a method to project PV is proposed that is based on collected, realistic PV distribution information, including the current and future PV power plant locations and penetrations in the WECC system. Both the utility-scale PV plant and residential rooftop PV are included in this study.« less

Developing High PV Penetration Cases for Frequency Response Study of U.S. Western Interconnection

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

Tan, Jin; Zhang, Yingchen; Veda, Santosh

Recent large penetrations of solar photovoltaic (PV) generation and the inertial characteristics of inverter-based generation technologies have caught the attention of those in the electric power industry in the United States. This paper presents a systematic approach to developing test cases of high penetrations of PV for the Western Interconnection. First, to examine the accuracy of the base case model, the Western Electricity Coordinating Council (WECC) model is validated by using measurement data from synchronized phasor measurement units. Based on the 2022 Light Spring case, we developed four high PV penetration cases for the WECC system that are of interestmore » to the industry: 5% PV+15 % wind, 25% PV+15% wind, 45% PV+15% wind, 65% PV+15% wind). Additionally, a method to project PV is proposed that is based on collected, realistic PV distribution information, including the current and future PV power plant locations and penetrations in the WECC system. Both the utility-scale PV plant and residential rooftop PV are included in this study.« less

A case of severe chlorite poisoning successfully treated with early administration of methylene blue, renal replacement therapy, and red blood cell transfusion: case report.

PubMed

Gebhardtova, Andrea; Vavrinec, Peter; Vavrincova-Yaghi, Diana; Seelen, Mark; Dobisova, Anna; Flassikova, Zora; Cikova, Andrea; Henning, Robert H; Yaghi, Aktham

2014-08-01

The case of a 55-year-old man who attempted suicide by ingesting <100 mL of 28% sodium chlorite solution is presented. On arrival in the intensive care unit, the patient appeared cyanotic with lowered consciousness and displayed anuria and chocolate brown serum.Initial laboratory tests revealed 40% of methemoglobin. The formation of methemoglobin was effectively treated with methylene blue (10% after 29 hours).To remove the toxin, and because of the anuric acute renal failure, the patient received renal replacement therapy. Despite these therapeutic measures, the patient developed hemolytic anemia and disseminated intravascular coagulation, which were treated with red blood cell transfusion and intermittent hemodialysis. These interventions led to the improvement of his condition and the patient eventually fully recovered. Patient gave written informed consent.This is the third known case of chlorite poisoning that has been reported. Based upon this case, we suggest the management of sodium chlorite poisoning to comprise the early administration of methylene blue, in addition to renal replacement therapy and transfusion of red blood cells.

Effectiveness of Telebehavioral Health Program Nurse Case Managers (NCM): Data Collection Tools and the Process for NCM-Sensitive Outcome Measures.

PubMed

Carlson, Judy; Cohen, Roslyn; Bice-Stephens, Wynona

2014-01-01

As a part of our nation's pursuit of improvements in patient care outcomes, continuity of care, and cost containment, the case manager has become a vital member on interdisciplinary teams and in health care agencies. Telebehavioral health programs, as a relatively new method of delivering behavioral health care, have recently begun to incorporate case management into their multidisciplinary teams. To determine the efficacy and efficiency of healthcare programs, program managers are charged with the determination of the outcomes of the care rendered to patient populations. However, programs that use telehealth methods to deliver care have unique structures in place that impact ability to collect outcome data. A military medical center that serves the Pacific region developed surveys and processes to distribute, administer, and collect information about a telehealth environment to obtain outcome data for the nurse case manager. This report describes the survey development and the processes created to capture nurse case manager outcomes. Additionally, the surveys and processes developed in this project for measuring outcomes may be useful in other settings and disciplines.

Developing High PV Penetration Cases for Frequency Response Study of U.S. Western Interconnection: Preprint

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

Tan, Jin; Zhang, Yingchen; Veda, Santosh

2017-04-11

Recent large penetrations of solar photovoltaic (PV) generation and the inertial characteristics of inverter-based generation technologies have caught the attention of those in the electric power industry in the United States. This paper presents a systematic approach to developing test cases of high penetrations of PV for the Western Interconnection. First, to examine the accuracy of the base case model, the Western Electricity Coordinating Council (WECC) model is validated by using measurement data from synchronized phasor measurement units. Based on the 2022 Light Spring case, we developed four high PV penetration cases for the WECC system that are of interestmore » to the industry: 5% PV+15 % wind, 25% PV+15% wind, 45% PV+15% wind, 65% PV+15% wind). Additionally, a method to project PV is proposed that is based on collected, realistic PV distribution information, including the current and future PV power plant locations and penetrations in the WECC system. Both the utility-scale PV plant and residential rooftop PV are included in this study.« less

Software Tech News. The DoD Source for Software Technology Information. Software Testing Series: Part 2, Volume 3, Number 3, 1999

DTIC Science & Technology

1999-01-01

published in December of 1998. In addition, Mr. Drake is the author of a theme article entitled: "Measuring Software Quality: A Case Study...and services may run on different platforms in differing combinations , • Partial application failure (e.g., a client running, service down) is...result in a combined utility function that is some aggregation of the underlying utility functions. The benefit a client receives from a service