Critical Evaluation of a Human In Vitro Biotransformation Rate Database

EPA Science Inventory

Chemical biotransformation is critical information in the understanding of how a chemical may elicit health effects in humans or in the environment. Despite the fundamental value of these data, very relatively few measured in vivo data are available for humans compared to the tho...

Pheromone routing protocol on a scale-free network.

PubMed

Ling, Xiang; Hu, Mao-Bin; Jiang, Rui; Wang, Ruili; Cao, Xian-Bin; Wu, Qing-Song

2009-12-01

This paper proposes a routing strategy for network systems based on the local information of "pheromone." The overall traffic capacity of a network system can be evaluated by the critical packet generating rate R(c). Under this critical generating rate, the total packet number in the system first increases and then decreases to reach a balance state. The system behaves differently from that with a local routing strategy based on the node degree or shortest path routing strategy. Moreover, the pheromone routing strategy performs much better than the local routing strategy, which is demonstrated by a larger value of the critical generating rate. This protocol can be an alternation for superlarge networks, in which the global topology may not be available.

Pheromone routing protocol on a scale-free network

NASA Astrophysics Data System (ADS)

Ling, Xiang; Hu, Mao-Bin; Jiang, Rui; Wang, Ruili; Cao, Xian-Bin; Wu, Qing-Song

2009-12-01

This paper proposes a routing strategy for network systems based on the local information of “pheromone.” The overall traffic capacity of a network system can be evaluated by the critical packet generating rate Rc . Under this critical generating rate, the total packet number in the system first increases and then decreases to reach a balance state. The system behaves differently from that with a local routing strategy based on the node degree or shortest path routing strategy. Moreover, the pheromone routing strategy performs much better than the local routing strategy, which is demonstrated by a larger value of the critical generating rate. This protocol can be an alternation for superlarge networks, in which the global topology may not be available.

Comparison of performance criteria for evaluating stake test data

Treesearch

Stan T. Lebow; Patricia K. Lebow; Grant T. Kirker

2017-01-01

Stake tests are a critical part of evaluating durability of wood in ground-contact, but there is a lack of criteria for interpreting stake test results. This paper discusses criteria that might be used to determine if short term ratings indicate satisfactory longterm performance. Ratings of 19 by 19 mm stakes from multiple plots in the Harrison Experimental Forest,...

The impact of critical appraisal workshops on residents' evidence based medicine skills and knowledge.

PubMed

Nasr, Justine A; Falatko, John; Halalau, Alexandra

2018-01-01

To assess the impact of four evidence based medicine (EBM) critical appraisal education workshops in improving residents' EBM knowledge and skills. The eligible participants in the workshops were 88 residents-in-training, postgraduate years one through four, rotating through the outpatient internal medicine clinic. Four EBM workshops, consisting of 3 days each (30 minutes daily), were taught by our faculty. Topics covered included critical appraisal of randomized controlled trials, case-control and cohort studies, diagnosis studies, and systematic reviews. As a program evaluation, anonymous pre-workshop and post-workshop tests were administered. Each of the four sets of tests showed improvement in scores: therapy from 58% to 77% (42% response rate), harm from 65% to 73% (38% response rate), diagnosis from 49% to 68% (49% response rate), and systematic review from 57% to 72% (30% response rate). We found that teaching EBM in four short workshops improved EBM knowledge and critical appraisal skills related to the four topics.

Impact of the introduction of a specialist critical care pharmacist on the level of pharmaceutical care provided to the critical care unit.

PubMed

Richter, Anja; Bates, Ian; Thacker, Meera; Jani, Yogini; O'Farrell, Bryan; Edwards, Caroline; Taylor, Helen; Shulman, Rob

2016-08-01

To evaluate the impact of a dedicated specialist critical care pharmacist service on patient care at a UK critical care unit (CCU). Pharmacist intervention data was collected in two phases. Phase 1 was with the provision of a non-specialist pharmacist chart review service and Phase 2 was after the introduction of a specialist dedicated pharmacy service. Two CCUs with established critical care pharmacist services were used as controls. The impact of pharmacist interventions on optimising drug therapy or preventing harm from medication errors was rated on a 4-point scale. There was an increase in the mean daily rate of pharmacist interventions after the introduction of the specialist critical care pharmacist (5.45 versus 2.69 per day, P < 0.0005). The critical care pharmacist intervened on more medication errors preventing potential harm and optimised more medications. There was no significant change to intervention rates at the control sites. Across all study sites the majority of pharmacist interventions were graded to have at least moderate impact on patient care. The introduction of a specialist critical care pharmacist resulted in an increased rate of pharmacist interventions compared to a non-specialist pharmacist service thus improving the quality of patient care. © 2016 The Authors. IJPP © 2016 Royal Pharmaceutical Society.

The State of Retrieval System Evaluation.

ERIC Educational Resources Information Center

Salton, Gerald

1992-01-01

The current state of information retrieval (IR) evaluation is reviewed with criticisms directed at the available test collections and the research and evaluation methodologies used, including precision and recall rates for online searches and laboratory tests not including real users. Automatic text retrieval systems are also discussed. (32…

An Analysis of Critical Issues in Korean Teacher Evaluation Systems

ERIC Educational Resources Information Center

Choi, Hee Jun; Park, Ji-Hye

2016-01-01

Korea has used three different teacher evaluation systems since the 1960s: teacher performance rating, teacher performance-based pay and teacher evaluation for professional development. A number of studies have focused on an analysis of each evaluation system in terms of its advent, development, advantages and disadvantages, but these studies have…

Considerations for Assessing Maximum Critical Temperatures in Small Ectothermic Animals: Insights from Leaf-Cutting Ants

PubMed Central

Ribeiro, Pedro Leite; Camacho, Agustín; Navas, Carlos Arturo

2012-01-01

The thermal limits of individual animals were originally proposed as a link between animal physiology and thermal ecology. Although this link is valid in theory, the evaluation of physiological tolerances involves some problems that are the focus of this study. One rationale was that heating rates shall influence upper critical limits, so that ecological thermal limits need to consider experimental heating rates. In addition, if thermal limits are not surpassed in experiments, subsequent tests of the same individual should yield similar results or produce evidence of hardening. Finally, several non-controlled variables such as time under experimental conditions and procedures may affect results. To analyze these issues we conducted an integrative study of upper critical temperatures in a single species, the ant Atta sexdens rubropiosa, an animal model providing large numbers of individuals of diverse sizes but similar genetic makeup. Our specific aims were to test the 1) influence of heating rates in the experimental evaluation of upper critical temperature, 2) assumptions of absence of physical damage and reproducibility, and 3) sources of variance often overlooked in the thermal-limits literature; and 4) to introduce some experimental approaches that may help researchers to separate physiological and methodological issues. The upper thermal limits were influenced by both heating rates and body mass. In the latter case, the effect was physiological rather than methodological. The critical temperature decreased during subsequent tests performed on the same individual ants, even one week after the initial test. Accordingly, upper thermal limits may have been overestimated by our (and typical) protocols. Heating rates, body mass, procedures independent of temperature and other variables may affect the estimation of upper critical temperatures. Therefore, based on our data, we offer suggestions to enhance the quality of measurements, and offer recommendations to authors aiming to compile and analyze databases from the literature. PMID:22384147

Evaluation of Enhanced Low Dose Rate Sensitivity in Discrete Bipolar Junction Transistors

NASA Technical Reports Server (NTRS)

Chen, Dakai; Ladbury Raymond; LaBel, Kenneth; Topper, Alyson; Ladbury, Raymond; Triggs, Brian; Kazmakites, Tony

2012-01-01

We evaluate the low dose rate sensitivity in several families of discrete bipolar transistors across device parameter, quality assurance level, and irradiation bias configuration. The 2N2222 showed the most significant low dose rate sensitivity, with low dose rate enhancement factor of 3.91 after 100 krad(Si). The 2N2907 also showed critical degradation levels. The devices irradiated at 10 mrad(Si)/s exceeded specifications after 40 and 50 krad(Si) for the 2N2222 and 2N2907 devices, respectively.

76 FR 79379 - Risk-Based Capital Guidelines: Market Risk; Alternatives to Credit Ratings for Debt and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-21

... play a critical ``gatekeeper'' role in the debt markets and perform evaluative and analytical services... assessments for fee-paying clients, nor does it provide the sort of evaluative and analytical services as...

Validation of the Family Meeting Behavioral Skills Checklist. An Instrument to Assess Fellows' Communication Skills.

PubMed

Gustin, Jillian L; Way, David P; Wells-Di Gregorio, Sharla; McCallister, Jennifer W

2016-08-01

Fellows in pulmonary and critical care medicine are required to show competency in facilitating family meetings for critically ill patients. There are many assessment measures available for evaluating physician-patient communication (e.g., the SEGUE Framework [Set the stage, Elicit information, Give information, Understand the patient's perspective, End the encounter]) and some designed for family meetings. However, no validated measure exists that is specifically designed to assess communication skills during family meetings with surrogate decision makers in intensive care settings. We developed the Family Meeting Behavioral Skills Checklist (FMBSC) to measure advanced communication skills of fellows in family meetings of critically ill patients based on a literature review and consensus of an interdisciplinary group of communications experts. We evaluated the psychometric properties of the FMBSC. We digitally recorded 16 pulmonary/critical care fellows performing a simulated family meeting for a critically ill patient at the end of 1 year of fellowship training. Two clinical health psychologists evaluated each recording independently using the FMBSC Rating Scale and the SEGUE Framework. Judges recorded the number of skills performed using the checklist and employed a summary rating scale to judge the level of performance for each of nine subsets of skills. Each instrument was scored and converted to percentage scores. The FMBSC and SEGUE Framework items were summed and converted to percentage scores for each category and as a total for each instrument. The rating scale items on the FMBSC were also summed and converted to a percentage score. Four primary analyses were conducted to evaluate interjudge reliability, internal consistency, and concurrent validity. Interrater reliability was higher for the FMBSC (intraclass correlation [ICC2,2] = 0.57) than for the SEGUE instrument (ICC2,2 = 0.32) or the FMBSC Rating Scale (ICC2,2 = 0.23). The FMBSC demonstrated evidence of concurrent validity through high positive correlations with both the FMBSC Rating Scale and the SEGUE instrument (r = +0.83, P ≤ 0.01; r = +0.65, P ≤ 0.01 respectively). All but one of the nine subscales on the FMBSC showed adequate internal consistency (reliabilities ranged from 0.18 to 0.68). Interjudge reliability was higher for the FMBSC (ICC2,2 = 0.57) than for the SEGUE instrument (ICC2,2 = 0.32) or the FMBSC Rating Scale (ICC2,2 = 0.23). The FMBSC demonstrated internal consistency and structural validity in assessing advanced communication skills of fellows in facilitating family meetings of critically ill patients in the ICU. Interjudge reliability was better for the FMBS Checklist than it was for the other measures.

Peer-assessment of medical communication skills: the impact of students' personality, academic and social reputation on behavioural assessment.

PubMed

Hulsman, Robert L; Peters, Joline F; Fabriek, Marcel

2013-09-01

Peer-assessment of communication skills may contribute to mastery of assessment criteria. When students develop the capacity to judge their peers' performance, they might improve their capacity to examine their own clinical performance. In this study peer-assessment ratings are compared to teacher-assessment ratings. The aim of this paper is to explore the impact of personality and social reputation as source of bias in assessment of communication skills. Second year students were trained and assessed history taking communication skills. Peers rated the students' personality and academic and social reputation. Peer-assessment ratings were significantly correlated with teacher-ratings in a summative assessment of medical communication. Peers did not provide negative ratings on final scales but did provide negative ratings on subcategories. Peer- and teacher-assessments were both related to the students' personality and academic reputation. Peer-assessment cannot replace teacher-assessment if the assessment should result in high-stake decisions about students. Our data do not confirm the hypothesis that peers are overly biased by personality and reputation characteristics in peer-assessment of performance. Early introduction of peer-assessment in medical education would facilitate early acceptance of this mode of evaluation and would promote early on the habit of critical evaluation of professional clinical performance and acceptance of being evaluated critically by peers. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Evaluation of Neutron Response of Criticality Accident Alarm System Detector to Quasi-Monoenergetic 24 keV Neutrons

NASA Astrophysics Data System (ADS)

Tsujimura, Norio; Yoshida, Tadayoshi; Yashima, Hiroshi

The criticality accident alarm system (CAAS), which was recently developed and installed at the Japan Atomic Energy Agency's Tokai Reprocessing Plant, consists of a plastic scintillator combined with a cadmium-lined polyethylene moderator and thereby responds to both neutrons and gamma rays. To evaluate the neutron absorbed dose rate response of the CAAS detector, a 24 keV quasi-monoenergetic neutron irradiation experiment was performed at the B-1 facility of the Kyoto University Research Reactor. The detector's evaluated neutron response was confirmed to agree reasonably well with prior computer-predicted responses.

Online Student Evaluations and Response Rates Reconsidered

ERIC Educational Resources Information Center

Anderson, Joan; Brown, Gary; Spaeth, Stephen

2006-01-01

Many administrators are moving toward using online student evaluations to assess courses and instructors, but critics of the practice fear that the online format will only result in lower levels of student participation. Joan Anderson, Gary Brown, and Stephen Spaeth claim that such a concern often fails to acknowledge how the evaluation process…

Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument--an observational study.

PubMed

Myers, Julia A; Powell, David M C; Psirides, Alex; Hathaway, Karyn; Aldington, Sarah; Haney, Michael F

2016-03-08

In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. In the first phase of the project the anaesthetists' non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors. The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (r(s) = 0.4, p = 0.11) or observed non-technical skills performance (r(s) = 0.4, p = 0.1). This study describes a framework which characterises the non-technical skills required by critical care air ambulance clinicians, and distinguishes higher and lower levels of performance. The AeroNOTS framework could be used to facilitate education and training in non-technical skills for air ambulance clinicians, and further evaluation of this rating system is merited.

In the linear quadratic model, the Poisson approximation and the Zaider-Minerbo formula agree on the ranking of tumor control probabilities, up to a critical cell birth rate.

PubMed

Ballhausen, Hendrik; Belka, Claus

2017-03-01

To provide a rule for the agreement or disagreement of the Poisson approximation (PA) and the Zaider-Minerbo formula (ZM) on the ranking of treatment alternatives in terms of tumor control probability (TCP) in the linear quadratic model. A general criterion involving a critical cell birth rate was formally derived. For demonstration, the criterion was applied to a distinct radiobiological model of fast growing head and neck tumors and a respective range of 22 conventional and nonconventional head and neck schedules. There is a critical cell birth rate b crit below which PA and ZM agree on which one out of two alternative treatment schemes with single-cell survival curves S'(t) and S''(t) offers better TCP: [Formula: see text] For cell birth rates b above this critical cell birth rate, PA and ZM disagree if and only if b >b crit > 0. In case of the exemplary head and neck schedules, out of 231 possible combinations, only 16 or 7% were found where PA and ZM disagreed. In all 231 cases the prediction of the criterion was numerically confirmed, and cell birth rates at crossovers between schedules matched the calculated critical cell birth rates. TCP estimated by PA and ZM almost never numerically coincide. Still, in many cases both formulas at least agree about which one out of two alternative fractionation schemes offers better TCP. In case of fast growing tumors featuring a high cell birth rate, however, ZM may suggest a re-evaluation of treatment options.

Formulation and process factors influencing product quality and in vitro performance of ophthalmic ointments.

PubMed

Xu, Xiaoming; Al-Ghabeish, Manar; Rahman, Ziyaur; Krishnaiah, Yellela S R; Yerlikaya, Firat; Yang, Yang; Manda, Prashanth; Hunt, Robert L; Khan, Mansoor A

2015-09-30

Owing to its unique anatomical and physiological functions, ocular surface presents special challenges for both design and performance evaluation of the ophthalmic ointment drug products formulated with a variety of bases. The current investigation was carried out to understand and identify the appropriate in vitro methods suitable for quality and performance evaluation of ophthalmic ointment, and to study the effect of formulation and process variables on its critical quality attributes (CQA). The evaluated critical formulation variables include API initial size, drug percentage, and mineral oil percentage while the critical process parameters include mixing rate, temperature, time and cooling rate. The investigated quality and performance attributes include drug assay, content uniformity, API particle size in ointment, rheological characteristics, in vitro drug release and in vitro transcorneal drug permeation. Using design of experiments (DoE) as well as a novel principle component analysis approach, five of the quality and performance attributes (API particle size, storage modulus of ointment, high shear viscosity of ointment, in vitro drug release constant and in vitro transcorneal drug permeation rate constant) were found to be highly influenced by the formulation, in particular the strength of API, and to a lesser degree by processing variables. Correlating the ocular physiology with the physicochemical characteristics of acyclovir ophthalmic ointment suggested that in vitro quality metrics could be a valuable predictor of its in vivo performance. Published by Elsevier B.V.

A case study evaluation of a Critical Care Information System adoption using the socio-technical and fit approach.

PubMed

Yusof, Maryati Mohd

2015-07-01

Clinical information systems have long been used in intensive care units but reports on their adoption and benefits are limited. This study evaluated a Critical Care Information System implementation. A case study summative evaluation was conducted, employing observation, interview, and document analysis in operating theatres and 16-bed adult intensive care units in a 400-bed Malaysian tertiary referral centre from the perspectives of users (nurses and physicians), management, and information technology staff. System implementation, factors influencing adoption, fit between these factors, and the impact of the Critical Care Information System were evaluated after eight months of operation. Positive influences on system adoption were associated with technical factors, including system ease of use, usefulness, and information relevancy; human factors, particularly user attitude; and organisational factors, namely clinical process-technology alignment and champions. Organisational factors such as planning, project management, training, technology support, turnover rate, clinical workload, and communication were barriers to system implementation and use. Recommendations to improve the current system problems were discussed. Most nursing staff positively perceived the system's reduction of documentation and data access time, giving them more time with patients. System acceptance varied among doctors. System use also had positive impacts on timesaving, data quality, and clinical workflow. Critical Care Information Systems is crucial and has great potentials in enhancing and delivering critical care. However, the case study findings showed that the system faced complex challenges and was underutilised despite its potential. The role of socio-technical factors and their fit in realizing the potential of Critical Care Information Systems requires continuous, in-depth evaluation and stakeholder understanding and acknowledgement. The comprehensive and specific evaluation measures of the Human-Organisation-Technology Fit framework can flexibly evaluate Critical Care Information Systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Event-rate and delta inflation when evaluating mortality as a primary outcome from randomized controlled trials of nutritional interventions during critical illness: a systematic review.

PubMed

Summers, Matthew J; Chapple, Lee-anne S; McClave, Stephen A; Deane, Adam M

2016-04-01

There is a lack of high-quality evidence that proves that nutritional interventions during critical illness reduce mortality. We evaluated whether power calculations for randomized controlled trials (RCTs) of nutritional interventions that used mortality as the primary outcome were realistic, and whether overestimation was systematic in the studies identified to determine whether this was due to overestimates of event rate or delta. A systematic review of the literature between 2005 and 2015 was performed to identify RCTs of nutritional interventions administered to critically ill adults that had mortality as the primary outcome. Predicted event rate (predicted mortality during the control), predicted mortality during intervention, predicted delta (predicted difference between mortality during the control and intervention), actual event rate (observed mortality during control), observed mortality during intervention, and actual delta (difference between observed mortality during the control and intervention) were recorded. The event-rate gap (predicted event rate minus observed event rate), the delta gap (predicted delta minus observed delta), and the predicted number needed to treat were calculated. Data are shown as median (range). Fourteen articles were extracted, with power calculations provided for 10 studies. The predicted event rate was 29.9% (20.0–52.4%), and the predicted delta was 7.9% (3.0–20.0%). If the study hypothesis was proven correct then, on the basis of the power calculations, the number needed to treat would have been 12.7 (5.0–33.3) patients. The actual event rate was 25.3% (6.1–50.0%), the observed mortality during the intervention was 24.4% (6.3–39.7%), and the actual delta was 0.5% (−10.2–10.3%), such that the event-rate gap was 2.6% (−3.9–23.7%) and delta gap was 7.5% (3.2–25.2%). Overestimates of delta occur frequently in RCTs of nutritional interventions in the critically ill that are powered to determine a mortality benefit. Delta inflation may explain the number of "negative" studies in this field of research.

Structural dynamic analysis of the Space Shuttle Main Engine

NASA Technical Reports Server (NTRS)

Scott, L. P.; Jamison, G. T.; Mccutcheon, W. A.; Price, J. M.

1981-01-01

This structural dynamic analysis supports development of the SSME by evaluating components subjected to critical dynamic loads, identifying significant parameters, and evaluating solution methods. Engine operating parameters at both rated and full power levels are considered. Detailed structural dynamic analyses of operationally critical and life limited components support the assessment of engine design modifications and environmental changes. Engine system test results are utilized to verify analytic model simulations. The SSME main chamber injector assembly is an assembly of 600 injector elements which are called LOX posts. The overall LOX post analysis procedure is shown.

The role of dose rate in radiation cancer risk: evaluating the effect of dose rate at the molecular, cellular and tissue levels using key events in critical pathways following exposure to low LET radiation

PubMed Central

Brooks, Antone L.; Hoel, David G.; Preston, R. Julian

2016-01-01

Abstract Purpose: This review evaluates the role of dose rate on cell and molecular responses. It focuses on the influence of dose rate on key events in critical pathways in the development of cancer. This approach is similar to that used by the U.S. EPA and others to evaluate risk from chemicals. It provides a mechanistic method to account for the influence of the dose rate from low-LET radiation, especially in the low-dose region on cancer risk assessment. Molecular, cellular, and tissues changes are observed in many key events and change as a function of dose rate. The magnitude and direction of change can be used to help establish an appropriate dose rate effectiveness factor (DREF). Conclusions: Extensive data on key events suggest that exposure to low dose-rates are less effective in producing changes than high dose rates. Most of these data at the molecular and cellular level support a large (2–30) DREF. In addition, some evidence suggests that doses delivered at a low dose rate decrease damage to levels below that observed in the controls. However, there are some data human and mechanistic data that support a dose-rate effectiveness factor of 1. In summary, a review of the available molecular, cellular and tissue data indicates that not only is dose rate an important variable in understanding radiation risk but it also supports the selection of a DREF greater than one as currently recommended by ICRP (2007) and BEIR VII (NRC/NAS 2006). PMID:27266588

Effect of Chronic Diseases on Work Productivity: A Propensity Score Analysis.

PubMed

Fouad, Ahmed Mahmoud; Waheed, Amani; Gamal, Amira; Amer, Shaimaa Ahmed; Abdellah, Rasha Farouk; Shebl, Fatma Mohamed

2017-05-01

The aim of this study was to evaluate the effect of chronic disease(s) on work productivity. Using the Health & Work Performance Questionnaire, information was collected from 516 workers on chronic disease status and work productivity. Propensity-score matching was performed to identify matched-pairs of workers. In the propensity-score matched sample, workers with chronic diseases were more likely to have increased absenteeism and presenteeism rates, 6.34 and 2.36 times the rates if no chronic diseases, respectively. In addition, they had greater odds for getting negative critical work incidents and less odds for positive incidents than none or balanced status. Multimorbidity showed more significant increase in absenteeism and presenteeism rates, as well as increased odds for excess negative critical work incidents. Chronic disease(s) can significantly reduce work productivity by increasing absenteeism, presenteeism, and net negative critical incidents.

Student Evaluations as Social Ritual.

ERIC Educational Resources Information Center

Whittington, Harold

The practice of student evaluation of college faculty is discussed in terms of the literature on social ritual. The following arguments that critics have raised are considered: student ratings of professors are neither scientific nor objective; feedback needed by professors to improve the quality of their work and data needed by administrators to…

Malaysia's social policies on mental health: a critical theory.

PubMed

Mubarak, A Rahamuthulla

2003-01-01

This article aims to review the social policies on mental health and mental illness in Malaysia. Using critical theory, major policy issues pertaining to mental health and mental illness such as mental health legislation, prevalence rates and quality of services available to the people with mental health problems are discussed in detail. Implications of these issues on persons with mental health problems are critically evaluated. The paper highlights that the other countries in ASEAN region also require similar review by policy literature.

Challenging Misconceptions about Student Ratings of Instruction. IDEA Paper #58

ERIC Educational Resources Information Center

Benton, Stephen L.; Ryalls, Kenneth R.

2016-01-01

Data from student ratings of instruction (SRI) are used ubiquitously as a key element in providing instructors with valuable feedback and evaluators with critical student input. Nonetheless, calls for the elimination of SRI continue to appear in academic journals and higher education periodicals. This paper brings to bear the huge body of research…

Assessing U.S. Public School Quality: The Advantages of Combining Internal "Consumer Ratings" with External NCLB Ratings

ERIC Educational Resources Information Center

Price, Heather E.

2016-01-01

The school quality assessment process under No Child Left Behind (NCLB) is criticized for oversimplifying and overemphasizing standardized test results and unfairly targeting diverse, urban schools. There has been much development in alternative test score evaluations, especially value-added models. These developments have tilted the public…

Critical Evaluation of a Human In Vitro Biotransformation Rate Database: Case Study of Seven Chemicals (SETAC Europe - 2018)

EPA Science Inventory

The utility of in vitro data as part of integrated chemical assessment strategies (e.g. REACH) in the determination of bioaccumulation (B) is recognized [1]. Human in vitro biotransformation rate data are available [2]; however, there is a high degree of variability in assay meth...

An Evaluation of the Student Service Expectations of Freshmen at a Small, Midwestern Liberal Arts University

ERIC Educational Resources Information Center

Bladdick, Jerry Michael

2012-01-01

Increasing freshmen student retention and ultimately increasing their graduation rates continues to be a critical matter for institutions of higher education. Therefore, colleges and universities are attempting to understand the student service expectations of freshmen students as a primary mechanism to enhance matriculation rates. University…

Contributions to Integral Nuclear Data in ICSBEP and IRPhEP since ND 2013

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

Bess, John D.; Briggs, J. Blair; Gulliford, Jim

2016-09-01

The status of the International Criticality Safety Benchmark Evaluation Project (ICSBEP) and the International Reactor Physics Experiment Evaluation Project (IRPhEP) was last discussed directly with the international nuclear data community at ND2013. Since ND2013, integral benchmark data that are available for nuclear data testing has continued to increase. The status of the international benchmark efforts and the latest contributions to integral nuclear data for testing is discussed. Select benchmark configurations that have been added to the ICSBEP and IRPhEP Handbooks since ND2013 are highlighted. The 2015 edition of the ICSBEP Handbook now contains 567 evaluations with benchmark specifications for 4,874more » critical, near-critical, or subcritical configurations, 31 criticality alarm placement/shielding configuration with multiple dose points apiece, and 207 configurations that have been categorized as fundamental physics measurements that are relevant to criticality safety applications. The 2015 edition of the IRPhEP Handbook contains data from 143 different experimental series that were performed at 50 different nuclear facilities. Currently 139 of the 143 evaluations are published as approved benchmarks with the remaining four evaluations published in draft format only. Measurements found in the IRPhEP Handbook include criticality, buckling and extrapolation length, spectral characteristics, reactivity effects, reactivity coefficients, kinetics, reaction-rate distributions, power distributions, isotopic compositions, and/or other miscellaneous types of measurements for various types of reactor systems. Annual technical review meetings for both projects were held in April 2016; additional approved benchmark evaluations will be included in the 2016 editions of these handbooks.« less

Theory of First Order Chemical Kinetics at the Critical Point of Solution.

PubMed

Baird, James K; Lang, Joshua R

2017-10-26

Liquid mixtures, which have a phase diagram exhibiting a miscibility gap ending in a critical point of solution, have been used as solvents for chemical reactions. The reaction rate in the forward direction has often been observed to slow down as a function of temperature in the critical region. Theories based upon the Gibbs free energy of reaction as the driving force for chemical change have been invoked to explain this behavior. With the assumption that the reaction is proceeding under relaxation conditions, these theories expand the free energy in a Taylor series about the position of equilibrium. Since the free energy is zero at equilibrium, the leading term in the Taylor series is proportional to the first derivative of the free energy with respect to the extent of reaction. To analyze the critical behavior of this derivative, the theories exploit the principle of critical point isomorphism, which is thought to govern all critical phenomena. They find that the derivative goes to zero in the critical region, which accounts for the slowing down observed in the reaction rate. As has been pointed out, however, most experimental rate investigations have been carried out under irreversible conditions as opposed to relaxation conditions [Shen et al. J. Phys. Chem. A 2015, 119, 8784-8791]. Below, we consider a reaction governed by first order kinetics and invoke transition state theory to take into account the irreversible conditions. We express the apparent activation energy in terms of thermodynamic derivatives evaluated under standard conditions as well as the pseudoequilibrium conditions associated with the reactant and the activated complex. We show that these derivatives approach infinity in the critical region. The apparent activation energy follows this behavior, and its divergence accounts for the slowing down of the reaction rate.

Examining Student Evaluations of Black College Faculty: Does Race Matter?

ERIC Educational Resources Information Center

Smith, Bettye P.; Hawkins, Billy

2011-01-01

The purpose of this study was twofold. First, to describe the undergraduate student ratings of teaching effectiveness based on the traditional 36-item end-of-course evaluation form used in the College of Education (COE) at a southeastern Research Extensive predominantly White institution. Second, using critical race theory (CRT) to compare the…

Comparisons of single event vulnerability of GaAs SRAMS

NASA Astrophysics Data System (ADS)

Weatherford, T. R.; Hauser, J. R.; Diehl, S. E.

1986-12-01

A GaAs MESFET/JFET model incorporated into SPICE has been used to accurately describe C-EJFET, E/D MESFET and D MESFET/resistor GaAs memory technologies. These cells have been evaluated for critical charges due to gate-to-drain and drain-to-source charge collection. Low gate-to-drain critical charges limit conventional GaAs SRAM soft error rates to approximately 1E-6 errors/bit-day. SEU hardening approaches including decoupling resistors, diodes, and FETs have been investigated. Results predict GaAs RAM cell critical charges can be increased to over 0.1 pC. Soft error rates in such hardened memories may approach 1E-7 errors/bit-day without significantly reducing memory speed. Tradeoffs between hardening level, performance and fabrication complexity are discussed.

Human Capital and Rates of Return: Brilliant Ideas or Ideological Dead Ends?

ERIC Educational Resources Information Center

Klees, Steven J.

2016-01-01

Human capital theory and rate of return methodology have long been a dominant framework in comparative and international education and other fields. While there have been criticisms since its inception, it has been ubiquitous and widely accepted as an important mechanism for educational planning, evaluation, and policy making. In this article, I…

A critical evaluation of the insect body size model and causes of metamorphosis in solitary bees

USDA-ARS?s Scientific Manuscript database

The insect body size model posits that adult size is determined by growth rate and the duration of growth during the larval stage of development. Within the model, growth rate is regulated by many mechanistic elements that are influenced by both internal and external factors. However, the duration o...

Caregiver-Teacher Concordance of Challenging Behaviors in Children with Autism Spectrum Disorder Served in Community Mental Health Settings

ERIC Educational Resources Information Center

Stadnick, Nicole; Chlebowski, Colby; Brookman-Frazee, Lauren

2017-01-01

Children with autism spectrum disorder (ASD) exhibit high rates of challenging behaviors that impair functioning and represent the primary presenting problem in mental health (MH) services. Obtaining symptom reports from multiple informants is critical for treatment planning. This study evaluated caregiver-teacher concordance of ratings of the…

Evaluation of postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning: a descriptive study.

PubMed

Currey, Judy; Oldland, Elizabeth; Considine, Julie; Glanville, David; Story, Ian

2015-02-01

The aim of this study was to evaluate postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning (TBL). A descriptive pre and post interventional design was used. Study data were collected by surveys and observation. University postgraduate critical care nursing programme. Students' attitudes to learning within teams (Team Experience Questionnaire) and student engagement (observed and self-reports). Twenty-eight of 32 students agreed to participate (87% response rate). There were significant changes in students' attitudes to learning within teams including increases in overall satisfaction with team experience, team impact on quality of learning, team impact on clinical reasoning ability and professional development. There was no significant increase in satisfaction with peer evaluation. Observation and survey results showed higher student engagement in TBL classes compared with standard lecturing. Postgraduate critical care nursing students responded positively to the introduction of TBL and showed increased engagement with learning. In turn, these factors enhanced nurses' professional skills in teamwork, communication, problem solving and higher order critical thinking. Developing professional skills and advancing knowledge should be core to all critical care nursing education programmes to improve the quality and safety of patient care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Perceptions of nursing students after performing an individual activity designed to develop their critical thinking: The "critical card" tool.

PubMed

Urcola-Pardo, Fernando; Blázquez-Ornat, Isabel; Anguas-Gracia, Ana; Gasch-Gallen, Ángel; Germán-Bes, Concepción

2018-03-01

Critical thinking in Health Sciences is among the transversal competences in the Nursing Degree. The critical card is a tool of individual learning, designed to develop critical thinking, and set in the process of environmental health learning. Every student must perform the activity to obtain the highest qualification in Community Health Nursing subject. The aim of this project was to evaluate this learning tool using the students' perceptions after its performance. The evaluation was based on the answers to a questionnaire obtained from the third course students of Nursing Degree at the University of Zaragoza. The questionnaire was made up of 14 Likert-type questions, grouped in four dimensions. The student participation rate was higher than 50%. The analysis of the questionnaire obtained 67,8% positive answers. The variability between dimensions ranged between 49% of positive answers for application in other subjects and 87% of positive answers for the improvements applicable to the instrument. The students coincided in indicating that the critical card is a useful learning tool and could be applicable in other subjects. However, the weight it is given in the global evaluation of the subject is considered to be too low, considering the time used to complete the activity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Are pediatric critical care medicine fellowships teaching and evaluating communication and professionalism?

PubMed

Turner, David A; Mink, Richard B; Lee, K Jane; Winkler, Margaret K; Ross, Sara L; Hornik, Christoph P; Schuette, Jennifer J; Mason, Katherine; Storgion, Stephanie A; Goodman, Denise M

2013-06-01

To describe the teaching and evaluation modalities used by pediatric critical care medicine training programs in the areas of professionalism and communication. Cross-sectional national survey. Pediatric critical care medicine fellowship programs. Pediatric critical care medicine program directors. None. Survey response rate was 67% of program directors in the United States, representing educators for 73% of current pediatric critical care medicine fellows. Respondents had a median of 4 years experience, with a median of seven fellows and 12 teaching faculty in their program. Faculty role modeling or direct observation with feedback were the most common modalities used to teach communication. However, six of the eight (75%) required elements of communication evaluated were not specifically taught by all programs. Faculty role modeling was the most commonly used technique to teach professionalism in 44% of the content areas evaluated, and didactics was the technique used in 44% of other professionalism content areas. Thirteen of the 16 required elements of professionalism (81%) were not taught by all programs. Evaluations by members of the healthcare team were used for assessment for both competencies. The use of a specific teaching technique was not related to program size, program director experience, or training in medical education. A wide range of techniques are currently used within pediatric critical care medicine to teach communication and professionalism, but there are a number of required elements that are not specifically taught by fellowship programs. These areas of deficiency represent opportunities for future investigation and improved education in the important competencies of communication and professionalism.

Effects of temperature, loading rate and nanowire length on torsional deformation and mechanical properties of aluminium nanowires investigated using molecular dynamics simulation

NASA Astrophysics Data System (ADS)

Sung, Po-Hsien; Wu, Cheng-Da; Fang, Te-Hua

2012-05-01

Single-crystal aluminium nanowires under torsion are studied using molecular dynamics simulations based on the many-body tight-binding potential. The effects of temperature, loading rate and nanowire length are evaluated in terms of atomic trajectories, potential energy, von Mises stress, a centrosymmetry parameter, torque, shear modulus and radial distribution function. Simulation results clearly show that torsional deformation begins at the surface, extends close to the two ends and finally diffuses to the middle part. The critical torsional angle which represents the beginning of plastic deformation varies with different conditions. Before the critical torsional angle is reached, the potential energy and the torque required for the deformation of a nanowire significantly increase with the torsional angle. The critical torsional angle increases with increasing nanowire length and loading rate and decreasing temperature. The torque required for the deformation decreases and the shear modulus increases with increasing nanowire length. For higher temperatures and higher loading rates, torsional buckling more easily occurs at the two ends of a nanowire, whereas it occurs towards the middle part at or below room temperature with lower loading rates. Geometry instability occurs before material instability (buckling) for a long nanowire.

Feasibility and safety of virtual-reality-based early neurocognitive stimulation in critically ill patients.

PubMed

Turon, Marc; Fernandez-Gonzalo, Sol; Jodar, Mercè; Gomà, Gemma; Montanya, Jaume; Hernando, David; Bailón, Raquel; de Haro, Candelaria; Gomez-Simon, Victor; Lopez-Aguilar, Josefina; Magrans, Rudys; Martinez-Perez, Melcior; Oliva, Joan Carles; Blanch, Lluís

2017-12-01

Growing evidence suggests that critical illness often results in significant long-term neurocognitive impairments in one-third of survivors. Although these neurocognitive impairments are long-lasting and devastating for survivors, rehabilitation rarely occurs during or after critical illness. Our aim is to describe an early neurocognitive stimulation intervention based on virtual reality for patients who are critically ill and to present the results of a proof-of-concept study testing the feasibility, safety, and suitability of this intervention. Twenty critically ill adult patients undergoing or having undergone mechanical ventilation for ≥24 h received daily 20-min neurocognitive stimulation sessions when awake and alert during their ICU stay. The difficulty of the exercises included in the sessions progressively increased over successive sessions. Physiological data were recorded before, during, and after each session. Safety was assessed through heart rate, peripheral oxygen saturation, and respiratory rate. Heart rate variability analysis, an indirect measure of autonomic activity sensitive to cognitive demands, was used to assess the efficacy of the exercises in stimulating attention and working memory. Patients successfully completed the sessions on most days. No sessions were stopped early for safety concerns, and no adverse events occurred. Heart rate variability analysis showed that the exercises stimulated attention and working memory. Critically ill patients considered the sessions enjoyable and relaxing without being overly fatiguing. The results in this proof-of-concept study suggest that a virtual-reality-based neurocognitive intervention is feasible, safe, and tolerable, stimulating cognitive functions and satisfying critically ill patients. Future studies will evaluate the impact of interventions on neurocognitive outcomes. Trial registration Clinical trials.gov identifier: NCT02078206.

Blood alcohol concentration testing and reporting by the states : traffic tech.

DOT National Transportation Integrated Search

2012-08-01

Accurate and complete data on blood alcohol concentration : (BAC) levels for drivers in fatal crashes are critical in monitoring : alcohol-impaired-driving rates across the country, developing : alcohol-impaired-driving programs, and evaluating : the...

A comparison of sleep assessment tools by nurses and patients in critical care.

PubMed

Richardson, Annette; Crow, Wendy; Coghill, Elaine; Turnock, Christopher

2007-09-01

The aim of this critical care sleep assessment pilot study was to evaluate the usefulness of three sleep assessment tools to identify which, if any, provided the closest comparison between the nurses' judgement and the patients' experience of their sleep. The study objectives were to: (i) compare patients' and nurses' assessment of sleep using three different rating tools. (ii) Ascertain patients' preferences with non-interventional, user friendly, practical tools in critical care. (iii) Recommend changes and improvements to the way that sleep is assessed and documented. Sleep is important for promoting critical care recovery and sleep disturbance is known to cause irritability, aggression and increased stress levels. The availability and use of valid critical care sleep assessment tools is limited. A descriptive comparative study using three sleep assessment-rating scales were constructed to provide easy to understand tools for completion by both patients and nurses in critical care. Structured interviews were undertaken with 82 patients and 82 nurses using a convenience sample from four multispecialty critical care units in one large teaching trust. Patients were included in the study if they met a list of pre-defined criteria to obtain responses from lucid orientated patients. No tool produced a close association between the nurses' assessment of the patients sleep and the patients' assessment of their sleep. Patients found two of the three tools easy to use when rating their sleep. Discussion. Objective invasive measurements of sleep as well as complex subjective tools appear inappropriate to be used as a part of daily critical care practice. The application of simple rating scores has a high degree of error when nurses assess patients' sleep, even though high levels of patient observation and assessment are practiced in critical care. More research is needed to examine the assessment of sleep in critical care, particularly linking rating scales to alternative methods of physiological assessment of sleep. Findings indicate nurses are unable to accurately assess critical care patients' sleep using rating assessment tools. However patients were found to prefer two sleep assessment tools, one banded in hours to assess sleep quantity and one as a comparison against normal sleep to assess sleep quality. This study reviews the importance of sleep assessment and the diverse methods available for assessing sleep focussing on the critically ill patient. More noteworthy it highlights how nurses sole judgements of patients sleep is not a reliable method in clinical practice, however it provides some indication on the application of 'easy to use' tools to assist in the patients assessments of their sleep.

The Increasing Trend in Global Ranking of Websites of Iranian Medical Universities during January 2012-2015.

PubMed

Ramezan Ghorbani, Nahid; Fakour, Yousef; Nojoumi, Seyed Ali

2017-08-01

Researchers and academic institutions need assessment and rating to measure their performance. The criteria are designed to evaluate quality and adequacy of research and welcome by most universities as an international process to increase monitoring academic achievements. The study aimed to evaluate the increasing trend in global ranking of Iranian medical universities websites emphasizing on comparative approach. This is a cross-sectional study involving websites of Iranian medical universities. Sampling was conducted by census selecting universities affiliated to the Ministry of Health in webometrics rating system. Web sites of Iranian medical universities were investigated based on the webometrics indicators, global ranking as well as the process of changing their rating. Universities of medical sciences were associated with improved ratings in seven periods from Jan 2012 until Jan 2015. The highest rank was in Jan 2014. Tehran University of Medical Sciences ranked the first in all periods. The highest ratings were about impact factor in universities of medical sciences reflecting the low level of this index in university websites. The least ranking was observed in type 1 universities. Despite the criticisms and weaknesses of these webometrics criteria, they are critical to this equation and should be checked for authenticity and suitability of goals. Therefore, localizing these criteria by the advantages model, ranking systems features, continuous development and medical universities evaluation based on these indicators provide new opportunities for the development of the country especially through online media.

The Increasing Trend in Global Ranking of Websites of Iranian Medical Universities during January 2012–2015

PubMed Central

RAMEZAN GHORBANI, Nahid; FAKOUR, Yousef; NOJOUMI, Seyed Ali

2017-01-01

Background: Researchers and academic institutions need assessment and rating to measure their performance. The criteria are designed to evaluate quality and adequacy of research and welcome by most universities as an international process to increase monitoring academic achievements. The study aimed to evaluate the increasing trend in global ranking of Iranian medical universities websites emphasizing on comparative approach. Methods: This is a cross-sectional study involving websites of Iranian medical universities. Sampling was conducted by census selecting universities affiliated to the Ministry of Health in webometrics rating system. Web sites of Iranian medical universities were investigated based on the webometrics indicators, global ranking as well as the process of changing their rating. Universities of medical sciences were associated with improved ratings in seven periods from Jan 2012 until Jan 2015. Results: The highest rank was in Jan 2014. Tehran University of Medical Sciences ranked the first in all periods. The highest ratings were about impact factor in universities of medical sciences reflecting the low level of this index in university websites. The least ranking was observed in type 1 universities. Conclusion: Despite the criticisms and weaknesses of these webometrics criteria, they are critical to this equation and should be checked for authenticity and suitability of goals. Therefore, localizing these criteria by the advantages model, ranking systems features, continuous development and medical universities evaluation based on these indicators provide new opportunities for the development of the country especially through online media. PMID:28894711

Unifying interdisciplinary education: designing and implementing an intern simulation educational curriculum to increase confidence in critical care from PGY1 to PGY2.

PubMed

Bullard, Mark J; Leuck, Jo Anna; Howley, Lisa D

2017-11-06

A longitudinal, multidisciplinary critical care simulation curriculum was developed and implemented within a teaching hospital to address the need for consistent, safe, efficient, and unified critical care training within graduate medical education. Primary goals were to increase learner confidence in critical care topics and procedural skills across all specialties. Secondary goals included improving communication skills and obtaining a high level of learner satisfaction. All interns caring for adult patients within our hospital participated in three 4-h simulation-based sessions scheduled over the second half of their intern year. Pre- and postcurricular surveys evaluated self-confidence in critical care topics, procedures, and communication skills. The Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV) Short Form was used to evaluate facilitator debriefing. Data were compared with Wilcoxon rank sum and signed rank test. Pre- and postcurricular surveys were collected from 51 of 52 interns (98% response rate) in curricular year 1 and 59 of 59 interns (100% response rate) in curricular year 2 in six programs within the hospital. Resident confidence significantly improved in all areas (p < .05). DASH-SV demonstrated overall effective facilitator debriefing and > 75% of interns in both curricular years 1 and 2 expressed a desire for future educational sessions. The implemented curriculum increased learner confidence in select critical care topics, procedures, and communication skills and demonstrated a high level of learner satisfaction. The curriculum has expanded to learners from three other teaching hospitals within our system to unify critical care education for all interns caring for adult patients.

A new approach using coagulation rate constant for evaluation of turbidity removal

NASA Astrophysics Data System (ADS)

Al-Sameraiy, Mukheled

2017-06-01

Coagulation-flocculation-sedimentation processes for treating three levels of bentonite synthetic turbid water using date seeds (DS) and alum (A) coagulants were investigated in the previous research work. In the current research, the same experimental results were used to adopt a new approach on a basis of using coagulation rate constant as an investigating parameter to identify optimum doses of these coagulants. Moreover, the performance of these coagulants to meet (WHO) turbidity standard was assessed by introducing a new evaluating criterion in terms of critical coagulation rate constant (kc). Coagulation rate constants (k2) were mathematically calculated in second order form of coagulation process for each coagulant. The maximum (k2) values corresponded to doses, which were obviously to be considered as optimum doses. The proposed criterion to assess the performance of coagulation process of these coagulants was based on the mathematical representation of (WHO) turbidity guidelines in second order form of coagulation process stated that (k2) for each coagulant should be ≥ (kc) for each level of synthetic turbid water. For all tested turbid water, DS coagulant could not satisfy it. While, A coagulant could satisfy it. The results obtained in the present research are exactly in agreement with the previous published results in terms of finding optimum doses for each coagulant and assessing their performances. On the whole, it is recommended considering coagulation rate constant to be a new approach as an indicator for investigating optimum doses and critical coagulation rate constant to be a new evaluating criterion to assess coagulants' performance.

Peer assessment of student-produced mechanics lab report videos

NASA Astrophysics Data System (ADS)

Douglas, Scott S.; Aiken, John M.; Lin, Shih-Yin; Greco, Edwin F.; Alicea-Muñoz, Emily; Schatz, Michael F.

2017-12-01

We examine changes in students' rating behavior during a semester-long sequence of peer evaluation laboratory exercises in an introductory mechanics course. We perform a quantitative analysis of the ratings given by students to peers' physics lab reports, and conduct interviews with students. We find that peers persistently assign higher ratings to lab reports than do experts, that peers begin the semester by giving high ratings most frequently and end the semester with frequent middle ratings, and that peers go through the semester without much change in the frequency of low ratings. We then use student interviews to develop a model for student engagement with peer assessment. This model is based on two competing influences which appear to shape peer evaluation behavior: a strong disinclination to give poor ratings with a complementary preference to give high ratings when in doubt, and an attempt to develop an expertlike criticality when assessing peers' work.

Antibiotic Dosing in Continuous Renal Replacement Therapy.

PubMed

Shaw, Alexander R; Mueller, Bruce A

2017-07-01

Appropriate antibiotic dosing is critical to improve outcomes in critically ill patients with sepsis. The addition of continuous renal replacement therapy makes achieving appropriate antibiotic dosing more difficult. The lack of continuous renal replacement therapy standardization results in treatment variability between patients and may influence whether appropriate antibiotic exposure is achieved. The aim of this study was to determine if continuous renal replacement therapy effluent flow rate impacts attaining appropriate antibiotic concentrations when conventional continuous renal replacement therapy antibiotic doses were used. This study used Monte Carlo simulations to evaluate the effect of effluent flow rate variance on pharmacodynamic target attainment for cefepime, ceftazidime, levofloxacin, meropenem, piperacillin, and tazobactam. Published demographic and pharmacokinetic parameters for each antibiotic were used to develop a pharmacokinetic model. Monte Carlo simulations of 5000 patients were evaluated for each antibiotic dosing regimen at the extremes of Kidney Disease: Improving Global Outcomes guidelines recommended effluent flow rates (20 and 35 mL/kg/h). The probability of target attainment was calculated using antibiotic-specific pharmacodynamic targets assessed over the first 72 hours of therapy. Most conventional published antibiotic dosing recommendations, except for levofloxacin, reach acceptable probability of target attainment rates when effluent rates of 20 or 35 mL/kg/h are used. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Analysis of Department of Defense Organic Depot Maintenance Capacity Management and Facility Utilization Factors

DTIC Science & Technology

1991-09-01

System ( CAPMS ) in lieu of using DODI 4151.15H. Facility utilization rate computation is not explicitly defined; it is merely identified as a ratio of...front of a bottleneck buffers the critical resource and protects against disruption of the system. This approach optimizes facility utilization by...run titled BUFFERED BASELINE. Three different levels of inventory were used to evaluate the effect of increasing the inventory level on critical

Advances in Biomarkers in Critical Ill Polytrauma Patients.

PubMed

Papurica, Marius; Rogobete, Alexandru F; Sandesc, Dorel; Dumache, Raluca; Cradigati, Carmen A; Sarandan, Mirela; Nartita, Radu; Popovici, Sonia E; Bedreag, Ovidiu H

2016-01-01

The complexity of the cases of critically ill polytrauma patients is given by both the primary, as well as the secondary, post-traumatic injuries. The severe injuries of organ systems, the major biochemical and physiological disequilibrium, and the molecular chaos lead to a high rate of morbidity and mortality in this type of patient. The 'gold goal' in the intensive therapy of such patients resides in the continuous evaluation and monitoring of their clinical status. Moreover, optimizing the therapy based on the expression of certain biomarkers with high specificity and sensitivity is extremely important because of the clinical course of the critically ill polytrauma patient. In this paper we wish to summarize the recent studies of biomarkers useful for the intensive care unit (ICU) physician. For this study the available literature on specific databases such as PubMed and Scopus was thoroughly analyzed. Each article was carefully reviewed and useful information for this study extracted. The keywords used to select the relevant articles were "sepsis biomarker", "traumatic brain injury biomarker" "spinal cord injury biomarker", "inflammation biomarker", "microRNAs biomarker", "trauma biomarker", and "critically ill patients". For this study to be carried out 556 original type articles were analyzed, as well as case reports and reviews. For this review, 89 articles with relevant topics for the present paper were selected. The critically ill polytrauma patient, because of the clinical complexity the case presents with, needs a series of evaluations and specific monitoring. Recent studies show a series of either tissue-specific or circulating biomarkers that are useful in the clinical status evaluation of these patients. The biomarkers existing today, with regard to the critically ill polytrauma patient, can bring a significant contribution to increasing the survival rate, by adapting the therapy according to their expressions. Nevertheless, the necessity remains to research new non-invasive diagnostic methods that present with higher specificity and selectivity.

Feasibility and perceived benefits of a framework for physician-parent follow-up meetings after a child's death in the PICU.

PubMed

Meert, Kathleen L; Eggly, Susan; Berg, Robert A; Wessel, David L; Newth, Christopher J L; Shanley, Thomas P; Harrison, Rick; Dalton, Heidi; Clark, Amy E; Dean, J Michael; Doctor, Allan; Nicholson, Carol E

2014-01-01

To evaluate the feasibility and perceived benefits of conducting physician-parent follow-up meetings after a child's death in the PICU according to a framework developed by the Collaborative Pediatric Critical Care Research Network. Prospective observational study. Seven Collaborative Pediatric Critical Care Research Network-affiliated children's hospitals. Critical care attending physicians, bereaved parents, and meeting guests (i.e., parent support persons, other health professionals). Physician-parent follow-up meetings using the Collaborative Pediatric Critical Care Research Network framework. Forty-six critical care physicians were trained to conduct follow-up meetings using the framework. All meetings were video recorded. Videos were evaluated for the presence or absence of physician behaviors consistent with the framework. Present behaviors were evaluated for performance quality using a 5-point scale (1 = low, 5 = high). Participants completed meeting evaluation surveys. Parents of 194 deceased children were mailed an invitation to a follow-up meeting. Of these, one or both parents from 39 families (20%) agreed to participate, 80 (41%) refused, and 75 (39%) could not be contacted. Of 39 who initially agreed, three meetings were canceled due to conflicting schedules. Thirty-six meetings were conducted including 54 bereaved parents, 17 parent support persons, 23 critical care physicians, and 47 other health professionals. Physician adherence to the framework was high; 79% of behaviors consistent with the framework were rated as present with a quality score of 4.3 ± 0.2. Of 50 evaluation surveys completed by parents, 46 (92%) agreed or strongly agreed the meeting was helpful to them and 40 (89%) to others they brought with them. Of 36 evaluation surveys completed by critical care physicians (i.e., one per meeting), 33 (92%) agreed or strongly agreed the meeting was beneficial to parents and 31 (89%) to them. Follow-up meetings using the Collaborative Pediatric Critical Care Research Network framework are feasible and viewed as beneficial by meeting participants. Future research should evaluate the effects of follow-up meetings on bereaved parents' health outcomes.

Quality by Design approach for studying the impact of formulation and process variables on product quality of oral disintegrating films.

PubMed

Mazumder, Sonal; Pavurala, Naresh; Manda, Prashanth; Xu, Xiaoming; Cruz, Celia N; Krishnaiah, Yellela S R

2017-07-15

The present investigation was carried out to understand the impact of formulation and process variables on the quality of oral disintegrating films (ODF) using Quality by Design (QbD) approach. Lamotrigine (LMT) was used as a model drug. Formulation variable was plasticizer to film former ratio and process variables were drying temperature, air flow rate in the drying chamber, drying time and wet coat thickness of the film. A Definitive Screening Design of Experiments (DoE) was used to identify and classify the critical formulation and process variables impacting critical quality attributes (CQA). A total of 14 laboratory-scale DoE formulations were prepared and evaluated for mechanical properties (%elongation at break, yield stress, Young's modulus, folding endurance) and other CQA (dry thickness, disintegration time, dissolution rate, moisture content, moisture uptake, drug assay and drug content uniformity). The main factors affecting mechanical properties were plasticizer to film former ratio and drying temperature. Dissolution rate was found to be sensitive to air flow rate during drying and plasticizer to film former ratio. Data were analyzed for elucidating interactions between different variables, rank ordering the critical materials attributes (CMA) and critical process parameters (CPP), and for providing a predictive model for the process. Results suggested that plasticizer to film former ratio and process controls on drying are critical to manufacture LMT ODF with the desired CQA. Published by Elsevier B.V.

A test of critical thresholds and their indicators in a desertification-prone ecosystem: more resilience than we thought

USGS Publications Warehouse

Bestelmeyer, Brandon T.; Duniway, Michael C.; James, Darren K.; Burkett, Laura M.; Havstad, Kris M.

2013-01-01

Theoretical models predict that drylands can cross critical thresholds, but experimental manipulations to evaluate them are non-existent. We used a long-term (13-year) pulse-perturbation experiment featuring heavy grazing and shrub removal to determine if critical thresholds and their determinants can be demonstrated in Chihuahuan Desert grasslands. We asked if cover values or patch-size metrics could predict vegetation recovery, supporting their use as early-warning indicators. We found that season of grazing, but not the presence of competing shrubs, mediated the severity of grazing impacts on dominant grasses. Recovery occurred at the same rate irrespective of grazing history, suggesting that critical thresholds were not crossed, even at low cover levels. Grass cover, but not patch size metrics, predicted variation in recovery rates. Some transition-prone ecosystems are surprisingly resilient; management of grazing impacts and simple cover measurements can be used to avert undesired transitions and initiate restoration.

Popular Encyclopedias as a Source of Information about Copyright: A Critical Comparison.

ERIC Educational Resources Information Center

Miller, Jerome K.

1983-01-01

Rating of five multi-volume encyclopedias ("Collier's Encyclopedia,""Encyclopedia Americana,""Encyclopedia Britannica (EB3),""World Book Encyclopedia,""Academic American Encyclopedia") used 20 evaluation criteria to determine usefulness in answering reference questions concerning copyright. Results…

Supercritical convection, critical heat flux, and coking characteristics of propane

NASA Technical Reports Server (NTRS)

Rousar, D. C.; Gross, R. S.; Boyd, W. C.

1984-01-01

The heat transfer characteristics of propane at subcritical and supercritical pressure were experimentally evaluated using electrically heated Monel K-500 tubes. A design correlation for supercritical heat transfer coefficient was established using the approach previously applied to supercritical oxygen. Flow oscillations were observed and the onset of these oscillations at supercritical pressures was correlated with wall-to-bulk temperature ratio and velocity. The critical heat flux measured at subcritical pressure was correlated with the product of velocity and subcooling. Long duration tests at fixed heat flux conditions were conducted to evaluate coking on the coolant side tube wall and coking rates comparable to RP-1 were observed.

An evaluation of the rate of absorption of solar radiation in the O2(X3Sigma-g - b1Sigma-g) transition

NASA Technical Reports Server (NTRS)

Mlynczak, Martin G.

1993-01-01

The rate at which molecular oxygen absorbs radiation in the O2(X3Sigma-g - b1Sigma-g) transition is calculated using a line-by-line radiative transfer model. This rate is critical to the determination of the population of the O2(b1Sigma-g) state required for studies of the O2(b1Sigma-g - X3Sigma-g) dayglow, the O2(a1Delta-g - X3Sigma-g) dayglow, and possibly the rates of oxidation of H2 and N2O. Previous evaluations of this rate (which is sometimes called the g-factor) have significantly overestimated its value. The rate is tabulated as a function of altitude, pressure, and solar zenith angle.

Recommendations to guide revision of the Guides to the Evaluation of Permanent Impairment. American Medical Association.

PubMed

Spieler, E A; Barth, P S; Burton, J F; Himmelstein, J; Rudolph, L

2000-01-26

The American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition, is the most commonly used tool in the United States for rating permanent impairments for disability systems. The Guides, currently undergoing revision, has been the focus of considerable controversy. Criticisms have focused on 2 areas: internal deficiencies, including the lack of a comprehensive, valid, reliable, unbiased, and evidence-based system for rating impairments; and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation. We focus on the internal deficiencies and recommend that the Guides remains a tool for evaluation of permanent impairment, not disability. To maintain wide acceptance of the Guides, its authors need to improve the validity, internal consistency, and comprehensiveness of the ratings; document reliability and reproducibility of the results; and make the Guides easily comprehensible and accessible to physicians.

Let's Talk Critical. Development and Evaluation of a Communication Skills Training Program for Critical Care Fellows.

PubMed

Hope, Aluko A; Hsieh, S Jean; Howes, Jennifer M; Keene, Adam B; Fausto, James A; Pinto, Priya A; Gong, Michelle Ng

2015-04-01

Although expert communication between intensive care unit clinicians with patients or surrogates improves patient- and family-centered outcomes, fellows in critical care medicine do not feel adequately trained to conduct family meetings. We aimed to develop, implement, and evaluate a communication skills program that could be easily integrated into a U.S. critical care fellowship. We developed four simulation cases that provided communication challenges that critical care fellows commonly face. For each case, we developed a list of directly observable tasks that could be used by faculty to evaluate fellows during each simulation. We developed a didactic curriculum of lectures/case discussions on topics related to palliative care, end-of-life care, communication skills, and bioethics; this month-long curriculum began and ended with the fellows leading family meetings in up to two simulated cases with direct observation by faculty who were not blinded to the timing of the simulation. Our primary measures of effectiveness were the fellows' self-reported change in comfort with leading family meetings after the program was completed and the quality of the communication as measured by the faculty evaluators during the family meeting simulations at the end of the month. Over 3 years, 31 critical care fellows participated in the program, 28 of whom participated in 101 family meeting simulations with direct feedback by faculty facilitators. Our trainees showed high rates of information disclosure during the simulated family meetings. During the simulations done at the end of the month compared with those done at the beginning, our fellows showed significantly improved rates in: (1) verbalizing an agenda for the meeting (64 vs. 41%; Chi-square, 5.27; P = 0.02), (2) summarizing what will be done for the patient (64 vs. 39%; Chi-square, 6.21; P = 0.01), and (3) providing a follow-up plan (60 vs. 37%; Chi-square, 5.2; P = 0.02). More than 95% of our participants (n = 27) reported feeling "slightly" or "much" more comfortable with discussing foregoing life-sustaining treatment and leading family discussions after the month-long curriculum. A communication skills program can be feasibly integrated into a critical care training program and is associated with improvements in fellows' skills and comfort with leading family meetings.

Let’s Talk Critical. Development and Evaluation of a Communication Skills Training Program for Critical Care Fellows

PubMed Central

Hsieh, S. Jean; Howes, Jennifer M.; Keene, Adam B.; Fausto, James A.; Pinto, Priya A.; Gong, Michelle Ng

2015-01-01

Rationale: Although expert communication between intensive care unit clinicians with patients or surrogates improves patient- and family-centered outcomes, fellows in critical care medicine do not feel adequately trained to conduct family meetings. Objectives: We aimed to develop, implement, and evaluate a communication skills program that could be easily integrated into a U.S. critical care fellowship. Methods: We developed four simulation cases that provided communication challenges that critical care fellows commonly face. For each case, we developed a list of directly observable tasks that could be used by faculty to evaluate fellows during each simulation. We developed a didactic curriculum of lectures/case discussions on topics related to palliative care, end-of-life care, communication skills, and bioethics; this month-long curriculum began and ended with the fellows leading family meetings in up to two simulated cases with direct observation by faculty who were not blinded to the timing of the simulation. Our primary measures of effectiveness were the fellows’ self-reported change in comfort with leading family meetings after the program was completed and the quality of the communication as measured by the faculty evaluators during the family meeting simulations at the end of the month. Measurements and Main Results: Over 3 years, 31 critical care fellows participated in the program, 28 of whom participated in 101 family meeting simulations with direct feedback by faculty facilitators. Our trainees showed high rates of information disclosure during the simulated family meetings. During the simulations done at the end of the month compared with those done at the beginning, our fellows showed significantly improved rates in: (1) verbalizing an agenda for the meeting (64 vs. 41%; Chi-square, 5.27; P = 0.02), (2) summarizing what will be done for the patient (64 vs. 39%; Chi-square, 6.21; P = 0.01), and (3) providing a follow-up plan (60 vs. 37%; Chi-square, 5.2; P = 0.02). More than 95% of our participants (n = 27) reported feeling “slightly” or “much” more comfortable with discussing foregoing life-sustaining treatment and leading family discussions after the month-long curriculum. Conclusions: A communication skills program can be feasibly integrated into a critical care training program and is associated with improvements in fellows’ skills and comfort with leading family meetings. PMID:25741996

Outcome evaluation of a new model of critical care orientation.

PubMed

Morris, Linda L; Pfeifer, Pamela; Catalano, Rene; Fortney, Robert; Nelson, Greta; Rabito, Robb; Harap, Rebecca

2009-05-01

The shortage of critical care nurses and the service expansion of 2 intensive care units provided a unique opportunity to create a new model of critical care orientation. The goal was to design a program that assessed critical thinking, validated competence, and provided learning pathways that accommodated diverse experience. To determine the effect of a new model of critical care orientation on satisfaction, retention, turnover, vacancy, preparedness to manage patient care assignment, length of orientation, and cost of orientation. A prospective, quasi-experimental design with both quantitative and qualitative methods. The new model improved satisfaction scores, retention rates, and recruitment of critical care nurses. Length of orientation was unchanged. Cost was increased, primarily because a full-time education consultant was added. A new model for nurse orientation that was focused on critical thinking and competence validation improved retention and satisfaction and serves as a template for orientation of nurses throughout the medical center.

Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

PubMed

Stelfox, Henry T; Niven, Daniel J; Clement, Fiona M; Bagshaw, Sean M; Cook, Deborah J; McKenzie, Emily; Potestio, Melissa L; Doig, Christopher J; O'Neill, Barbara; Zygun, David

2015-01-01

Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap). We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare. We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14) and pediatric (n = 2) medical-surgical intensive care units (ICUs) in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38) and frontline providers (n = 1,790). Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale) and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback. Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants) over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate) evaluated the priorities, and rated 9 as 'necessary' (median score 7-9). Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU) and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs). A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

Real-time assessment of critical quality attributes of a continuous granulation process.

PubMed

Fonteyne, Margot; Vercruysse, Jurgen; Díaz, Damián Córdoba; Gildemyn, Delphine; Vervaet, Chris; Remon, Jean Paul; De Beer, Thomas

2013-02-01

There exists the intention to shift pharmaceutical manufacturing of solid dosage forms from traditional batch production towards continuous production. The currently applied conventional quality control systems, based on sampling and time-consuming off-line analyses in analytical laboratories, would annul the advantages of continuous processing. It is clear that real-time quality assessment and control is indispensable for continuous production. This manuscript evaluates strengths and weaknesses of several complementary Process Analytical Technology (PAT) tools implemented in a continuous wet granulation process, which is part of a fully continuous from powder-to-tablet production line. The use of Raman and NIR-spectroscopy and a particle size distribution analyzer is evaluated for the real-time monitoring of critical parameters during the continuous wet agglomeration of an anhydrous theophylline- lactose blend. The solid state characteristics and particle size of the granules were analyzed in real-time and the critical process parameters influencing these granule characteristics were identified. The temperature of the granulator barrel, the amount of granulation liquid added and, to a lesser extent, the powder feed rate were the parameters influencing the solid state of the active pharmaceutical ingredient (API). A higher barrel temperature and a higher powder feed rate, resulted in larger granules.

Using the rate of bacterial clearance determined by real-time polymerase chain reaction as a timely surrogate marker to evaluate the appropriateness of antibiotic usage in critical patients with Acinetobacter baumannii bacteremia.

PubMed

Chuang, Yu-Chung; Chang, Shan-Chwen; Wang, Wei-Kung

2012-08-01

Bacteremia caused by Acinetobacter baumannii is becoming more frequent among critically ill patients, and has been associated with high mortality and prolonged hospital stay. Multidrug resistance and delay in blood culture have been shown to be significant barriers to appropriate antibiotic treatment. Quantitative polymerase chain reaction assays were recently used to monitor bacterial loads; we hypothesized that the rate of bacterial clearance determined by quantitative polymerase chain reaction can be used as a timely surrogate marker to evaluate the appropriateness of antibiotic usage. Prospective observational study. University hospital and research laboratory. Patients with culture-proven A. baumannii bacteremia in the intensive care units were prospectively enrolled from April 2008 to February 2009. Plasmid Oxa-51/pCRII-TOPO, which contained a 431-bp fragment of the A. baumannii-specific Oxa-51 gene in a pCRII-TOPO vector, was used as the standard. Sequential bacterial DNA loads in the blood were measured by a quantitative polymerase chain reaction assay. We enrolled 51 patients with A. baumannii bacteremia, and examined 318 sequential whole blood samples. The initial mean bacterial load was 2.15 log copies/mL, and the rate of bacterial clearance was 0.088 log copies/mL/day. Multivariate linear regression using the generalized estimation equation approach revealed that the use of immunosuppressants was an independent predictor for slower bacterial clearance (coefficient, 1.116; p<.001), and appropriate antibiotic usage was an independent predictor for more rapid bacterial clearance (coefficient, -0.995; p<.001). Patients with a slower rate of bacterial clearance experienced higher in-hospital mortality (odds ratio, 2.323; p=.04) Immunosuppression and appropriate antibiotic usage were independent factors affecting the rate of clearance of A. baumannii bacteremia in critical patients. These findings highlight the importance of appropriate antibiotic usage and development of effective antibiotics against A. baumannii in an era of emerging antibiotic resistance. The rate of bacterial clearance could serve as a timely surrogate marker for evaluating the appropriateness of antibiotics.

Perception of altered smile esthetics among Moroccan professionals and lay people.

PubMed

Ousehal, L; Aghoutan, H; Chemlali, S; Anssari, I Filali; Talic, N

2016-10-01

To evaluate and compare the impact of altered smile characteristics on the perception of smile esthetics between Moroccan dentists and lay people. Thirty-four digital smile photographs displaying alterations in crown length and width, lateral incisor gingival margin position, gingival exposition, midline diastema, and upper midline deviation were presented to a sample of 30 dentists and 30 lay people. The ratings were assessed with a visual analog scale. Compared to that of lay people, Moroccan dentists' evaluation of the gingival smile was more critical when the decrease in central incisor crown length was 2.5 mm ( p  < 0.001) or greater and when the increase in gingival exposition was 4 mm or greater ( p  < 0.01). Moroccan dentists were also critical in their evaluation of maxillary lateral incisor crown width alterations ( p  < 0.05) and incisal midline deviations ( p  < 0.05). However, the professionals and lay people similarly evaluated irregularities in the incisor gingival margin position. Increases in the midline diastema were judged critically by both Moroccan dentists and lay people. In this sample, Moroccan dentists evaluate smile esthetic alterations more critically than Moroccan lay people. This difference in perception of smile discrepancies must be taken into account during the finishing phases of orthodontic treatment and restoration of the anterior teeth in Moroccan patients.

Use of failure mode, effect and criticality analysis to improve safety in the medication administration process.

PubMed

Rodriguez-Gonzalez, Carmen Guadalupe; Martin-Barbero, Maria Luisa; Herranz-Alonso, Ana; Durango-Limarquez, Maria Isabel; Hernandez-Sampelayo, Paloma; Sanjurjo-Saez, Maria

2015-08-01

To critically evaluate the causes of preventable adverse drug events during the nurse medication administration process in inpatient units with computerized prescription order entry and profiled automated dispensing cabinets in order to prioritize interventions that need to be implemented and to evaluate the impact of specific interventions on the criticality index. This is a failure mode, effects and criticality analysis (FMECA) study. A multidisciplinary consensus committee composed of pharmacists, nurses and doctors evaluated the process of administering medications in a hospital setting in Spain. By analysing the process, all failure modes were identified and criticality was determined by rating severity, frequency and likelihood of failure detection on a scale of 1 to 10, using adapted versions of already published scales. Safety strategies were identified and prioritized. Through consensus, the committee identified eight processes and 40 failure modes, of which 20 were classified as high risk. The sum of the criticality indices was 5254. For the potential high-risk failure modes, 21 different potential causes were found resulting in 24 recommendations. Thirteen recommendations were prioritized and developed over a 24-month period, reducing total criticality from 5254 to 3572 (a 32.0% reduction). The recommendations with a greater impact on criticality were the development of an electronic medication administration record (-582) and the standardization of intravenous drug compounding in the unit (-168). Other improvements, such as barcode medication administration technology (-1033), were scheduled for a longer period of time because of lower feasibility. FMECA is a useful approach that can improve the medication administration process. © 2015 John Wiley & Sons, Ltd.

INTEGRAL BENCHMARK DATA FOR NUCLEAR DATA TESTING THROUGH THE ICSBEP AND THE NEWLY ORGANIZED IRPHEP

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

J. Blair Briggs; Lori Scott; Yolanda Rugama

The status of the International Criticality Safety Benchmark Evaluation Project (ICSBEP) was last reported in a nuclear data conference at the International Conference on Nuclear Data for Science and Technology, ND-2004, in Santa Fe, New Mexico. Since that time the number and type of integral benchmarks have increased significantly. Included in the ICSBEP Handbook are criticality-alarm / shielding and fundamental physic benchmarks in addition to the traditional critical / subcritical benchmark data. Since ND 2004, a reactor physics counterpart to the ICSBEP, the International Reactor Physics Experiment Evaluation Project (IRPhEP) was initiated. The IRPhEP is patterned after the ICSBEP, butmore » focuses on other integral measurements, such as buckling, spectral characteristics, reactivity effects, reactivity coefficients, kinetics measurements, reaction-rate and power distributions, nuclide compositions, and other miscellaneous-type measurements in addition to the critical configuration. The status of these two projects is discussed and selected benchmarks highlighted in this paper.« less

Study on viscosity of conventional and polymer modified asphalt binders in steady and dynamic shear domain

NASA Astrophysics Data System (ADS)

Saboo, Nikhil; Singh, Bhupendra; Kumar, Praveen; Vikram, Durgesh

2018-02-01

This study focuses on evaluating the flow behavior of conventional and polymer modified asphalt binders in steady- and dynamic-shear domain, for a temperature range of 20-70 °C, using a Dynamic Shear Rheometer (DSR). Steady-shear viscosity and frequency sweep tests were carried out on two conventional (VG 10 and VG 30) and two polymer (SBS and EVA) modified asphalt binders. Applicability of the Cox-Merz principle was evaluated and complex viscosity master curves were analyzed at five different reference temperatures. Cross model was used to simulate the complex viscosity master curves at different temperatures. It was found that asphalt binders exhibited shear-thinning behavior at all the test temperatures. The critical shear rate increased with increase in temperature and was found to be lowest for plastomeric modified asphalt binder. The Cox-Merz principle was found to be valid in the zero-shear viscosity (ZSV) domain and deviated at higher frequency/shear rate for all the binders. Results from the study indicated that the ratio of ZSV can be successfully used as shift factors for construction of master curves at different reference temperatures. Cross model was found to be suitable in simulating the complex viscosity master curves at all the test temperatures. Analysis of model parameters indicated that a strong relationship exists between ZSV and the critical shear rate. ZSV and critical shear rate varied exponentially with temperature. This relationship was used to propose a simple equation for assessing the shift factors for construction of master curves.

Information needs for the rapid response team electronic clinical tool.

PubMed

Barwise, Amelia; Caples, Sean; Jensen, Jeffrey; Pickering, Brian; Herasevich, Vitaly

2017-10-02

Information overload in healthcare is dangerous. It can lead to critical errors and delays. During Rapid Response Team (RRT) activations providers must make decisions quickly to rescue patients from physiological deterioration. In order to understand the clinical data required and how best to present that information in electronic systems we aimed to better assess the data needs of providers on the RRT when they respond to an event. A web based survey to evaluate clinical data requirements was created and distributed to all RRT providers at our institution. Participants were asked to rate the importance of each data item in guiding clinical decisions during a RRT event response. There were 96 surveys completed (24.5% response rate) with fairly even distribution throughout all clinical roles on the RRT. Physiological data including heart rate, respiratory rate, and blood pressure were ranked by more than 80% of responders as being critical information. Resuscitation status was also considered critically useful by more than 85% of providers. There is a limited dataset that is considered important during an RRT. The data is widely available in EMR. The findings from this study could be used to improve user-centered EMR interfaces.

Incidence and Outcomes for Patients With Cirrhosis Admitted to the United Kingdom Critical Care Units.

PubMed

McPhail, Mark J W; Parrott, Francesca; Wendon, Julia A; Harrison, David A; Rowan, Kathy A; Bernal, William

2018-05-01

To assess the epidemiology and outcome of patients with cirrhosis following critical care unit admission. Retrospective cohort study. Critical care units in England, Wales, and Northern Ireland participating in the U.K. Intensive Care National Audit and Research Centre Case Mix Programme. Thirty-one thousand three hundred sixty-three patients with cirrhosis identified of 1,168,650 total critical care unit admissions (2.7%) admitted to U.K. critical care units between 1998 and 2012. None. Ten thousand nine hundred thirty-six patients had alcohol-related liver disease (35%). In total, 1.6% of critical care unit admissions in 1998 had cirrhosis rising to 3.1% in 2012. The crude critical care unit mortality of patients with cirrhosis was 41% in 1998 falling to 31% in 2012 (p < 0.001). Crude hospital mortality fell from 58% to 46% over the study period (p < 0.001). Mean(SD) Acute Physiology and Chronic Health Evaluation II score in 1998 was 20.3 (8.5) and 19.5 (7.1) in 2012. Mean Acute Physiology and Chronic Health Evaluation II score for patients with alcohol-related liver disease in 2012 was 20.6 (7.0) and 19.0 (7.2) for non-alcohol-related liver disease (p < 0.001). In adjusted analysis, alcohol-related liver disease was associated with increased risk of death (odds ratio, 1.51 [95% CI, 1.42-1.62; p < 0.001]) with a year-on-year reduction in hospital mortality (adjusted odds ratio, 0.95/yr, [0.94-0.96, p < 0.001]). More patients with cirrhosis are being admitted to critical care units but with increasing survival rates. Patients with alcohol-related liver disease have reduced survival rates partly explained by higher levels of organ failure at admission. Patients with cirrhosis and organ failure warrant a trial of organ support and universal prognostic pessimism is not justified.

Biphasic β-TCP mixed with silicon increases bone formation in critical site defects in rabbit calvaria.

PubMed

Calvo-Guirado, José Luis; Garces, Miguel; Delgado-Ruiz, Rafael Arcesio; Ramirez Fernandez, Maria P; Ferres-Amat, Eduard; Romanos, Georgios E

2015-08-01

The aim of this study was to assess the bone regeneration of critical size defects in rabbit calvarias filled with β-TCP doped with silicon. Twenty-one New Zealand rabbits were used in this study. Two critical size defects were created in the parietal bones. Three experimental groups were evaluated: Test A (HA/β-TCP granules alone), Test B (HA/β-TCP granules plus 3% silicon), Control (empty defect). The animals were sacrificed at 8 and 12 weeks. Evaluation was performed by μCT analysis and histomorphometry. μCT evaluation showed higher volume reduction in Test A group compared with Test B (P < 0.05). The Test B group showed the highest values for cortical closure and bone formation around the particles, followed by Test A and controls (P < 0.05). Within the limitations of this animal study, it can be concluded that HA/β-TCP plus 3% silicon increases bone formation in critical size defects in rabbit calvarias, and the incorporation of 3% silicon reduces the resorption rate of the HA/β-TCP granules. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Evaluating true BCI communication rate through mutual information and language models.

PubMed

Speier, William; Arnold, Corey; Pouratian, Nader

2013-01-01

Brain-computer interface (BCI) systems are a promising means for restoring communication to patients suffering from "locked-in" syndrome. Research to improve system performance primarily focuses on means to overcome the low signal to noise ratio of electroencephalogric (EEG) recordings. However, the literature and methods are difficult to compare due to the array of evaluation metrics and assumptions underlying them, including that: 1) all characters are equally probable, 2) character selection is memoryless, and 3) errors occur completely at random. The standardization of evaluation metrics that more accurately reflect the amount of information contained in BCI language output is critical to make progress. We present a mutual information-based metric that incorporates prior information and a model of systematic errors. The parameters of a system used in one study were re-optimized, showing that the metric used in optimization significantly affects the parameter values chosen and the resulting system performance. The results of 11 BCI communication studies were then evaluated using different metrics, including those previously used in BCI literature and the newly advocated metric. Six studies' results varied based on the metric used for evaluation and the proposed metric produced results that differed from those originally published in two of the studies. Standardizing metrics to accurately reflect the rate of information transmission is critical to properly evaluate and compare BCI communication systems and advance the field in an unbiased manner.

Evaluation of SLS: APG mixed surfactant systems as carrier for solid dispersion.

PubMed

Patel, Ashok R; Joshi, Vishal Y

2008-01-01

The present investigation aims at studying the effect of mixed surfactant system of sodium lauryl sulphate (SLS) and alkyl polyglucosides (C(10)APG, C(12)APG and C(12/14)APG) on dissolution rate enhancement of poorly water soluble drug. Aceclofenac--a non-steroidal anti-inflammatory agent was used as a model drug as it has limited water solubility. The influence of the surfactant concentration in various blends on dissolution rate of Solid Dispersion (SD), prepared using solution method with ethanol as the solvent was studied and the advantage of mixed surfactant systems over the individual surfactants was illustrated by differences in the in-vitro dissolution profiles of SD. Physico chemical evaluation (critical micellar concentration, zeta potential and beta-parameter calculations) was carried out to study the mixed surfactant systems. Solid mixtures were characterized by Infrared spectroscopy (FT-IR); X-ray diffraction studies (XRD) and scanning electron microscopy (SEM). It was seen that the dissolution rate of aceclofenac from SD increased with the increase in the APG proportion relative to SLS with the optimum ratio of 0.2 SLS:0.8 APG showing the best effect in all cases. Results obtained from physico-chemical evaluation (the decrease in the value of critical micelle concentration and higher negative value of beta-parameters) suggested the existence of synergism between surfactants blends. The observed results in the dissolution rate enhancement could be attributed to the drug--surfactant interactions as evident from FT-IR, SEM and XRD results.

Beta- and gamma-dose measurements of the Godiva IV critical assembly.

PubMed

Hankins, D E

1984-03-01

To aid in the re-evaluation of an exposure that occurred in 1963, information was required on the response of film badges to the beta- and gamma-ray doses from a critical assembly. Of particular interest was the beta spectra from the assembly. The techniques used and the results obtained in this study are of interest to health physicists at facilities where exposures to betas occur. The dose rates from the Los Alamos National Laboratory Godiva IV Critical Assembly were measured at numerous distances from the assembly four and 12 days following a burst. Information was obtained on the beta-particle spectra using absorption curve studies. The beta/gamma dose-rate ratio as a function of distance from the assembly was determined. Shielding provided by various metals, gloves and clothing was measured. The beta- and gamma-ray doses measured were compared with a film packet used in the past at the Nevada Test Site with two types of current TLD personnel badges. Measurements made with a commercial thin-window ion chamber instrument are compared with the dose rates obtained using other dosimeters.

Sensitivity of a critical tracking task to alcohol impairment

NASA Technical Reports Server (NTRS)

Tennant, J. A.; Thompson, R. R.

1973-01-01

A first order critical tracking task is evaluated for its potential to discriminate between sober and intoxicated performances. Mean differences between predrink and postdrink performances as a function of BAC are analyzed. Quantification of the results shows that intoxicated failure rates of 50% for blood alcohol concentrations (BACs) at or above 0.1%, and 75% for BACs at or above 0.14%, can be attained with no sober failure rates. A high initial rate of learning is observed, perhaps due to the very nature of the task whereby the operator is always pushed to his limit, and the scores approach a stable asymptote after approximately 50 trials. Finally, the implementation of the task as an ignition interlock system in the automobile environment is discussed. It is pointed out that lower critical performance limits are anticipated for the mechanized automotive units because of the introduction of larger hardware and neuromuscular lags. Whether such degradation in performance would reduce the effectiveness of the device or not will be determined in a continuing program involving a broader based sample of the driving population and performance correlations with both BACs and driving proficiency.

Development and evaluation of a monitoring-aid system for a nuclear power plant in control room system manipulation.

PubMed

Lin, Jhih-Tsong; Chen, Yan-Cheng; Wu, Shih-Chieh; Hwang, Sheue-Ling

2017-01-01

In an advanced nuclear power plant (NPP), the operators are responsible for monitoring a massive number of alarm parameters. To assist the operators, a monitoring-aid system (MAS), that applies four quality control chart methods, was proposed and evaluated. Two types of MAS, namely, text and graph marks, were proposed and compared with the original display. To validate the proposed MAS, 17 professional engineers and operators were invited to join an experiment. Two different system states, normal and abnormal, were simulated. The operators were asked to manipulate the system, monitor the critical parameters, search for operational procedures, and deal with other secondary tasks. The primary and secondary task performance and heart rate were measured. After each task was conducted, three subjective rating questionnaires, namely, mental workload, situation awareness, and preference ratings, were implemented for the proposed MAS and the original system. With the assistance of the MAS, the alarm detection rate, secondary task performance, and subjective mental workload demonstrate significant improvements. The proposed MAS helps the operators monitor critical parameters. Therefore, the MAS should be considered for implementation with the control panel to increase the safety of NPPs. Furthermore, the MAS could reduce the mental workload might decrease the health hazard of the operators.

RAPID ASSESSMENT OF URBAN WETLANDS: FUNCTIONAL ASSESSMENT MODEL DEVELOPMENT AND EVALUATION

EPA Science Inventory

The objective of this study was to test the ability of existing hydrogeomorphic (HGM) functional assessment models and our own proposed models to predict rates of nitrate production and removal, functions critical to water quality protection, in forested riparian wetlands in nort...

Functional recovery following critical illness in children: the "wee-cover" pilot study.

PubMed

Choong, Karen; Al-Harbi, Samah; Siu, Katie; Wong, Katie; Cheng, Ji; Baird, Burke; Pogorzelski, David; Timmons, Brian; Gorter, Jan-Willem; Thabane, Lehana; Khetani, Mary

2015-05-01

To determine the feasibility of conducting a longitudinal prospective study to evaluate functional recovery and predictors of impaired functional recovery in critically ill children. Prospective pilot study. Single-center PICU at McMaster Children's Hospital, Hamilton, Canada. Children aged 12 months to 17 years, with at least one organ dysfunction, limited mobility or bed rest during the first 48 hours of PICU admission, and a minimum 48-hour PICU length of stay, were eligible. Patients transferred from a neonatal ICU prior to ever being discharged home, already mobilizing well or at baseline functional status at time of screening, with an English language barrier, and prior enrollment into this study, were excluded. None. The primary outcome was feasibility, as defined by the ability to screen, enroll eligible patients, and execute the study procedures and measurements on participants. Secondary outcomes included functional status at baseline, 3 and 6 months, PICU morbidity, and mortality. Functional status was measured using the Pediatric Evaluation of Disability Inventory and the Participation and Environment Measure for Children and Youth. Thirty-three patients were enrolled between October 2012 and April 2013. Consent rate was 85%, and follow-up rates were 93% at 3 months and 71% at 6 months. We were able to execute the study procedures and measurements, demonstrating feasibility of conducting a future longitudinal study. Functional status deteriorated following critical illness. Recovery appears to be influenced by baseline health or functional status and severity of illness. Longitudinal research is needed to understand how children recover after a critical illness. Our results suggest factors that may influence the recovery trajectory and were used to inform the methodology, outcomes of interest, and appropriate sample size of a larger multicenter study evaluating functional recovery in this population.

Soft error evaluation and vulnerability analysis in Xilinx Zynq-7010 system-on chip

NASA Astrophysics Data System (ADS)

Du, Xuecheng; He, Chaohui; Liu, Shuhuan; Zhang, Yao; Li, Yonghong; Xiong, Ceng; Tan, Pengkang

2016-09-01

Radiation-induced soft errors are an increasingly important threat to the reliability of modern electronic systems. In order to evaluate system-on chip's reliability and soft error, the fault tree analysis method was used in this work. The system fault tree was constructed based on Xilinx Zynq-7010 All Programmable SoC. Moreover, the soft error rates of different components in Zynq-7010 SoC were tested by americium-241 alpha radiation source. Furthermore, some parameters that used to evaluate the system's reliability and safety were calculated using Isograph Reliability Workbench 11.0, such as failure rate, unavailability and mean time to failure (MTTF). According to fault tree analysis for system-on chip, the critical blocks and system reliability were evaluated through the qualitative and quantitative analysis.

Application of ICH Q9 Quality Risk Management Tools for Advanced Development of Hot Melt Coated Multiparticulate Systems.

PubMed

Stocker, Elena; Becker, Karin; Hate, Siddhi; Hohl, Roland; Schiemenz, Wolfgang; Sacher, Stephan; Zimmer, Andreas; Salar-Behzadi, Sharareh

2017-01-01

This study aimed to apply quality risk management based on the The International Conference on Harmonisation guideline Q9 for the early development stage of hot melt coated multiparticulate systems for oral administration. N-acetylcysteine crystals were coated with a formulation composing tripalmitin and polysorbate 65. The critical quality attributes (CQAs) were initially prioritized using failure mode and effects analysis. The CQAs of the coated material were defined as particle size, taste-masking efficiency, and immediate release profile. The hot melt coated process was characterized via a flowchart, based on the identified potential critical process parameters (CPPs) and their impact on the CQAs. These CPPs were prioritized using a process failure mode, effects, and criticality analysis and their critical impact on the CQAs was experimentally confirmed using a statistical design of experiments. Spray rate, atomization air pressure, and air flow rate were identified as CPPs. Coating amount and content of polysorbate 65 in the coating formulation were identified as critical material attributes. A hazard and critical control points analysis was applied to define control strategies at the critical process points. A fault tree analysis evaluated causes for potential process failures. We successfully demonstrated that a standardized quality risk management approach optimizes the product development sustainability and supports the regulatory aspects. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Experimental and computational correlation of fracture parameters KIc, JIc, and GIc for unimodular and bimodular graphite components

NASA Astrophysics Data System (ADS)

Bhushan, Awani; Panda, S. K.

2018-05-01

The influence of bimodularity (different stress ∼ strain behaviour in tension and compression) on fracture behaviour of graphite specimens has been studied with fracture toughness (KIc), critical J-integral (JIc) and critical strain energy release rate (GIc) as the characterizing parameter. Bimodularity index (ratio of tensile Young's modulus to compression Young's modulus) of graphite specimens has been obtained from the normalized test data of tensile and compression experimentation. Single edge notch bend (SENB) testing of pre-cracked specimens from the same lot have been carried out as per ASTM standard D7779-11 to determine the peak load and critical fracture parameters KIc, GIc and JIc using digital image correlation technology of crack opening displacements. Weibull weakest link theory has been used to evaluate the mean peak load, Weibull modulus and goodness of fit employing two parameter least square method (LIN2), biased (MLE2-B) and unbiased (MLE2-U) maximum likelihood estimator. The stress dependent elasticity problem of three-dimensional crack progression behaviour for the bimodular graphite components has been solved as an iterative finite element procedure. The crack characterizing parameters critical stress intensity factor and critical strain energy release rate have been estimated with the help of Weibull distribution plot between peak loads versus cumulative probability of failure. Experimental and Computational fracture parameters have been compared qualitatively to describe the significance of bimodularity. The bimodular influence on fracture behaviour of SENB graphite has been reflected on the experimental evaluation of GIc values only, which has been found to be different from the calculated JIc values. Numerical evaluation of bimodular 3D J-integral value is found to be close to the GIc value whereas the unimodular 3D J-value is nearer to the JIc value. The significant difference between the unimodular JIc and bimodular GIc indicates that GIc should be considered as the standard fracture parameter for bimodular brittle specimens.

Subintimal recanalization of femoropopliteal occlusive lesions in patients with critical ischemia: 66 cases.

PubMed

Mousnier, Aurélien; Jean-Baptiste, Elixène; Sadaghianloo, Nirvana; Declemy, Serge; Brizzi, Sophie; Hassen-Khodja, Réda

2013-05-01

Subintimal recanalization allows for the treatment of percutaneously extended occlusive lesions. The aim of this study was to evaluate the feasibility and short- and mid-term results of subintimal recanalization in the treatment of femoropopliteal occlusive lesions in patients with critical ischemia. Between January 2009 and December 2010, consecutive patients with critical ischemia presenting with femoropopliteal arterial occlusion were included in this study. These patients underwent subintimal recanalization, and all patients had clinical and ultrasound follow-up. Sixty-six procedures were performed on 66 patients (mean age, 79±10 yrs). All patients were American Society of Anesthesiologists classification 3 or 4. Thirty-two patients had diabetes and 27 had chronic renal insufficiency. More than two-thirds (76%) of the lesions had a Trans-Atlantic Inter-Society Classification of C or D. The mean occlusion length was 13.5±7 cm. The rate of technical success was 85%. The peroperative complication rate was 4.5%. There were no cases of operative mortality. Occlusion length was the only predictive factor of restenosis (P=0.049). At 1 year, primary and secondary patency rates were 56% and 70%, respectively, for a 92% rate of limb salvage. The subintimal recanalization technique is feasible and minimally invasive. At 1 year postprocedure, the primary patency is poor, but this technique is associated with a high rate of limb salvage. It is suitable for the treatment of critical ischemia, taking into account the often precarious clinical backgrounds of these patients. Copyright © 2013 Elsevier Inc. All rights reserved.

Negative Cognitive Styles Synergistically Predict Suicidal Ideation in Bipolar Spectrum Disorders: A Three-Year Prospective Study

PubMed Central

Stange, Jonathan P.; Hamilton, Jessica L.; Burke, Taylor A.; Kleiman, Evan M.; O’Garro-Moore, Jared K.; Seligman, Nicole D.; Abramson, Lyn Y.; Alloy, Lauren B.

2015-01-01

Rates of suicidal ideation and behavior are extremely high in Bipolar Spectrum Disorders (BSDs). However, relatively little work has evaluated potentially synergistic relationships between cognitive and emotion-regulatory processes proposed by theoretical models of suicidality in BSDs. The present study evaluated whether negative cognitive style and subtypes of rumination would exacerbate the impact of self-criticism on suicidal ideation in a prospective study of individuals with BSDs. Seventy-two young adults with BSDs (bipolar II, bipolar NOS, or cyclothymia) completed diagnostic interviews and trait measures of self-criticism, negative cognitive style, and brooding and reflective rumination at a baseline assessment. The occurrence of suicidal ideation was assessed as part of diagnostic interviews completed every four months for an average of three years of follow-up. Negative cognitive style and reflective rumination strengthened the association between self-criticism and the prospective occurrence of suicidal ideation across follow-up. Individuals with high levels of self-criticism in conjunction with negative cognitive style or reflective rumination were most likely to experience the onset of suicidal ideation. Self-criticism may work synergistically with negative cognitive style and rumination to confer risk for suicidal ideation in bipolar spectrum disorders. These results support theoretical models of suicidality in BSDs and indicate that evaluating and understanding negative cognitive styles may help to identify individuals who are at risk for suicide. PMID:25660736

Assessing the influence of lower facial profile convexity on perceived attractiveness in the orthognathic patient, clinician, and layperson.

PubMed

Naini, Farhad B; Donaldson, Ana Nora A; McDonald, Fraser; Cobourne, Martyn T

2012-09-01

The aim was a quantitative evaluation of how the severity of lower facial profile convexity influences perceived attractiveness. The lower facial profile of an idealized image was altered incrementally between 14° to -16°. Images were rated on a Likert scale by orthognathic patients, laypeople, and clinicians. Attractiveness ratings were greater for straight profiles in relation to convex/concave, with no significant difference between convex and concave profiles. Ratings decreased by 0.23 of a level for every degree increase in the convexity angle. Class II/III patients gave significantly reduced ratings of attractiveness and had greater desire for surgery than class I. A straight profile is perceived as most attractive and greater degrees of convexity or concavity deemed progressively less attractive, but a range of 10° to -12° may be deemed acceptable; beyond these values surgical correction is desired. Patients are most critical, and clinicians are more critical than laypeople. Copyright © 2012 Elsevier Inc. All rights reserved.

Colonization of a territory by a stochastic population under a strong Allee effect and a low immigration pressure

NASA Astrophysics Data System (ADS)

Be'er, Shay; Assaf, Michael; Meerson, Baruch

2015-06-01

We study the dynamics of colonization of a territory by a stochastic population at low immigration pressure. We assume a sufficiently strong Allee effect that introduces, in deterministic theory, a large critical population size for colonization. At low immigration rates, the average precolonization population size is small, thus invalidating the WKB approximation to the master equation. We circumvent this difficulty by deriving an exact zero-flux solution of the master equation and matching it with an approximate nonzero-flux solution of the pertinent Fokker-Planck equation in a small region around the critical population size. This procedure provides an accurate evaluation of the quasistationary probability distribution of population sizes in the precolonization state and of the mean time to colonization, for a wide range of immigration rates. At sufficiently high immigration rates our results agree with WKB results obtained previously. At low immigration rates the results can be very different.

Colonization of a territory by a stochastic population under a strong Allee effect and a low immigration pressure.

PubMed

Be'er, Shay; Assaf, Michael; Meerson, Baruch

2015-06-01

We study the dynamics of colonization of a territory by a stochastic population at low immigration pressure. We assume a sufficiently strong Allee effect that introduces, in deterministic theory, a large critical population size for colonization. At low immigration rates, the average precolonization population size is small, thus invalidating the WKB approximation to the master equation. We circumvent this difficulty by deriving an exact zero-flux solution of the master equation and matching it with an approximate nonzero-flux solution of the pertinent Fokker-Planck equation in a small region around the critical population size. This procedure provides an accurate evaluation of the quasistationary probability distribution of population sizes in the precolonization state and of the mean time to colonization, for a wide range of immigration rates. At sufficiently high immigration rates our results agree with WKB results obtained previously. At low immigration rates the results can be very different.

Critically evaluating the theory and performance of Bayesian analysis of macroevolutionary mixtures

PubMed Central

Moore, Brian R.; Höhna, Sebastian; May, Michael R.; Rannala, Bruce; Huelsenbeck, John P.

2016-01-01

Bayesian analysis of macroevolutionary mixtures (BAMM) has recently taken the study of lineage diversification by storm. BAMM estimates the diversification-rate parameters (speciation and extinction) for every branch of a study phylogeny and infers the number and location of diversification-rate shifts across branches of a tree. Our evaluation of BAMM reveals two major theoretical errors: (i) the likelihood function (which estimates the model parameters from the data) is incorrect, and (ii) the compound Poisson process prior model (which describes the prior distribution of diversification-rate shifts across branches) is incoherent. Using simulation, we demonstrate that these theoretical issues cause statistical pathologies; posterior estimates of the number of diversification-rate shifts are strongly influenced by the assumed prior, and estimates of diversification-rate parameters are unreliable. Moreover, the inability to correctly compute the likelihood or to correctly specify the prior for rate-variable trees precludes the use of Bayesian approaches for testing hypotheses regarding the number and location of diversification-rate shifts using BAMM. PMID:27512038

Evaluating the process parameters of the dry coating process using a 2(5-1) factorial design.

PubMed

Kablitz, Caroline Désirée; Urbanetz, Nora Anne

2013-02-01

A recent development of coating technology is dry coating, where polymer powder and liquid plasticizer are layered on the cores without using organic solvents or water. Several studies evaluating the process were introduced in literature, however, little information about the critical process parameters (CPPs) is given. Aim of the study was the investigation and optimization of CPPs with respect to one of the critical quality attributes (CQAs), the coating efficiency of the dry coating process in a rotary fluid bed. Theophylline pellets were coated with hydroxypropyl methylcellulose acetate succinate as enteric film former and triethyl citrate and acetylated monoglyceride as plasticizer. A 2(5-1) design of experiments (DOEs) was created investigating five independent process parameters namely coating temperature, curing temperature, feeding/spraying rate, air flow and rotor speed. The results were evaluated by multilinear regression using the software Modde(®) 7. It is shown, that generally, low feeding/spraying rates and low rotor speeds increase coating efficiency. High coating temperatures enhance coating efficiency, whereas medium curing temperatures have been found to be optimum in terms of coating efficiency. This study provides a scientific base for the design of efficient dry coating processes with respect to coating efficiency.

Reliability of Beam Loss Monitors System for the Large Hadron Collider

NASA Astrophysics Data System (ADS)

Guaglio, G.; Dehning, B.; Santoni, C.

2004-11-01

The employment of superconducting magnets in high energy colliders opens challenging failure scenarios and brings new criticalities for the whole system protection. For the LHC beam loss protection system, the failure rate and the availability requirements have been evaluated using the Safety Integrity Level (SIL) approach. A downtime cost evaluation is used as input for the SIL approach. The most critical systems, which contribute to the final SIL value, are the dump system, the interlock system, the beam loss monitors system and the energy monitor system. The Beam Loss Monitors System (BLMS) is critical for short and intense particle losses, while at medium and higher loss time it is assisted by other systems, such as the quench protection system and the cryogenic system. For BLMS, hardware and software have been evaluated in detail. The reliability input figures have been collected using historical data from the SPS, using temperature and radiation damage experimental data as well as using standard databases. All the data have been processed by reliability software (Isograph). The analysis ranges from the components data to the system configuration.

[Dysphagia management of acute and long-term critically ill intensive care patients].

PubMed

Zielske, J; Bohne, S; Axer, H; Brunkhorst, F M; Guntinas-Lichius, O

2014-10-01

Dysphagia is a severe complication in critically ill patients and affects more than half the patients in an intensive care unit. Dysphagia also has a strong impact on morbidity and mortality. Risk factors for the development of dysphagia are neurological diseases, age >55-70 years, intubation >7 days and sepsis. With increasing numbers of long-term survivors chronic dysphagia is becoming an increasing problem. There is not much knowledge on the influence of specific diseases, including the direct impact of sepsis on the development of dysphagia. Fiberoptic evaluation of swallowing is a standardized tool for bedside evaluation, helping to plan swallowing training during the acute phase and to decrease the rate of chronic dysphagia. For evaluation of chronic dysphagia even more extensive diagnostic tools as well as several options of stepwise rehabilitation using restitution, compensation and adaption strategies for swallowing exist. Currently it seems that these options are not being sufficiently utilized. In general, there is a need for controlled clinical trials analyzing specific swallowing rehabilitation concepts for former critically ill patients and long-term survivors.

Retaining clients in an outcome monitoring evaluation study: HIV prevention efforts in community settings.

PubMed

Smith, Bryce D; Kalayil, Elizabeth J; Patel-Larson, Alpa; Chen, Brenda; Vaughan, Marla

2012-02-01

The Centers for Disease Control and Prevention (CDC), Division of HIV/AIDS Prevention (DHAP) conducted outcome monitoring studies on evidence-based interventions (EBIs) provided by CDC-funded community-based organizations (CBOs). Critical to the success of outcome monitoring was the ability of CBOs to recruit and retain clients in evaluation studies. Two EBIs, Video Opportunities for Innovative Condom Education and Safer Sex (VOICES/VOCES) and Healthy Relationships, were evaluated using repeated measure studies, which require robust follow-up retention rates to increase the validity and usefulness of the findings. The retention rates were high for both VOICES/VOCES CBOs (95.8% at 30 days and 91.1% at 120 days), and Healthy Relationships CBOs (89.5% at 90 days and 83.5% at 180 days). This paper presents an overview of the retention of clients, challenges to follow-up, and strategies developed by CBOs to achieve high retention rates. These strategies and rates are discussed within the context of the CBOs' target populations and communities. Published by Elsevier Ltd.

Point-of-care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients.

PubMed

Nya-Ngatchou, Jean-Jacques; Corl, Dawn; Onstad, Susan; Yin, Tom; Tylee, Tracy; Suhr, Louise; Thompson, Rachel E; Wisse, Brent E

2015-02-01

Hypoglycaemia is associated with morbidity and mortality in critically ill patients, and many hospitals have programmes to minimize hypoglycaemia rates. Recent studies have established the hypoglycaemic patient-day as a key metric and have published benchmark inpatient hypoglycaemia rates on the basis of point-of-care blood glucose data even though these values are prone to measurement errors. A retrospective, cohort study including all patients admitted to Harborview Medical Center Intensive Care Units (ICUs) during 2010 and 2011 was conducted to evaluate a quality improvement programme to reduce inappropriate documentation of point-of-care blood glucose measurement errors. Laboratory Medicine point-of-care blood glucose data and patient charts were reviewed to evaluate all episodes of hypoglycaemia. A quality improvement intervention decreased measurement errors from 31% of hypoglycaemic (<70 mg/dL) patient-days in 2010 to 14% in 2011 (p < 0.001) and decreased the observed hypoglycaemia rate from 4.3% of ICU patient-days to 3.4% (p < 0.001). Hypoglycaemic events were frequently recurrent or prolonged (~40%), and these events are not identified by the hypoglycaemic patient-day metric, which also may be confounded by a large number of very low risk or minimally monitored patient-days. Documentation of point-of-care blood glucose measurement errors likely overestimates ICU hypoglycaemia rates and can be reduced by a quality improvement effort. The currently used hypoglycaemic patient-day metric does not evaluate recurrent or prolonged events that may be more likely to cause patient harm. The monitored patient-day as currently defined may not be the optimal denominator to determine inpatient hypoglycaemic risk. Copyright © 2014 John Wiley & Sons, Ltd.

Accuracy of the energy-corrected sudden (ECS) scaling procedure for rotational excitation of CO by collisions with Ar

NASA Technical Reports Server (NTRS)

Green, S.; Cochrane, D. L.; Truhlar, D. G.

1986-01-01

The utility of the energy-corrected sudden (ECS) scaling method is evaluated on the basis of how accurately it predicts the entire matrix of state-to-state rate constants, when the fundamental rate constants are independently known. It is shown for the case of Ar-CO collisions at 500 K that when a critical impact parameter is about 1.75-2.0 A, the ECS method yields excellent excited state rates on the average and has an rms error of less than 20 percent.

Effect of Common Cryoprotectants on Critical Warming Rates and Ice Formation in Aqueous Solutions

PubMed Central

Hopkins, Jesse B.; Badeau, Ryan; Warkentin, Matthew; Thorne, Robert E.

2012-01-01

Ice formation on warming is of comparable or greater importance to ice formation on cooling in determining survival of cryopreserved samples. Critical warming rates required for ice-free warming of vitrified aqueous solutions of glycerol, dimethyl sulfoxide, ethylene glycol, polyethylene glycol 200 and sucrose have been measured for warming rates of order 10 to 104 K/s. Critical warming rates are typically one to three orders of magnitude larger than critical cooling rates. Warming rates vary strongly with cooling rates, perhaps due to the presence of small ice fractions in nominally vitrified samples. Critical warming and cooling rate data spanning orders of magnitude in rates provide rigorous tests of ice nucleation and growth models and their assumed input parameters. Current models with current best estimates for input parameters provide a reasonable account of critical warming rates for glycerol solutions at high concentrations/low rates, but overestimate both critical warming and cooling rates by orders of magnitude at lower concentrations and larger rates. In vitrification protocols, minimizing concentrations of potentially damaging cryoprotectants while minimizing ice formation will require ultrafast warming rates, as well as fast cooling rates to minimize the required warming rates. PMID:22728046

Terrorist bombings. Lessons learned from Belfast to Beirut.

PubMed Central

Frykberg, E R; Tepas, J J

1988-01-01

Experience in the management of mass casualties following a disaster is relatively sparse. The terrorist bombing serves as a timely and effective model for the analysis of patterns of injury and mortality and the determination of the factors influencing casualty survival in the wake of certain forms of disaster. For this purpose, a review of the published experience with terrorist bombings was carried out, providing a study population of 3357 casualties from 220 incidents worldwide. There were 2934 immediate survivors of these incidents (87%), of whom 881 (30%) were hospitalized. Forty deaths ultimately occurred among these survivors (1.4%), 39 of whom were among those hospitalized (4.4%). Injury severity was determined from available data for 1339 surviving casualties, 251 of whom were critically injured (18.7%). Of this population evaluable for injury severity, there were 31 late deaths, all of which occurred among those critically injured, accounting for an overall "critical mortality" rate of 12.4%. Overall triage efficiency was characterized by a mean overtriage rate (noncritically injured among those hospitalized or evacuated) of 59%, and a mean undertriage rate (critically injured among those not hospitalized or evacuated) of .05%. Multiple linear regression analysis of all major bombing incidents demonstrated a direct linear relationship between overtriage and critical mortality (r2 = .845), and an inversely proportional relationship between triage discrimination and critical mortality (r2 = 0.855). Although head injuries predominated in both immediate (71%) and late (52%) fatalities, injury to the abdomen carried the highest specific mortality rate (19%) of any single body system injury among immediate survivors. These data clearly document the importance of accurate triage as a survival determinant for critically injured casualties of these disasters. Furthermore, the data suggest that explosive force, time interval from injury to treatment, and anatomic site of injury are all factors that correlated with the ultimate outcome of terrorist bombing victims. Critical analysis of past disasters should allow for sufficient preparation so as to minimize casualty mortality in the future. Images Fig. 1. Fig. 2. PMID:3056287

Structured Head and Neck CT Angiography Reporting Reduces Resident Revision Rates.

PubMed

Johnson, Tucker F; Brinjikji, Waleed; Doolittle, Derrick A; Nagelschneider, Alex A; Welch, Brian T; Kotsenas, Amy L

2018-04-12

This resident-driven quality improvement project was undertaken to assess the effectiveness of structured reporting to reduce revision rates for afterhours reports dictated by residents. The first part of the study assessed baseline revision rates for head and neck CT angiography (CTA) examinations dictated by residents during afterhours call. A structured report was subsequently created based on templates on the RSNA informatics reporting website and critical findings that should be assessed for on all CTA examinations. The template was made available to residents through the speech recognition software for all head and neck CTA examinations for a duration of 2 months. Report revision rates were then compared with and without use of the structured template. The structured template was found to reduce revision rates by approximately 50% with 10/41 unstructured reports revised and 2/17 structured reports revised. We believe that structured reporting can help reduce reporting errors, particularly in term of typographical errors, train residents to evaluate complex examinations in a systematic fashion, and assist them in recalling critical findings on these examinations. Copyright © 2018 Elsevier Inc. All rights reserved.

Mechanism of Kinetically Controlled Capillary Condensation in Nanopores: A Combined Experimental and Monte Carlo Approach.

PubMed

Hiratsuka, Tatsumasa; Tanaka, Hideki; Miyahara, Minoru T

2017-01-24

We find the rule of capillary condensation from the metastable state in nanoscale pores based on the transition state theory. The conventional thermodynamic theories cannot achieve it because the metastable capillary condensation inherently includes an activated process. We thus compute argon adsorption isotherms on cylindrical pore models and atomistic silica pore models mimicking the MCM-41 materials by the grand canonical Monte Carlo and the gauge cell Monte Carlo methods and evaluate the rate constant for the capillary condensation by the transition state theory. The results reveal that the rate drastically increases with a small increase in the chemical potential of the system, and the metastable capillary condensation occurs for any mesopores when the rate constant reaches a universal critical value. Furthermore, a careful comparison between experimental adsorption isotherms and the simulated ones on the atomistic silica pore models reveals that the rate constant of the real system also has a universal value. With this finding, we can successfully estimate the experimental capillary condensation pressure over a wide range of temperatures and pore sizes by simply applying the critical rate constant.

The Fuzzy Scarlet Letter

ERIC Educational Resources Information Center

Pallas, Aaron M.

2012-01-01

Critics of the public release of teacher evaluation scores sometimes liken these ratings to the scarlet letter worn by Hester Prynne in Nathaniel Hawthorne's classic novel. The comparison is apt. But public school teachers who are subjected to public shaming because of their students' test scores can rarely expect the opportunities for redemption…

Perceptions of Students with Autism and Their Parents: The College Experience

ERIC Educational Resources Information Center

Hendrickson, Jo M.; Woods-Groves, Suzanne; Rodgers, Derek B.; Datchuk, Shawn

2017-01-01

Students with autism spectrum disorder (ASD) are attending postsecondary programs at unprecedented rates. Transitions are especially challenging for students with ASD, yet little is known about critical transitions during the college experience. Using the College Adjustment Program Evaluation Scales (CAPES), we examined student and parent…

Technology Demonstration Summary Shirco Electric Infrared Incineration At The Peak Oil Superfund Site

EPA Science Inventory

Under the auspices of the Superfund Innovative Technology Evaluation or SITE Program, a critical assessment is made of the performance of the transportable Shirco Infrared Thermal Destruction System during three separate test runs at an operating feed rate of 100 tons per day. Th...

Factors Affecting the Textural Properties of Pork

ERIC Educational Resources Information Center

Holmer, Sean Frederick

2009-01-01

Research concerning rate and extent of tenderization has focused on beef or lamb. However, it is critical to understand these processes in pork, especially as retailers move towards minimally processed or non-enhanced product. The objectives of this experiment were to evaluate the textural properties of pork (firmness and tenderness) by examining…

The New "LJ" Index

ERIC Educational Resources Information Center

Lance, Keith Curry; Lyons, Ray

2008-01-01

As published critics of Hennen's American Public Library Ratings (HAPLR), the authors propose a new ranking system that focuses more transparently on ranking libraries based on their performance. These annual rankings are intended to contribute to self-evaluation and peer comparison, prompt questions about the statistics and how to improve them,…

A Novel Method of Evaluating Key Factors for Success in a Multifaceted Critical Care Fellowship Using Data Envelopment Analysis.

PubMed

Tiwari, Vikram; Kumar, Avinash B

2018-01-01

The current system of summative multi-rater evaluations and standardized tests to determine readiness to graduate from critical care fellowships has limitations. We sought to pilot the use of data envelopment analysis (DEA) to assess what aspects of the fellowship program contribute the most to an individual fellow's success. DEA is a nonparametric, operations research technique that uses linear programming to determine the technical efficiency of an entity based on its relative usage of resources in producing the outcome. Retrospective cohort study. Critical care fellows (n = 15) in an Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship at a major academic medical center in the United States. After obtaining institutional review board approval for this retrospective study, we analyzed the data of 15 anesthesiology critical care fellows from academic years 2013-2015. The input-oriented DEA model develops a composite score for each fellow based on multiple inputs and outputs. The inputs included the didactic sessions attended, the ratio of clinical duty works hours to the procedures performed (work intensity index), and the outputs were the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP) score and summative evaluations of fellows. A DEA efficiency score that ranged from 0 to 1 was generated for each of the fellows. Five fellows were rated as DEA efficient, and 10 fellows were characterized in the DEA inefficient group. The model was able to forecast the level of effort needed for each inefficient fellow, to achieve similar outputs as their best performing peers. The model also identified the work intensity index as the key element that characterized the best performers in our fellowship. DEA is a feasible method of objectively evaluating peer performance in a critical care fellowship beyond summative evaluations alone and can potentially be a powerful tool to guide individual performance during the fellowship.

Benchmark Evaluation of Fuel Effect and Material Worth Measurements for a Beryllium-Reflected Space Reactor Mockup

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

Marshall, Margaret A.; Bess, John D.

2015-02-01

The critical configuration of the small, compact critical assembly (SCCA) experiments performed at the Oak Ridge Critical Experiments Facility (ORCEF) in 1962-1965 have been evaluated as acceptable benchmark experiments for inclusion in the International Handbook of Evaluated Criticality Safety Benchmark Experiments. The initial intent of these experiments was to support the design of the Medium Power Reactor Experiment (MPRE) program, whose purpose was to study “power plants for the production of electrical power in space vehicles.” The third configuration in this series of experiments was a beryllium-reflected assembly of stainless-steel-clad, highly enriched uranium (HEU)-O 2 fuel mockup of a potassium-cooledmore » space power reactor. Reactivity measurements cadmium ratio spectral measurements and fission rate measurements were measured through the core and top reflector. Fuel effect worth measurements and neutron moderating and absorbing material worths were also measured in the assembly fuel region. The cadmium ratios, fission rate, and worth measurements were evaluated for inclusion in the International Handbook of Evaluated Criticality Safety Benchmark Experiments. The fuel tube effect and neutron moderating and absorbing material worth measurements are the focus of this paper. Additionally, a measurement of the worth of potassium filling the core region was performed but has not yet been evaluated Pellets of 93.15 wt.% enriched uranium dioxide (UO 2) were stacked in 30.48 cm tall stainless steel fuel tubes (0.3 cm tall end caps). Each fuel tube had 26 pellets with a total mass of 295.8 g UO 2 per tube. 253 tubes were arranged in 1.506-cm triangular lattice. An additional 7-tube cluster critical configuration was also measured but not used for any physics measurements. The core was surrounded on all side by a beryllium reflector. The fuel effect worths were measured by removing fuel tubes at various radius. An accident scenario was also simulated by moving outward twenty fuel rods from the periphery of the core so they were touching the core tank. The change in the system reactivity when the fuel tube(s) were removed/moved compared with the base configuration was the worth of the fuel tubes or accident scenario. The worth of neutron absorbing and moderating materials was measured by inserting material rods into the core at regular intervals or placing lids at the top of the core tank. Stainless steel 347, tungsten, niobium, polyethylene, graphite, boron carbide, aluminum and cadmium rods and/or lid worths were all measured. The change in the system reactivity when a material was inserted into the core is the worth of the material.« less

Countermeasures (iRED, ARED CEVIS, MEC, TVIS, T2, Periodic Fitness Evaluation, BP-ECG, HRM). Critical Readiness Review Increment 23 and 24

NASA Technical Reports Server (NTRS)

Toder, Carly; Gipson, Iona; Conly, Danielle; Nieschwitz, Linda; Perk, Austin

2010-01-01

This slide presentation reviews attempts to counteract the effects of being in space. It includes information on the Resistive Exercise Device (RED), the Advanced Resistive Exercise Device (ARED), Cycle Ergometer with Vibration Isolation and Stabilization (CEVIS), Treadmill with Vibration Isolation and Stabilization (TVIS) and periodic fitness evaluation with specific information on BP/ECG, heart rate monitor 2 and data distribution.

Male Infertility Diagnosis and Treatment in the Era of In Vitro Fertilization and Intracytoplasmic Sperm Injection.

PubMed

Pan, Michael M; Hockenberry, Mark S; Kirby, Edgar W; Lipshultz, Larry I

2018-03-01

As assisted reproductive technologies use increases, the evaluation of male factor infertility has often become overlooked. However, male evaluation remains critically important, with benefits seen in overall health, as well as in natural and assisted pregnancy and birth rates. A comprehensive assessment of the male partner should be offered to all couples seeking infertility care. Copyright © 2017 Elsevier Inc. All rights reserved.

The use of Facebook and WhatsApp application in learning process of physics to train students’ critical thinking skills

NASA Astrophysics Data System (ADS)

Kustijono, R.; Zuhri, F.

2018-01-01

The purpose of this research is to describe the learning process by using Facebook and WhatsApp to train students’ critical thinking skills. The research steps are: 1) analysis; 2) design; 3) development; 4) implementation; 5) evaluation. The research subjects are 40 students of Physics Department of Universitas Negeri Surabaya. This research used descriptive qualitative approach. The study The validation point, practicality, effectiveness, and critical thinking skills of students assessment use Likert scale. Learning process criteria are eligible if ≥ 60% is rated good or excellent. The results are: 1) the use of Facebook and WhatsApp can be implemented in the learning process, and the existing constraints can be overcome; 2) the assessment of students’ critical thinking skills is categorized as good and excellent. These results suggest that learning by using Facebook and WhatsApp can be used to train students’ critical thinking skills.

Tuned critical avalanche scaling in bulk metallic glasses

DOE PAGES

Antonaglia, James; Xie, Xie; Schwarz, Gregory; ...

2014-03-17

In this study, ingots of the bulk metallic glass (BMG), Zr 64.13Cu 15.75Ni 10.12Al 10 in atomic percent (at. %), are compressed at slow strain rates. The deformation behavior is characterized by discrete, jerky stress-drop bursts (serrations). Here we present a quantitative theory for the serration behavior of BMGs, which is a critical issue for the understanding of the deformation characteristics of BMGs. The mean-field interaction model predicts the scaling behavior of the distribution, D(S), of avalanche sizes, S, in the experiments. D(S) follows a power law multiplied by an exponentially-decaying scaling function. The size of the largest observed avalanchemore » depends on experimental tuning-parameters, such as either imposed strain rate or stress. Similar to crystalline materials, the plasticity of BMGs reflects tuned criticality showing remarkable quantitative agreement with the slip statistics of slowly-compressed nanocrystals. The results imply that material-evaluation methods based on slip statistics apply to both crystalline and BMG materials.« less

Automated agitation management accounting for saturation dynamics.

PubMed

Rudge, A D; Chase, J G; Shaw, G M; Lee, D

2004-01-01

Agitation-sedation cycling in critically ill is damaging to patient health and increases length of and cost. A physiologically representative model of the agitation-sedation system is used as a platform to evaluate feedback controllers offering improved agitation management. A heavy-derivative controller with upper and infusion rate bounds maintains minimum plasma concentrations through a low constant infusion, and minimizes outbursts of agitation through strong, timely boluses. controller provides improved agitation management using from 37 critically ill patients, given the saturation of effect at high concentration. Approval was obtained the Canterbury Ethics Board for this research.

Determining the Relative Criticality of Diverse Exploration Risks in NASA's Human Research Program

NASA Technical Reports Server (NTRS)

Kundrot, Craig E.; Edwards, J. Michelle; Anton, Wilma; Robotham, Kwesi

2009-01-01

The mission of NASA s Human Research Program (HRP) is to understand and reduce the risk to crew health and performance in exploration missions. The HRP addresses 27 specific risks, primarily in the context of Continuous Risk Management. Each risk is evaluated in terms of two missions (a six month stay on the Moon and a thirty month round trip to Mars) and three types of consequences (in-mission crew health, post-mission crew health, and in-mission performance). The lack of a common metric between the three consequence scales, such as financial costs or quality adjusted life years lost, makes it difficult to compare the relative criticality of the risks. We are, therefore, exploring the use of a ternary scale of criticality based on the common metric of influencing an operational decision. The three levels correspond to the level of concern the risk generates for a "go/no-go" decision to launch a mission: 1) no-go; 2) go with significant reservations; 3) go. The criticality of each of the 27 risks is scored for the three types of consequence in both types of mission. The scores are combined to produce an overall criticality rating for each risk. The overall criticality rating can then be used to guide the prioritization of resources to affect the greatest amount of risk reduction.

Evaluating supplier quality performance using analytical hierarchy process

NASA Astrophysics Data System (ADS)

Kalimuthu Rajoo, Shanmugam Sundram; Kasim, Maznah Mat; Ahmad, Nazihah

2013-09-01

This paper elaborates the importance of evaluating supplier quality performance to an organization. Supplier quality performance evaluation reflects the actual performance of the supplier exhibited at customer's end. It is critical in enabling the organization to determine the area of improvement and thereafter works with supplier to close the gaps. Success of the customer partly depends on supplier's quality performance. Key criteria as quality, cost, delivery, technology support and customer service are categorized as main factors in contributing to supplier's quality performance. 18 suppliers' who were manufacturing automotive application parts evaluated in year 2010 using weight point system. There were few suppliers with common rating which led to common ranking observed by few suppliers'. Analytical Hierarchy Process (AHP), a user friendly decision making tool for complex and multi criteria problems was used to evaluate the supplier's quality performance challenging the weight point system that was used for 18 suppliers'. The consistency ratio was checked for criteria and sub-criteria. Final results of AHP obtained with no overlap ratings, therefore yielded a better decision making methodology as compared to weight point rating system.

Situated peer coaching and unfolding cases in the fundamentals skills laboratory.

PubMed

Himes, Deborah O; Ravert, Patricia K

2012-09-03

Using unfolding case studies and situated peer coaching for the Fundamentals Skills Laboratory provides students with individualized feedback and creates a realistic clinical learning experience. A quasi-experimental design with pre- and post-intervention data was used to evaluate changes in student ratings of the course. An instrument was used to examine students' self-ratings and student comments about each lab. We found that students' ratings of the lab remained high with the new method and self-evaluations of their performance were higher as the semester progressed. Students appreciated the personalized feedback associated with peer coaching and demonstrated strong motivation and self-regulation in learning. By participating in unfolding case studies with situated peer coaching, students focus on safety issues, practice collaborative communication, and critical thinking in addition to performing psychomotor skills.

Comparison of cardiac TnI outliers using a contemporary and a high-sensitivity assay on the Abbott Architect platform.

PubMed

Ryan, J B; Southby, S J; Stuart, L A; Mackay, R; Florkowski, C M; George, P M

2014-07-01

Assays for cardiac troponin (cTn) have undergone improvements in sensitivity and precision in recent years. Increased rates of outliers, however, have been reported on various cTn platforms, typically giving irreproducible, falsely higher results. We aimed to evaluate the outlier rate occurring in patients with elevated cTnI using a contemporary and high-sensitivity assay. All patients with elevated cTnI (up to 300 ng/L) performed over a 21-month period were assayed in duplicate. A contemporary assay (Abbott STAT Troponin-I) was used for the first part of the study and subsequently a high-sensitivity assay (Abbott STAT High-Sensitive Troponin-I) was used. Outliers exceeded a calculated critical difference (CD) (CD = z × √2 × SDAnalytical) where z = 3.5 (for probability of 0.0005) and critical outliers also were on a different side of the decision level. The respective outlier and critical outlier rates were 0.22% and 0.10% for the contemporary assay (n = 4009) and 0.18% and 0.13% for the high-sensitivity assay (n = 3878). There was no significant reduction in outlier rate between the two assays (χ(2) = 0.034, P = 0.854). Fifty-six percent of outliers occurred in samples where cTn was an 'add-on' test (and was stored and refrigerated prior to assay). Despite recent improvements in cTn methods, outliers (including critical outliers) still occur at a low rate in both a contemporary and high-sensitivity cTnI assay. Laboratory and clinical staff should be aware of this potential analytical error, particularly in samples with suboptimal sample handling such as add-on tests. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Outcome of Pediatric Critical Care Medicine Abstracts Presented at North American Academic National Meetings.

PubMed

Basu, Sonali; Pollack, Murray M

2017-05-05

Pediatric critical care medicine abstracts presented at North American national academic meetings have not been followed up to determine their publication outcomes. Our objective was to determine the following: 1) the proportion of these presentations that are published in peer-reviewed journals within 5 years; 2) the impact of trainee status on time to and success of publication; and 3) the quality of the research as reflected in the publishing journal's impact factor. Four years of abstracts (2007-2011) were reviewed from the American Academy of Pediatrics, Pediatric Academic Societies, and Society of Critical Care Medicine national meetings. Pediatric critical care medicine abstracts were delineated by the meeting or identified by keyword search. Data included mode of presentation, trainee status of first author, publication status within 5 years based on a PubMed search, trainee position in the journal of publication authorship list, and the impact factor of journal of publication. We evaluated 267 pediatric critical care medicine abstracts, 85-94 from each meeting. Overall, 41% were published, with the highest rate in Pediatric Academic Societies abstracts (54% Pediatric Academic Societies, 38% Society of Critical Care Medicine, and 33% American Academy of Pediatrics; p = 0.011). Mean time to publication was 22 (± 3) months and did not differ by conference or presentation mode. Journal first authorship was retained in 84%. Journal impact factor was highest in Society of Critical Care Medicine abstracts (3.38 Society of Critical Care Medicine, 2.64 Pediatric Academic Societies, and 1.92 American Academy of Pediatrics; p = 0.006). First author trainee status was not associated with publication rate, time to publication, and impact factor. A total of 100% of trainees but only 79% of nontrainees who published retained first authorship. Less than half of pediatric critical care medicine research abstracts presented at North American national academic meetings culminate in articles. Pediatric Academic Societies had the highest publication success rate, and Society of Critical Care Medicine abstracts were published in journals with the highest impact factors. All trainees who were first authors retained that status in the journal publications.

A critical evaluation of theories for predicting microcracking in composite laminates

NASA Technical Reports Server (NTRS)

Nairn, John A.; Hu, Shoufeng; Bark, Jong S.

1993-01-01

We present experimental results on 21 different layups of Hercules AS4 carbon fiber/3501-6 epoxy laminates. All laminates had 90 deg plies; some had them in the middle, while some had them on a free surface. During tensile loading, the first form of damage in all laminates was microcracking of the 90 deg plies. For each laminate, we recorded both the crack density and the complete distribution of crack spacings as a function of the applied load. By rearranging various microcracking theories, we developed a master-curve approach that permitted plotting the results from all laminates on a single plot. By comparing master-curve plots for different theories, it was possible to critically evaluate the quality of those theories. We found that a critical-energy-release-rate criterion calculated using a 2D variational stress analysis gave the best results. All microcracking theories based on a strength-failure criteria gave poor results. All microcracking theories using 1D stress analyses, regardless of the failure criterion, also gave poor results.

Estimating the Critical Point of Crowding in the Emergency Department for the Warning System

NASA Astrophysics Data System (ADS)

Chang, Y.; Pan, C.; Tseng, C.; Wen, J.

2011-12-01

The purpose of this study is to deduce a function from the admissions/discharge rate of patient flow to estimate a "Critical Point" that provides a reference for warning systems in regards to crowding in the emergency department (ED) of a hospital or medical clinic. In this study, a model of "Input-Throughput-Output" was used in our established mathematical function to evaluate the critical point. The function is defined as dPin/dt=dwait/dt+Cp×B+ dPout/dt where Pin= number of registered patients, Pwait= number of waiting patients, Cp= retention rate per bed (calculated for the critical point), B= number of licensed beds in the treatment area, and Pout= number of patients discharged from the treatment area. Using the average Cp of ED crowding, we could start the warning system at an appropriate time and then plan for necessary emergency response to facilitate the patient process more smoothly. It was concluded that ED crowding could be quantified using the average value of Cp and the value could be used as a reference for medical staff to give optimal emergency medical treatment to patients. Therefore, additional practical work should be launched to collect more precise quantitative data.

THE USE OF GEOMORPHOLOGY AND STREAM STABILITY IN THE ASSESSMENT OF THE RISK OF STREAM IMPAIRMENT FROM SEDIMENT

EPA Science Inventory

The evaluation of the current condition is critical to the management of streams impaired by sediment and other non-point source stressors, which adversely affect both physical habitat and water quality. Several rating and classification systems based on geomorphic data exist for...

Chapter 8: Demographic characteristics and population modeling

Treesearch

Scott H. Stoleson; Mary J. Whitfield; Mark K. Sogge

2000-01-01

An understanding of the basic demography of a species is necessary to estimate and evaluate population trends. The relative impact of different demographic parameters on growth rates can be assessed through a sensitivity analysis, in which different parameters are altered singly to assess the effect on population growth. Identification of critical parameters can allow...

Evaluating the Validity and Reliability of a Student Self-Advocacy Teacher Rating Scale

ERIC Educational Resources Information Center

Walick, Christopher M.

2017-01-01

Self-advocacy skills are critical to high school and post-secondary success. Unfortunately, students with disabilities often times struggle with self-advocacy. While there are effective, evidence-based programs to teach self-advocacy skills, there are few scales that directly measure self-advocacy. The current research study was conducted to…

In-line filtration minimizes organ dysfunction: new aspects from a prospective, randomized, controlled trial.

PubMed

Boehne, Martin; Jack, Thomas; Köditz, Harald; Seidemann, Kathrin; Schmidt, Florian; Abura, Michaela; Bertram, Harald; Sasse, Michael

2013-02-06

Infused particles induce thrombogenesis, impair microcirculation and modulate immune response. We have previously shown in critically ill children, that particle-retentive in-line filtration reduced the overall complication rate of severe events, length of stay and duration of mechanical ventilation. We now evaluated the influence of in-line filtration on different organ function and thereby elucidated the potential underlying pathophysiological effects of particle infusion. In this single-centre, prospective, randomized controlled trial 807 critically ill children were assigned to either control (n = 406) or filter group (n = 401), the latter receiving in-line filtration for complete infusion therapy. Both groups were compared regarding the differences of incidence rates and its 95% confidence interval (CI) of different organ dysfunction as defined by the International Pediatric Sepsis Consensus Conference 2005. The incidence rates of respiratory (-5.06%; 95% CI, -9.52 to -0.59%), renal (-3.87%; 95% CI, -7.58 to -0.15%) and hematologic (-3.89%; 95% CI, -7.26 to -0.51%) dysfunction were decreased in the filter group. No difference was demonstrated for the occurrence rates of cardiovascular, hepatic, or neurologic dysfunction between both groups. In-line filtration has beneficial effects on the preservation of hematologic, renal and respiratory function in critically ill patients. The presented clinical data further support our hypothesis regarding potential harmful effects of particles. In critically ill patients infused particles may lead to further deterioration of the microcirculation, induce a systemic hypercoagulability and inflammation with consecutive negative effects on organ function. ClinicalTrials.gov number; NCT00209768.

Paediatric electronic infusion calculator: An intervention to eliminate infusion errors in paediatric critical care.

PubMed

Venkataraman, Aishwarya; Siu, Emily; Sadasivam, Kalaimaran

2016-11-01

Medication errors, including infusion prescription errors are a major public health concern, especially in paediatric patients. There is some evidence that electronic or web-based calculators could minimise these errors. To evaluate the impact of an electronic infusion calculator on the frequency of infusion errors in the Paediatric Critical Care Unit of The Royal London Hospital, London, United Kingdom. We devised an electronic infusion calculator that calculates the appropriate concentration, rate and dose for the selected medication based on the recorded weight and age of the child and then prints into a valid prescription chart. Electronic infusion calculator was implemented from April 2015 in Paediatric Critical Care Unit. A prospective study, five months before and five months after implementation of electronic infusion calculator, was conducted. Data on the following variables were collected onto a proforma: medication dose, infusion rate, volume, concentration, diluent, legibility, and missing or incorrect patient details. A total of 132 handwritten prescriptions were reviewed prior to electronic infusion calculator implementation and 119 electronic infusion calculator prescriptions were reviewed after electronic infusion calculator implementation. Handwritten prescriptions had higher error rate (32.6%) as compared to electronic infusion calculator prescriptions (<1%) with a p  < 0.001. Electronic infusion calculator prescriptions had no errors on dose, volume and rate calculation as compared to handwritten prescriptions, hence warranting very few pharmacy interventions. Use of electronic infusion calculator for infusion prescription significantly reduced the total number of infusion prescribing errors in Paediatric Critical Care Unit and has enabled more efficient use of medical and pharmacy time resources.

Design and validation of a questionnaire to evaluate the usability of computerized critical care information systems.

PubMed

von Dincklage, Falk; Lichtner, Gregor; Suchodolski, Klaudiusz; Ragaller, Maximilian; Friesdorf, Wolfgang; Podtschaske, Beatrice

2017-08-01

The implementation of computerized critical care information systems (CCIS) can improve the quality of clinical care and staff satisfaction, but also holds risks of disrupting the workflow with consecutive negative impacts. The usability of CCIS is one of the key factors determining their benefits and weaknesses. However, no tailored instrument exists to measure the usability of such systems. Therefore, the aim of this study was to design and validate a questionnaire that measures the usability of CCIS. Following a mixed-method design approach, we developed a questionnaire comprising two evaluation models to assess the usability of CCIS: (1) the task-specific model rates the usability individually for several tasks which CCIS could support and which we derived by analyzing work processes in the ICU; (2) the characteristic-specific model rates the different aspects of the usability, as defined by the international standard "ergonomics of human-system interaction". We tested validity and reliability of the digital version of the questionnaire in a sample population. In the sample population of 535 participants both usability evaluation models showed a strong correlation with the overall rating of the system (multiple correlation coefficients ≥0.80) as well as a very high internal consistency (Cronbach's alpha ≥0.93). The novel questionnaire is a valid and reliable instrument to measure the usability of CCIS and can be used to study the influence of the usability on their implementation benefits and weaknesses.

[Prospective assessment of medication errors in critically ill patients in a university hospital].

PubMed

Salazar L, Nicole; Jirón A, Marcela; Escobar O, Leslie; Tobar, Eduardo; Romero, Carlos

2011-11-01

Critically ill patients are especially vulnerable to medication errors (ME) due to their severe clinical situation and the complexities of their management. To determine the frequency and characteristics of ME and identify shortcomings in the processes of medication management in an Intensive Care Unit. During a 3 months period, an observational prospective and randomized study was carried out in the ICU of a university hospital. Every step of patient's medication management (prescription, transcription, dispensation, preparation and administration) was evaluated by an external trained professional. Steps with higher frequency of ME and their therapeutic groups involved were identified. Medications errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention. In 52 of 124 patients evaluated, 66 ME were found in 194 drugs prescribed. In 34% of prescribed drugs, there was at least 1 ME during its use. Half of ME occurred during medication administration, mainly due to problems in infusion rates and schedule times. Antibacterial drugs had the highest rate of ME. We found a 34% rate of ME per drug prescribed, which is in concordance with international reports. The identification of those steps more prone to ME in the ICU, will allow the implementation of an intervention program to improve the quality and security of medication management.

Benchmark Evaluation of the HTR-PROTEUS Absorber Rod Worths (Core 4)

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

John D. Bess; Leland M. Montierth

2014-06-01

PROTEUS was a zero-power research reactor at the Paul Scherrer Institute (PSI) in Switzerland. The critical assembly was constructed from a large graphite annulus surrounding a central cylindrical cavity. Various experimental programs were investigated in PROTEUS; during the years 1992 through 1996, it was configured as a pebble-bed reactor and designated HTR-PROTEUS. Various critical configurations were assembled with each accompanied by an assortment of reactor physics experiments including differential and integral absorber rod measurements, kinetics, reaction rate distributions, water ingress effects, and small sample reactivity effects [1]. Four benchmark reports were previously prepared and included in the March 2013 editionmore » of the International Handbook of Evaluated Reactor Physics Benchmark Experiments (IRPhEP Handbook) [2] evaluating eleven critical configurations. A summary of that effort was previously provided [3] and an analysis of absorber rod worth measurements for Cores 9 and 10 have been performed prior to this analysis and included in PROTEUS-GCR-EXP-004 [4]. In the current benchmark effort, absorber rod worths measured for Core Configuration 4, which was the only core with a randomly-packed pebble loading, have been evaluated for inclusion as a revision to the HTR-PROTEUS benchmark report PROTEUS-GCR-EXP-002.« less

Quantifying the Evolutionary Conservation of Genes Encoding Multidrug Efflux Pumps in the ESKAPE Pathogens To Identify Antimicrobial Drug Targets.

PubMed

Brooks, Lauren E; Ul-Hasan, Sabah; Chan, Benjamin K; Sistrom, Mark J

2018-01-01

Increasing rates of antibiotic-resistant bacterial infection are one of the most pressing contemporary global health concerns. The ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) have been identified as the leading global cause of multidrug-resistant bacterial infections, and overexpression of multidrug efflux (MEX) transport systems has been identified as one of the most critical mechanisms facilitating the evolution of multidrug resistance in ESKAPE pathogens. Despite efforts to develop efflux pump inhibitors to combat antibiotic resistance, the need persists to identify additional targets for future investigations. We evaluated evolutionary pressures on 110 MEX-encoding genes from all annotated ESKAPE organism genomes. We identify several MEX genes under stabilizing selection-representing targets which can facilitate broad-spectrum treatments with evolutionary constraints limiting the potential emergence of escape mutants. We also examine MEX systems being evaluated as drug targets, demonstrating that divergent selection may underlie some of the problems encountered in the development of effective treatments-specifically in relation to the NorA system in S. aureus. This study provides a comprehensive evolutionary context to efflux in the ESKAPE pathogens, which will provide critical context to the evaluation of efflux systems as antibiotic targets. IMPORTANCE Increasing rates of antibiotic-resistant bacterial infection are one of the most pressing contemporary global health concerns. The ESKAPE pathogen group represents the leading cause of these infections, and upregulation of efflux pump expression is a significant mechanism of resistance in these pathogens. This has resulted in substantial interest in the development of efflux pump inhibitors to combat antibiotic-resistant infections; however, no widespread treatments have been developed to date. Our study evaluates an often-underappreciated aspect of resistance-the impact of evolutionary selection. We evaluate selection on all annotated efflux genes in all sequenced ESKAPE pathogens, providing critical context for and insight into current and future development of efflux-targeting treatments for resistant bacterial infections.

Quantifying the Evolutionary Conservation of Genes Encoding Multidrug Efflux Pumps in the ESKAPE Pathogens To Identify Antimicrobial Drug Targets

PubMed Central

Ul-Hasan, Sabah; Chan, Benjamin K.; Sistrom, Mark J.

2018-01-01

ABSTRACT Increasing rates of antibiotic-resistant bacterial infection are one of the most pressing contemporary global health concerns. The ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) have been identified as the leading global cause of multidrug-resistant bacterial infections, and overexpression of multidrug efflux (MEX) transport systems has been identified as one of the most critical mechanisms facilitating the evolution of multidrug resistance in ESKAPE pathogens. Despite efforts to develop efflux pump inhibitors to combat antibiotic resistance, the need persists to identify additional targets for future investigations. We evaluated evolutionary pressures on 110 MEX-encoding genes from all annotated ESKAPE organism genomes. We identify several MEX genes under stabilizing selection—representing targets which can facilitate broad-spectrum treatments with evolutionary constraints limiting the potential emergence of escape mutants. We also examine MEX systems being evaluated as drug targets, demonstrating that divergent selection may underlie some of the problems encountered in the development of effective treatments—specifically in relation to the NorA system in S. aureus. This study provides a comprehensive evolutionary context to efflux in the ESKAPE pathogens, which will provide critical context to the evaluation of efflux systems as antibiotic targets. IMPORTANCE Increasing rates of antibiotic-resistant bacterial infection are one of the most pressing contemporary global health concerns. The ESKAPE pathogen group represents the leading cause of these infections, and upregulation of efflux pump expression is a significant mechanism of resistance in these pathogens. This has resulted in substantial interest in the development of efflux pump inhibitors to combat antibiotic-resistant infections; however, no widespread treatments have been developed to date. Our study evaluates an often-underappreciated aspect of resistance—the impact of evolutionary selection. We evaluate selection on all annotated efflux genes in all sequenced ESKAPE pathogens, providing critical context for and insight into current and future development of efflux-targeting treatments for resistant bacterial infections. PMID:29719870

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

PubMed

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

2015-04-01

This study sought to determine the prevalence, test characteristics, and severity of illness of pediatric patients with systemic inflammatory response syndrome (SIRS) vital signs among pediatric emergency department (ED) visits. This was a retrospective descriptive cohort study of all visits to the ED of a tertiary academic free-standing pediatric hospital over 1 year. Visits were included if the patient was <18 years of age and did not leave before full evaluation or against medical advice. Exclusion criteria were trauma diagnoses or missing documentation of vital signs. Data were electronically extracted from the medical record. The primary predictor was presence of vital signs meeting pediatric SIRS definitions. Specific vital sign pairs comprising SIRS were evaluated as predictors (temperature-heart rate, temperature-respiratory rate, and temperature-corrected heart rate, in which a formula was used to correct heart rate for degree of temperature elevation). The primary outcome measure was requirement for critical care (receipt of a vasoactive agent or intubation) within 24 hours of ED arrival. There were 56,210 visits during the study period; 40,356 met inclusion criteria. Of these, 6,596 (16.3%) visits had fever >38.5°C, and 6,122 (15.2% of included visits) met SIRS vital sign criteria. Among included visits, those with SIRS vital signs accounted for 92.8% of all visits with fever >38.5°C. Among patients with SIRS vital signs, 4993 (81.6%) were discharged from the ED without intravenous (IV) therapy and without 72-hour readmission. Critical care within the first 24 hours was present in 99 (0.25%) patients: 23 patients with and 76 without SIRS vital signs. Intensive care unit (ICU) admission was present in 126 (2.06%) with SIRS vital signs and 487 (1.42%) without SIRS vital signs. SIRS vital signs were associated with increased risk of critical care within 24 hours (relative risk [RR] = 1.69, 95% confidence interval [CI] = 1.06 to 2.70), ICU admission (RR = 1.45, 95% CI = 1.19 to 1.76), ED laboratory tests (RR = 1.41, 95% CI = 1.37 to 1.45), ED IV medication/fluid administration (RR = 2.54, 95% CI = 2.29 to 2.82), hospital admission (RR = 1.52, 95% CI = 1.42 to 1.63), and 72-hour readmission (RR = 1.31, 95% CI = 1.01 to 1.69). SIRS vital signs were not associated with 30-day in-hospital mortality (RR = 0.37, 95% CI = 0.05 to 2.82). SIRS vital signs had a low sensitivity for critical care requirement (23.2%, 95% CI = 15.3% to 32.8%). The pair of SIRS vital signs with the strongest association with critical care requirement was temperature and corrected heart rate (positive likelihood ratio = 2.74, 95% CI = 1.87 to 4.01). Systemic inflammatory response syndrome vital signs are common among medical pediatric patients presenting to an ED, and critical illness is rare. The majority of patients with SIRS vital signs were discharged without IV therapy and without readmission. Patients with SIRS vital signs had a statistically significant increased risk of critical care requirement, ED IV treatment, ED laboratory tests, admission, and readmission. However, SIRS vital sign criteria did not identify the majority of patients with mortality or need for critical care. SIRS vital signs had low sensitivity for critical illness, making it poorly suited for use in isolation in this setting as a test to detect children requiring sepsis resuscitation. © 2015 by the Society for Academic Emergency Medicine.

Data Analysis & Statistical Methods for Command File Errors

NASA Technical Reports Server (NTRS)

Meshkat, Leila; Waggoner, Bruce; Bryant, Larry

2014-01-01

This paper explains current work on modeling for managing the risk of command file errors. It is focused on analyzing actual data from a JPL spaceflight mission to build models for evaluating and predicting error rates as a function of several key variables. We constructed a rich dataset by considering the number of errors, the number of files radiated, including the number commands and blocks in each file, as well as subjective estimates of workload and operational novelty. We have assessed these data using different curve fitting and distribution fitting techniques, such as multiple regression analysis, and maximum likelihood estimation to see how much of the variability in the error rates can be explained with these. We have also used goodness of fit testing strategies and principal component analysis to further assess our data. Finally, we constructed a model of expected error rates based on the what these statistics bore out as critical drivers to the error rate. This model allows project management to evaluate the error rate against a theoretically expected rate as well as anticipate future error rates.

Basic Competence of Intensive Care Unit Nurses: Cross-Sectional Survey Study

PubMed Central

Lakanmaa, Riitta-Liisa; Suominen, Tarja; Ritmala-Castrén, Marita; Vahlberg, Tero; Leino-Kilpi, Helena

2015-01-01

Critical care patients benefit from the attention of nursing personnel with a high competence level. The aim of the study was to describe and evaluate the self-assessed basic competence of intensive care unit nurses and related factors. A cross-sectional survey design was used. A basic competence scale (Intensive and Critical Care Nursing Competence Scale version 1, Likert scale 1–5, 1 = poor and 5 = excellent) was employed among Finnish intensive care unit nurses (n = 431). Intensive care unit nurses' self-assessed basic competence was good (mean 4.19, SD 0.40). The attitude and value base of basic competence was excellent whereas experience base was the poorest compared to the knowledge base and skill base of intensive and critical care nursing. The strongest factor explaining nurses' basic competence was their experience of autonomy in nursing care (F value 60.85, β 0.11, SE 0.01, and P ≤ 0.0001). Clinical competence was self-rated as good. Nurses gave their highest competence self-ratings for ICU patient care according to the principles of nursing care. The ICU nurses also self-rated their professional competence as good. Collaboration was self-rated as the best competence. In basic and continuing education and professional self-development discussions it is meaningful to consider and find solutions for how to improve nurses' experienced autonomy in nursing. PMID:26557676

Reliability of Beam Loss Monitor Systems for the Large Hadron Collider

NASA Astrophysics Data System (ADS)

Guaglio, G.; Dehning, B.; Santoni, C.

2005-06-01

The increase of beam energy and beam intensity, together with the use of super conducting magnets, opens new failure scenarios and brings new criticalities for the whole accelerator protection system. For the LHC beam loss protection system, the failure rate and the availability requirements have been evaluated using the Safety Integrity Level (SIL) approach. A downtime cost evaluation is used as input for the SIL approach. The most critical systems, which contribute to the final SIL value, are the dump system, the interlock system, the beam loss monitors system, and the energy monitor system. The Beam Loss Monitors System (BLMS) is critical for short and intense particles losses at 7 TeV and assisted by the Fast Beam Current Decay Monitors at 450 GeV. At medium and higher loss time it is assisted by other systems, such as the quench protection system and the cryogenic system. For BLMS, hardware and software have been evaluated in detail. The reliability input figures have been collected using historical data from the SPS, using temperature and radiation damage experimental data as well as using standard databases. All the data has been processed by reliability software (Isograph). The analysis spaces from the components data to the system configuration.

The British Climate Change Act: a critical evaluation and proposed alternative approach

NASA Astrophysics Data System (ADS)

Pielke, Roger A., Jr.

2009-04-01

This paper evaluates the United Kingdom's Climate Change Act of 2008 in terms of the implied rates of decarbonization of the UK economy for a short-term and a long-term target established in law. The paper uses the Kaya identity to structure the evaluation, employing both a bottom up approach (based on projections of future UK population, economic growth, and technology) and a top down approach (deriving implied rates of decarbonization consistent with the targets and various rates of projected economic growth). Both approaches indicate that the UK economy would have to achieve annual rates of decarbonization in excess of 4 or 5%. To place these numbers in context, the UK would have to achieve the 2006 carbon efficiency of France by about 2015, a level of effort comparable to the building of about 30 new nuclear power plants, displacing an equivalent amount of fossil energy. The paper argues that the magnitude of the task implied by the UK Climate Change Act strongly suggests that it is on course to fail, and discusses implications.

Cost-effectiveness of dalteparin vs unfractionated heparin for the prevention of venous thromboembolism in critically ill patients.

PubMed

Fowler, Robert A; Mittmann, Nicole; Geerts, William; Heels-Ansdell, Diane; Gould, Michael K; Guyatt, Gordon; Krahn, Murray; Finfer, Simon; Pinto, Ruxandra; Chan, Brian; Ormanidhi, Orges; Arabi, Yaseen; Qushmaq, Ismael; Rocha, Marcelo G; Dodek, Peter; McIntyre, Lauralyn; Hall, Richard; Ferguson, Niall D; Mehta, Sangeeta; Marshall, John C; Doig, Christopher James; Muscedere, John; Jacka, Michael J; Klinger, James R; Vlahakis, Nicholas; Orford, Neil; Seppelt, Ian; Skrobik, Yoanna K; Sud, Sachin; Cade, John F; Cooper, Jamie; Cook, Deborah

2014-11-26

Venous thromboembolism (VTE) is a common complication of acute illness, and its prevention is a ubiquitous aspect of inpatient care. A multicenter blinded, randomized trial compared the effectiveness of the most common pharmocoprevention strategies, unfractionated heparin (UFH) and the low-molecular-weight heparin (LMWH) dalteparin, finding no difference in the primary end point of leg deep-vein thrombosis but a reduced rate of pulmonary embolus and heparin-induced thrombocytopenia among critically ill medical-surgical patients who received dalteparin. To evaluate the comparative cost-effectiveness of LMWH vs UFH for prophylaxis against VTE in critically ill patients. Prospective economic evaluation concurrent with the Prophylaxis for Thromboembolism in Critical Care Randomized Trial (May 2006 to June 2010). The economic evaluation adopted a health care payer perspective and in-hospital time horizon; derived baseline characteristics and probabilities of intensive care unit and in-hospital events; and measured costs among 2344 patients in 23 centers in 5 countries and applied these costs to measured resource use and effects of all enrolled patients. Costs, effects, incremental cost-effectiveness of LMWH vs UFH during the period of hospitalization, and sensitivity analyses across cost ranges. Hospital costs per patient were $39,508 (interquartile range [IQR], $24,676 to $71,431) for 1862 patients who received LMWH compared with $40,805 (IQR, $24,393 to $76,139) for 1862 patients who received UFH (incremental cost, -$1297 [IQR, -$4398 to $1404]; P = .41). In 78% of simulations, a strategy using LMWH was most effective and least costly. In sensitivity analyses, a strategy using LMWH remained least costly unless the drug acquisition cost of dalteparin increased from $8 to $179 per dose and was consistent among higher- and lower-spending health care systems. There was no threshold at which lowering the acquisition cost of UFH favored prophylaxis with UFH. From a health care payer perspective, the use of the LMWH dalteparin for VTE prophylaxis among critically ill medical-surgical patients was more effective and had similar or lower costs than the use of UFH. These findings were driven by lower rates of pulmonary embolus and heparin-induced thrombocytopenia and corresponding lower overall use of resources with LMWH.

Economic evaluation of genomic sequencing in the paediatric population: a critical review.

PubMed

Alam, Khurshid; Schofield, Deborah

2018-05-24

Systematic evidence is critical to the formulation of national health policy to provide public funding for the integration of genomic sequencing into routine clinical care. The purpose of this review is to present systematic evidence on the economic evaluation of genomic sequencing conducted for paediatric patients in clinical care, and to identify any gaps in the methodology of economic evaluations. We undertook a critical review of the empirical evidence from economic evaluations of genomic sequencing among paediatric patients searching five electronic databases. Our inclusion criteria were limited to literature published in the English language between 2010 and 2017 in OECD countries. Articles that met our inclusion criteria were assessed using a recognised checklist for a well-designed economic evaluation. We found 11 full-text articles that met our inclusion criteria. Our analysis found that genomic sequencing markedly increased the diagnostic rate to 16-79%, but lowered the cost by 11-64% compared to the standard diagnostic pathway. Only five recent studies in paediatric clinical cohorts met most of the criteria for a well-designed economic evaluation and demonstrated cost-effectiveness of genomic sequencing in paediatric clinical cohorts of patients. Our review identified the need for improvement in the rigour of the methodologies used to provide robust evidence for the formulation of health policy on public funding to integrate genomic sequencing into routine clinical care. Nonetheless, there is emerging evidence of the cost-effectiveness of genomic sequencing over usual care for paediatric patients.

Pandemic influenza-implications for critical care resources in Australia and New Zealand.

PubMed

Anderson, Therese A; Hart, Graeme K; Kainer, Marion A

2003-09-01

To quantify resource requirements (additional beds and ventilator capacity), for critical care services in the event of pandemic influenza. Cross-sectional survey about existing and potential critical care resources. Participants comprised 156 of the 176 Australasian (Australia and New Zealand) critical care units on the database of the Australian and New Zealand Intensive Care Society (ANZICS) Research Centre for Critical Care Resources. The Meltzer, Cox and Fukuda model was adapted to map a range of influenza attack rate estimates for hospitalisation and episodes likely to require intensive care and to predict critical care admission rates and bed day requirements. Estimations of ventilation rates were based on those for community-acquired pneumonia. The estimated extra number of persons requiring hospitalisation ranged from 8,455 (10% attack rate) to 150,087 (45% attack rate). The estimated number of additional admissions to critical care units ranged from 423 (5% admission rate, 10% attack rate) to 37,522 (25% admission rate, 45% attack rate). The potential number of required intensive care bed days ranged from 846 bed days (2 day length of stay, 10% attack rate) to 375,220 bed days (10 day length of stay, 45% attack rate). The number of persons likely to require mechanical ventilation ranged from 106 (25% of projected critical care admissions, 10% attack rate) to 28,142 (75% of projected critical care admissions, 45% attack rate). An additional 1,195 emergency ventilator beds were identified in public sector and 248 in private sector hospitals. Cancellation of elective surgery could release a potential 76,402 intensive care bed days (per annum), but in the event of pandemic influenza, 31,150 bed days could be required over an 8- to 12-week period. Australasian critical care services would be overwhelmed in the event of pandemic influenza. More work is required in relation to modelling, contingency plans, and resource allocation.

Teaching Cardiac Autonomic Function Dynamics Employing the Valsalva (Valsalva-Weber) Maneuver

ERIC Educational Resources Information Center

Junqueira, Luiz Fernando, Jr.

2008-01-01

In this report, a brief history of the Valsalva (Valsalva-Weber) maneuver is outlined, followed by an explanation on the use of this approach for the evaluation of cardiac autonomic function based on underlying heart rate changes. The most important methodological and interpretative aspects of the Valsalva-Weber maneuver are critically updated,…

Benefits of invasion prevention: Effect of time lags, spread rates, and damage persistence

Treesearch

Rebecca S. Epanchin-Niell; Andrew M. Liebhold

2015-01-01

Quantifying economic damages caused by invasive species is crucial for cost-benefit analyses of biosecurity measures. Most studies focus on short-term damage estimates, but evaluating exclusion or prevention measures requires estimates of total anticipated damages from the time of establishment onward. The magnitude of such damages critically depends on the timing of...

Multiple Choice Questions Can Be Designed or Revised to Challenge Learners' Critical Thinking

ERIC Educational Resources Information Center

Tractenberg, Rochelle E.; Gushta, Matthew M.; Mulroney, Susan E.; Weissinger, Peggy A.

2013-01-01

Multiple choice (MC) questions from a graduate physiology course were evaluated by cognitive-psychology (but not physiology) experts, and analyzed statistically, in order to test the independence of content expertise and cognitive complexity ratings of MC items. Integration of higher order thinking into MC exams is important, but widely known to…

Monitoring Academic and Social Skills in Elementary School: A Psychometric Evaluation of the Classroom Performance Survey

ERIC Educational Resources Information Center

Caldarella, Paul; Larsen, Ross A. A.; Williams, Leslie; Wehby, Joseph H.; Wills, Howard; Kamps, Debra

2017-01-01

Numerous well-validated academic progress monitoring tools are used in schools, but there are fewer behavioral progress monitoring measures available. Some brief behavior rating scales have been shown to be effective in monitoring students' progress, but most focus only on students' social skills and do not address critical academic-related…

Monitoring Academic and Social Skills in Elementary School: A Psychometric Evaluation of the Classroom Performance Survey

ERIC Educational Resources Information Center

Caldarella, Paul; Larsen, Ross A. A.; Williams, Leslie; Wehby, Joseph H.; Wills, Howard P.; Kamps, Debra M.

2017-01-01

Numerous well validated academic progress monitoring tools are used in schools, but there are fewer behavioral progress monitoring measures available. Some brief behavior rating scales have been shown to be effective in monitoring students' progress, but most focus only on students' social skills and do not address critical academic-related…

Incidence rates and deaths of tuberculosis in HIV-negative patients in the United States and Germany as analyzed by new predictive model for infection

USDA-ARS?s Scientific Manuscript database

Incidence and mortality due to tuberculosis (TB) have been decreasing worldwide. Given that TB is a cosmopolitan disease, proper surveillance and evaluation are critical for controlling dissemination. Herein, mathematical modeling was performed in order to: 1) demonstrate a correlation between the i...

The Effects of Self-Monitoring and Performance Feedback on the Treatment Integrity of Behavior Intervention Plan Implementation and Generalization

ERIC Educational Resources Information Center

Mouzakitis, Angela; Codding, Robin S.; Tryon, Georgiana

2015-01-01

Accurate implementation of individualized behavior intervention plans (BIPs) is a critical aspect of evidence-based practice. Research demonstrates that neither training nor consultation is sufficient to improve and maintain high rates of treatment integrity (TI). Therefore, evaluation of ongoing support strategies is needed. The purpose of this…

The roles of xylan and lignin in oxalic acid pretreated corncob during separate enzymatic hydrolysis and ethanol fermentation

Treesearch

Jae-Won Lee; Rita C.L.B. Rodrigues; Hyun Joo Kim; In-Gyu Choi; Thomas W. Jeffries

2010-01-01

High yields of hemicellulosic and cellulosic sugars are critical in obtaining economical conversion of agricultural residues to ethanol. To optimize pretreatment conditions, we evaluated oxalic acid loading rates, treatment temperatures and times in a 23 full factorial design. Response-surface analysis revealed an optimal oxalic acid pretreatment...

Quality-by-Design (QbD): An integrated process analytical technology (PAT) approach for a dynamic pharmaceutical co-precipitation process characterization and process design space development.

PubMed

Wu, Huiquan; White, Maury; Khan, Mansoor A

2011-02-28

The aim of this work was to develop an integrated process analytical technology (PAT) approach for a dynamic pharmaceutical co-precipitation process characterization and design space development. A dynamic co-precipitation process by gradually introducing water to the ternary system of naproxen-Eudragit L100-alcohol was monitored at real-time in situ via Lasentec FBRM and PVM. 3D map of count-time-chord length revealed three distinguishable process stages: incubation, transition, and steady-state. The effects of high risk process variables (slurry temperature, stirring rate, and water addition rate) on both derived co-precipitation process rates and final chord-length-distribution were evaluated systematically using a 3(3) full factorial design. Critical process variables were identified via ANOVA for both transition and steady state. General linear models (GLM) were then used for parameter estimation for each critical variable. Clear trends about effects of each critical variable during transition and steady state were found by GLM and were interpreted using fundamental process principles and Nyvlt's transfer model. Neural network models were able to link process variables with response variables at transition and steady state with R(2) of 0.88-0.98. PVM images evidenced nucleation and crystal growth. Contour plots illustrated design space via critical process variables' ranges. It demonstrated the utility of integrated PAT approach for QbD development. Published by Elsevier B.V.

Assessing planetary and regional nitrogen boundaries related to food security and adverse environmental impacts

NASA Astrophysics Data System (ADS)

de Vries, Wim; Kros, Hans; Kroeze, Carolien; Seitzinger, Sybil

2014-05-01

In this presentation, we first discuss the concept of -, governance interest in- and criticism on planetary boundaries, specifically with respect to the nitrogen (N) cycle. We then systematically evaluate the criticism and argue that planetary N boundaries need to include both the benefits and adverse impacts of reactive N (Nr) and the spatial variability of Nr impacts, in terms of shortage and surplus, being main arguments for not deriving such boundaries. Next, we present an holistic approach for an updated planetary N boundary by considering the need to: (i) avoid adverse impacts of elevated Nr emissions to water, air and soils, and (ii) feed the world population in an adequate way. The derivation of a planetary N boundary, in terms of anthropogenic fixation of di-nitrogen (N2) by growing legumes and production of N fertilizer, is illustrated by (i) identification of multiple threat N indicators and setting critical limits for them, (ii) back calculating critical N losses from critical limits for N indicators, while accounting for the spatial variability of indicators and their exceedance and (iii) back calculating critical N fixation rates from critical N losses. The derivation of the needed planetary N fixation is assessed from the global population, the recommended dietary N consumption per capita and the N use efficiency in the complete chain from N fixation to N consumption. Results of example applications show that the previously suggested planetary N boundary of 25% of the current value is too low in view of needed N fixation and also unnecessary in view of most environmental impacts. We also illustrate the impacts of changes in the N use efficiency on planetary boundaries in terms of critical N fixation rates.

Decreases in perceived maternal criticism predict improvement in subthreshold psychotic symptoms in a randomized trial of family-focused therapy for individuals at clinical high risk for psychosis.

PubMed

O'Brien, Mary P; Miklowitz, David J; Cannon, Tyrone D

2015-12-01

Perceived criticism (PC) is a measure of how much criticism from 1 family member "gets through" to another. PC ratings have been found to predict the course of psychotic disorders, but questions remain regarding whether psychosocial treatment can effectively decrease PC, and whether reductions in PC predict symptom improvement. In a sample of individuals at high risk for psychosis, we examined a) whether Family Focused Therapy for Clinical High-Risk (FFT-CHR), an 18-session intervention that consists of psychoeducation and training in communication and problem solving, brought about greater reductions in perceived maternal criticism, compared to a 3-session family psychoeducational intervention; and b) whether reductions in PC from baseline to 6-month reassessment predicted decreases in subthreshold positive symptoms of psychosis at 12-month follow-up. This study was conducted within a randomized controlled trial across 8 sites. The perceived criticism scale was completed by 90 families prior to treatment and by 41 families at 6-month reassessment. Evaluators, blind to treatment condition, rated subthreshold symptoms of psychosis at baseline, 6- and 12-month assessments. Perceived maternal criticism decreased from pre- to posttreatment for both treatment groups, and this change in criticism predicted decreases in subthreshold positive symptoms at 12-month follow-up. This study offers evidence that participation in structured family treatment is associated with improvement in perceptions of the family environment. Further, a brief measure of perceived criticism may be useful in predicting the future course of attenuated symptoms of psychosis for CHR youth. (c) 2015 APA, all rights reserved).

Photodestruction rates for cometary parent molecules

NASA Astrophysics Data System (ADS)

Crovisier, J.

1994-02-01

New evaluations of the photodestruction rates for several molecules of cometary interest are presented along with a critical comparison with other estimations from 1976 to 1993, and a summary of the need for future laboratory measurements. Photodestruction rates for a heliocentric distance of 1 AU (assuming the quiet Sun reference spectrum of Huebner and Carpenter) are tabulated for molecules from the water group, hydrocarbons, CO group, CHO species, nitrogen compounds, and sulfur compounds. Inspection of the table shows reasonable agreement between new and previously calculated photodestruction rates. Further work is needed on unstable species, photodissociation channel and quantum yields, temperature effects, kinematics and anistropic ejection of the fragments, and the effects of solar radiation field variations.

Evaluation of a Teleform-based data collection system: a multi-center obesity research case study.

PubMed

Jenkins, Todd M; Wilson Boyce, Tawny; Akers, Rachel; Andringa, Jennifer; Liu, Yanhong; Miller, Rosemary; Powers, Carolyn; Ralph Buncher, C

2014-06-01

Utilizing electronic data capture (EDC) systems in data collection and management allows automated validation programs to preemptively identify and correct data errors. For our multi-center, prospective study we chose to use TeleForm, a paper-based data capture software that uses recognition technology to create case report forms (CRFs) with similar functionality to EDC, including custom scripts to identify entry errors. We quantified the accuracy of the optimized system through a data audit of CRFs and the study database, examining selected critical variables for all subjects in the study, as well as an audit of all variables for 25 randomly selected subjects. Overall we found 6.7 errors per 10,000 fields, with similar estimates for critical (6.9/10,000) and non-critical (6.5/10,000) variables-values that fall below the acceptable quality threshold of 50 errors per 10,000 established by the Society for Clinical Data Management. However, error rates were found to widely vary by type of data field, with the highest rate observed with open text fields. Copyright © 2014 Elsevier Ltd. All rights reserved.

Decreases in Suicide Deaths and Attempts Linked to the White Mountain Apache Suicide Surveillance and Prevention System, 2001-2012.

PubMed

Cwik, Mary F; Tingey, Lauren; Maschino, Alexandra; Goklish, Novalene; Larzelere-Hinton, Francene; Walkup, John; Barlow, Allison

2016-12-01

We evaluated the impact of a comprehensive, multitiered youth suicide prevention program among the White Mountain Apache of Arizona since its implementation in 2006. Using data from the tribally mandated Celebrating Life surveillance system, we compared the rates, numbers, and characteristics of suicide deaths and attempts from 2007 to 2012 with those from 2001 to 2006. The overall Apache suicide death rates dropped from 40.0 to 24.7 per 100 000 (38.3% decrease), and the rate among those aged 15 to 24 years dropped from 128.5 to 99.0 per 100 000 (23.0% decrease). The annual number of attempts also dropped from 75 (in 2007) to 35 individuals (in 2012). National rates remained relatively stable during this time, at 10 to 13 per 100 000. Although national rates remained stable or increased slightly, the overall Apache suicide death rates dropped following the suicide prevention program. The community surveillance system served a critical role in providing a foundation for prevention programming and evaluation.

Evaluation of extracurricular internships in the adult's intensive care units.

PubMed

Nascimento, Diego Teixeira; Dias, Maria Almeida; Mota, Rodrigo de Sousa; Barberino, Luciana; Durães, Larissa; Santos, Paulo André Jesuino Dos

2008-12-01

Students of Salvador - BA, Brazil were trained in critical care medicine by accomplishing extracurricular internships. This study aims to detect changes in attitude and interest of students who concluded these internships as well as the most frequent activities developed. Descriptive cross-sectional survey conducted with students who did extracurricular internships in adult intensive care units during the second semester of 2006. A self-administered questionnaire was given using objective questions. We evaluated 49 students. Interest in becoming an intensivist was classified as high/very high by 32.7% before internship, after which 61.2% reported increased interest. Before internship, students on a 1 to 5 scale rated the importance of critical care medicine as 4.55 ± 0.70. After internship, 98% felt more confident to refer a patient to the intensive care unit, 95.9% to evaluate with supervision, patients admitted to intensive care units and 89.8% to attend patients in the emergency room. The most common procedures observed were: central venous access (100%), peripheral venous access (91.8%) and orotracheal intubation (91.8%). Topics ranked in terms of interest from 1 to 5 were: systemic inflammatory response syndrome/sepsis (4.82 ± 0.48), shock (4.81 ± 0.44) and cardiopulmonary resuscitation (4.77 ± 0.55). This study showed that internships in adult intensive care units of Salvador (BA), Brazil provided students with greater assurance to evaluate critical patients, increased their interest to follow an intensivist physician career and allowed contact with the main procedures and topics related to critical care medicine.

A Critical Evaluation of the Representation of Black Patients With Heart Failure and Preserved Ejection Fraction in Clinical Trials: A Literature Review.

PubMed

Lekavich, Carolyn L; Barksdale, Debra J

2016-01-01

In the United States, heart failure costs $34.4 billion annually and is associated with a mortality rate of 20% within 5 years of diagnosis. Heart failure preserved ejection fraction (HFpEF) accounts for 50% of all hospital admissions for heart failure. Black patients develop HFpEF at a significantly earlier age than do white patients, and the 5-year mortality rate for blacks with HFpEF is 30% to 44% higher compared with white patients. Current trials may not represent black patients proportionately to the general population. The primary aim of this literature review was to critically evaluate the representation of black patients in HFpEF trials and propose solutions for future research. PubMed and CINAHL were queried for peer-reviewed journal articles from 1997 to 2014 using 2 sets of search terms that included HFpEF or preserved left ventricular function and all relevant search terms for black patients. Initially, 182 articles were identified; however, after exclusionary criteria were applied, 22 articles remained. After critical review of each article for relevance, a total of 9 articles remained for the review. For the 9 trials reviewed including a total of 63,065 patients with HFpEF, 10,436 (17%) of the patients were black. Three of the 9 trials included less than 10% black patients, 4 trials included 10% to 20% black patients, and 2 trials included greater than 20% black patients. In 2 studies, the percentage of black patients in the HFpEF trial (13% and 17%) was significantly less than the percentage of black patients in the general regional population (53% and 39%), respectively. Although the mortality rate for black patients with HFpEF is 30% to 45% higher than the rate for white patients, 2 of the 9 studies did not have a representative sample of the general HFpEF population and none of the studies reported the objective of establishing a representative study population.

Simulation Testing for Selection of Critical Care Medicine Trainees. A Pilot Feasibility Study.

PubMed

Cocciante, Adriano G; Nguyen, Martin N; Marane, Candida F; Panayiotou, Anita E; Karahalios, Amalia; Beer, Janet A; Johal, Navroop; Morris, John; Turner, Stacy; Hessian, Elizabeth C

2016-04-01

Selection of physicians into anesthesiology, intensive care, and emergency medicine training has traditionally relied on evaluation of curriculum vitae, letters of recommendation, and interviews, despite these methods being poor predictors of subsequent workplace performance. In this study, we evaluated the feasibility and face validity of incorporating assessment of nontechnical skills in simulation and personality traits into an existing junior doctor selection framework. Candidates short-listed for a critical care residency position were invited to participate in the study. On the interview day, consenting candidates participated in a simulation scenario and debriefing and completed a personality test (16 Personality Factor Questionnaire) and a survey. Timing of participants' progression through the stations and faculty staff numbers were evaluated. Nontechnical skills were evaluated and candidates ranked using the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Nontechnical skills ranking and traditional selection method ranking were compared using the concordance correlation coefficient. Interrater reliability was assessed using the concordance correlation coefficient. Thirteen of 20 eligible participants consented to study inclusion. All participants completed the necessary stations without significant time delays. Eighteen staff members were required to conduct interviews, simulation, debriefing, and personality testing. Participants rated the simulation station to be acceptable, fair, and relevant and as providing an opportunity to demonstrate abilities. Personality testing was rated less fair, less relevant, and less acceptable, and as giving less opportunity to demonstrate abilities. Participants reported that simulation was equally as stressful as the interview, whereas personality testing was rated less stressful. Assessors rated both personality testing and simulation as acceptable and able to provide additional information about candidates. The Ottawa GRS showed moderate interrater concordance. There was moderate concordance between rankings based on traditional selection methods and Ottawa GRS rankings (ρ = 0.52; 95% confidence interval, -0.02 to 0.82; P = 0.06). A multistation selection process involving interviews, simulation, and personality testing is feasible and has face validity. A potential barrier to adoption is the high number of faculty required to conduct the process.

Open Evaluation: A Vision for Entirely Transparent Post-Publication Peer Review and Rating for Science

PubMed Central

Kriegeskorte, Nikolaus

2012-01-01

The two major functions of a scientific publishing system are to provide access to and evaluation of scientific papers. While open access (OA) is becoming a reality, open evaluation (OE), the other side of the coin, has received less attention. Evaluation steers the attention of the scientific community and thus the very course of science. It also influences the use of scientific findings in public policy. The current system of scientific publishing provides only journal prestige as an indication of the quality of new papers and relies on a non-transparent and noisy pre-publication peer-review process, which delays publication by many months on average. Here I propose an OE system, in which papers are evaluated post-publication in an ongoing fashion by means of open peer review and rating. Through signed ratings and reviews, scientists steer the attention of their field and build their reputation. Reviewers are motivated to be objective, because low-quality or self-serving signed evaluations will negatively impact their reputation. A core feature of this proposal is a division of powers between the accumulation of evaluative evidence and the analysis of this evidence by paper evaluation functions (PEFs). PEFs can be freely defined by individuals or groups (e.g., scientific societies) and provide a plurality of perspectives on the scientific literature. Simple PEFs will use averages of ratings, weighting reviewers (e.g., by H-index), and rating scales (e.g., by relevance to a decision process) in different ways. Complex PEFs will use advanced statistical techniques to infer the quality of a paper. Papers with initially promising ratings will be more deeply evaluated. The continual refinement of PEFs in response to attempts by individuals to influence evaluations in their own favor will make the system ungameable. OA and OE together have the power to revolutionize scientific publishing and usher in a new culture of transparency, constructive criticism, and collaboration. PMID:23087639

Implementing clinical guidelines to prevent catheter-associated urinary tract infections and improve catheter care in nursing homes: Systematic review.

PubMed

Gould, Dinah; Gaze, Sarah; Drey, Nicholas; Cooper, Tracey

2017-05-01

Catheter-associated urinary tract infection is the most common health care-associated infection, is considered avoidable, and has cost implications for health services. Prevalence is high in nursing homes, but little research has been undertaken to establish whether implementing clinical guidelines can reduce infection rates in long-term care or improve quality of urinary catheter care. Systematic search and critical appraisal of the literature. Three studies evaluated the impact of implementing a complete clinical guideline. Five additional studies evaluated the impact of implementing individual elements of a clinical guideline. Prevention of catheter-associated urinary tract infection in nursing homes has received little clinical or research attention. Studies concerned with whole guideline implementation emerged as methodologically poor using recognized criteria for critically appraising epidemiologic studies concerned with infection prevention. Research evaluating the impact of single elements of clinical guidelines is more robust, and their findings could be implemented to prevent urinary infections in nursing homes. Copyright © 2017. Published by Elsevier Inc.

Technical and investigative support for high density digital satellite recording systems

NASA Technical Reports Server (NTRS)

Schultz, R. A.

1983-01-01

Recent results of dropout measurements and defect analysis conducted on one reel of Ampex 721 which was submitted for evaluation by the manufacturer are described. The results or status of other tape evaluation activities are also reviewed. Several changes in test interpretations and applications are recommended. In some cases, deficiencies in test methods or equipment became apparent during continued work on this project and other IITRI tape evaluation projects. Techniques and equipment for future tasks such as tape qualification are also recommended and discussed. Project effort and expenditures were kept at a relatively low level. This rate provided added development time and experience with the IITRI Dropout Measurement System, which is approaching its potential as a computer based dropout analysis tool. Another benefit is the expanded data base on critical parameters that can be achieved from tests on different tape types and lots as they become available. More consideration and effort was directed toward identification of critical parameters, development of meaningful repeatable test procedures, and tape procurement strategy.

The Effects of Reflective Training on the Disposition of Critical Thinking for Nursing Students in China: A Controlled Trial.

PubMed

Zhang, Caihong; Fan, Huiying; Xia, Jieqiong; Guo, Honghua; Jiang, Xinjun; Yan, Yane

2017-09-01

The aim of this study was to evaluate the effects of reflective trainings for nursing students on their critical thinking disposition. A total of 157 senior undergraduate nursing students sampled from Hainan Medical University in China participated in this study in 2014. They were randomly divided into experimental and control groups. The experimental group students were provided the reflective training during their entire 12-month clinical internship, whereas students in the control group were requested to keep their reflective diaries but without a formal training. Before and after the intervention, nursing students' critical thinking disposition was rated using the Chinese version of Critical Thinking Disposition Inventory (CTDI-CV). Before the start of the intervention, the critical thinking disposition scores of the two groups had no significant differences. At the end of the intervention, it was found that the experimental students performed better in each subscale of CTDI-CV. These include the search for truth, open mind, analytical ability, systematic ability, critical thinking, self-confidence, curiosity, and cognitive maturity. By summing the scores of all categories, the results showed that the experimental group had a significantly higher total score than that of the control group (p ≤ .044). Evaluating the score difference in each function indicated that there was a range of improvements on the critical thinking disposition because of the reflective training intervention. Reflective training during the internship period improves nursing students' disposition of critical thinking and promotes their readiness for their clinical practices in the rapidly increasing demands of the healthcare field. Copyright © 2017. Published by Elsevier B.V.

Daptomycin experience in critical care patients: results from a registry.

PubMed

Brown, Jack E; Fominaya, Cory; Christensen, Keith J; McConnell, Scott A; Lamp, Kenneth C

2012-04-01

Vancomycin is often the drug of choice in critically ill patients with gram-positive infections, although circumstances often prevent its use. In these situations, clinicians are frequently left with limited data regarding alternative agents. To describe patients with reported sepsis receiving daptomycin in a critical care unit. This multicenter, noncomparative, noninterventional study identified patients in critical care units, using the Cubicin Outcomes Registry and Experience (CORE) 2005-2009 registry. A descriptive account of patient characteristics, infectious etiology, outcomes at the end of daptomycin therapy, and 30-day mortality is reported. Nonevaluable patients were excluded from the efficacy analysis but included in the safety analysis. We identified 128 patients, 98 (77%) of whom were evaluable for efficacy. Patient characteristics for the efficacy population were 55 (56%) males, 30 (31%) aged 66 years or older, 38 (39%) had creatinine clearance less than 30 mL/min, and 27 (28%) were on dialysis. Common underlying diseases included acute or chronic renal failure 44 (45%), hypertension 40 (41%), and diabetes 27 (28%). Seventy-two (73%) patients were bacteremic. The most common pathogens found were methicillin-resistant Staphylococcus aureus (32%), vancomycin-resistant Enterococcus faecium (21%), and coagulase-negative staphylococci (20%). Prior to daptomycin, antibiotics were used in 84 (86%) patients, most commonly vancomycin (65/84; 77%). The median (range) initial daptomycin dose was 6 mg/kg (3-10) and duration of 10 days (1-58). Overall success rate was 70% (31% cured; 39% improved). Twelve adverse events possibly related to daptomycin were reported in 9 of 128 (7%) patients in the safety population; 4 of these in 4 (3%) patients were serious. The mortality rate within 30 days of completing daptomycin was 42 of 128 (33%) patients. These data provide preliminary results on the use of daptomycin in critically ill patients with complicated conditions. Controlled studies are needed to best evaluate daptomycin use in these patients.

Evaluated kinetic and photochemical data for atmospheric chemistry

NASA Technical Reports Server (NTRS)

Baulch, D. L.; Cox, R. A.; Hampson, R. F., Jr.; Kerr, J. A.; Troe, J.; Watson, R. T.

1980-01-01

This paper contains a critical evaluation of the kinetics and photochemistry of gas phase chemical reactions of neutral species involved in middle atmosphere chemistry (10-55 km altitude). Data sheets have been prepared for 148 thermal and photochemical reactions, containing summaries of the available experimental data with notes giving details of the experimental procedures. For each reaction a preferred value of the rate coefficient at 298 K is given together with a temperature dependency where possible. The selection of the preferred value is discussed, and estimates of the accuracies of the rate coefficients and temperature coefficients have been made for each reaction. The data sheets are intended to provide the basic physical chemical data needed as input for calculations which model atmospheric chemistry. A table summarizing the preferred rate data is provided, together with an appendix listing the available data on enthalpies of formation of the reactant and product species.

Unraveling Gender Bias from Student Evaluations of their High School Physics Teachers

NASA Astrophysics Data System (ADS)

Hazari, Zahra; Potvin, Geoff; Tai, Robert; Sadler, Philip

2009-05-01

In this talk, the evaluation of high school physics, chemistry, and biology teachers by their students is examined according to the gender of the student and the gender of the teacher. Female teachers are rated significantly lower than male teachers by male students in all three disciplines, while female students under-rate female teachers only in physics. Interestingly, physics is also the field that suffers the greatest lack of females and has been criticized most for its androcentric culture. The gender bias in teacher ratings persists even after accounting for academic performance, classroom experiences, and family support. Further, male and female teachers in each discipline appear equally effective at preparing their students for future science study in college, suggesting that students have a discipline-specific gender bias. Such a bias may negatively impact female students and contribute to the loss of females in STEM fields.

Job analysis and student assessment tool: perfusion education clinical preceptor.

PubMed

Riley, Jeffrey B

2007-09-01

The perfusion education system centers on the cardiac surgery operating room and the perfusionist teacher who serves as a preceptor for the perfusion student. One method to improve the quality of perfusion education is to create a valid method for perfusion students to give feedback to clinical teachers. The preceptor job analysis consisted of a literature review and interviews with preceptors to list their critical tasks, critical incidents, and cognitive and behavioral competencies. Behaviorally anchored rating traits associated with the preceptors' tasks were identified. Students voted to validate the instrument items. The perfusion instructor rating instrument with a 0-4, "very weak" to "very strong" Likert rating scale was used. The five preceptor traits for student evaluation of clinical instruction (SECI) are as follows: The clinical instructor (1) encourages self-learning, (2) encourages clinical reasoning, (3) meets student's learning needs, (4) gives continuous feedback, and (5) represents a good role model. Scores from 430 student-preceptor relationships for 28 students rotating at 24 affiliate institutions with 134 clinical instructors were evaluated. The mean overall good preceptor average (GPA) was 3.45 +/- 0.76 and was skewed to the left, ranging from 0.0 to 4.0 (median = 3.8). Only 21 of the SECI relationships earned a GPA < 2.0. Analyzing the role of the clinical instructor and performing SECI are methods to provide valid information to improve the quality of a perfusion education program.

Determination of leakage areas in nuclear piping

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

Keim, E.

1997-04-01

For the design and operation of nuclear power plants the Leak-Before-Break (LBB) behavior of a piping component has to be shown. This means that the length of a crack resulting in a leak is smaller than the critical crack length and that the leak is safely detectable by a suitable monitoring system. The LBB-concept of Siemens/KWU is based on computer codes for the evaluation of critical crack lengths, crack openings, leakage areas and leakage rates, developed by Siemens/KWU. In the experience with the leak rate program is described while this paper deals with the computation of crack openings and leakagemore » areas of longitudinal and circumferential cracks by means of fracture mechanics. The leakage areas are determined by the integration of the crack openings along the crack front, considering plasticity and geometrical effects. They are evaluated with respect to minimum values for the design of leak detection systems, and maximum values for controlling jet and reaction forces. By means of fracture mechanics LBB for subcritical cracks has to be shown and the calculation of leakage areas is the basis for quantitatively determining the discharge rate of leaking subcritical through-wall cracks. The analytical approach and its validation will be presented for two examples of complex structures. The first one is a pipe branch containing a circumferential crack and the second one is a pipe bend with a longitudinal crack.« less

Understanding and Reducing Disability in Older Adults Following Critical Illness

PubMed Central

Brummel, N.E.; Balas, M.C.; Morandi, A.; Ferrante, L.E.; Gill, T.M.; Ely, E.W.

2015-01-01

Objective To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness. Data Sources Review of the literature describing post-critical illness disability in older adults and expert opinion. Results We identified 19 studies evaluating disability outcomes in critically ill patients age 65 years and older. Newly acquired disability in activities of daily living, instrumental activities of daily living and mobility activities was commonplace among older adults who survived a critical illness. Incident dementia and less-severe cognitive impairment was also highly prevalent. Factors related to the acute critical illness, intensive care unit practices such as heavy sedation, physical restraints and immobility as well as aging physiology and coexisting geriatric conditions can combine to result in these poor outcomes. Conclusion Older adults who survive critical illness suffer physical and cognitive declines resulting in disability at greater rates than hospitalized, non-critically ill and community dwelling older adults. Interventions derived from widely available geriatric care models in use outside of the ICU, which address modifiable risk factors including immobility and delirium, are associated with improved functional and cognitive outcomes and can be used to complement ICU-focused models such as the ABCDEs. PMID:25756418

Elastic interactions between single microcrack and single osteon microstructure of human femur cortical bone

NASA Astrophysics Data System (ADS)

Mansor, N. N.; Daud, R.; Basaruddin, K. S.; Mat, F.; Bajuri, Y.; Ariffin, A. K.

2017-09-01

Inmultiscale Haversian system of cortical bone fracture, a homogenous bone modeling consideration is limited to only one Young modulus was significant for each cortex without having any constituents in that bone. A two dimension model of human femur cortical bone is presented by considering the anatomical positions of four cortices, e.g anterior, posterior, medial and lateral. The Haversian system is modeled under tensile loading by considering the interstitial matrix, osteon and cement line mechanical properties. The interaction between single microcrack and single osteon is evaluated using linear elastic fracture mechanics theory, and was determined using of stress intensity factor, strain energy release rate, and the critical stress intensity factor and critical strain energy release rate parameter. The results indicate that the medial cortex has the highest SIFs while the lowest was posterior cortex. The Young modulus of material was greatly influence the fracture parameters. More stiff the material, the SIF was reduced.

Microwave power transmission system studies. Volume 4: Sections 9 through 14 with appendices. [ground tests and antenna design

NASA Technical Reports Server (NTRS)

Maynard, O. E.; Brown, W. C.; Edwards, A.; Haley, J. T.; Meltz, G.; Howell, J. M.; Nathan, A.

1975-01-01

The microwave rectifier technology, approaches to the receiving antenna, topology of rectenna circuits, assembly and construction, ROM cost estimates are discussed. Analyses and cost estimates for the equipment required to transmit the ground power to an external user. Noise and harmonic considerations are presented for both the amplitron and klystron and interference limits are identified and evaluated. The risk assessment discussion is discussed wherein technology risks are rated and ranked with regard to their importance in impacting the microwave power transmission system. The system analyses and evaluation are included of parametric studies of system relationships pertaining to geometry, materials, specific cost, specific weight, efficiency, converter packing, frequency selection, power distribution, power density, power output magnitude, power source, transportation and assembly. Capital costs per kW and energy costs as a function of rate of return, power source and transportation costs as well as build cycle time are presented. The critical technology and ground test program are discussed along with ROM costs and schedule. The orbital test program with associated critical technology and ground based program based on full implementation of the defined objectives is discussed.

On the respective contributions of awareness of unconditioned stimulus valence and unconditioned stimulus identity in attitude formation through evaluative conditioning.

PubMed

Stahl, Christoph; Unkelbach, Christian; Corneille, Olivier

2009-09-01

Evaluative conditioning (EC) is a central mechanism for both classic and current theories of attitude formation. In contrast to Pavlovian conditioning, it is often conceptualized as a form of evaluative learning that occurs without awareness of the conditioned stimulus-unconditioned stimulus (CS-US) contingencies. In the present research, the authors directly address this point by assessing the respective roles of US valence awareness and US identity awareness in attitude formation through EC. Across 4 experiments, EC was assessed with evaluative ratings as well as evaluative priming measures, and the impact of valence and identity awareness on EC was evaluated. EC effects on priming and rating measures occurred only for CSs for which participants could report the associated US valence, and US identity awareness did not further contribute to EC. This finding was obtained both for semantically meaningless (i.e., nonword letter sequences) and meaningful (i.e., consumer products) CSs. These results provide further support for the critical role of contingency awareness in EC, albeit valence awareness, not identity awareness. (c) 2009 APA, all rights reserved).

A nationwide analysis of 30-day readmissions related to critical limb ischemia.

PubMed

Masoomi, Reza; Shah, Zubair; Quint, Clay; Hance, Kirk; Vamanan, Karthik; Prasad, Anand; Hoel, Andrew; Dawn, Buddhadeb; Gupta, Kamal

2018-06-01

Objectives There is paucity of information regarding critical limb ischemia-related readmission rates in patients admitted with critical limb ischemia. We studied 30-day critical limb ischemia-related readmission rate, its predictors, and clinical outcomes using a nationwide real-world dataset. Methods We did a secondary analysis of the 2013 Nationwide Readmissions Database. We included all patients with a primary diagnosis of extremity rest pain, ulceration, and gangrene secondary to peripheral arterial disease. From this group, all patients readmitted with similar diagnosis within 30 days were recorded. Results Of the total 25,111 index hospitalization for critical limb ischemia, 1270 (5%) were readmitted with a primary diagnosis of critical limb ischemia within 30 days. The readmission rate was highest (9.5%) for the group that did not have any intervention (revascularization or major amputation) and was lowest for surgical revascularization and major amputation groups (2.6% and 1.3%, P value <0.001 for all groups). Severity of critical limb ischemia at index admission was associated with a significantly higher rate of 30-day readmission. Critical limb ischemia-related readmission was associated with a higher rate of major amputation (29.6% vs. 16.2%, P<0.001), a lower rate of any revascularization procedure (46% vs. 62.6%, P<0.001), and a higher likelihood of discharge to a skilled nursing facility (43.2% vs. 32.2%, P<0.001) compared to index hospitalization. Conclusions In patients with primary diagnosis of critical limb ischemia, 30-day critical limb ischemia-related readmission rate was affected by initial management strategy and the severity of critical limb ischemia. Readmission was associated with a significantly higher rate of amputation, increased length of stay, and a more frequent discharge to an alternate care facility than index admission and thus may serve as a useful quality of care metric in critical limb ischemia patients.

Criticism in the Romantic Relationships of Individuals With Social Anxiety.

PubMed

Porter, Eliora; Chambless, Dianne L; Keefe, John R

2017-07-01

Social anxiety is associated with difficulties in intimate relationships. Because fear of negative evaluation is a cardinal feature of social anxiety disorder, perceived criticism and upset due to criticism from partners may play a significant role in socially anxious individuals' intimate relationships. In the present study, we examine associations between social anxiety and perceived, observed, and expressed criticism in interactions with romantic partners. In Study 1, we collected self-report data from 343 undergraduates and their romantic partners on social anxiety symptoms, perceived and expressed criticism, and upset due to criticism. One year later couples reported whether they were still in this relationship. Results showed that social anxiety was associated with being more critical of one's partner, and among women, being more upset by criticism from a partner. Social anxiety was not related to perceived criticism, nor did criticism variables predict relationship status at Time 2. In Study 2, undergraduate couples with a partner high (n = 26) or low (n = 26) in social anxiety completed a 10-minute, video-recorded problem-solving task. Both partners rated their perceived and expressed criticism and upset due to criticism following the interaction, and observers coded interactions for criticism. Results indicated that social anxiety was not significantly related to any of the criticism variables, but post hoc analyses cast doubts upon the external validity of the problem-solving task. Results are discussed in light of known difficulties with intimacy among individuals with social anxiety. Copyright © 2016. Published by Elsevier Ltd.

An Anesthesia Preinduction Checklist to Improve Information Exchange, Knowledge of Critical Information, Perception of Safety, and Possibly Perception of Teamwork in Anesthesia Teams.

PubMed

Tscholl, David W; Weiss, Mona; Kolbe, Michaela; Staender, Sven; Seifert, Burkhardt; Landert, Daniel; Grande, Bastian; Spahn, Donat R; Noethiger, Christoph B

2015-10-01

An anesthesia preinduction checklist (APIC) to be performed before anesthesia induction was introduced and evaluated with respect to 5 team-level outcomes, each being a surrogate end point for patient safety: information exchange (the percentage of checklist items exchanged by a team, out of 12 total items); knowledge of critical information (the percentage of critical information items out of 5 total items such as allergies, reported as known by the members of a team); team members' perceptions of safety (the median scores given by the members of a team on a continuous rating scale); their perception of teamwork (the median scores given by the members of a team on a continuous rating scale); and clinical performance (the percentage of completed items out of 14 required tasks, e.g., suction device checked). A prospective interventional study comparing anesthesia teams using the APIC with a control group not using the APIC was performed using a multimethod design. Trained observers rated information exchange and clinical performance during on-site observations of anesthesia inductions. After the observations, each team member indicated the critical information items they knew and their perceptions of safety and teamwork. One hundred five teams using the APIC were compared with 100 teams not doing so. The medians of the team-level outcome scores in the APIC group versus the control group were as follows: information exchange: 100% vs 33% (P < 0.001), knowledge of critical information: 100% vs 90% (P < 0.001), perception of safety: 91% vs 84% (P < 0.001), perception of teamwork: 90% vs 86% (P = 0.028), and clinical performance: 93% vs 93% (P = 0.60). This study provides empirical evidence that the use of a preinduction checklist significantly improves information exchange, knowledge of critical information, and perception of safety in anesthesia teams-all parameters contributing to patient safety. There was a trend indicating improved perception of teamwork.

Acute kidney injury in critically ill child.

PubMed

Al-Jboor, Wejdan; Almardini, Reham; Al Bderat, Jwaher; Frehat, Mahdi; Al Masri, Hazem; Alajloni, Mohammad Saleh

2016-01-01

Acute kidney injury (AKI) is a common and serious complication in patients in the Pediatric Intensive Care Unit (PICU). We conducted this study to estimate the incidence and the mortality rate of AKI in critically ill children as well as to describe some other related factors. A retrospective study was conducted at PICU of Queen Rania Abdulla Children Hospital, Amman, Jordan for the period extending from May 2011 to June 2013. The medical records of all patients admitted during this period, and their demographic data were reviewed. Patients with AKI were identified, and management and outcomes were reviewed and analyzed. AKI was evaluated according to modified RIFLE criteria. Of the 372 patients admitted to PICU, 64 (17.2%) patients developed AKI. Of these 64 patients who had AKI, 28 (43.7%) patients reached RIFLE max of risk, 21 (32.8%) patients reached injury, and 15 (23.4%) reached failure. Mean Pediatric Risk of Mortality II score at admission was significantly higher in patients with AKI than those without P <0.001. The age ranged between one month and 14 years with the median age as 5.4 year. Thirty-five (54.7%) were males. Sepsis was the most common cause of AKI. The mortality rate in critically ill children without AKI was 58.7%, whereas increased in children with AKI to 73.4%. The mortality rate in patients who received renal replacement therapy was 71.4% and was higher (81.5%) in patients who received mechanical ventilation (95%, [confidence interval (CI)] 79.3-83.4%) and was significantly higher in patients with multi-organ system dysfunction 90.3% (95%, [CI] 88.7-92.5%). The incidence of AKI in critically ill children is high and increased their mortality rate and higher mortality seen in the younger age group, especially those below one year. High mortality rate was associated with multi-organ system dysfunction and the need for mechanical ventilation.

Enhancing traditional, televised, and videotaped courses with Web-based technologies: a comparison of student satisfaction.

PubMed

Sole, M L; Lindquist, M

2001-01-01

Varied distance learning strategies can be used to deliver nursing courses, including interactive television, videotape, and Web-based approaches. (1) To assess student assess student satisfaction with a critical care elective course offered simultaneously via traditional and distance learning formats in which Web-based strategies were added, and (2) to compare satisfaction of students taking the traditional course versus those taking the class via distance technology. Students (n = 113) who took the course during the spring 1998 and 1999 semesters completed a teacher-constructed evaluation at the end of the semester. Mean ratings on the evaluation were positive. Ratings of interaction, communication with instructor, and facilitation of learning were higher from students who took the traditional course. The application of Web-based technologies may be one factor for the overall course satisfaction. However, it is important to continue to evaluate strategies that work best for students taking courses via distance technology.

Evaluation of microfinance projects.

PubMed

Johnson, S

1999-08-01

This paper criticizes the quick system proposed by Henk Moll for evaluating microfinance projects in the article ¿How to Pre-Evaluate Credit Projects in Ten Minutes¿. The author contended that there is a need to emphasize the objectives of the project. The procedure used by Moll, he contended, is applicable only to projects that have only two key objectives, such as credit operations, and the provision of services. Arguments are presented on the three specific questions proposed by Moll, ranging from the availability of externally audited financial reports, the performance of interest rate on loans vis-a-vis the inflation rate, and the provision of loans according to the individual requirements of the borrowers. Lastly, the author emphasizes that the overall approach is not useful and suggests that careful considerations should be observed in the use or abuse of a simple scoring system or checklist such as the one proposed by Moll.

Evaluation of traditional classroom teaching methods versus course delivery via the World Wide Web.

PubMed

Ryan, M; Carlton, K H; Ali, N S

1999-09-01

Higher education is moving with deliberate speed to an electronic classroom. Much has been published on faculty experiences with World Wide Web (WWW) course delivery. However, little research exists on the evaluation of these methods. The purpose of this study was to evaluate students' perceptions of two approaches to teaching: classroom and WWW modules. Classroom methods were rated significantly higher in relation to content, interaction, participation, faculty preparation, and communication. Technical skills were rated higher for WWW modules. Critical thinking and time allotted for assignments were not significantly different between classroom and WWW instruction. Open-ended comments were rich and supported both positive and negative aspects of classroom and WWW-based modules. Implications call for creativity in course development, course redesign and orientation, active communication with students, support for technical problems, faculty development, and university-wide planning through partnerships.

Novel, Family-Centered Intervention to Improve Nutrition in Patients Recovering From Critical Illness: A Feasibility Study.

PubMed

Marshall, Andrea P; Lemieux, Margot; Dhaliwal, Rupinder; Seyler, Hilda; MacEachern, Kristen N; Heyland, Daren K

2017-06-01

Critically ill patients are at increased risk of developing malnutrition-related complications because of physiological changes, suboptimal delivery, and reduced intake. Strategies to improve nutrition during critical illness recovery are required to prevent iatrogenic underfeeding and risk of malnutrition. The purpose of this study was to assess the feasibility and acceptability of a novel family-centered intervention to improve nutrition in critically ill patients. A 3-phase, prospective cohort feasibility study was conducted in 4 intensive care units (ICUs) across 2 countries. Intervention feasibility was determined by patient eligibility, recruitment, and retention rates. The acceptability of the intervention was assessed by participant perspectives collected through surveys. Participants included family members of the critically ill patients and ICU and ward healthcare professionals (HCPs). A total of 75 patients and family members, as well as 56 HCPs, were enrolled. The consent rate was 66.4%, and 63 of 75 (84%) of family participants completed the study. Most family members (53/55; 98.1%) would recommend the nutrition education program to others and reported improved ability to ask questions about nutrition (16/20; 80.0%). Family members viewed nutrition care more positively in the ICU. HCPs agreed that families should partner with HCPs to achieve optimal nutrition in the ICU and the wards. Health literacy was identified as a potential barrier to family participation. The intervention was feasible and acceptable to families of critically ill patients and HCPs. Further research to evaluate intervention impact on nutrition intake and patient-centered outcomes is required.

ENDF/B-VII.1 Neutron Cross Section Data Testing with Critical Assembly Benchmarks and Reactor Experiments

NASA Astrophysics Data System (ADS)

Kahler, A. C.; MacFarlane, R. E.; Mosteller, R. D.; Kiedrowski, B. C.; Frankle, S. C.; Chadwick, M. B.; McKnight, R. D.; Lell, R. M.; Palmiotti, G.; Hiruta, H.; Herman, M.; Arcilla, R.; Mughabghab, S. F.; Sublet, J. C.; Trkov, A.; Trumbull, T. H.; Dunn, M.

2011-12-01

The ENDF/B-VII.1 library is the latest revision to the United States' Evaluated Nuclear Data File (ENDF). The ENDF library is currently in its seventh generation, with ENDF/B-VII.0 being released in 2006. This revision expands upon that library, including the addition of new evaluated files (was 393 neutron files previously, now 423 including replacement of elemental vanadium and zinc evaluations with isotopic evaluations) and extension or updating of many existing neutron data files. Complete details are provided in the companion paper [M. B. Chadwick et al., "ENDF/B-VII.1 Nuclear Data for Science and Technology: Cross Sections, Covariances, Fission Product Yields and Decay Data," Nuclear Data Sheets, 112, 2887 (2011)]. This paper focuses on how accurately application libraries may be expected to perform in criticality calculations with these data. Continuous energy cross section libraries, suitable for use with the MCNP Monte Carlo transport code, have been generated and applied to a suite of nearly one thousand critical benchmark assemblies defined in the International Criticality Safety Benchmark Evaluation Project's International Handbook of Evaluated Criticality Safety Benchmark Experiments. This suite covers uranium and plutonium fuel systems in a variety of forms such as metallic, oxide or solution, and under a variety of spectral conditions, including unmoderated (i.e., bare), metal reflected and water or other light element reflected. Assembly eigenvalues that were accurately predicted with ENDF/B-VII.0 cross sections such as unmoderated and uranium reflected 235U and 239Pu assemblies, HEU solution systems and LEU oxide lattice systems that mimic commercial PWR configurations continue to be accurately calculated with ENDF/B-VII.1 cross sections, and deficiencies in predicted eigenvalues for assemblies containing selected materials, including titanium, manganese, cadmium and tungsten are greatly reduced. Improvements are also confirmed for selected actinide reaction rates such as 236U, 238,242Pu and 241,243Am capture in fast systems. Other deficiencies, such as the overprediction of Pu solution system critical eigenvalues and a decreasing trend in calculated eigenvalue for 233U fueled systems as a function of Above-Thermal Fission Fraction remain. The comprehensive nature of this critical benchmark suite and the generally accurate calculated eigenvalues obtained with ENDF/B-VII.1 neutron cross sections support the conclusion that this is the most accurate general purpose ENDF/B cross section library yet released to the technical community.

Factors influencing nurses' decisions to activate medical emergency teams.

PubMed

Pantazopoulos, Ioannis; Tsoni, Aikaterini; Kouskouni, Evangelia; Papadimitriou, Lila; Johnson, Elizabeth O; Xanthos, Theodoros

2012-09-01

To evaluate the relationship between nurse demographics and correct identification of clinical situations warranting specific nursing actions, including activation of the medical emergency team. If abnormal physiology is left untreated, the patient may develop cardiac arrest. Nurses in general wards are those who perceive any clinical deterioration in patients. A descriptive, quantitative design was selected. An anonymous survey with 13 multiple choice questions was distributed to 150 randomly selected nurses working in general medical and surgical wards of a large tertiary hospital in Athens, Greece. After explanation of the purposes of the study, 94 nurses (response ratio: 62%) agreed to respond to the questionnaire. Categories with the greatest nursing concern were patients with heart rate<40/minute, an atypical thoracic pain, foreign body airway obstruction and bronchial secretions, respiratory rate<5/minute and heart rate=100/minute. However, almost 50% of nurses were able to accurately identify the critical nursing action for patients with respiratory rate<4/minute, 72% for patients with airway obstruction and 73% for patients with chest pain. Nurses who had graduated from a four-year educational programme identified clinical situations that necessitated medical emergency team activation in a significantly higher rate and also scored significantly higher in questions concerning clinical evaluation than nurses who had graduated from a two-year educational programme. Activation of the medical emergency team is influenced by factors such as level of education and cardiopulmonary resuscitation courses attendance. Graduating from a four-year educational programme helps nurses identify emergencies. However, irrespective of the educational programme they have followed, undertaking a basic life support or advanced life support provider course is critical as it helps them identify cardiac or respiratory emergencies. © 2012 Blackwell Publishing Ltd.

Impact of Cognitive-Behavioral Therapy for Social Anxiety Disorder on the Neural Bases of Emotional Reactivity to and Regulation of Social Evaluation

PubMed Central

Goldin, Philippe R.; Ziv, Michal; Jazaieri, Hooria; Weeks, Justin; Heimberg, Richard G.; Gross, James J.

2014-01-01

We examined whether Cognitive-Behavioral Therapy (CBT) for social anxiety disorder (SAD) would modify self-reported negative emotion and functional magnetic resonance imaging brain responses when reacting to and reappraising social evaluation, and tested whether changes would predict treatment outcome in 59 patients with SAD who completed CBT or waitlist groups. For reactivity, compared to waitlist, CBT resulted in (a) increased brain responses in right superior frontal gyrus (SFG), inferior parietal lobule (IPL), and middle occipital gyrus (MOG) when reacting to social praise, and (b) increases in right SFG and IPL and decreases in left posterior superior temporal gyrus (pSTG) when reacting to social criticism. For reappraisal, compared to waitlist, CBT resulted in greater (c) reductions in self-reported negative emotion, and (d) increases in brain responses in right SFG and MOG, and decreases in left pSTG. A linear regression found that after controlling for CBT-induced changes in reactivity and reappraisal negative emotion ratings and brain changes in reactivity to praise and criticism, reappraisal of criticism brain response changes predicted 24% of the unique variance in CBT-related reductions in social anxiety. Thus, one mechanism underlying CBT for SAD may be changes in reappraisal-related brain responses to social criticism. PMID:25193002

Decentralisation of directly observed treatment in a large African city: evaluation of the experience of Djibouti.

PubMed

Bernatas, J J; Ali, I M; Ismaël, H A; Matan, A B; Aboubakar, I H

2003-08-01

Decentralisation of directly observed treatment (DOT) for tuberculosis patients in three public centres in Djibouti city from April 2000. To evaluate decentralisation based on the success rate by site of treatment and according to certain critical variables. Comparative evaluation of the success rate of smear-positive patients followed in all treatment centres from 1 May 2000 to 31 March 2001. The success rate was 58% for the main centre, Centre Paul Faure, and 81% for all the peripheral centres together (P < 10.6). It was 80% for the three new centres and 85% for the established centres (P > 0.05). Age under 20 years, female sex and treatment centre were factors linked to success. After stratification, sex was shown to be the confounding variable. Multivariate analysis shows that non-Djibouti nationality is related to treatment success (P = 0.02). In the groups of established and new centres, there is an inverse linear relationship between success rate and workload, with greater capacity in the established centres. Urban decentralisation of DOT increases the chances of treatment success among smear-positive patients. Another centre for supervised treatment needs to be created in one of the public health centres in Djibouti city.

Evaluation of the Carefusion Alaris PC infusion pump for hyperbaric oxygen therapy conditions: Technical report.

PubMed

Smale, Andrew; Tsouras, Theo

2017-01-01

We present a standardized test methodology and results for our evaluation of the Carefusion Alaris PC infusion pump, comprising the model 8015 PC Unit and the model 8100 Large Volume Pump (LVP) module. The evaluation consisted of basic suitability testing, internal component inspection, surface temperature measurement of selected internal components, and critical performance testing (infusion rate accuracy and occlusion alarm pressure) during conditions of typical hyperbaric oxygen (HBO₂) treatment in our facility's class A multiplace chamber. We have found that the pumps pose no enhanced risk as an ignition source, and that the pumps operate within manufacturer's specifications for flow rate and occlusion alarms at all stages of HBO₂ treatments, up to 4.0 ATA and pressurization and depressurization rates up to 180 kPa/minute. The pumps do not require purging with air or nitrogen and can be used unmodified, subject to the following conditions: pumps are undamaged, clean, fully charged, and absent from alcohol cleaning residue; pumps are powered from the internal NiMH battery only; maximum pressure exposure 4.0 ATA; maximum pressurization and depressurization rate of 180 kPa/minute; LVP modules locked in place with retaining screws. Copyright© Undersea and Hyperbaric Medical Society.

Screening level risk assessment model for chemical fate and effects in the environment.

PubMed

Arnot, Jon A; Mackay, Don; Webster, Eva; Southwood, Jeanette M

2006-04-01

A screening level risk assessment model is developed and described to assess and prioritize chemicals by estimating environmental fate and transport, bioaccumulation, and exposure to humans and wildlife for a unit emission rate. The most sensitive risk endpoint is identified and a critical emission rate is then calculated as a result of that endpoint being reached. Finally, this estimated critical emission rate is compared with the estimated actual emission rate as a risk assessment factor. This "back-tracking" process avoids the use of highly uncertain emission rate data as model input. The application of the model is demonstrated in detail for three diverse chemicals and in less detail for a group of 70 chemicals drawn from the Canadian Domestic Substances List. The simple Level II and the more complex Level III fate calculations are used to "bin" substances into categories of similar probable risk. The essential role of the model is to synthesize information on chemical and environmental properties within a consistent mass balance framework to yield an overall estimate of screening level risk with respect to the defined endpoint. The approach may be useful to identify and prioritize those chemicals of commerce that are of greatest potential concern and require more comprehensive modeling and monitoring evaluations in actual regional environments and food webs.

Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession.

PubMed

Garzon-Serrano, Jaime; Ryan, Cheryl; Waak, Karen; Hirschberg, Ronald; Tully, Susan; Bittner, Edward A; Chipman, Daniel W; Schmidt, Ulrich; Kasotakis, Georgios; Benjamin, John; Zafonte, Ross; Eikermann, Matthias

2011-04-01

To evaluate whether the level of mobilization achieved and the barriers for progressing to the next mobilization level differ between nurses and physical therapists. Prospective, observational study. Twenty-bed surgical intensive care unit (SICU) of the Massachusetts General Hospital. Sixty-three critically ill patients. Physical therapists and nurses performed 179 mobilization therapies with 63 patients. Mobilization was defined as the process of enhancing mobility in the SICU, including bed mobility, edge of bed activities, transfers out of bed to a chair, and gait training; the mobilization level was measured on the SICU optimal mobilization scale, a 5-point (0-4) numerical rating scale. Patients' level of mobilization achieved by physical therapists was significantly higher compared with that achieved by nurses (2.3 ± 1.2 mean ± SD versus 1.2 ± 1.2, respectively P < .0001). Different barriers for mobilization were identified by physical therapists and nurses: hemodynamic instability (26% versus 12%, P = .03) and renal replacement therapy (12% versus 1%, P = .03) were barriers rated higher by nurses, whereas neurologic impairment was rated higher by physical therapists providers (18% versus 38%, P = .002). No mobilization-associated adverse events were observed in this study. This study showed that physical therapists mobilize their critically ill patients to higher levels compared with nurses. Nurse and physical therapists identify different barriers for mobilization. Routine involvement of physical therapists in directing mobilization treatment may promote early mobilization of critically ill patients. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Dryout-type critical heat flux in vertical upward annular flow: effects of entrainment rate, initial entrained fraction and diameter

NASA Astrophysics Data System (ADS)

Wu, Zan; Wadekar, Vishwas; Wang, Chenglong; Sunden, Bengt

2018-01-01

This study aims to reveal the effects of liquid entrainment, initial entrained fraction and tube diameter on liquid film dryout in vertical upward annular flow for flow boiling. Entrainment and deposition rates of droplets were included in mass conservation equations to estimate the local liquid film mass flux in annular flow, and the critical vapor quality at dryout conditions. Different entrainment rate correlations were evaluated using flow boiling data of water and organic liquids including n-pentane, iso-octane and R134a. Effect of the initial entrained fraction (IEF) at the churn-to-annular flow transition was also investigated. A transitional Boiling number was proposed to separate the IEF-sensitive region at high Boiling numbers and the IEF-insensitive region at low Boiling numbers. Besides, the diameter effect on dryout vapor quality was studied. The dryout vapor quality increases with decreasing tube diameter. It needs to be pointed out that the dryout characteristics of submillimeter channels might be different because of different mechanisms of dryout, i.e., drying of liquid film underneath long vapor slugs and flow boiling instabilities.

Energy expenditure during barbiturate coma.

PubMed

Ashcraft, Christine M; Frankenfield, David C

2013-10-01

Barbiturate coma may have a significant effect on metabolic rate, but the phenomenon is not extensively studied. The primary purpose of the current study was to compare the metabolic rate of general critical care patients with those requiring barbiturate coma. A secondary purpose was to evaluate the accuracy of the Penn State prediction equation between these 2 groups of patients. Indirect calorimetry was used to measure the resting metabolic rate of mechanically ventilated, critically ill patients in a barbiturate coma and those of similar height, weight, and age but not in a barbiturate coma. Measurements of resting metabolic rate were compared with predictions using the Penn State equation accounting for body size, body temperature, and minute ventilation. The barbiturate coma group had a lower resting metabolic rate than the control group that remained lower even after adjustment for predicted healthy metabolic rate and maximum body temperature (1859 ± 290 vs 2037 ± 289 kcal/d, P = .020). When minute ventilation was also included in the analysis, the resting metabolic rate between the groups became statistically insignificant (1929 ± 229 vs 2023 ± 226 kcal/d, P = .142). The Penn State equation, which uses these variables, was accurate in 73% of the control patients and also the barbiturate coma patients. Resting metabolic rate is moderately reduced in barbiturate coma, but the decrease is out of proportion with changes in body temperature. However, if both body temperature and minute ventilation are considered, then the change is predictable.

Evaluating critical thinking in clinical practice.

PubMed

Oermann, M H

1997-01-01

Although much has been written about measurement instruments for evaluating critical thinking in nursing, this article describes clinical evaluation strategies for critical thinking. Five methods are discussed: 1) observation of students in practice; 2) questions for critical thinking, including Socratic questioning; 3) conferences; 4) problem-solving strategies; and 5) written assignments. These methods provide a means of evaluating students' critical thinking within the context of clinical practice.

Experiences of Vulnerable Residential Customer Subpopulations with Critical Peak Pricing

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

Cappers, Peter; Spurlock, C. Anna; Todd, Annika

DOE decided to co-fund ten utilities to undertake eleven experimentally-designed Consumer Behavior Studies (CBS) that proposed to examine a wide range of the topics of interest to the electric utility industry. Each chosen utility was to design, implement and evaluate their own study in order to address questions of interest both to itself and to its applicable regulatory authority, whose approval was generally necessary for the study to proceed. The DOE Office of Energy Delivery and Electricity Reliability (OE), however, did set guidelines, both in the FOA and subsequently during the contracting period, for what would constitute an acceptable studymore » under the Grant. To assist in ensuring these guidelines were adhered to, OE requested that LBNL act as project manager for these Consumer Behavior Studies to achieve consistency of experimental design and adherence to data collection and reporting protocols across the ten utilities. As part of its role, LBNL formed technical advisory groups (TAG) to separately assist each of the utilities by providing technical assistance in all aspects of the design, implementation and evaluation of their studies. LBNL was also given a unique opportunity to perform a comprehensive, cross-study analysis that uses the customer-level interval meter and demographic data made available by these utilities due to SGIG-imposed reporting requirements, in order to analyze critical policy issues associated with AMI-enabled rates and control/information technology. LBNL will publish the results of these analyses in a series of research reports, of which this is one, that attempt to address critical policy issues relating to a variety of topics including customer acceptance, retention and load response to time-based rates and various forms of enabling control and information technologies. This report extends the existing empirical literature on the experiences of low-income customers exposed to critical peak pricing, and provides the first glimpses into the experiences of the elderly and those who reported being chronically ill. Specifically, we analyzed two of the time-based rate consumer behavior studies, which were co-funded by the Department of Energy as part of the Smart Grid Investment Grant program.« less

Propylene glycol accumulation in critically ill patients receiving continuous intravenous lorazepam infusions.

PubMed

Horinek, Erica L; Kiser, Tyree H; Fish, Douglas N; MacLaren, Robert

2009-12-01

Lorazepam is recommended by the Society of Critical Care Medicine as the preferred agent for sedation of critically ill patients. Intravenous lorazepam contains propylene glycol, which has been associated with toxicity when high doses of lorazepam are administered. To evaluate the accumulation of propylene glycol in critically ill patients receiving lorazepam by continuous infusion and determine factors associated with propylene glycol concentration. A 6-month, retrospective, safety assessment was conducted of adults admitted to the medical intensive care unit who were receiving lorazepam by continuous infusion for 12 hours or more. Propylene glycol serum concentrations were obtained 24-48 hours after continuous-infusion lorazepam was initiated and every 3-5 days thereafter. Propylene glycol accumulation was defined as concentrations of 25 mg/dL or more. Groups with and without propylene glycol accumulation were compared and factors associated with propylene glycol concentration were determined using multivariate correlation regression analyses. Forty-eight propylene glycol serum samples were obtained from 33 patients. Fourteen (42%) patients had propylene glycol accumulation, representing 23 (48%) serum samples. Univariate analyses showed the following factors were related to propylene glycol accumulation: baseline renal dysfunction, presence of alcohol withdrawal, sex, age, Acute Physiology and Chronic Health Evaluation (APACHE II) score, rate of lorazepam continuous infusion, and 24-hour lorazepam dose. Multivariate linear regression modeling demonstrated that propylene glycol concentration was strongly associated with the continuous infusion rate and 24-hour dose (adjusted r(2) > or = 0.77; p < 0.001). Independent correlation analyses showed that these 2 variables were so strongly associated with propylene glycol concentration (r(2) > or = 0.71; p < 0.001) that they alone predicted propylene glycol concentration. Seven (21%) patients developed renal dysfunction after continuous-infusion lorazepam was initiated, but associated causes were indeterminable. Other possible propylene glycol-associated adverse effects were not observed. The continuous infusion rate and cumulative 24-hour lorazepam dose are strongly associated with and independently predict propylene glycol concentrations. Despite the absence of confirmed propylene glycol-associated adverse effects, clinicians should be aware that propylene glycol accumulation may occur with continuous-infusion lorazepam.

Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database

PubMed Central

2005-01-01

Introduction Risk prediction scores usually overestimate mortality in obstetric populations because mortality rates in this group are considerably lower than in others. Studies examining this effect were generally small and did not distinguish between obstetric and nonobstetric pathologies. We evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II model in obstetric admissions to critical care units contributing to the ICNARC Case Mix Programme. Methods All obstetric admissions were extracted from the ICNARC Case Mix Programme Database of 219,468 admissions to UK critical care units from 1995 to 2003 inclusive. Cases were divided into direct obstetric pathologies and indirect or coincidental pathologies, and compared with a control cohort of all women aged 16–50 years not included in the obstetric categories. The predictive ability of APACHE II was evaluated in the three groups. A prognostic model was developed for direct obstetric admissions to predict the risk for hospital mortality. A log-linear model was developed to predict the length of stay in the critical care unit. Results A total of 1452 direct obstetric admissions were identified, the most common pathologies being haemorrhage and hypertensive disorders of pregnancy. There were 278 admissions identified as indirect or coincidental and 22,938 in the nonpregnant control cohort. Hospital mortality rates were 2.2%, 6.0% and 19.6% for the direct obstetric group, the indirect or coincidental group, and the control cohort, respectively. Cox regression calibration analysis showed a reasonable fit of the APACHE II model for the nonpregnant control cohort (slope = 1.1, intercept = -0.1). However, the APACHE II model vastly overestimated mortality for obstetric admissions (mortality ratio = 0.25). Risk prediction modelling demonstrated that the Glasgow Coma Scale score was the best discriminator between survival and death in obstetric admissions. Conclusion This study confirms that APACHE II overestimates mortality in obstetric admissions to critical care units. This may be because of the physiological changes in pregnancy or the unique scoring profile of obstetric pathologies such as HELLP syndrome. It may be possible to recalibrate the APACHE II score for obstetric admissions or to devise an alternative score specifically for obstetric admissions.

The Northern Forest Futures Project: A forward look at forest conditions in the northern United States

Treesearch

W. Keith Moser; Stephen R. Shifley

2012-01-01

Forests and forest ecosystems provide a critical array of benefits, from clean air and water to commercial products to open space. The forests and their ability to provide desired benefi ts constantly change in response to natural forces, human decisions, and human needs. The complexity and rate of change demand a rigorous evaluation of existing and emerging natural...

Kinetics and mechanisms of some atomic oxygen reactions

NASA Technical Reports Server (NTRS)

Cvetanovic, R. J.

1987-01-01

Mechanisms and kinetics of some reactions of the ground state of oxygen atoms, O(3P), are briefly summarized. Attention is given to reactions of oxygen atoms with several different types of organic and inorganic compounds such as alkanes, alkenes, alkynes, aromatics, and some oxygen, nitrogen, halogen and sulfur derivatives of these compounds. References to some recent compilations and critical evaluations of reaction rate constants are given.

Critical Social Theory: Core Tenets, Inherent Issues

ERIC Educational Resources Information Center

Freeman, Melissa; Vasconcelos, Erika Franca S.

2010-01-01

This chapter outlines the core tenets of critical social theory and describes inherent issues facing evaluators conducting critical theory evaluation. Using critical pedagogy as an example, the authors describe the issues facing evaluators by developing four of the subtheories that comprise a critical social theory: (a) a theory of false…

Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy

PubMed Central

Hager, David R.; Persaud, Rosemary A.; Naseman, Ryan W.; Choudhary, Kavish; Carter, Kristen E.; Hansen, Amanda

2017-01-01

Background: While hospital beds continue to decline as patients previously treated as inpatients are stabilized in ambulatory settings, the number of critical care beds available in the United States continues to rise. Growth in pharmacy student graduation, postgraduate year 2 critical care (PGY2 CC) residency programs, and positions has also increased. There is a perception that the critical care trained pharmacist market is saturated, yet this has not been evaluated since the rise in pharmacy graduates and residency programs. Purpose: To describe the current perception of critical care residency program directors (CC RPDs) and directors of pharmacy (DOPs) on the critical care pharmacist job market and to evaluate critical care postresidency placement and anticipated changes in PGY2 CC programs. Methods: Two electronic surveys were distributed from October 2015 to November 2015 through Vizient/University HealthSystem Consortium, American Society of Health-System Pharmacists (ASHP), Society of Critical Care Medicine, and American College of Clinical Pharmacy listservs to target 2 groups of respondents: CC RPDs and DOPs. Questions were based on the ASHP Pharmacy Forecast and the Pharmacy Workforce Center’s Aggregate Demand Index and were intended to identify perceptions of the critical care market of the 2 groups. Results: Of 116 CC RPDs, there were 66 respondents (56.9% response rate). Respondents have observed an increase in applicants; however, they do not anticipate increasing the number of positions in the next 5 years. The overall perception is that there is a balance in supply and demand in the critical care trained pharmacist market. A total of 82 DOPs responded to the survey. Turnover of critical care pharmacists within respondent organizations is expected to be low. Although a majority of DOPs plan to expand residency training positions, only 9% expect to increase positions in critical care PGY2 training. Overall, DOP respondents indicated a balance of supply and demand in the critical care trained pharmacist market. In comparing RPD and DOP perceptions of the demand for critical care pharmacists, DOPs perceived demand to be higher than RPDs (mean, 3.2 vs 2.8; P = .032). Conclusion: Although there is a perception of the oversupply of critical care trained pharmacists, a survey of DOPs and CC RPDs found a market with positions available, rapid hiring, stable salaries, and plans for expanded hiring of critical care trained pharmacists. PMID:28804148

Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy.

PubMed

Hager, David R; Persaud, Rosemary A; Naseman, Ryan W; Choudhary, Kavish; Carter, Kristen E; Hansen, Amanda

2017-05-01

Background: While hospital beds continue to decline as patients previously treated as inpatients are stabilized in ambulatory settings, the number of critical care beds available in the United States continues to rise. Growth in pharmacy student graduation, postgraduate year 2 critical care (PGY2 CC) residency programs, and positions has also increased. There is a perception that the critical care trained pharmacist market is saturated, yet this has not been evaluated since the rise in pharmacy graduates and residency programs. Purpose: To describe the current perception of critical care residency program directors (CC RPDs) and directors of pharmacy (DOPs) on the critical care pharmacist job market and to evaluate critical care postresidency placement and anticipated changes in PGY2 CC programs. Methods: Two electronic surveys were distributed from October 2015 to November 2015 through Vizient/University HealthSystem Consortium, American Society of Health-System Pharmacists (ASHP), Society of Critical Care Medicine, and American College of Clinical Pharmacy listservs to target 2 groups of respondents: CC RPDs and DOPs. Questions were based on the ASHP Pharmacy Forecast and the Pharmacy Workforce Center's Aggregate Demand Index and were intended to identify perceptions of the critical care market of the 2 groups. Results: Of 116 CC RPDs, there were 66 respondents (56.9% response rate). Respondents have observed an increase in applicants; however, they do not anticipate increasing the number of positions in the next 5 years. The overall perception is that there is a balance in supply and demand in the critical care trained pharmacist market. A total of 82 DOPs responded to the survey. Turnover of critical care pharmacists within respondent organizations is expected to be low. Although a majority of DOPs plan to expand residency training positions, only 9% expect to increase positions in critical care PGY2 training. Overall, DOP respondents indicated a balance of supply and demand in the critical care trained pharmacist market. In comparing RPD and DOP perceptions of the demand for critical care pharmacists, DOPs perceived demand to be higher than RPDs (mean, 3.2 vs 2.8; P = .032). Conclusion: Although there is a perception of the oversupply of critical care trained pharmacists, a survey of DOPs and CC RPDs found a market with positions available, rapid hiring, stable salaries, and plans for expanded hiring of critical care trained pharmacists.

Evaluating biomarkers to model cancer risk post cosmic ray exposure

PubMed Central

Sridhara, Deepa M.; Asaithamby, Aroumougame; Blattnig, Steve R.; Costes, Sylvain V.; Doetsch, Paul W.; Dynan, William S.; Hahnfeldt, Philip; Hlatky, Lynn; Kidane, Yared; Kronenberg, Amy; Naidu, Mamta D.; Peterson, Leif E.; Plante, Ianik; Ponomarev, Artem L.; Saha, Janapriya; Snijders, Antoine M.; Srinivasan, Kalayarasan; Tang, Jonathan; Werner, Erica; Pluth, Janice M.

2017-01-01

Robust predictive models are essential to manage the risk of radiation-induced carcinogenesis. Chronic exposure to cosmic rays in the context of the complex deep space environment may place astronauts at high cancer risk. To estimate this risk, it is critical to understand how radiation-induced cellular stress impacts cell fate decisions and how this in turn alters the risk of carcinogenesis. Exposure to the heavy ion component of cosmic rays triggers a multitude of cellular changes, depending on the rate of exposure, the type of damage incurred and individual susceptibility. Heterogeneity in dose, dose rate, radiation quality, energy and particle flux contribute to the complexity of risk assessment. To unravel the impact of each of these factors, it is critical to identify sensitive biomarkers that can serve as inputs for robust modeling of individual risk of cancer or other long-term health consequences of exposure. Limitations in sensitivity of biomarkers to dose and dose rate, and the complexity of longitudinal monitoring, are some of the factors that increase uncertainties in the output from risk prediction models. Here, we critically evaluate candidate early and late biomarkers of radiation exposure and discuss their usefulness in predicting cell fate decisions. Some of the biomarkers we have reviewed include complex clustered DNA damage, persistent DNA repair foci, reactive oxygen species, chromosome aberrations and inflammation. Other biomarkers discussed, often assayed for at longer points post exposure, include mutations, chromosome aberrations, reactive oxygen species and telomere length changes. We discuss the relationship of biomarkers to different potential cell fates, including proliferation, apoptosis, senescence, and loss of stemness, which can propagate genomic instability and alter tissue composition and the underlying mRNA signatures that contribute to cell fate decisions. Our goal is to highlight factors that are important in choosing biomarkers and to evaluate the potential for biomarkers to inform models of post exposure cancer risk. Because cellular stress response pathways to space radiation and environmental carcinogens share common nodes, biomarker-driven risk models may be broadly applicable for estimating risks for other carcinogens. PMID:27345199

Evaluating biomarkers to model cancer risk post cosmic ray exposure

NASA Astrophysics Data System (ADS)

Sridharan, Deepa M.; Asaithamby, Aroumougame; Blattnig, Steve R.; Costes, Sylvain V.; Doetsch, Paul W.; Dynan, William S.; Hahnfeldt, Philip; Hlatky, Lynn; Kidane, Yared; Kronenberg, Amy; Naidu, Mamta D.; Peterson, Leif E.; Plante, Ianik; Ponomarev, Artem L.; Saha, Janapriya; Snijders, Antoine M.; Srinivasan, Kalayarasan; Tang, Jonathan; Werner, Erica; Pluth, Janice M.

2016-06-01

Robust predictive models are essential to manage the risk of radiation-induced carcinogenesis. Chronic exposure to cosmic rays in the context of the complex deep space environment may place astronauts at high cancer risk. To estimate this risk, it is critical to understand how radiation-induced cellular stress impacts cell fate decisions and how this in turn alters the risk of carcinogenesis. Exposure to the heavy ion component of cosmic rays triggers a multitude of cellular changes, depending on the rate of exposure, the type of damage incurred and individual susceptibility. Heterogeneity in dose, dose rate, radiation quality, energy and particle flux contribute to the complexity of risk assessment. To unravel the impact of each of these factors, it is critical to identify sensitive biomarkers that can serve as inputs for robust modeling of individual risk of cancer or other long-term health consequences of exposure. Limitations in sensitivity of biomarkers to dose and dose rate, and the complexity of longitudinal monitoring, are some of the factors that increase uncertainties in the output from risk prediction models. Here, we critically evaluate candidate early and late biomarkers of radiation exposure and discuss their usefulness in predicting cell fate decisions. Some of the biomarkers we have reviewed include complex clustered DNA damage, persistent DNA repair foci, reactive oxygen species, chromosome aberrations and inflammation. Other biomarkers discussed, often assayed for at longer points post exposure, include mutations, chromosome aberrations, reactive oxygen species and telomere length changes. We discuss the relationship of biomarkers to different potential cell fates, including proliferation, apoptosis, senescence, and loss of stemness, which can propagate genomic instability and alter tissue composition and the underlying mRNA signatures that contribute to cell fate decisions. Our goal is to highlight factors that are important in choosing biomarkers and to evaluate the potential for biomarkers to inform models of post exposure cancer risk. Because cellular stress response pathways to space radiation and environmental carcinogens share common nodes, biomarker-driven risk models may be broadly applicable for estimating risks for other carcinogens.

Evaluating biomarkers to model cancer risk post cosmic ray exposure.

PubMed

Sridharan, Deepa M; Asaithamby, Aroumougame; Blattnig, Steve R; Costes, Sylvain V; Doetsch, Paul W; Dynan, William S; Hahnfeldt, Philip; Hlatky, Lynn; Kidane, Yared; Kronenberg, Amy; Naidu, Mamta D; Peterson, Leif E; Plante, Ianik; Ponomarev, Artem L; Saha, Janapriya; Snijders, Antoine M; Srinivasan, Kalayarasan; Tang, Jonathan; Werner, Erica; Pluth, Janice M

2016-06-01

Robust predictive models are essential to manage the risk of radiation-induced carcinogenesis. Chronic exposure to cosmic rays in the context of the complex deep space environment may place astronauts at high cancer risk. To estimate this risk, it is critical to understand how radiation-induced cellular stress impacts cell fate decisions and how this in turn alters the risk of carcinogenesis. Exposure to the heavy ion component of cosmic rays triggers a multitude of cellular changes, depending on the rate of exposure, the type of damage incurred and individual susceptibility. Heterogeneity in dose, dose rate, radiation quality, energy and particle flux contribute to the complexity of risk assessment. To unravel the impact of each of these factors, it is critical to identify sensitive biomarkers that can serve as inputs for robust modeling of individual risk of cancer or other long-term health consequences of exposure. Limitations in sensitivity of biomarkers to dose and dose rate, and the complexity of longitudinal monitoring, are some of the factors that increase uncertainties in the output from risk prediction models. Here, we critically evaluate candidate early and late biomarkers of radiation exposure and discuss their usefulness in predicting cell fate decisions. Some of the biomarkers we have reviewed include complex clustered DNA damage, persistent DNA repair foci, reactive oxygen species, chromosome aberrations and inflammation. Other biomarkers discussed, often assayed for at longer points post exposure, include mutations, chromosome aberrations, reactive oxygen species and telomere length changes. We discuss the relationship of biomarkers to different potential cell fates, including proliferation, apoptosis, senescence, and loss of stemness, which can propagate genomic instability and alter tissue composition and the underlying mRNA signatures that contribute to cell fate decisions. Our goal is to highlight factors that are important in choosing biomarkers and to evaluate the potential for biomarkers to inform models of post exposure cancer risk. Because cellular stress response pathways to space radiation and environmental carcinogens share common nodes, biomarker-driven risk models may be broadly applicable for estimating risks for other carcinogens. Copyright © 2016 The Committee on Space Research (COSPAR). All rights reserved.

Relationships between maternal emotional expressiveness and children's sensitivity to teacher criticism.

PubMed

Mizokawa, Ai

2013-01-01

Caregivers' emotional responses to children influence children's social and emotional development. This study investigated the association between maternal emotional expressiveness in the context of mother-child interactions and young children's sensitivity to teacher criticism. Sensitivity to teacher criticism was assessed among 53 Japanese preschoolers using hypothetical scenarios in which a puppet child representing the participant made a small error, and a puppet teacher pointed out the error. Self-report questionnaires were used to measure maternal expressiveness. The results demonstrated that negative maternal expressiveness toward one's own children was positively related to children's ratings of their own ability and negatively related to children's motivation to continue with the task after teacher criticism. Positive maternal expressiveness was not related to children's sensitivity to criticism. These findings suggest that children who have experienced more negative emotion from mothers may be more likely to hold negative beliefs about how others will respond to their behavior more generally. This may, in turn, lead to a defensively positive view of one's own abilities and a disinclination to persevere as protection from additional opportunities for teacher evaluation.

Inclusion models of tensile fracture in fiber-reinforced brittle-matrix composites. Ph.D. Thesis

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

Tsai, W.

1993-12-31

Inclusion models of tensile fracture in fiber-reinforced brittle-matrix composites are proposed in this study. Three stages of matrix cracking including initiation of microcracks, propagation of a bridged crack and multiplication of periodic cracks are modeled using the unique approach - Eshelby`s equivalent inclusion method. Moreover, the interfacial debonding may occur during matrix cracking and is taken into account by the present analysis. After interfacial debonding initiates, the fiber slides against the friction which is assumed to be constant in chapter 2 and chapter 3. However, the fiber-matrix interfaces are assumed to be Coulomb`s friction controlled in chapter 4. Energy releasemore » rate and crack resistance are obtained analytically. From the fracture criterion, the equivalence of energy release rate and crack resistance, the critical applied stress is also obtained. On the critical applied stress the effects of material parameters such as interfacial frictional stress, interfacial surface energy, volume fraction of fibers, misfit strain are evaluated. These evaluations are important for the purpose of material design. Finally, it is attempted in chapter 5 to solve the crack-inhomogeneity interaction problem inhomogeneities. First, the formulation of two inhomogeneities without overlapping is derived in detail. When one of the inhomogeneities is the penny-shape crack and the other one is the ellipsoidal inhomogeneity, the interaction energy between the crack and the applied stress and the energy release rate of the crack are evaluated. Based on the framework of this chapter, one can deal with the real configuration including many inhomogeneities in the similar way. Also, the misfit strains due to thermal mismatch, phase transformation et al. can be included in the present analysis with no difficulty.« less

Application of a modified sequential organ failure assessment score to critically ill patients

PubMed Central

Ñamendys-Silva, S.A.; Silva-Medina, M.A.; Vásquez-Barahona, G.M.; Baltazar-Torres, J.A.; Rivero-Sigarroa, E.; Fonseca-Lazcano, J.A.; Domínguez-Cherit, G.

2013-01-01

The purpose of the present study was to explore the usefulness of the Mexican sequential organ failure assessment (MEXSOFA) score for assessing the risk of mortality for critically ill patients in the ICU. A total of 232 consecutive patients admitted to an ICU were included in the study. The MEXSOFA was calculated using the original SOFA scoring system with two modifications: the PaO2/FiO2 ratio was replaced with the SpO2/FiO2 ratio, and the evaluation of neurologic dysfunction was excluded. The ICU mortality rate was 20.2%. Patients with an initial MEXSOFA score of 9 points or less calculated during the first 24 h after admission to the ICU had a mortality rate of 14.8%, while those with an initial MEXSOFA score of 10 points or more had a mortality rate of 40%. The MEXSOFA score at 48 h was also associated with mortality: patients with a score of 9 points or less had a mortality rate of 14.1%, while those with a score of 10 points or more had a mortality rate of 50%. In a multivariate analysis, only the MEXSOFA score at 48 h was an independent predictor for in-ICU death with an OR = 1.35 (95%CI = 1.14-1.59, P < 0.001). The SOFA and MEXSOFA scores calculated 24 h after admission to the ICU demonstrated a good level of discrimination for predicting the in-ICU mortality risk in critically ill patients. The MEXSOFA score at 48 h was an independent predictor of death; with each 1-point increase, the odds of death increased by 35%. PMID:23369978

Study on the criterion to determine the bottom deployment modes of a coilable mast

NASA Astrophysics Data System (ADS)

Ma, Haibo; Huang, Hai; Han, Jianbin; Zhang, Wei; Wang, Xinsheng

2017-12-01

A practical design criterion that allows the coilable mast bottom to deploy in local coil mode was proposed. The criterion was defined with initial bottom helical angle and obtained by bottom deformation analyses. Discretizing the longerons into short rods, analyses were conducted based on the cylinder assumption and Kirchhoff's kinetic analogy theory. Then, iterative calculations aiming at the bottom four rods were carried out. A critical bottom helical angle was obtained while the angle changing rate equaled to zero. The critical value was defined as a criterion for judgement of bottom deployment mode. Subsequently, micro-gravity deployment tests were carried out and bottom deployment simulations based on finite element method were developed. Through comparisons of bottom helical angles in critical state, the proposed criterion was evaluated and modified, that is, an initial bottom helical angle less than critical value with a design margin of -13.7% could ensure the mast bottom deploying in local coil mode, and further determine a successful local coil deployment of entire coilable mast.

Interdisciplinary approach to neurocritical care in the intensive care nursery.

PubMed

Glass, Hannah C; Rogers, Elizabeth E; Peloquin, Susan; Bonifacio, Sonia L

2014-12-01

Neurocritical care is a multidisciplinary subspecialty that combines expertise in critical care medicine, neurology, and neurosurgery, and has led to improved outcomes in adults who have critical illnesses. Advances in resuscitation and critical care have led to high rates of survival among neonates with life-threatening conditions such as perinatal asphyxia, extreme prematurity, and congenital malformations. The sequelae of neurologic conditions arising in the neonatal period include lifelong disabilities such as cerebral palsy and epilepsy, as well as intellectual and behavioral disabilities. Centers of excellence have adapted the principles of neurocritical care to reflect the needs of the developing newborn brain, including early involvement of a neurologist for recognition and treatment of neurologic conditions, attention to physiology to help prevent secondary brain injury, a protocol-driven approach for common conditions like seizures and hypoxic-ischemic encephalopathy, and education of specialized teams that use brain monitoring and imaging to evaluate the effect of critical illness on brain function and development. Copyright © 2014. Published by Elsevier Inc.

Use of Multi-Response Format Test in the Assessment of Medical Students' Critical Thinking Ability.

PubMed

Mafinejad, Mahboobeh Khabaz; Arabshahi, Seyyed Kamran Soltani; Monajemi, Alireza; Jalili, Mohammad; Soltani, Akbar; Rasouli, Javad

2017-09-01

To evaluate students critical thinking skills effectively, change in assessment practices is must. The assessment of a student's ability to think critically is a constant challenge, and yet there is considerable debate on the best assessment method. There is evidence that the intrinsic nature of open and closed-ended response questions is to measure separate cognitive abilities. To assess critical thinking ability of medical students by using multi-response format of assessment. A cross-sectional study was conducted on a group of 159 undergraduate third-year medical students. All the participants completed the California Critical Thinking Skills Test (CCTST) consisting of 34 multiple-choice questions to measure general critical thinking skills and a researcher-developed test that combines open and closed-ended questions. A researcher-developed 48-question exam, consisting of 8 short-answers and 5 essay questions, 19 Multiple-Choice Questions (MCQ), and 16 True-False (TF) questions, was used to measure critical thinking skills. Correlation analyses were performed using Pearson's coefficient to explore the association between the total scores of tests and subtests. One hundred and fifty-nine students participated in this study. The sample comprised 81 females (51%) and 78 males (49%) with an age range of 20±2.8 years (mean 21.2 years). The response rate was 64.1%. A significant positive correlation was found between types of questions and critical thinking scores, of which the correlations of MCQ (r=0.82) and essay questions (r=0.77) were strongest. The significant positive correlations between multi-response format test and CCTST's subscales were seen in analysis, evaluation, inference and inductive reasoning. Unlike CCTST subscales, multi-response format test have weak correlation with CCTST total score (r=0.45, p=0.06). This study highlights the importance of considering multi-response format test in the assessment of critical thinking abilities of medical students by using both open and closed-ended response questions.

Inhaled Epoprostenol Through Noninvasive Routes of Ventilator Support Systems.

PubMed

Ammar, Mahmoud A; Sasidhar, Madhu; Lam, Simon W

2018-06-01

The administration of inhaled epoprostenol (iEPO) through noninvasive routes of ventilator support systems has never been previously evaluated. Describe the use of iEPO when administered through noninvasive routes of ventilator support systems. Critically ill patients admitted to the intensive care unit who received iEPO through noninvasive routes were analyzed. Improvements in respiratory status and hemodynamic parameters were evaluated. Safety end points assessed included hypotension, rebound hypoxemia, significant bleeding, and thrombocytopenia. A total of 36 patients received iEPO through noninvasive routes: high-flow oxygen therapy through nasal cannula, n = 29 (81%) and noninvasive positive-pressure ventilation, n = 7 (19%). Sixteen patients had improvement in their respiratory status: mean decrease in fraction of inspired oxygen (FiO 2 ), 20% ± 13%; mean increase in partial pressure of arterial oxygen to FiO 2 (PaO 2 /FiO 2 ) ratio, 60 ± 50 mm Hg; and mean decrease in HFNC oxygen flow rate, 6 ± 3 liters per minute (LPM). Eight patients had declines in their respiratory status (mean increase in FiO 2 , 30% ± 20%; mean decrease in PaO 2 /FiO 2 ratio, 38 ± 20 mm Hg; and mean increase in HFNC oxygen flow rate, 15 ± 10 LPM), and 12 patients had no change in their respiratory status. Conclusion and Relevance: This represents the first evaluation of the administration of iEPO through noninvasive routes of ventilator support systems and demonstrates that in critically ill patients, iEPO could be administered through a noninvasive route. Further evaluation is needed to determine the extent of benefit with this route of administration.

Improved amputation-free survival in unreconstructable critical limb ischemia and its implications for clinical trial design and quality measurement.

PubMed

Benoit, Eric; O'Donnell, Thomas F; Kitsios, Georgios D; Iafrati, Mark D

2012-03-01

Amputation-free survival (AFS), a composite endpoint of mortality and amputation, is the preferred outcome measure in critical limb ischemia (CLI). Given the improvements in systemic management of atherosclerosis and interventional management of limb ischemia over the past 2 decades, we examined whether these outcomes have changed in patients with CLI without revascularization options (no option-critical limb ischemia [NO-CLI]). We reviewed the literature for published 1-year AFS, mortality, and amputation rates from control groups in NO-CLI trials. Summary proportions of events were estimated by conducting a random effects meta-analysis of proportions. To determine whether there had been any change in event rates over time, we performed a random effects meta-regression and a mixed effects logistic regression, both regressed against the variable "final year of recruitment." Eleven trials consisting of 886 patients satisfied search criteria, 7 of which presented AFS data. Summary proportion of events (95% confidence interval) were 0.551 (0.399 to 0.693) for AFS; 0.198 (0.116 to 0.317) for death; and 0.341 (0.209 to 0.487) for amputation. Regression analyses demonstrated that AFS has risen over time as mortality rates have fallen, and these improvements are statistically significant. The decrease in amputation rates failed to reach statistical significance. The lack of published data precluded a quantitative evaluation of any change in the clinical severity or comorbidities in the NO-CLI population. AFS and mortality rates in NO-CLI have improved over the past 2 decades. Due to declining event rates, clinical trials may underestimate treatment effects and thus fail to reach statistical significance unless sample sizes are increased or unless a subgroup with a higher event rate can be identified. Alternatively, comparing outcomes to historical values for quality measurement may overestimate treatment effects. Benchmark values of AFS and morality require periodic review and updating. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Gender related Long-term Differences after Open Infrainguinal Surgery for Critical Limb Ischemia.

PubMed

Lejay, A; Schaeffer, M; Georg, Y; Lucereau, B; Roussin, M; Girsowicz, E; Delay, C; Schwein, A; Thaveau, F; Geny, B; Chakfe, N

2015-10-01

The role of gender on long-term infrainguinal open surgery outcomes still remains uncertain in critical limb ischemia patients. The aim of this study is to evaluate the gender-specific differences in patient characteristics and long-term clinical outcomes in terms of survival, primary patency and limb salvage among patients undergoing infrainguinal open surgery for CLI. All consecutive patients undergoing infrainguinal open surgery for critical limb ischemia between 2003 and 2012 were included. Survival, limb salvage and primary patency rates were assessed. Independent outcome determinants were identified by the Cox proportional hazard ratio using age and gender as adjustment factors. 584 patients (269 women and 315 men, mean age 76 and 71 years respectively) underwent 658 infrainguinal open surgery (313 in women and 345 in men). Survival rate at 6 years was lower among women compared to men with 53.5% vs 70.9% (p < 0.001). The same applied to primary patency (35.9% vs 52.4%, p < 0.001) and limb salvage (54.3% vs 81.1%, p < 0.001) at 6 years. Female-gender was an independent factor predicting death (hazard ratio 1.50), thrombosis (hazard ratio 2.37) and limb loss (hazard ratio 7.05) in age and gender-adjusted analysis. Gender-related disparity in critical limb ischemia open surgical revascularization outcomes still remains. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Implications of contact metamorphism of Mancos Shale for critical zone processes

NASA Astrophysics Data System (ADS)

Navarre-Sitchler, A.

2016-12-01

Bedrock lithology imparts control on some critical zone processes, for example rates and extent of chemical weathering, solute release though mineral dissolution, and water flow. Bedrock can be very heterogeneous resulting in spatial variability of these processes throughout a catchment. In the East River watershed outside of Crested Butte, Colorado, bedrock is dominantly comprised of the Mancos Shale; a Cretaceous aged, organic carbon rich marine shale. However, in some areas the Mancos Shale appears contact metamorphosed by nearby igneous intrusions resulting in a potential gradient in lithologic change in part of the watershed where impacts of lithology on critical zone processes can be evaluated. Samples were collected in the East River valley along a transect from the contact between the Tertiary Gothic Mountain laccolith of the Mount Carbon igneous system and the underlying Manocs shale. Porosity of these samples was analyzed by small-angle and ultra small-angle neutron scattering. Results indicate contact metamorphism decreases porosity of the shale and changes the pore shape from slightly anisotropic pores aligned with bedding in the unmetamorphosed shale to isotropic pores with no bedding alignment in the metamorphosed shales. The porosity analysis combined with clay mineralogy, surface area, carbon content and oxidation state, and solute release rates determined from column experiments will be used to develop a full understanding of the impact of contact metamorphism on critical zone processes in the East River.

A Comprehensive Analysis of the Current Status and Unmet Needs in Kidney Transplantation in Southeast Asia

PubMed Central

Chan-on, Chitranon; Sarwal, Minnie M.

2017-01-01

To address the unmet needs in the face of a growing demand for end-stage renal failure management and kidney transplantation in Asia, we have conducted a critical analysis of published literature and national registries to evaluate clinical outcomes and the rates of organ donation in Southeast Asia and the challenges facing these regions with regards to regulation, choice of donor source, and funding. Based on the available data, suggestions are proposed for an advancement of rates of organ donation and access, with emphasis on improved regulation and public education. PMID:28691007

The Impact of Telemedicine on Pediatric Critical Care Triage.

PubMed

Harvey, Jillian B; Yeager, Brooke E; Cramer, Christina; Wheeler, David; McSwain, S David

2017-11-01

To examine the relationship between pediatric critical care telemedicine consultation to rural emergency departments and triage decisions. We compare the triage location and provider rating of the accuracy of remote assessment for a cohort of patients who receive critical care telemedicine consultations and a similar group of patients receiving telephone consultations. Retrospective evaluation of consultations occurring between April 2012 and March 2016. Pediatric critical care telemedicine and telephone consultations in 52 rural healthcare settings in South Carolina. Pediatric patients receiving critical care telemedicine or telephone consultations. Telemedicine consultations. Data were collected from the consulting provider for 484 total consultations by telephone or telemedicine. We examined the providers' self-reported assessments about the consultation, decision-making, and triage outcomes. We estimate a logit model to predict triage location as a function of telemedicine consult age and sex. For telemedicine patients, the odds of triage to a non-ICU level of care are 2.55 times larger than the odds for patients receiving telephone consultations (p = 0.0005). Providers rated the accuracy of their assessments higher when consultations were provided via telemedicine. When patients were transferred to a non-ICU location following a telemedicine consultation, providers indicated that the use of telemedicine influenced the triage decision in 95.7% of cases (p < 0.001). For patients transferred to a non-ICU location, an increase in transfers to a higher level of care within 24 hours was not observed. Pediatric critical care telemedicine consultation to community hospitals is feasible and results in a reduction in PICU admissions. This study demonstrates an improvement in provider-reported accuracy of patient assessment via telemedicine compared with telephone, which may produce a higher comfort level with transporting patients to a lower level of care. Pediatric critical care telemedicine consultations represent a promising means of improving care and reducing costs for critically ill children in rural areas.

Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infection rates in critically ill patients.

PubMed

Martínez-Reséndez, Michel Fernando; Garza-González, Elvira; Mendoza-Olazaran, Soraya; Herrera-Guerra, Alexis; Rodríguez-López, Juan Manuel; Pérez-Rodriguez, Edelmiro; Mercado-Longoria, Roberto; Camacho-Ortiz, Adrián

2014-07-01

Up to 25% of all nosocomial infections (NIs) develop in critically ill patients. Our objective was to evaluate chlorhexidine (CHX) bathing and hand hygiene (HH) compliance in the reduction of NIs in the intensive care unit. The study comprised three 6-month periods: preintervention (PIP; soap/water bathing), intervention (IP; bathing with CHX-impregnated wipes), and postintervention (PoIP; soap/water bathing). An HH program was implemented during the IP and PoIP. Primary outcomes were global and specific NI rates. A total of 1007 patients were included. Infection rates per 100 discharges were higher in the PIP compared with the IP and also higher in the PoIP compared with the IP (P = .0004 and .0109, respectively). Global infection rates per 1000 hospital-days were higher in the PIP than in the IP (P = .0268). The rates of ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI) were higher in the PIP than in the IP (P = .036 and .0001, respectively). Isolation of Acinetobacter baumannii from VAP specimens (P = .0204) and isolation of Candida spp from CAUTI specimens (P = .0005) decreased as well. The combined intervention reduced global and specific infection rates, including rates of VAP associated with A baumannii and CAUTI associated with Candida spp. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Job Analysis and Student Assessment Tool: Perfusion Education Clinical Preceptor

PubMed Central

Riley, Jeffrey B.

2007-01-01

Abstract: The perfusion education system centers on the cardiac surgery operating room and the perfusionist teacher who serves as a preceptor for the perfusion student. One method to improve the quality of perfusion education is to create a valid method for perfusion students to give feedback to clinical teachers. The preceptor job analysis consisted of a literature review and interviews with preceptors to list their critical tasks, critical incidents, and cognitive and behavioral competencies. Behaviorally anchored rating traits associated with the preceptors’ tasks were identified. Students voted to validate the instrument items. The perfusion instructor rating instrument with a 0–4, “very weak” to “very strong” Likert rating scale was used. The five preceptor traits for student evaluation of clinical instruction (SECI) are as follows: The clinical instructor (1) encourages self-learning, (2) encourages clinical reasoning, (3) meets student’s learning needs, (4) gives continuous feedback, and (5) represents a good role model. Scores from 430 student–preceptor relationships for 28 students rotating at 24 affiliate institutions with 134 clinical instructors were evaluated. The mean overall good preceptor average (GPA) was 3.45 ± 0.76 and was skewed to the left, ranging from 0.0 to 4.0 (median = 3.8). Only 21 of the SECI relationships earned a GPA <2.0. Analyzing the role of the clinical instructor and performing SECI are methods to provide valid information to improve the quality of a perfusion education program. PMID:17972453

A compliance assessment of midpoint formative assessments completed by APPE preceptors.

PubMed

Lea Bonner, C; Staton, April G; Naro, Patricia B; McCullough, Elizabeth; Lynn Stevenson, T; Williamson, Margaret; Sheffield, Melody C; Miller, Mindi; Fetterman, James W; Fan, Shirley; Momary, Kathryn M

Experiential pharmacy preceptors should provide formative and summative feedback during a learning experience. Preceptors are required to provide colleges and schools of pharmacy with assessments or evaluations of students' performance. Students and experiential programs value on-time completion of midpoint evaluations by preceptors. The objective of this study was to determine the number of on-time electronically documented formative midpoint evaluations completed by preceptors during advanced pharmacy practice experiences (APPEs). Compliance rates of on-time electronically documented formative midpoint evaluations were reviewed by the Office of Experiential Education of a five-member consortium during the two-year study period prior to the adoption of Standards 2016. Pearson chi-square test and generalized linear models were used to determine if statistically significant differences were present. Average midpoint compliance rates for the two-year research period were 40.7% and 41% respectively. No statistical significance was noted comparing compliance rates for year one versus year two. However, statistical significance was present when comparing compliance rates between schools during year two. Feedback from students and preceptors pointed to the need for brief formal midpoint evaluations that require minimal time to complete, user friendly experiential management software, and methods for documenting verbal feedback through student self-reflection. Additional education and training to both affiliate and faculty preceptors on the importance of written formative feedback at midpoint is critical to remaining in compliance with Standards 2016. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of measurement properties of self-administered PROMs aimed at patients with non-specific shoulder pain and "activity limitations": a systematic review.

PubMed

Thoomes-de Graaf, M; Scholten-Peeters, G G M; Schellingerhout, J M; Bourne, A M; Buchbinder, R; Koehorst, M; Terwee, C B; Verhagen, A P

2016-09-01

To critically appraise and compare the measurement properties of self-administered patient-reported outcome measures (PROMs) focussing on the shoulder, assessing "activity limitations." Systematic review. The study population had to consist of patients with shoulder pain. We excluded postoperative patients or patients with generic diseases. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using the COSMIN checklist. Out of a total of 3427 unique hits, 31 articles, evaluating 7 different questionnaires, were included. The SPADI is the most frequently evaluated PROM and its measurement properties seem adequate apart from a lack of information regarding its measurement error and content validity. For English, Norwegian and Turkish users, we recommend to use the SPADI. Dutch users could use either the SDQ or the SST. In German, we recommend the DASH. In Tamil, Slovene, Spanish and the Danish languages, the evaluated PROMs were not yet of acceptable validity. None of these PROMs showed strong positive evidence for all measurement properties. We propose to develop a new shoulder PROM focused on activity limitations, taking new knowledge and techniques into account.

How few and far between? Examining the effects of probe rate on self-reported mind wandering

PubMed Central

Seli, Paul; Carriere, Jonathan S. A.; Levene, Merrick; Smilek, Daniel

2013-01-01

We examined whether the temporal rate at which thought probes are presented affects the likelihood that people will report periods of mind wandering. To evaluate this possibility, we had participants complete a sustained-attention task (the Metronome Response Task; MRT) during which we intermittently presented thought probes. Critically, we varied the average time between probes (i.e., probe rate) across participants, allowing us to examine the relation between probe rate and mind-wandering rate. We observed a positive relation between these variables, indicating that people are more likely to report mind wandering as the time between probes increases. We discuss the methodological implications of this finding in the context of the mind-wandering literature, and suggest that researchers include a range of probe rates in future work to provide more insight into this methodological issue. PMID:23882239

Lessons learnt from the Wenchuan earthquake: performance evaluation of treatment of critical injuries in hardest-hit areas.

PubMed

Jiang, Jie; Li, Youping; Huang, Xiaolin; Li, Bing; Su, Lin; Zhong, Dake; Shi, Chenghu; Li, Mingxu; Shan, Juan; Chen, Yin

2012-08-01

Critical injury treatment in the hardest-hit areas after a great earthquake was retrospectively analyzed to determine how best to reduce mortality and disability and increase the rehabilitation rate through postquake medical relief. Retrospective analysis, primary sources, and secondary sources were comprehensively retrieved and analyzed. According to incomplete data, 30,620 injured were rescued by themselves among the hardest-hit areas in the 72 hours immediately following the earthquake. Critically injured patients accounted for 22% of total inpatients. Mortality rates declined with greater distance from the epicenter: rates were 12.21% for municipal healthcare centers in the hardest-hit areas, 4.50% for municipal medical units in peripheral quake-hit areas, 2.50% for provincial medical units in peripheral quake-hit areas, and 2.17% for Ministry of Health-affiliated hospitals in peripheral quake-hit areas. The number of injured with fractures on body, limbs or unknown-parts, severe conditions as well as other kinds of non-traumatic diseases received in second-line hospitals was much more than those treated in first-line hospitals with more severe injuries. Among 10,373 injured in stable condition transferred to third-line hospitals, 99.07% were discharged from hospitals within four months, while the mortality rate was 0.017%. The medical relief model of "supervising body helping subordinate unit, severely stricken areas assisting hardest-hit areas, least-hit areas supporting both hardest-hit and severely stricken areas, and self help and mutual assistance applied between hardest-hit areas" was roughly established for injured from severely stricken areas after the Wenchuan Earthquake. The "four-centralization" treatment principle, which referred to concentrating patients, experts, resources and treatment for those injured in critical condition effectively reduced the mortality from 15.06% to 2.9%. Timely, scientific, and standard on-site triage and postmedical transfer guided by accurate injury information determine rescue effect for the injured, while there is large space to fulfill as for treatment for critical diseases among the hardest-hit areas under extreme conditions after the Wenchuan earthquake. © 2012 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

A nurse-led intensive care after-care programme - development, experiences and preliminary evaluation.

PubMed

Samuelson, Karin A M; Corrigan, Ingrid

2009-01-01

The benefits of critical care follow-up services include increased understanding of the long-term consequences of intensive care and entail helping patients and their next of kin to come to terms with their problems and distress following critical illness and intensive care treatment. To establish an intensive care after-care programme and to conduct a preliminary evaluation of the follow-up service from the patients' and relatives' perspectives in a general intensive care unit (ICU) in Sweden. A descriptive and evaluative design was used, and data from the first year of the after-care programme were collected. The final programme was nurse led and included five main points; a patient diary with colour photographs, ward visits, a patient information pamphlet, a follow-up consultation 2-3 months after intensive care discharge and feedback to the ICU staff. An evaluation questionnaire was handed out to patients and next of kin attending the follow-up clinic, e.g. asking the respondents to rate their satisfaction of the consultation on a visual analogue scale (VAS). The first year of after-care statistics showed that 170 survivors with a stay of 48 h or more were discharged from the ICU, resulting in 190 ward visits and 79 follow-up consultations. The preliminary evaluation revealed that the 2-month follow-up consultation achieved a median VAS rating of 9.8 (ranging from 1 to 10, poor to excellent) from both patients and next of kin. The development and preliminary evaluation of this nurse-led intensive care programme resulted in a feasible programme, requiring modest resources, with a high level of patient and relative satisfaction. This paper attempts to share with professional colleagues important steps during the developmental process of establishing an intensive care follow-up service and presents the content and preliminary evaluation of a nurse-led intensive care after-care programme focusing on the patients' and relatives' perspectives.

Critical region within 22q11.2 linked to higher rate of autism spectrum disorder.

PubMed

Clements, Caitlin C; Wenger, Tara L; Zoltowski, Alisa R; Bertollo, Jennifer R; Miller, Judith S; de Marchena, Ashley B; Mitteer, Lauren M; Carey, John C; Yerys, Benjamin E; Zackai, Elaine H; Emanuel, Beverly S; McDonald-McGinn, Donna M; Schultz, Robert T

2017-01-01

Previous studies have reported no clear critical region for medical comorbidities in children with deletions or duplications of 22q11.2. The purpose of this study was to evaluate whether individuals with small nested deletions or duplications of the LCR-A to B region of 22q11.2 show an elevated rate of autism spectrum disorder (ASD) compared to individuals with deletions or duplications that do not include this region. We recruited 46 patients with nested deletions ( n  = 33) or duplications ( n  = 13) of 22q11.2, including LCR-A to B ( n del  = 11), LCR-A to C ( n del  = 4), LCR-B to D ( n del  = 14; n dup  = 8), LCR-C to D ( n del  = 4; n dup  = 2), and smaller nested regions ( n  = 3). Parent questionnaire, record review, and, for a subset, in-person evaluation were used for ASD diagnostic classification. Rates of ASD in individuals with involvement of LCR-B to LCR-D were compared with Fisher's exact test to LCR-A to LCR-B for deletions, and to a previously published sample of LCR-A to LCR-D for duplications. The rates of medical comorbidities and psychiatric diagnoses were determined from questionnaires and chart review. We also report group mean differences on psychiatric questionnaires. Individuals with deletions involving LCR-A to B showed a 39-44% rate of ASD compared to 0% in individuals whose deletions did not involve LCR-A to B. We observed similar rates of medical comorbidities in individuals with involvement of LCR-A to B and LCR-B to D for both duplications and deletions, consistent with prior studies. Children with nested deletions of 22q11.2 may be at greater risk for autism spectrum disorder if the region includes LCR-A to LCR-B. Replication is needed.

Teaching clinical research methodology to the academic medical community: a fifteen-year retrospective of a comprehensive curriculum.

PubMed

Supino, Phyllis G; Borer, Jeffrey S

2007-05-01

Due to inadequate preparation, many medical professionals are unable to critically evaluate published research articles or properly design, execute and present their own research. To increase exposure among physicians, medical students, and allied health professionals to diverse methodological issues involved in performing research. A comprehensive course on research methodology was newly designed for physicians and other members of an academic medical community, and has been successfully implemented beginning 1991. The role of the study hypothesis is highlighted; interactive pedagogical techniques are employed to promote audience engagement. Participants complete an annual evaluation to assess course quality and perceived outcomes. Outcomes also are assessed qualitatively by faculty. More than 500 physicians/other professionals have participated. Ratings have been consistently high. Topics deemed most valuable are investigational planning, hypothesis construction and study designs. An enhancement of capacity to define hypotheses and apply methodological concepts in the criticism of scientific papers and development of protocols/manuscripts has been observed. Participants and faculty believe the course improves critical appraisal skills and ability to conduct research. Our experience shows it is feasible to accomplish these objectives, with a high level of satisfaction, through a didactic program targeted to the general academic community.

Banking: shop and compare.

PubMed

O'Brien, Jennifer A; DeJarnette, Sherry

2014-01-01

There are many reasons to take a critical look at the practice's banking relationship(s)--technology advancements, security measures, improvements in available services, recent banking enhancements designed specifically for medical practices, the impact of the financial crisis on bank ratings and stability, changing practice needs, opportunities for operational automation at the practice--and it is just simply smart to periodically evaluate and compare the features, pricing, and potential savings offered by vendors.

Evaluation of Alternative Means of Implementing Section 1362 of the National Flood Insurance Act of 1968.

DTIC Science & Technology

1981-03-01

Near the Regulated Floodplain. Research paper submitted in partial fulfillment of the requirements for the deuree of Master of Science , Dept. of...discretionary funds, and private corporations and foundations . 17. Soldiers Grove, Wisconsin. The city has begun to acquire its central business...for single-farily homes) * Data on Federal Disaster relief expenditures analyzed for this study ** Estimated average acturial rate of critical

Evaluating the Impact of Disseminating of Information in Learners on Fighting Corruption in Kenya through a Kiswahili Set Book Mstahiki Meya

ERIC Educational Resources Information Center

Kuyuni, Stephen Muhala

2017-01-01

Corruption has been a worldwide issue in the contemporary world today. Many parts the world including Kenya is affected by corruption. Many writers and critics have shown that it's spreading at a very high rate just like HIV/AIDS and environmental degradation. They have noted that corruption is caused by the following factors: poor governance,…

The competence and the cooperation of nurse educators.

PubMed

Salminen, Leena; Minna, Stolt; Sanna, Koskinen; Jouko, Katajisto; Helena, Leino-Kilpi

2013-11-01

The competence of nurse educators and cooperation between nurse educators and nurse leaders and mentors are important in terms of producing high-quality and evidence-based nursing education. The purpose of this study was to assess the competence of nurse educators based on their own evaluations as well as those of nursing students, educational administrators, nurse leaders and nurse mentors and to describe the cooperation between educators and educational administrators, nurse leaders and nurse mentors. A descriptive, cross-sectional survey design was used. The research was conducted in educational and clinical nursing settings. The nurse educators, students and educational administrators were from polytechnics offering degree programs in nursing, public health nursing, emergency nursing and midwifery. The nurse leaders represented special health care and primary health care. The nurse mentors were nurses working in the medical wards of the university hospitals. The data were collected via email using a structured questionnaire (A Tool for Evaluation of Requirements of Nurse Teacher). In total 689 responses were received from nurse educators (n=342), nursing students (n=202), educational administrators (n=17), nurse leaders (n=64) and nurse mentors (n=64). The results show that nurse educators rated their competence as being very good. Nursing students and nurse mentors were the most critical in their evaluations. The cooperation between nurse educators and educational administrators and nurse leaders was rated as good but nurse mentors were quite critical. To maintain and improve the competence and cooperation of nurse educators, interventions are needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

A comparative evaluation of in-vehicle side view displays layouts in critical lane changing situation.

PubMed

Beck, Donghyun; Lee, Minho; Park, Woojin

2017-12-01

This study conducted a driving simulator experiment to comparatively evaluate three in-vehicle side view displays layouts for camera monitor systems (CMS) and the traditional side view mirror arrangement. The three layouts placed two electronic side view displays near the traditional mirrors positions, on the dashboard at each side of the steering wheel and on the centre fascia with the two displays joined side-by-side, respectively. Twenty-two participants performed a time- and safety-critical driving task that required rapidly gaining situation awareness through the side view displays/mirrors and making a lane change to avoid collision. The dependent variables were eye-off-the-road time, response time, and, ratings of perceived workload, preference and perceived safety. Overall, the layout placing the side view displays on the dashboard at each side of the steering wheel was found to be the best. The results indicated that reducing eye gaze travel distance and maintaining compatibility were both important for the design of CMS displays layout. Practitioner Summary: A driving simulator study was conducted to comparatively evaluate three in-vehicle side view displays layouts for camera monitor systems (CMS) and the traditional side view mirror arrangement in critical lane changing situation. Reducing eye movement and maintaining compatibility were found to be both important for the ergonomics design of CMS displays layout.

Oxygen dependence of respiration in rat spinotrapezius muscle in situ

PubMed Central

Pittman, Roland N.

2012-01-01

The oxygen dependence of respiration in striated muscle in situ was studied by measuring the rate of decrease of interstitial Po2 [oxygen disappearance curve (ODC)] following rapid arrest of blood flow by pneumatic tissue compression, which ejected red blood cells from the muscle vessels and made the ODC independent from oxygen bound to hemoglobin. After the contribution of photo-consumption of oxygen by the method was evaluated and accounted for, the corrected ODCs were converted into the Po2 dependence of oxygen consumption, V̇o2, proportional to the rate of Po2 decrease. Fitting equations obtained from a model of heterogeneous intracellular Po2 were applied to recover the parameters describing respiration in muscle fibers, with a predicted sigmoidal shape for the dependence of V̇o2 on Po2. This curve consists of two regions connected by the point for critical Po2 of the cell (i.e., Po2 at the sarcolemma when the center of the cell becomes anoxic). The critical Po2 was below the Po2 for half-maximal respiratory rate (P50) for the cells. In six muscles at rest, the rate of oxygen consumption was 139 ± 6 nl O2/cm3·s and mitochondrial P50 was k = 10.5 ± 0.8 mmHg. The range of Po2 values inside the muscle fibers was found to be 4–5 mmHg at the critical Po2. The oxygen dependence of respiration can be studied in thin muscles under different experimental conditions. In resting muscle, the critical Po2 was substantially lower than the interstitial Po2 of 53 ± 2 mmHg, a finding that indicates that V̇o2 under this circumstance is independent of oxygen supply and is discordant with the conventional hypothesis of metabolic regulation of the oxygen supply to tissue. PMID:22523254

Columnar joint morphology and cooling rate: A starch-water mixture experiment

NASA Astrophysics Data System (ADS)

Toramaru, A.; Matsumoto, T.

2004-02-01

An analogue experiment using a starch-water mixture has been carried out in order to understand the effect of cooling rate on the morphological characteristics of a basalt columnar joint. If the contraction of material is essential for the formation of columnar joint structure, the water loss rate by desiccation (hereafter referred to as desiccation rate) in the experiment is analogous to the cooling rate in solidifying basalt. In the experiment the desiccation rate is controlled by varying the distance between the starch-water mixture and a lamp used as the heat source. We find that there are three regimes in the relation between joint formation and desiccation rate: (1) At desiccation rates higher than ˜1.4 × 10-2 (g cm-2 h-1) (normal columnar joint regime), the average cross-sectional area S of a column is inversely proportional to the average desiccation rate, (i.e., S ∝ -δ, with δ = 1). (2) Between that desiccation rate and a critical desiccation rate, 0.8 × 10-2 (g/cm2h), S approaches infinity as decreases close to a critical desiccation rate (i.e., exponent δ monotonically increases from unity to infinity) (critical regime). (3) Below the critical desiccation rate, no columnar structure forms (no columnar joint regime forms). Applying the present experimental result to the formation of basalt column, the basalt columnar cross-sectional area is inversely proportional to the cooling rate with factors including elasticity, crack growth coefficient, thermal expansion, glass transition temperature, and crack density ratio at stress maximum. Also, it can be predicted that there exists a critical cooling rate below which the columnar joint does not form; the presence of a critical regime between the normal columnar jointing and no columnar jointing during a certain cooling rate range can also be predicted. We find that at higher cooling rate the preferred column shape is a pentagon, whereas at lower cooling rate it is a hexagon.

Critical values in hematology of 862 institutions in China.

PubMed

Ye, Y Y; Zhao, H J; Fei, Y; Wang, W; He, F L; Zhong, K; Yuan, S; Wang, Z G

2017-10-01

A national survey on critical values in hematology of China laboratories was conducted to determine the current practice and assess the quality indicators so as to obtain a quality improvement. Laboratories participating were asked to submit the general information, the practice of critical value reporting, and the status of timeliness of critical value reporting. A total of 862 laboratories submitted the results. The majority of participants have included white blood cell count, blood platelet count, hemoglobin, prothrombin time, and activated partial thromboplastin time in their critical value lists. Many sources are used for establishing a critical value policy, and some of the laboratories consult with clinicians. The unreported critical value rate, late critical value reporting rate, and clinically unacknowledged rate in China are relatively low, and the median of critical value reporting time is 8-9 minutes. There exists a wide variety for critical value reporting in hematology in China. Laboratories should establish a policy of critical value reporting suited for their own situations and consult with clinicians to set critical value lists. Critical values are generally reported in a timely manner in China, but some measures should be taken to further improve the timeliness of critical value reporting. © 2017 John Wiley & Sons Ltd.

Evaluation and management of bradycardia in neonates and children.

PubMed

Baruteau, Alban-Elouen; Perry, James C; Sanatani, Shubhayan; Horie, Minoru; Dubin, Anne M

2016-02-01

Heart rate is commonly used in pediatric early warning scores. Age-related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiogram features that differ from adults and vary with age. Bradycardia is defined as a heart rate below the lowest normal value for age. Pediatric bradycardia most commonly manifests as sinus bradycardia, junctional bradycardia, or atrioventricular block. As a result of several different etiologies, it may occur in an entirely structurally normal heart or in association with concomitant congenital heart disease. Genetic variants in multiple genes have been described to date in the pathogenesis of inherited sinus node dysfunction or progressive cardiac conduction disorders. Management and eventual prognosis of bradycardia in the young are entirely dependent upon the underlying cause. Reasons to intervene for bradycardia are the association of related symptoms and/or the downstream risk of heart failure or pause-dependent tachyarrhythmia. The simplest aspect of severe bradycardia management is reflected in the Pediatric and Advanced Life Support (PALS) guidelines. Early diagnosis and appropriate management are critical in many cases in order to prevent sudden death, and this review critically assesses our current practice for evaluation and management of bradycardia in neonates and children. Bradycardia is defined as a heart rate below the lowest normal value for age. Age related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiogram features that differ from adults and vary with age. Pediatric bradycardia most commonly manifests as sinus bradycardia, junctional bradycardia, or atrioventricular block. Management and eventual prognosis of bradycardia in the young are entirely dependent upon the underlying cause. Bradycardia may occur in a structurally normal heart or in association with congenital heart disease. Genetic variants in multiple genes have been described. Reasons to intervene for bradycardia are the association of related symptoms and/or the downstream risk of heart failure or pause-dependent tachyarrhythmia. Early diagnosis and appropriate management are critical in order to prevent sudden death.

Reliability and availability analysis of a 10 kW@20 K helium refrigerator

NASA Astrophysics Data System (ADS)

Li, J.; Xiong, L. Y.; Liu, L. Q.; Wang, H. R.; Wang, B. M.

2017-02-01

A 10 kW@20 K helium refrigerator has been established in the Technical Institute of Physics and Chemistry, Chinese Academy of Sciences. To evaluate and improve this refrigerator’s reliability and availability, a reliability and availability analysis is performed. According to the mission profile of this refrigerator, a functional analysis is performed. The failure data of the refrigerator components are collected and failure rate distributions are fitted by software Weibull++ V10.0. A Failure Modes, Effects & Criticality Analysis (FMECA) is performed and the critical components with higher risks are pointed out. Software BlockSim V9.0 is used to calculate the reliability and the availability of this refrigerator. The result indicates that compressors, turbine and vacuum pump are the critical components and the key units of this refrigerator. The mitigation actions with respect to design, testing, maintenance and operation are proposed to decrease those major and medium risks.

National survey on current situation of critical value reporting in 973 laboratories in China.

PubMed

Fei, Yang; Zhao, Haijian; Wang, Wei; He, Falin; Zhong, Kun; Yuan, Shuai; Wang, Zhiguo

2017-10-15

The aim of the study was to investigate the state-of-the-art of the performance of critical value reporting and provide recommendations for laboratories setting critical value reporting time frames. The National Centre for Clinical Laboratories in China initiated a critical value reporting investigation in 2015. A questionnaire related to critical value reporting policy was sent to 1589 clinical laboratories in China online. The questionnaire consisted of a set of questions related to critical value reporting policy and a set of questions related to timeliness of critical value reporting. The survey data were collected between March and April 2015. A total survey response rate was 61.2%. The critical value unreported rate, unreported timely rate, and clinical unacknowledged rate of more than half of participants were all 0.0%. More than 75.0% of participants could report half of critical values to clinicians within 20 minutes and could report 90.0% of critical values to clinicians within 25 minutes (from result validation to result communication to the clinician). The median of target critical value reporting time was 15 minutes. "Reporting omission caused by laboratory staff", "communications equipment failure to connect", and "uncompleted application form without contact information of clinician" were the three major reasons for unreported critical value. The majority of laboratories can report critical values to responsible clinical staff within 25 minutes. Thus, this value could be recommended as suitable critical value reporting time frame for biochemistry laboratories in China. However, careful monitoring of the complete reporting process and improvement of information systems should ensure further improvement of critical value reporting timeliness.

A study of malware detection on smart mobile devices

NASA Astrophysics Data System (ADS)

Yu, Wei; Zhang, Hanlin; Xu, Guobin

2013-05-01

The growing in use of smart mobile devices for everyday applications has stimulated the spread of mobile malware, especially on popular mobile platforms. As a consequence, malware detection becomes ever more critical in sustaining the mobile market and providing a better user experience. In this paper, we review the existing malware and detection schemes. Using real-world malware samples with known signatures, we evaluate four popular commercial anti-virus tools and our data shows that these tools can achieve high detection accuracy. To deal with the new malware with unknown signatures, we study the anomaly based detection using decision tree algorithm. We evaluate the effectiveness of our detection scheme using malware and legitimate software samples. Our data shows that the detection scheme using decision tree can achieve a detection rate up to 90% and a false positive rate as low as 10%.

Fast frame rate rodent cardiac x-ray imaging using scintillator lens coupled to CMOS camera

NASA Astrophysics Data System (ADS)

Swathi Lakshmi, B.; Sai Varsha, M. K. N.; Kumar, N. Ashwin; Dixit, Madhulika; Krishnamurthi, Ganapathy

2017-03-01

Micro-Computed Tomography (MCT) systems for small animal imaging plays a critical role for monitoring disease progression and therapy evaluation. In this work, an in-house built micro-CT system equipped with a X-ray scintillator lens coupled to a commercial CMOS camera was used to test the feasibility of its application to Digital Subtraction Angiography (DSA). Literature has reported such studies being done with clinical X-ray tubes that can be pulsed rapidly or with rotating gantry systems, thus increasing the cost and infrastructural requirements.The feasibility of DSA was evaluated by injected Iodinated contrast agent (ICA) through the tail vein of a mouse. Projection images of the heart were acquired pre and post contrast using the high frame rate X-ray detector and processing done to visualize transit of ICA through the heart.

Evaluating the impact of an educational intervention to increase CRC screening rates in the African American community: a preliminary study.

PubMed

Philip, Errol J; DuHamel, Katherine; Jandorf, Lina

2010-10-01

Despite the acknowledged importance of colorectal cancer (CRC) screening and its proven prognostic benefit, African American men and women simultaneously possess the highest rates of CRC-related incidence and mortality (Swan et al. in Cancer 97(6):1528-1540, 2003) and lowest screening rates in the United States (Polite et al. in Med Clin N Am 89(4):771-793, 2005). Effective, targeted interventions that promote CRC screening for this community are therefore critical. The current study evaluated the impact of a print-based educational intervention on screening behavior and associated patient-based factors, including cancer-related knowledge, fatalism, worry, and decisional balance (pros-cons). One hundred and eighteen individuals (mean age = 56.08, SD = 5.58) who had not undergone screening were recruited from two health clinics in New York City. Each participant received educational print materials regarding the need for screening, the process of undergoing screening, and the benefits of regular CRC screening. One in four individuals had undergone post-intervention screening at a three-month follow-up. Whereas all participants reported a decrease in cancer-related worry (p < .05), it was a decrease in fatalism (p < .05) and an increase in decisional balance (p < .05) that was associated with post-intervention screening behavior. These preliminary results suggest that fatalistic beliefs and an individual's assessment of the benefits and barriers of screening may be critical in the decision to undergo CRC screening. Future interventions to increase CRC-screening rates for this community may be improved by focusing on these patient-based factors.

Nuclear relaxation and critical fluctuations in membranes containing cholesterol

NASA Astrophysics Data System (ADS)

McConnell, Harden

2009-04-01

Nuclear resonance frequencies in bilayer membranes depend on lipid composition. Our calculations describe the combined effects of composition fluctuations and diffusion on nuclear relaxation near a miscibility critical point. Both tracer and gradient diffusion are included. The calculations involve correlation functions and a correlation length ξ =ξ0T/(T -Tc), where T -Tc is temperature above the critical temperature and ξ0 is a parameter of molecular length. Several correlation functions are examined, each of which is related in some degree to the Ising model correlation function. These correlation functions are used in the calculation of transverse deuterium relaxation rates in magic angle spinning and quadrupole echo experiments. The calculations are compared with experiments that report maxima in deuterium and proton nuclear relaxation rates at the critical temperature [Veatch et al., Proc. Nat. Acad. Sci. U.S.A. 104, 17650 (2007)]. One Ising-model-related correlation function yields a maximum 1/T2 relaxation rate at the critical temperature for both magic angle spinning and quadrupole echo experiments. The calculated rates at the critical temperature are close to the experimental rates. The rate maxima involve relatively rapid tracer diffusion in a static composition gradient over distances of up to 10-100 nm.

Robust numerical solution of the reservoir routing equation

NASA Astrophysics Data System (ADS)

Fiorentini, Marcello; Orlandini, Stefano

2013-09-01

The robustness of numerical methods for the solution of the reservoir routing equation is evaluated. The methods considered in this study are: (1) the Laurenson-Pilgrim method, (2) the fourth-order Runge-Kutta method, and (3) the fixed order Cash-Karp method. Method (1) is unable to handle nonmonotonic outflow rating curves. Method (2) is found to fail under critical conditions occurring, especially at the end of inflow recession limbs, when large time steps (greater than 12 min in this application) are used. Method (3) is computationally intensive and it does not solve the limitations of method (2). The limitations of method (2) can be efficiently overcome by reducing the time step in the critical phases of the simulation so as to ensure that water level remains inside the domains of the storage function and the outflow rating curve. The incorporation of a simple backstepping procedure implementing this control into the method (2) yields a robust and accurate reservoir routing method that can be safely used in distributed time-continuous catchment models.

Malocclusions and perceptions of attractiveness, intelligence, and personality, and behavioral intentions.

PubMed

Olsen, Jase A; Inglehart, Marita Rohr

2011-11-01

In this study, we explored how others perceive persons with normal occlusion or different malocclusions (open bite, deepbite, underbite, overjet, crowding, and spacing). The objectives were to investigate (1) how occlusion affects others' perceptions of attractiveness, intelligence, and personality, and their desire to interact in personal and professional settings, and (2) whether these assessments are affected by the target person's sex or the respondent's characteristics. Survey data were collected from 889 patients or accompanying adults (46% male, 54% female; age range, 18-90 years) who evaluated target photos that had been manipulated to display either a normal occlusion or 1 of 6 malocclusions. The ratings of attractiveness, intelligence, conscientiousness, agreeableness, and extraversion differed significantly depending on the occlusion status depicted. Persons with normal occlusion were rated as most attractive, intelligent, agreeable, and extraverted, whereas persons with an underbite were rated as least attractive, intelligent, and extraverted. Female targets were rated more positively than male targets. Younger respondents and more educated respondents were more critical in their evaluations than were older and less educated respondents. Occlusion status affects a person's perceptions comprehensively. Subjects with normal occlusion were rated the most positively. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Rating the methodological quality of single-subject designs and n-of-1 trials: introducing the Single-Case Experimental Design (SCED) Scale.

PubMed

Tate, Robyn L; McDonald, Skye; Perdices, Michael; Togher, Leanne; Schultz, Regina; Savage, Sharon

2008-08-01

Rating scales that assess methodological quality of clinical trials provide a means to critically appraise the literature. Scales are currently available to rate randomised and non-randomised controlled trials, but there are none that assess single-subject designs. The Single-Case Experimental Design (SCED) Scale was developed for this purpose and evaluated for reliability. Six clinical researchers who were trained and experienced in rating methodological quality of clinical trials developed the scale and participated in reliability studies. The SCED Scale is an 11-item rating scale for single-subject designs, of which 10 items are used to assess methodological quality and use of statistical analysis. The scale was developed and refined over a 3-year period. Content validity was addressed by identifying items to reduce the main sources of bias in single-case methodology as stipulated by authorities in the field, which were empirically tested against 85 published reports. Inter-rater reliability was assessed using a random sample of 20/312 single-subject reports archived in the Psychological Database of Brain Impairment Treatment Efficacy (PsycBITE). Inter-rater reliability for the total score was excellent, both for individual raters (overall ICC = 0.84; 95% confidence interval 0.73-0.92) and for consensus ratings between pairs of raters (overall ICC = 0.88; 95% confidence interval 0.78-0.95). Item reliability was fair to excellent for consensus ratings between pairs of raters (range k = 0.48 to 1.00). The results were replicated with two independent novice raters who were trained in the use of the scale (ICC = 0.88, 95% confidence interval 0.73-0.95). The SCED Scale thus provides a brief and valid evaluation of methodological quality of single-subject designs, with the total score demonstrating excellent inter-rater reliability using both individual and consensus ratings. Items from the scale can also be used as a checklist in the design, reporting and critical appraisal of single-subject designs, thereby assisting to improve standards of single-case methodology.

Implementation of a critical incident reporting system in a neurosurgical department.

PubMed

Kantelhardt, P; Müller, M; Giese, A; Rohde, V; Kantelhardt, S R

2011-02-01

Critical incident monitoring is an important tool for quality improvement and the maintenance of high safety standards. It was developed for aviation safety and is now widely accepted as a useful tool to reduce medical care-related morbidity and mortality. Despite this widespread acceptance, the literature has no reports on any neurosurgical applications of critical incident monitoring. We describe the introduction of a mono-institutional critical incident reporting system in a neurosurgical department. Furthermore, we have developed a formula to assess possible counterstrategies. All staff members of a neurosurgical department were advised to report critical incidents. The anonymous reporting form contained a box for the description of the incident, several multiple-choice questions on specific risk factors, place and reason for occurrence of the incident, severity of the consequences and suggested counterstrategies. The incident data was entered into an online documentation system (ADKA DokuPik) and evaluated by an external specialist. For data analysis we applied a modified assessment scheme initially designed for flight safety. Data collection was started in September 2008. The average number of reported incidents was 18 per month (currently 216 in total). Most incidents occurred on the neurosurgical ward (64%). Human error was involved in 86% of the reported incidents. The largest group of incidents consisted of medication-related problems. Accordingly, counterstrategies were developed, resulting in a decrease in the relative number of reported medication-related incidents from 42% (March 09) to 30% (September 09). Implementation of the critical incident reporting system presented no technical problems. The reporting rate was high compared to that reported in the current literature. The formulation, evaluation and introduction of specific counterstrategies to guard against selected groups of incidents may improve patient safety in neurosurgical departments. © Georg Thieme Verlag KG Stuttgart · New York.

Heuristic evaluation of infusion pumps: implications for patient safety in Intensive Care Units.

PubMed

Graham, Mark J; Kubose, Tate K; Jordan, Desmond; Zhang, Jiajie; Johnson, Todd R; Patel, Vimla L

2004-11-01

The goal of this research was to use a heuristic evaluation methodology to uncover design and interface deficiencies of infusion pumps that are currently in use in Intensive Care Units (ICUs). Because these infusion systems cannot be readily replaced due to lease agreements and large-scale institutional purchasing procedures, we argue that it is essential to systematically identify the existing usability problems so that the possible causes of errors can be better understood, passed on to the end-users (e.g., critical care nurses), and used to make policy recommendations. Four raters conducted the heuristic evaluation of the three-channel infusion pump interface. Three raters had a cognitive science background as well as experience with the heuristic evaluation methodology. The fourth rater was a veteran critical care nurse who had extensive experience operating the pumps. The usability experts and the domain expert independently evaluated the user interface and physical design of the infusion pump and generated a list of heuristic violations based upon a set of 14 heuristics developed in previous research. The lists were compiled and then rated on the severity of the violation. From 14 usability heuristics considered in this evaluation of the Infusion Pump, there were 231 violations. Two heuristics, "Consistency" and "Language", were found to have the most violations. The one with fewest violations was "Document". While some heuristic evaluation categories had more violations than others, the most severe ones were not confined to one type. The Primary interface location (e.g., where loading the pump, changing doses, and confirming drug settings takes place) had the most occurrences of heuristic violations. We believe that the Heuristic Evaluation methodology provides a simple and cost-effective approach to discovering medical device deficiencies that affect a patient's general well being. While this methodology provides information for the infusion pump designs of the future, it also identifies important insights concerning equipment that is currently in use in critical care environments.

Alumni-based evaluation of a novel veterinary curriculum: are Nottingham graduates prepared for clinical practice?

PubMed Central

Cobb, K. A.; Brown, G. A.; Hammond, R. H.; Mossop, L. H.

2015-01-01

Introduction Outcomes-based education has been the core of the curriculum strategy of the Nottingham School of Veterinary Medicine and Science (SVMS) since its inception in 2006. As part of the ongoing curriculum evaluation, the first two graduating cohorts were invited to provide an appraisal of their preparation by the SVMS curriculum for their role in clinical practice. This paper provides brief accounts of the SVMS curriculum model, the development of the evaluation instrument and the findings of the alumni survey. Materials and Methods The evaluation instrument contained 25 attributes expected of SVMS graduates. Alumni rated their preparation for practice in relation to each attribute. Results The four highest rated characteristics were compassion for animals and the application of ethics to animal welfare; communication skills; recognising own limitations and seeking help and advice where needed and clinical examination skills. The four lowest rated were clinical case management and therapeutic strategies; dealing with veterinary public health and zoonotic issues; knowledge of current veterinary legislation and dealing with emergency and critical care cases. Free text responses were in line with these quantitative findings. Conclusion The results indicate that this sample of SVMS graduates were satisfied with their undergraduate education and felt well prepared for their role in clinical practice. PMID:26392910

Final Technical Report for Award DE-FG02-98ER41080

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

Chen, Alan

The prime motivation of the project at McMaster University was to carry out the critical evaluation and compilation of Nuclear Structure and Decay data, and of nuclear astrophysics data with continued participation in the United States Nuclear Data Program (US-NDP). A large body of evaluated and compiled structure data were supplied for databases such as ENSDF, XUNDL, NSR, etc. residing on webpage of National Nuclear Data Center of the Brookhaven National Laboratory, Upton, New York, USA. Thermonuclear reaction rates of importance to stellar explosions, such as novae, x-ray bursts and supernovae, were evaluated as well. This effort was closely coupledmore » to our ongoing experimental effort, which took advantage of radioactive ion beam and stable beam facilities worldwide to study these key reaction rates. This report contains brief descriptions of the various activities together with references to all the publications in peer-reviewed journals which were the result of work carried out with the award DE-FG02-98-ER41080, during 1998-2013.« less

The effect of fatigue and environment on the adhesion and delamination of thin polymer films

NASA Astrophysics Data System (ADS)

Snodgrass, Jeffrey Matthew

Polymers are increasingly used in the interconnect and packaging levels of microelectronic devices. Thus, adhesion of polymer films to their adjacent inorganic layers is critical to the manufacturability and reliability of microelectronic components. Weak interfacial adhesion can result in delamination, causing a loss of package hermeticity or the failure of electrical contacts. Recently, interface fracture mechanics techniques have been applied to the problem of thin film delamination and are now used to measure interface adhesion. These techniques allow for characterization of interface adhesion in terms of the critical strain energy release rate, GC, in units of J/m2. In this dissertation, studies are described that quantify the effects of fundamental parameters on the critical adhesion and resistance to subcritical (time-dependent) delamination of benzocyclobutene (BCB)/silica and epoxy underfill/polyimide interfaces. Results are presented detailing the action of small-molecule adhesion promoters on the critical interface adhesion energy of BCB/silica. Silane coupling agents with different functional end groups were used to increase chemical bonding at this interface in order to achieve optimized adhesion. Testing was performed at different mode mixities to evaluate the effect of loading mode on the polymer interface fracture. Subcritical debonding data were measured under two different loading conditions and results are presented in terms of the debond growth rate as a function of applied strain energy release rate. Monotonic loading was used to examine environment-assisted delamination processes, while fatigue loading was used to understand the effects of thermomechanical cycling. Debond growth rates over the range of 10-3 to 10-9 m/s were characterized under mode I and mixed-mode loading. Atomic force microscopy and X-ray photoelectron spectroscopy were used to characterize the fracture surfaces of these interfaces and to generate detailed information about the debond fracture path and mechanisms. The AFM and XPS results suggest that the failure mode of BCB/silica interfaces is cohesive in the BCB layer, in a region very close to the interface. Mechanical fatigue was found to considerably accelerate subcritical debond growth rates and decrease debond growth thresholds to as low as 25% of the critical adhesion energy. Fatigue loading produced fatigue striations on the BCB surface with a striation height of ˜1--2 nm and a spacing that was correlated with the debond growth rate. Finally, a model is presented for the mechanism of striation formation.

Is high–dose rate RapidArc-based radiosurgery dosimetrically advantageous for the treatment of intracranial tumors?

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

Zhao, Bo; Yang, Yong, E-mail: yangy2@upmc.edu; Li, Xiang

In linac-based stereotactic radiosurgery (SRS) and radiotherapy (SRT), circular cone(s) or conformal arc(s) are conventionally used to treat intracranial lesions. However, when the target is in close proximity to critical structures, it is frequently quite challenging to generate a quality plan using these techniques. In this study, we investigated the dosimetric characteristics of using high–dose rate RapidArc (RA) technique for radiosurgical treatment of intracranial lesions. A total of 10 intracranial SRS/SRT cases previously planned using dynamic conformal arc (DCA) or cone-based techniques have been included in this study. For each case, 3 treatment plans were generated: (1) a DCA planmore » with multiple noncoplanar arcs, (2) a high–dose rate RA plan with arcs oriented the same as DCA (multiple-arc RA), and 3) a high–dose rate RA plan with a single coplanar arc (single-arc RA). All treatment plans were generated under the same prescription and similar critical structure dose limits. Plan quality for different plans was evaluated by comparing various dosimetric parameters such as target coverage, conformity index (CI), homogeneity index (HI), critical structures, and normal brain tissue doses as well as beam delivery time. With similar critical structure sparing, high–dose rate RA plans can achieve much better target coverage, dose conformity, and dose homogeneity than the DCA plans can. Plan quality indices CI and HI, for the DCA, multiple-arc RA, and single-arc RA techniques, were measured as 1.67 ± 0.39, 1.32 ± 0.28, and 1.38 ± 0.30 and 1.24 ± 0.11, 1.10 ± 0.04, and 1.12 ± 0.07, respectively. Normal brain tissue dose (V{sub 12} {sub Gy}) was found to be similar for DCA and multiple-arc RA plans but much larger for the single-arc RA plans. Beam delivery was similar for DCA and multiple-arc RA plans but shorter with single-arc RA plans. Multiple-arc RA SRS/SRT can provide better treatment plans than conventional DCA plans, especially for complex cases.« less

A critical evaluation of the UK SunSmart campaign and its relevance to Black and minority ethnic communities.

PubMed

Oyebanjo, Evelyn; Bushell, Fiona

2014-05-01

Skin cancer is the most common cancer in the United Kingdom and is rising to epidemic proportions. While the majority of skin cancers are treatable, malignant melanoma kills over 2,000 people in the United Kingdom each year, with all skin cancers killing a total of more than 2,500 people annually. SunSmart, the United Kingdom's major skin cancer public health initiative, was implemented to raise awareness about sun exposure and to promote sun safety behaviours. However, it has failed to curb the incidence and mortality rates. Furthermore, while Australia has the highest skin cancer incidence rates globally, the mortality rates are lower than those in the United Kingdom. There has also been a growing amount of evidence demonstrating ethnic disparities in skin cancer survival rates. Even though incidence rates of skin cancer among Black and minority ethnic (BME) groups are significantly lower, it is often diagnosed late, resulting in higher mortality rates. This, coupled with climate change and the proportion of BME groups expected to rise in the United Kingdom from 8% to 20% by 2051, raises public health concerns. This article aims to critically analyse the UK SunSmart campaign's success in addressing skin cancer in the population and in particular its relevance to BME communities. It also compares this approach with the Australian campaign. This article demonstrates that Australia's campaign has been more successful than the United Kingdom's due to their more comprehensive application of health promotion and public health principles.

Testing of Candidate Icons to Identify Acetaminophen-Containing Medicines

PubMed Central

Shiffman, Saul; Cotton, Helene; Jessurun, Christina; Sembower, Mark A.; Pype, Steve; Phillips, Jerry

2016-01-01

Adding icons on labels of acetaminophen-containing medicines could help users identify the active ingredient and avoid concomitant use of multiple medicines containing acetaminophen. We evaluated five icons for communication effectiveness. Adults (n = 300) were randomized to view a prescription container label or over-the-counter labels with either one or two icons. Participants saw two icon candidates, and reported their interpretation; experts judged whether these reflected critical confusions that might cause harm. Participants rated how effectively each icon communicated key messages. Icons based on abbreviations of “acetaminophen” (“Ac”, “Ace”, “Acm”) were rated less confusing and more effective in communicating the active ingredient than icons based on “APAP” or an abstract symbol. Icons did not result in critical confusion when seen on a readable medicine label. Icon implementation on prescription labels was more effective at communicating the warning against concomitant use than implementation on over-the-counter (OTC) labels. Adding an icon to a second location on OTC labels did not consistently enhance this communication, but reduced rated effectiveness of acetaminophen ingredient communication among participants with limited health literacy. The abbreviation-based icons seem most suitable for labeling acetaminophen-containing medications to enable users to identify acetaminophen-containing products. PMID:28970383

Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient.

PubMed

Mercado, Pablo; Maizel, Julien; Beyls, Christophe; Titeca-Beauport, Dimitri; Joris, Magalie; Kontar, Loay; Riviere, Antoine; Bonef, Olivier; Soupison, Thierry; Tribouilloy, Christophe; de Cagny, Bertrand; Slama, Michel

2017-06-09

Cardiac output (CO) monitoring is a valuable tool for the diagnosis and management of critically ill patients. In the critical care setting, few studies have evaluated the level of agreement between CO estimated by transthoracic echocardiography (CO-TTE) and that measured by the reference method, pulmonary artery catheter (CO-PAC). The objective of the present study was to evaluate the precision and accuracy of CO-TTE relative to CO-PAC and the ability of transthoracic echocardiography to track variations in CO, in critically ill mechanically ventilated patients. Thirty-eight mechanically ventilated patients fitted with a PAC were included in a prospective observational study performed in a 16-bed university hospital ICU. CO-PAC was measured via intermittent thermodilution. Simultaneously, a second investigator used standard-view TTE to estimate CO-TTE as the product of stroke volume and the heart rate obtained during the measurement of the subaortic velocity time integral. Sixty-four pairs of CO-PAC and CO-TTE measurements were compared. The two measurements were significantly correlated (r = 0.95; p < 0.0001). The median bias was 0.2 L/min, the limits of agreement (LOAs) were -1.3 and 1.8 L/min, and the percentage error was 25%. The precision was 8% for CO-PAC and 9% for CO-TTE. Twenty-six pairs of ΔCO measurements were compared. There was a significant correlation between ΔCO-PAC and ΔCO-TTE (r = 0.92; p < 0.0001). The median bias was -0.1 L/min and the LOAs were -1.3 and +1.2 L/min. With a 15% exclusion zone, the four-quadrant plot had a concordance rate of 94%. With a 0.5 L/min exclusion zone, the polar plot had a mean polar angle of 1.0° and a percentage error LOAs of -26.8 to 28.8°. The concordance rate was 100% between 30 and -30°. When using CO-TTE to detect an increase in ΔCO-PAC of more than 10%, the area under the receiving operating characteristic curve (95% CI) was 0.82 (0.62-0.94) (p < 0.001). A ΔCO-TTE of more than 8% yielded a sensitivity of 88% and specificity of 66% for detecting a ΔCO-PAC of more than 10%. In critically ill mechanically ventilated patients, CO-TTE is an accurate and precise method for estimating CO. Furthermore, CO-TTE can accurately track variations in CO.

A practical approach to the sensitivity analysis for kinetic Monte Carlo simulation of heterogeneous catalysis

DOE PAGES

Hoffmann, Max J.; Engelmann, Felix; Matera, Sebastian

2017-01-31

Lattice kinetic Monte Carlo simulations have become a vital tool for predictive quality atomistic understanding of complex surface chemical reaction kinetics over a wide range of reaction conditions. In order to expand their practical value in terms of giving guidelines for atomic level design of catalytic systems, it is very desirable to readily evaluate a sensitivity analysis for a given model. The result of such a sensitivity analysis quantitatively expresses the dependency of the turnover frequency, being the main output variable, on the rate constants entering the model. In the past the application of sensitivity analysis, such as Degree ofmore » Rate Control, has been hampered by its exuberant computational effort required to accurately sample numerical derivatives of a property that is obtained from a stochastic simulation method. Here in this study we present an efficient and robust three stage approach that is capable of reliably evaluating the sensitivity measures for stiff microkinetic models as we demonstrate using CO oxidation on RuO 2(110) as a prototypical reaction. In a first step, we utilize the Fisher Information Matrix for filtering out elementary processes which only yield negligible sensitivity. Then we employ an estimator based on linear response theory for calculating the sensitivity measure for non-critical conditions which covers the majority of cases. Finally we adopt a method for sampling coupled finite differences for evaluating the sensitivity measure of lattice based models. This allows efficient evaluation even in critical regions near a second order phase transition that are hitherto difficult to control. The combined approach leads to significant computational savings over straightforward numerical derivatives and should aid in accelerating the nano scale design of heterogeneous catalysts.« less

A practical approach to the sensitivity analysis for kinetic Monte Carlo simulation of heterogeneous catalysis.

PubMed

Hoffmann, Max J; Engelmann, Felix; Matera, Sebastian

2017-01-28

Lattice kinetic Monte Carlo simulations have become a vital tool for predictive quality atomistic understanding of complex surface chemical reaction kinetics over a wide range of reaction conditions. In order to expand their practical value in terms of giving guidelines for the atomic level design of catalytic systems, it is very desirable to readily evaluate a sensitivity analysis for a given model. The result of such a sensitivity analysis quantitatively expresses the dependency of the turnover frequency, being the main output variable, on the rate constants entering the model. In the past, the application of sensitivity analysis, such as degree of rate control, has been hampered by its exuberant computational effort required to accurately sample numerical derivatives of a property that is obtained from a stochastic simulation method. In this study, we present an efficient and robust three-stage approach that is capable of reliably evaluating the sensitivity measures for stiff microkinetic models as we demonstrate using the CO oxidation on RuO 2 (110) as a prototypical reaction. In the first step, we utilize the Fisher information matrix for filtering out elementary processes which only yield negligible sensitivity. Then we employ an estimator based on the linear response theory for calculating the sensitivity measure for non-critical conditions which covers the majority of cases. Finally, we adapt a method for sampling coupled finite differences for evaluating the sensitivity measure for lattice based models. This allows for an efficient evaluation even in critical regions near a second order phase transition that are hitherto difficult to control. The combined approach leads to significant computational savings over straightforward numerical derivatives and should aid in accelerating the nano-scale design of heterogeneous catalysts.

A practical approach to the sensitivity analysis for kinetic Monte Carlo simulation of heterogeneous catalysis

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

Hoffmann, Max J.; Engelmann, Felix; Matera, Sebastian

Lattice kinetic Monte Carlo simulations have become a vital tool for predictive quality atomistic understanding of complex surface chemical reaction kinetics over a wide range of reaction conditions. In order to expand their practical value in terms of giving guidelines for atomic level design of catalytic systems, it is very desirable to readily evaluate a sensitivity analysis for a given model. The result of such a sensitivity analysis quantitatively expresses the dependency of the turnover frequency, being the main output variable, on the rate constants entering the model. In the past the application of sensitivity analysis, such as Degree ofmore » Rate Control, has been hampered by its exuberant computational effort required to accurately sample numerical derivatives of a property that is obtained from a stochastic simulation method. Here in this study we present an efficient and robust three stage approach that is capable of reliably evaluating the sensitivity measures for stiff microkinetic models as we demonstrate using CO oxidation on RuO 2(110) as a prototypical reaction. In a first step, we utilize the Fisher Information Matrix for filtering out elementary processes which only yield negligible sensitivity. Then we employ an estimator based on linear response theory for calculating the sensitivity measure for non-critical conditions which covers the majority of cases. Finally we adopt a method for sampling coupled finite differences for evaluating the sensitivity measure of lattice based models. This allows efficient evaluation even in critical regions near a second order phase transition that are hitherto difficult to control. The combined approach leads to significant computational savings over straightforward numerical derivatives and should aid in accelerating the nano scale design of heterogeneous catalysts.« less

A practical approach to the sensitivity analysis for kinetic Monte Carlo simulation of heterogeneous catalysis

NASA Astrophysics Data System (ADS)

Hoffmann, Max J.; Engelmann, Felix; Matera, Sebastian

2017-01-01

Lattice kinetic Monte Carlo simulations have become a vital tool for predictive quality atomistic understanding of complex surface chemical reaction kinetics over a wide range of reaction conditions. In order to expand their practical value in terms of giving guidelines for the atomic level design of catalytic systems, it is very desirable to readily evaluate a sensitivity analysis for a given model. The result of such a sensitivity analysis quantitatively expresses the dependency of the turnover frequency, being the main output variable, on the rate constants entering the model. In the past, the application of sensitivity analysis, such as degree of rate control, has been hampered by its exuberant computational effort required to accurately sample numerical derivatives of a property that is obtained from a stochastic simulation method. In this study, we present an efficient and robust three-stage approach that is capable of reliably evaluating the sensitivity measures for stiff microkinetic models as we demonstrate using the CO oxidation on RuO2(110) as a prototypical reaction. In the first step, we utilize the Fisher information matrix for filtering out elementary processes which only yield negligible sensitivity. Then we employ an estimator based on the linear response theory for calculating the sensitivity measure for non-critical conditions which covers the majority of cases. Finally, we adapt a method for sampling coupled finite differences for evaluating the sensitivity measure for lattice based models. This allows for an efficient evaluation even in critical regions near a second order phase transition that are hitherto difficult to control. The combined approach leads to significant computational savings over straightforward numerical derivatives and should aid in accelerating the nano-scale design of heterogeneous catalysts.

Matrix resin effects in composite delamination - Mode I fracture aspects

NASA Technical Reports Server (NTRS)

Hunston, Donald L.; Moulton, Richard J.; Johnston, Norman J.; Bascom, Willard D.

1987-01-01

A number of thermoset, toughened thermoset, and thermoplastic resin matrix systems were characterized for Mode I critical strain energy release rates, and their composites were tested for interlaminar critical strain energy release rates using the double cantilever beam method. A clear correlation is found between the two sets of data. With brittle resins, the interlaminar critical strain energy release rates are somewhat larger than the neat resin values due to a full transfer of the neat resin toughness to the composite and toughening mechanisms associated with crack growth. With tougher matrices, the higher critical strain energy release rates are only partially transferred to the composites, presumably because the fibers restrict the crack-tip deformation zones.

Corrosion Prevention of Rebar in Concrete in Critical Facilities Located in Coastal Environments at Okinawa

DTIC Science & Technology

2009-08-01

for affected structures and equipment amounts to hundreds of millions of dollars each year, and the degradation negatively impacts military readiness...protection to the rebar, but quantifying the extent of protection or positive impact on service life would require further monitoring and evaluation...sacrificial coating system interferes with the Galva Pulse measure- ment. It was therefore hard to quantitatively determine the impact on the corrosion rate

A Comprehensive Critique and Review of Published Measures of Acne Severity

PubMed Central

Furber, Gareth; Leach, Matthew; Segal, Leonie

2016-01-01

Objective: Acne vulgaris is a dynamic, complex condition that is notoriously difficult to evaluate. The authors set out to critically evaluate currently available measures of acne severity, particularly in terms of suitability for use in clinical trials. Design: A systematic review was conducted to identify methods used to measure acne severity, using MEDLINE, CINAHL, Scopus, and Wiley Online. Each method was critically reviewed and given a score out of 13 based on eight quality criteria under two broad groupings of psychometric testing and suitability for research and evaluation. Results: Twenty-four methods for assessing acne severity were identified. Four scales received a quality score of zero, and 11 scored ≤3. The highest rated scales achieved a total score of 6. Six scales reported strong inter-rater reliability (ICC>0.75), and four reported strong intra-rater reliability (ICC>0.75). The poor overall performance of most scales, largely characterized by the absence of reliability testing or evidence for independent assessment and validation indicates that generally, their application in clinical trials is not supported. Conclusion: This review and appraisal of instruments for measuring acne severity supports previously identified concerns regarding the quality of published measures. It highlights the need for a valid and reliable acne severity scale, especially for use in research and evaluation. The ideal scale would demonstrate adequate validation and reliability and be easily implemented for third-party analysis. The development of such a scale is critical to interpreting results of trials and facilitating the pooling of results for systematic reviews and meta-analyses. PMID:27672410

Influence of multiple categories on the prediction of unknown properties

PubMed Central

Verde, Michael F.; Murphy, Gregory L.; Ross, Brian H.

2006-01-01

Knowing an item's category helps us predict its unknown properties. Previous studies suggest that when asked to evaluate the probability of an unknown property, people tend to consider only an item's most likely category, ignoring alternative categories. In the present study, property prediction took the form of either a probability rating or a speeded, binary-choice judgment. Consistent with past findings, subjects ignored alternative categories in their probability ratings. However, their binary-choice judgments were influenced by alternative categories. This novel finding suggests that the way category knowledge is used in prediction depends critically on the form of the prediction. PMID:16156183

Longitudinal outcomes after tibioperoneal angioplasty alone compared to tibial stenting and atherectomy for critical limb ischemia.

PubMed

Reynolds, Shaun; Galiñanes, Edgar Luis; Dombrovskiy, Viktor Y; Vogel, Todd R

2013-10-01

There are limited data available evaluating longitudinal outcomes after tibioperoneal angioplasty (TA) alone compared to adjunctive tibial procedures including stenting and atherectomy. Using the Centers for Medicare & Medicaid Services inpatient claims (2005-2007), patients evaluated TA only, TA plus stent placement (TA + S), and TA plus atherectomy (TA + A). A total of 2080 patients with critical limb ischemia underwent percutaneous tibioperoneal intervention for the indication of ulceration. Procedures included TA (56.3%), TA + S (16.2%), and TA + A (27.5%). Rates of amputation were not statistically different between the groups at 30, 90, and 365 days after the intervention. Mean total hospital charges were TA ($35,867), TA + A ($41,698; P = .0004), and TA + S ($51,040; P < .0001). Patients undergoing TA alone compared to concomitant stenting or atherectomy for ulceration demonstrated no improvement in limb salvage. Future analysis of adjunctive tibioperoneal interventions is essential to temper cost, as they fail to improve long-term limb salvage.

Evaluation of possible prognostic factors for the success, survival, and failure of dental implants.

PubMed

Geckili, Onur; Bilhan, Hakan; Geckili, Esma; Cilingir, Altug; Mumcu, Emre; Bural, Canan

2014-02-01

To analyze the prognostic factors that are associated with the success, survival, and failure rates of dental implants. Data including implant sizes, insertion time, implant location, and prosthetic treatment of 1656 implants have been collected, and the association of these factors with success, survival, and failure of implants was analyzed. The success rate was lower for short and maxillary implants. The failure rate of maxillary implants exceeded that of mandibular implants, and the failure rate of implants that were placed in the maxillary anterior region was significantly higher than other regions. The failure rates of implants that were placed 5 years ago or more were higher than those that were placed later. Anterior maxilla is more critical for implant loss than other sites. Implants in the anterior mandible show better success compared with other locations, and longer implants show better success rates. The learning curve of the clinician influences survival and success rates of dental implants.

Understandings of Nature of Science and Multiple Perspective Evaluation of Science News by Non-science Majors

NASA Astrophysics Data System (ADS)

Leung, Jessica Shuk Ching; Wong, Alice Siu Ling; Yung, Benny Hin Wai

2015-10-01

Understandings of nature of science (NOS) are a core component of scientific literacy, and a scientifically literate populace is expected to be able to critically evaluate science in the media. While evidence has remained inconclusive on whether better NOS understandings will lead to critical evaluation of science in the media, this study aimed at examining the correlation therein. Thirty-eight non-science majors, enrolled in a science course for non-specialists held in a local community college, evaluated three health news articles by rating the extent to which they agreed with the reported claims and providing as many justifications as possible. The majority of the participants were able to evaluate and justify their viewpoint from multiple perspectives. Students' evaluation was compared with their NOS conceptions, including the social and cultural embedded NOS, the tentative NOS, the peer review process and the community of practice. Results indicated that participants' understanding of the tentative NOS was significantly correlated with multiple perspective evaluation of science news reports of socioscientific nature (r = 0.434, p < 0.05). This moderate correlation suggested the association between understanding of the tentative NOS and multiple perspective evaluation of science in the media of socioscientific nature. However, the null result for other target NOS aspects in this study suggested a lack of evidence to assume that understanding the social dimensions of science would have significant influence on the evaluation of science in the media. Future research on identifying the reasons for why and why not NOS understandings are applied in the evaluation will move this field forward.

Critical Thresholds in Earth-System Dynamics

NASA Astrophysics Data System (ADS)

Rothman, D.

2017-12-01

The history of the Earth system is a story of change. Some changesare gradual and benign, but others, especially those associated withcatastrophic mass extinction, are relatively abrupt and destructive.What sets one group apart from the other? Here I hypothesize thatperturbations of Earth's carbon cycle lead to mass extinction if theyexceed either a critical rate at long time scales or a critical sizeat short time scales. By analyzing 31 carbon-isotopic events duringthe last 542 million years, I identify the critical rate with a limitimposed by mass conservation. Further analysis identifies thecrossover timescale separating fast from slow events with thetimescale of the ocean's homeostatic response to a change in pH. Theproduct of the critical rate and the crossover timescale then yieldsthe critical size. The modern critical size for the marine carboncycle is roughly similar to the mass of carbon that human activitieswill likely have added to the oceans by the year 2100.

Management of Uncomplicated Acute Appendicitis as Day Case Surgery: Feasibility and a Critical Analysis of Exclusion Criteria and Treatment Failure.

PubMed

Grelpois, Gérard; Sabbagh, Charles; Cosse, Cyril; Robert, Brice; Chapuis-Roux, Emilie; Ntouba, Alexandre; Lion, Thierry; Regimbeau, Jean-Marc

2016-11-01

Day case surgery (DCS) for uncomplicated acute appendicitis (NCAA) is evaluated. The objective of this prospective, single-center, descriptive, nonrandomized, intention-to-treat cohort study was to assess the feasibility of DCS for NCAA with a critical analysis of the reasons for exclusion and treatment failures and a focus on patients discharged to home and admitted for DCS on the following day. From April 2013 to December 2015, NCAA patients meeting the inclusion criteria were included in the study. The primary end point was the success rate for DCS (length of stay less than 12 hours) in the intention-to-treat population (all NCAA) and in the per-protocol population (no pre- or perioperative exclusion criteria). The secondary end points were morbidity, DCS quality criteria, predictive factors for successful DCS, patient satisfaction, quality of life, and reasons for pre- or perioperative exclusion. A subgroup of patients discharged to home the day before operation was also analyzed. A total of 240 patients were included. The success rate of DCS was 31.5% in the intention-to-treat population and 91.5% in the per-protocol population. The rates of unplanned consultations, hospitalization, and reoperation were 13%, 4%, and 1%, respectively. An analysis of the reasons for DCS exclusion showed that 73% could have been modified. For the 68 patients discharged to home on the day before operation, the DCS success rate was 91%. Day case surgery is feasible in NCAA. A critical analysis of the reasons for exclusion from DCS showed that it should be possible to dramatically increase the eligible population. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Procalcitonin-guided antibiotic treatment in critically ill patients.

PubMed

Hohn, Andreas; Heising, Bernhard; Schütte, Jan-Karl; Schroeder, Olaf; Schröder, Stefan

2017-02-01

In critically ill patients, length of antibiotic treatment can be effectively guided by procalcitonin (PCT) protocols. International sepsis guidelines and guidelines on antibiotic stewardship strategies recommend PCT as helpful laboratory marker for a rational use of antibiotics. A number of studies and meta-analyses have confirmed the effectiveness of PCT-protocols for shortening antibiotic treatment without compromising clinical outcome in critically ill patients. But in clinical practice, there is still uncertainty how to interpret PCT levels and how to adjust antibiotic treatment in various infectious situations, especially in the perioperative period. This narrative review gives an overview on the application of PCT-protocols in critically ill patients with severe bacterial infections on the basis of 5 case reports and the available literature. Beside strengths and limitations of this biomarker, also varying kinetics and different maximum values with regard to the infectious focus and pathogens are discussed. PCT-guided antibiotic treatment appears to be safe and effective. Most of the studies revealed a shorter antibiotic treatment without negative clinical outcomes. Cost effectiveness is still a matter of debate and effects on bacterial resistance due to shorter treatments, possible lower rates of drug-related adverse events, or decreased rates of Clostridium difficile infections are not yet evaluated. Guidance of antibiotic treatment can effectively be supported by PCT-protocols. However, it is important to consider the limitations of this biomarker and to use PCT protocols along with antibiotic stewardship programmes and regular clinical rounds together with infectious diseases specialists.

Endovascular Recanalization of Chronically Occluded Native Arteries After Failed Bypass Surgery in Patients with Critical Ischemia.

PubMed

Yin, Minyi; Wang, Wei; Huang, Xintian; Hong, Biao; Liu, Xiaobing; Li, Weimin; Lu, Xinwu; Lu, Min; Jiang, Mier

2015-12-01

The study aimed to evaluate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTO) in patients with critical limb ischemia (CLI) and lower extremities bypass graft failure. A retrospective review of CLI patients with failed lower limb grafts (>30 days after surgery) that underwent recanalization of native CTO was conducted in two institutions from January 2010 to June 2014. Twenty-eight patients (28 limbs) were included in the study, and all had limited surgical revascularization options. Demographics, procedural data, technical success, complications, vessel patency, limb salvage rates, and survival rates were analyzed. The mean follow-up period was 12.8 months. The technical success rate was 92.9% (26/28 limbs). The combined ipsilateral antegrade-retrograde approach was performed in nine limbs (32.1%). Major periprocedural (<30 days) complications included two myocardial infarctions (7.1%) and two stent thromboses (7.1%), resulting in one amputation. The ankle brachial index before discharge was significantly improved after recanalization (0.78 ± 0.08 vs. 0.31 ± 0.10, p < 0.01). The primary, assisted primary, and secondary patency rates at 12 months were 52.2, 65.8, and 82.2%, respectively. The limb salvage rate and amputation-free survival rate at 12 months were 91.6 and 87.0%, respectively. Endovascular recanalization of native CTO in patients with graft failure-related CLI is a feasible, safe, and effective procedure, with reasonable technical success, vessel patency, and limb salvage rates. The technique should be attempted before amputation in patients with limited surgical revascularization options.

Energy and Protein in Critically Ill Patients with AKI: A Prospective, Multicenter Observational Study Using Indirect Calorimetry and Protein Catabolic Rate.

PubMed

Sabatino, Alice; Theilla, Miriam; Hellerman, Moran; Singer, Pierre; Maggiore, Umberto; Barbagallo, Maria; Regolisti, Giuseppe; Fiaccadori, Enrico

2017-07-26

The optimal nutritional support in Acute Kidney Injury (AKI) still remains an open issue. The present study was aimed at evaluating the validity of conventional predictive formulas for the calculation of both energy expenditure and protein needs in critically ill patients with AKI. A prospective, multicenter, observational study was conducted on adult patients hospitalized with AKI in three different intensive care units (ICU). Nutrient needs were estimated by different methods: the Guidelines of the European Society of Parenteral and Enteral Nutrition (ESPEN) for both calories and proteins, the Harris-Benedict equation, the Penn-State and Faisy-Fagon equations for energy. Actual energy and protein needs were repeatedly measured by indirect calorimetry (IC) and protein catabolic rate (PCR) until oral nutrition start, hospital discharge or renal function recovery. Forty-two patients with AKI were enrolled, with 130 IC and 123 PCR measurements obtained over 654 days of artificial nutrition. No predictive formula was precise enough, and Bland-Altman plots wide limits of agreement for all equations highlight the potential to under- or overfeed individual patients. Conventional predictive formulas may frequently lead to incorrect energy and protein need estimation. In critically ill patients with AKI an increased risk for under- or overfeeding is likely when nutrient needs are estimated instead of measured.

The Radiologist Is in, but Was it Worth the Wait? Radiology Resident Note Quality in an Outpatient Interventional Radiology Clinic.

PubMed

Abboud, Salim E; Soriano, Stephanie; Abboud, Rayan; Patel, Indravadan; Davidson, Jon; Azar, Nami R; Nakamoto, Dean A

Preprocedural evaluation of patients in an interventional radiology (IR) clinic is a complex synthesis of physical examination and imaging findings, and as IR transitions to an independent clinical specialty, such evaluations will become an increasingly critical component of a successful IR practice and quality patient care. Prior research suggests that preprocedural evaluations increased patient's perceived quality of care and may improve procedural technical success rates. Appropriate documentation of a preprocedural evaluation in the medical record is also paramount for an interventional radiologist to add value and function as an effective member of a larger IR service and multidisciplinary health care team. The purpose of this study is to examine the quality of radiology resident notes for patients seen in an outpatient IR clinic at a single academic medical center before and after the adoption of clinic note template with reminders to include platelet count, international normalized ratio, glomerular filtration rate, and plan for periprocedural coagulation status. Before adoption of the template, platelet count, international normalized ratio, glomerular filtration rate and an appropriate plan for periprocedural coagulation status were documented in 72%, 82%, 42%, and 33% of patients, respectively. After adoption of the template, appropriate documentation of platelet count, international normalized ratio, and glomerular filtration rate increased to 96%, and appropriate plan for periprocedural coagulation status was documented in 83% of patients. Patient evaluation and clinical documentation skills may not be adequately practiced during radiology residency, and tools such as templates may help increase documentation quality by radiology residents. Copyright © 2017 Elsevier Inc. All rights reserved.

Gas-turbine critical research and advanced technology support project

NASA Technical Reports Server (NTRS)

Clark, J. S.; Hodge, P. E.; Lowell, C. E.; Anderson, D. N.; Schultz, D. F.

1981-01-01

A technology data base for utility gas turbine systems capable of burning coal derived fuels was developed. The following areas are investigated: combustion; materials; and system studies. A two stage test rig is designed to study the conversion of fuel bound nitrogen to NOx. The feasibility of using heavy fuels in catalytic combustors is evaluated. A statistically designed series of hot corrosion burner rig tests was conducted to measure the corrosion rates of typical gas turbine alloys with several fuel contaminants. Fuel additives and several advanced thermal barrier coatings are tested. Thermal barrier coatings used in conjunction with low critical alloys and those used in a combined cycle system in which the stack temperature was maintained above the acid corrosion temperature are also studied.

Visualized Evaluation of Blood Flow to the Gastric Conduit and Complications in Esophageal Reconstruction.

PubMed

Noma, Kazuhiro; Shirakawa, Yasuhiro; Kanaya, Nobuhiko; Okada, Tsuyoshi; Maeda, Naoaki; Ninomiya, Takayuki; Tanabe, Shunsuke; Sakurama, Kazufumi; Fujiwara, Toshiyoshi

2018-03-01

Evaluation of the blood supply to gastric conduits is critically important to avoid complications after esophagectomy. We began visual evaluation of blood flow using indocyanine green (ICG) fluorescent imaging in July 2015, to reduce reconstructive complications. In this study, we aimed to statistically verify the efficacy of blood flow evaluation using our simplified ICG method. A total of 285 consecutive patients who underwent esophagectomy and gastric conduit reconstruction were reviewed and divided into 2 groups: before and after introduction of ICG evaluation. The entire cohort and 68 patient pairs after propensity score matching (PS-M) were evaluated for clinical outcomes and the effect of visualized evaluation on reducing the risk of complication. The leakage rate in the ICG group was significantly lower than in the non-ICG group for each severity grade, both in the entire cohort (285 subjects) and after PS-M; the rates of other major complications, including recurrent laryngeal nerve palsy and pneumonia, were not different. The duration of postoperative ICU stay was approximately 1 day shorter in the ICG group than in the non-ICG group in the entire cohort, and approximately 2 days shorter after PS-M. Visualized evaluation of blood flow with ICG methods significantly reduced the rate of anastomotic complications of all Clavien-Dindo (CD) grades. Odds ratios for ICG evaluation decreased with CD grade (0.3419 for CD ≥ 1; 0.241 for CD ≥ 2; and 0.2153 for CD ≥ 3). Objective evaluation of blood supply to the reconstructed conduit using ICG fluorescent imaging reduces the risk and degree of anastomotic complication. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Characteristics of Resting Metabolic Rate in Critically Ill, Mechanically Ventilated Adults With Cystic Fibrosis.

PubMed

Frankenfield, David C; Ashcraft, Christine M; Drasher, Tammy L; Reid, Elizabeth K; Vender, Robert L

2017-05-01

Critically ill patients with cystic fibrosis may be especially sensitive to the negative consequences of overfeeding and underfeeding, yet there is almost no information available about the energy needs of these patients. The purpose of this study was to characterize the metabolic rate of critically ill adult patients with cystic fibrosis requiring mechanical ventilation. This was an observational study in which the resting metabolic rate, oxygen consumption, and carbon dioxide production of adult patients with cystic fibrosis requiring critical care, sedation, and mechanical ventilation were measured with indirect calorimetry. This group was compared with a cohort of adult critical care patients without cystic fibrosis. Twelve patients with cystic fibrosis were identified and measured. These were compared with a control group of 25 critically ill patients. Both groups were underweight (body mass index, 17.4 ± 4.0 kg/m 2 in cystic fibrosis and 18.4 ± 2.3 kg/m 2 in control). Adjusting for differences in age, sex, height, and weight, there was no difference in resting metabolic rate between the cystic fibrosis and control groups (1702 ± 193 vs 1642 ± 194 kcal/d, P = .388). Measured resting metabolic rate matched predicted values 58% of the time in cystic fibrosis and 60% of the time in control. The resting metabolic rate of sedated adult patients with cystic fibrosis being assisted with mechanical ventilation is not different from that of adult critical care patients without cystic fibrosis. In both these underweight groups, accurate prediction of resting metabolic rate is difficult to obtain.

Primary weathering rates, water transit times and concentration-discharge relations: A theoretical analysis for the critical zone

NASA Astrophysics Data System (ADS)

Ameli, Ali; Erlandsson, Martin; Beven, Keith; Creed, Irena; McDonnell, Jeffrey; Bishop, Kevin

2017-04-01

The permeability architecture of the critical zone exerts a major influence on the hydrogeochemistry of the critical zone. Water flowpath dynamics drive the spatio-temporal pattern of geochemical evolution and resulting streamflow concentration-discharge (C-Q) relation, but these flowpaths are complex and difficult to map quantitatively. Here, we couple a new integrated flow and particle tracking transport model with a general reversible Transition-State-Theory style dissolution rate-law to explore theoretically how C-Q relations and concentration in the critical zone respond to decline in saturated hydraulic conductivity (Ks) with soil depth. We do this for a range of flow rates and mineral reaction kinetics. Our results show that for minerals with a high ratio of equilibrium concentration to intrinsic weathering rate, vertical heterogeneity in Ks enhances the gradient of weathering-derived solute concentration in the critical zone and strengthens the inverse stream C-Q relation. As the ratio of equilibrium concentration to intrinsic weathering rate decreases, the spatial distribution of concentration in the critical zone becomes more uniform for a wide range of flow rates, and stream C-Q relation approaches chemostatic behaviour, regardless of the degree of vertical heterogeneity in Ks. These findings suggest that the transport-controlled mechanisms in the hillslope can lead to chemostatic C-Q relations in the stream while the hillslope surface reaction-controlled mechanisms are associated with an inverse stream C-Q relation. In addition, as the ratio of equilibrium concentration to intrinsic weathering rate decreases, the concentration in the critical zone and stream become less dependent on groundwater age (or transit time)

Critical fluid light scattering

NASA Technical Reports Server (NTRS)

Gammon, Robert W.

1988-01-01

The objective is to measure the decay rates of critical density fluctuations in a simple fluid (xenon) very near its liquid-vapor critical point using laser light scattering and photon correlation spectroscopy. Such experiments were severely limited on Earth by the presence of gravity which causes large density gradients in the sample when the compressibility diverges approaching the critical point. The goal is to measure fluctuation decay rates at least two decades closer to the critical point than is possible on earth, with a resolution of 3 microK. This will require loading the sample to 0.1 percent of the critical density and taking data as close as 100 microK to the critical temperature. The minimum mission time of 100 hours will allow a complete range of temperature points to be covered, limited by the thermal response of the sample. Other technical problems have to be addressed such as multiple scattering and the effect of wetting layers. The experiment entails measurement of the scattering intensity fluctuation decay rate at two angles for each temperature and simultaneously recording the scattering intensities and sample turbidity (from the transmission). The analyzed intensity and turbidity data gives the correlation length at each temperature and locates the critical temperature. The fluctuation decay rate data from these measurements will provide a severe test of the generalized hydrodynamic theories of transport coefficients in the critical regions. When compared to equivalent data from binary liquid critical mixtures they will test the universality of critical dynamics.

The effect of augmenting early nutritional energy delivery on quality of life and employment status one year after ICU admission.

PubMed

Reid, D B; Chapple, L S; O'Connor, S N; Bellomo, R; Buhr, H; Chapman, M J; Davies, A R; Eastwood, G M; Ferrie, S; Lange, K; McIntyre, J; Needham, D M; Peake, S L; Rai, S; Ridley, E J; Rodgers, H; Deane, A M

2016-05-01

Augmenting energy delivery during the acute phase of critical illness may reduce mortality and improve functional outcomes. The objective of this sub-study was to evaluate the effect of early augmented enteral nutrition (EN) during critical illness, on outcomes one year later. We performed prospective longitudinal evaluation of study participants, initially enrolled in The Augmented versus Routine approach to Giving Energy Trial (TARGET), a feasibility study that randomised critically ill patients to 1.5 kcal/ml (augmented) or 1.0 kcal/ml (routine) EN administered at the same rate for up to ten days, who were alive at one year. One year after randomisation Short Form-36 version 2 (SF-36v2) and EuroQol-5D-5L quality of life surveys, and employment status were assessed via telephone survey. At one year there were 71 survivors (1.5 kcal/ml 38 versus 1.0 kcal/ml 33; P=0.55). Thirty-nine (55%) patients consented to this follow-up study and completed the surveys (n = 23 and 16, respectively). The SF-36v2 physical and mental component summary scores were below normal population means but were similar in 1.5 kcal/ml and 1.0 kcal/ml groups (P=0.90 and P=0.71). EuroQol-5D-5L data were also comparable between groups (P=0.70). However, at one-year follow-up, more patients who received 1.5 kcal/ml were employed (7 versus 2; P=0.022). The delivery of 1.5 kcal/ml for a maximum of ten days did not affect self-rated quality of life one year later.

[Cancer pain management: Systematic review and critical appraisal of clinical practice guidelines].

PubMed

Martínez-Nicolás, I; Ángel-García, D; Saturno, P J; López-Soriano, F

2016-01-01

Although several clinical practice guidelines have been developed in the last decades, cancer pain management is still deficient. The purpose of this work was to carry out a comprehensive and systematic literature review of current clinical practice guidelines on cancer pain management, and critically appraise their methodology and content in order to evaluate their quality and validity to cope with this public health issue. A systematic review was performed in the main databases, using English, French and Spanish as languages, from 2008 to 2013. Reporting and methodological quality was rated with the Appraisal of Guidelines, Research and Evaluation II (AGREE-II) tool, including an inter-rater reliability analysis. Guideline recommendations were extracted and classified into several categories and levels of evidence, aiming to analyse guidelines variability and evidence-based content comprehensiveness. Six guidelines were included. A wide variability was found in both reporting and methodological quality of guidelines, as well as in the content and the level of evidence of their recommendations. The Scottish Intercollegiate Guidelines Network guideline was the best rated using AGREE-II, while the Sociedad Española de Oncología Médica guideline was the worst rated. The Ministry of Health Malaysia guideline was the most comprehensive, and the Scottish Intercollegiate Guidelines Network guideline was the second one. The current guidelines on cancer pain management have limited quality and content. We recommend Ministry of Health Malaysia and Scottish Intercollegiate Guidelines Network guidelines, whilst Sociedad Española de Oncología Médica guideline still needs to improve. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

Eating and weight/shape criticism as a specific life-event related to bulimia nervosa: a case control study.

PubMed

Gonçalves, Sonia Ferreira; Machado, Bárbara César; Martins, Carla

2014-01-01

The present study aims to evaluate the occurrence of life events preceding the onset of eating problems in bulimia nervosa patients. A case-control design was used involving the comparison of 60 female subjects who meet DSM-IV criteria for bulimia nervosa with 60 healthy control subjects and 60 subjects with other psychiatric disorders. The RFI (Fairburn et al., 1998) subset of factors that represent exposure to life events in the 12 months immediately before the development of eating problems was used. Women with bulimia nervosa reported higher rates of major stress, criticism about eating, weight and shape and also a great number of antecedent life events during the year preceding the development of eating problems than the healthy control group. However, when compared with the general psychiatric control group only the exposure to critical comments about weight, shape, or eating emerged as a specific trigger for bulimia nervosa. Our findings support the fact that eating and shape/weight criticism in the year preceding the development of eating disturbance seems to be specifically related to bulimia nervosa.

Competency of new graduate nurses: a review of their weaknesses and strategies for success.

PubMed

Theisen, Janelle L; Sandau, Kristin E

2013-09-01

Because of the ongoing nursing shortage and the increasing acuity of patients, new graduate nurses must master both psychomotor and critical thinking skills rapidly. Inadequate orientation leads to high turnover rates for new graduates. Health care leaders must examine the competencies needed for new graduate nurses to succeed in this environment. A critical review of studies (n = 26) was conducted to identify crucial competencies that are needed for new graduate nurses to be successful. Six areas were identified in which new graduates lacked competence: communication, leadership, organization, critical thinking, specific situations, and stress management. Strategies were identified to improve the transition of new graduates. Hospitals should consider implementing nurse residency programs that include strategies for clear communication and conflict management, prioritization skills, and leadership development. Schools of nursing should add communication strategies to their current focus on critical thinking, clinical reasoning, and simulation scenarios and include situation-specific skills such as end-of-life scenarios. Further research should focus on stress management, leadership, clinical reasoning, and evaluation of measurement tools for new graduates. Copyright 2013, SLACK Incorporated.

Design of low SWaP optical terminals for free space optical communications

NASA Astrophysics Data System (ADS)

Shubert, P.; Cline, A.; McNally, J.; Pierson, R.

2017-02-01

Along with advantages in higher data rates, spectrum contention, and security, free space optical communications can provide size, weight, and power (SWaP) advantages over radio frequency (RF) systems. SWaP is always an issue in space systems and can be critical in applying free space optical communications to small satellite platforms. The system design of small space-based free space optical terminals with Gbps data rates is addressed. System architectures and requirements are defined to ensure the terminals are capable of acquisition, establishment and maintenance of a free space optical communications link. Design trades, identification of blocking technologies, and performance analyses are used to evaluate the practical limitations to terminal SWaP. Small terminal design concepts are developed to establish their practicality and feasibility. Techniques, such as modulation formats and capacity approaching encoding, are considered to mitigate the disadvantages brought by SWaP limitations, and performance as a function of SWaP is evaluated.

Growth and variability in health plan premiums in the individual insurance market before the Affordable Care Act.

PubMed

Gruber, Jonathan

2014-06-01

Before we can evaluate the impact of the Affordable Care Act on health insurance premiums in the individual market, it is critical to understand the pricing trends of these premiums before the implementation of the law. Using rates of increase in the individual insurance market collected from state regulators, this issue brief documents trends in premium growth in the pre-ACA period. From 2008 to 2010, premiums grew by 10 percent or more per year. This growth was also highly variable across states, and even more variable across insurance plans within states. The study suggests that evaluating trends in premiums requires looking across a broad array of states and plans, and that policymakers must examine how present and future changes in premium rates compare with the more than 10 percent per year premium increases in the years preceding health reform.

A “Fundamentals” Train-the-Trainer Approach to Building Pediatric Critical Care Expertise in the Developing World

PubMed Central

Crow, Sheri S.; Ballinger, Beth A.; Rivera, Mariela; Tsibadze, David; Gakhokidze, Nino; Zavrashvili, Nino; Ritter, Matthew J.; Arteaga, Grace M.

2018-01-01

Pediatric Fundamental Critical Care Support (PFCCS) is an educational tool for training non-intensivists, nurses, and critical care practitioners in diverse health-care settings to deal with the acute deterioration of pediatric patients. Our objective was to evaluate the PFCCS course as a tool for developing a uniform, reproducible, and sustainable model for educating local health-care workers in the optimal management of critically ill children in the Republic of Georgia. Over a period of 18 months and four visits to the country, we worked with Georgian pediatric critical care leadership to complete the following tasks: (1) survey health-care needs within the Republic of Georgia, (2) present representative PFCCS lectures and simulation scenarios to evaluate interest and obtain “buy-in” from key stakeholders throughout the Georgian educational infrastructure, and (3) identify PFCCS instructor candidates. Georgian PFCCS instructor training included the following steps: (1) US PFCCS consultant and content experts presented PFCCS course to Georgian instructor candidates. (2) Simulation learning principles were taught and basic equipment was acquired. (3) Instructor candidates presented PFCCS to Georgian learners, mentored by PFCCS course consultants. Objective evaluation and debriefing with instructor candidates concluded each visit. Between training visits Georgian instructors translated PFCCS slides to the Georgian language. Six candidates were identified and completed PFCCS instructor training. These Georgian instructors independently presented the PFCCS course to 15 Georgian medical students. Student test scores improved significantly from pretest results (n = 14) (pretest: 38.7 ± 7 vs. posttest 62.7 ± 6, p < 0.05). A Likert-type scale of 1 to 5 (1 = not useful or effective, 5 = extremely useful or effective) was used to evaluate each student’s perception regarding (1) relevance of course content to clinical work students rated as median (IQR): (a) relevance of PFCCS content to clinical work, 5 (4–5); (b) effectiveness of lecture delivery, 4 (3–4); and (c) value of skill stations for clinical practice, 5 (4–5). Additionally, the mean (±SD) responses were 4.6 (±0.5), 3.7 (±0.6), and 4.5 (±0.6), respectively. Training local PFCCS instructors within an international environment is an effective method for establishing a uniform, reproducible, and sustainable approach to educating health-care providers in the fundamentals of pediatric critical care. Future collaborations will evaluate the clinical impact of PFCCS throughout the Georgian health-care system. PMID:29780789

A "Fundamentals" Train-the-Trainer Approach to Building Pediatric Critical Care Expertise in the Developing World.

PubMed

Crow, Sheri S; Ballinger, Beth A; Rivera, Mariela; Tsibadze, David; Gakhokidze, Nino; Zavrashvili, Nino; Ritter, Matthew J; Arteaga, Grace M

2018-01-01

Pediatric Fundamental Critical Care Support (PFCCS) is an educational tool for training non-intensivists, nurses, and critical care practitioners in diverse health-care settings to deal with the acute deterioration of pediatric patients. Our objective was to evaluate the PFCCS course as a tool for developing a uniform, reproducible, and sustainable model for educating local health-care workers in the optimal management of critically ill children in the Republic of Georgia. Over a period of 18 months and four visits to the country, we worked with Georgian pediatric critical care leadership to complete the following tasks: (1) survey health-care needs within the Republic of Georgia, (2) present representative PFCCS lectures and simulation scenarios to evaluate interest and obtain "buy-in" from key stakeholders throughout the Georgian educational infrastructure, and (3) identify PFCCS instructor candidates. Georgian PFCCS instructor training included the following steps: (1) US PFCCS consultant and content experts presented PFCCS course to Georgian instructor candidates. (2) Simulation learning principles were taught and basic equipment was acquired. (3) Instructor candidates presented PFCCS to Georgian learners, mentored by PFCCS course consultants. Objective evaluation and debriefing with instructor candidates concluded each visit. Between training visits Georgian instructors translated PFCCS slides to the Georgian language. Six candidates were identified and completed PFCCS instructor training. These Georgian instructors independently presented the PFCCS course to 15 Georgian medical students. Student test scores improved significantly from pretest results ( n  = 14) (pretest: 38.7 ± 7 vs. posttest 62.7 ± 6, p  < 0.05). A Likert-type scale of 1 to 5 (1 = not useful or effective, 5 = extremely useful or effective) was used to evaluate each student's perception regarding (1) relevance of course content to clinical work students rated as median (IQR): (a) relevance of PFCCS content to clinical work, 5 (4-5); (b) effectiveness of lecture delivery, 4 (3-4); and (c) value of skill stations for clinical practice, 5 (4-5). Additionally, the mean (±SD) responses were 4.6 (±0.5), 3.7 (±0.6), and 4.5 (±0.6), respectively. Training local PFCCS instructors within an international environment is an effective method for establishing a uniform, reproducible, and sustainable approach to educating health-care providers in the fundamentals of pediatric critical care. Future collaborations will evaluate the clinical impact of PFCCS throughout the Georgian health-care system.

Multiwavelet grading of prostate pathological images

NASA Astrophysics Data System (ADS)

Soltanian-Zadeh, Hamid; Jafari-Khouzani, Kourosh

2002-05-01

We have developed image analysis methods to automatically grade pathological images of prostate. The proposed method generates Gleason grades to images, where each image is assigned a grade between 1 and 5. This is done using features extracted from multiwavelet transformations. We extract energy and entropy features from submatrices obtained in the decomposition. Next, we apply a k-NN classifier to grade the image. To find optimal multiwavelet basis, preprocessing, and classifier, we use features extracted by different multiwavelets with either critically sampled preprocessing or repeated row preprocessing and different k-NN classifiers and compare their performances, evaluated by total misclassification rate (TMR). To evaluate sensitivity to noise, we add white Gaussian noise to images and compare the results (TMR's). We applied proposed methods to 100 images. We evaluated the first and second levels of decomposition using Geronimo, Hardin, and Massopust (GHM), Chui and Lian (CL), and Shen (SA4) multiwavelets. We also evaluated k-NN classifier for k=1,2,3,4,5. Experimental results illustrate that first level of decomposition is quite noisy. They also show that critically sampled preprocessing outperforms repeated row preprocessing and has less sensitivity to noise. Finally, comparison studies indicate that SA4 multiwavelet and k-NN classifier (k=1) generates optimal results (with smallest TMR of 3%).

Use of Multi-Response Format Test in the Assessment of Medical Students’ Critical Thinking Ability

PubMed Central

Mafinejad, Mahboobeh Khabaz; Monajemi, Alireza; Jalili, Mohammad; Soltani, Akbar; Rasouli, Javad

2017-01-01

Introduction To evaluate students critical thinking skills effectively, change in assessment practices is must. The assessment of a student’s ability to think critically is a constant challenge, and yet there is considerable debate on the best assessment method. There is evidence that the intrinsic nature of open and closed-ended response questions is to measure separate cognitive abilities. Aim To assess critical thinking ability of medical students by using multi-response format of assessment. Materials and Methods A cross-sectional study was conducted on a group of 159 undergraduate third-year medical students. All the participants completed the California Critical Thinking Skills Test (CCTST) consisting of 34 multiple-choice questions to measure general critical thinking skills and a researcher-developed test that combines open and closed-ended questions. A researcher-developed 48-question exam, consisting of 8 short-answers and 5 essay questions, 19 Multiple-Choice Questions (MCQ), and 16 True-False (TF) questions, was used to measure critical thinking skills. Correlation analyses were performed using Pearson’s coefficient to explore the association between the total scores of tests and subtests. Results One hundred and fifty-nine students participated in this study. The sample comprised 81 females (51%) and 78 males (49%) with an age range of 20±2.8 years (mean 21.2 years). The response rate was 64.1%. A significant positive correlation was found between types of questions and critical thinking scores, of which the correlations of MCQ (r=0.82) and essay questions (r=0.77) were strongest. The significant positive correlations between multi-response format test and CCTST’s subscales were seen in analysis, evaluation, inference and inductive reasoning. Unlike CCTST subscales, multi-response format test have weak correlation with CCTST total score (r=0.45, p=0.06). Conclusion This study highlights the importance of considering multi-response format test in the assessment of critical thinking abilities of medical students by using both open and closed-ended response questions. PMID:29207742

Effects of materials and design on the criticality and shielding assessment of canister concepts for the disposal of spent nuclear fuel.

PubMed

Gutiérrez, Miguel Morales; Caruso, Stefano; Diomidis, Nikitas

2018-05-19

According to the Swiss disposal concept, the safety of a deep geological repository for spent nuclear fuel (SNF) is based on a multi-barrier system. The disposal canister is an important component of the engineered barrier system, aiming to provide containment of the SNF for thousands of years. This study evaluates the criticality safety and shielding of candidate disposal canister concepts, focusing on the fulfilment of the sub-criticality criterion and on limiting radiolysis processes at the outer surface of the canister which can enhance corrosion mechanisms. The effective neutron multiplication factor (k-eff) and the surface dose rates are calculated for three different canister designs and material combinations for boiling water reactor (BWR) canisters, containing 12 spent fuel assemblies (SFA), and pressurized water reactor (PWR) canisters, with 4 SFAs. For each configuration, individual criticality and shielding calculations were carried out. The results show that k-eff falls below the defined upper safety limit (USL) of 0.95 for all BWR configurations, while staying above USL for the PWR ones. Therefore, the application of a burnup credit methodology for the PWR case is required, being currently under development. Relevant is also the influence of canister material and internal geometry on criticality, enabling the identification of safer fuel arrangements. For a final burnup of 55MWd/kgHM and 30y cooling time, the combined photon-neutron surface dose rate is well below the threshold of 1 Gy/h defined to limit radiation-induced corrosion of the canister in all cases. Copyright © 2018 Elsevier Ltd. All rights reserved.

Repaying in Kind: Examination of the Reciprocity Effect in Faculty and Resident Evaluations.

PubMed

Gardner, Aimee K; Scott, Daniel J

Although the reciprocity hypothesis (that trainees have a tendency to modify evaluations based on the grades they receive from instructors) has been documented in other fields, very little work has examined this phenomenon in the surgical residency environment. The purpose of this study was to investigate the extent to which lenient-grading faculty receive higher evaluations from surgery residents. Evaluation data from 2 consecutive academic years were collected retrospectively at a large university-based General Surgery residency program. Monthly faculty evaluations of residents (15 items) and resident evaluations of faculty (8 items; 1 = never demonstrates, 10 = always demonstrates) were included. Correlation and regression analyses were conducted with SPSS version 22 (IBM; Chicago, IL). A total of 2274 faculty assessments and 1480 resident assessments were included in this study, representing 2 years of evaluations for 32 core faculty members responsible for completing all resident evaluations and 68 PGY1-5 general surgery residents. Faculty (63% men, 13.5 ± 9.8 years out of training) represented 5 different divisions (general surgery, surgical oncology, transplant, trauma critical care, and vascular) within the general surgery department. Faculty received an average of 71.1 ± 33.9 evaluations from residents over the course of 2 years. The average rating of faculty teaching by residents was 9.5 ± 0.4. Residents received an average of 21.8 ± 0.5 evaluations with average ratings of 4.2 ± 0.4. Correlation analyses indicated a positive relationship between the average rating received from residents and the number of years since faculty completed training (r = 0.44, p = 0.01). Additionally, a significant relationship emerged between ratings received from residents and ratings given to residents (r = 0.40, p = 0.04). Regression analyses indicated that when both variables (years since training, ratings given to residents) were included in the model, only ratings given to residents remained a significant predictor of evaluation ratings received from residents (F (1,32) = 4.40, p = 0.04), with an R 2 of 0.16. Sex or division affiliation did not account for any unique variance. These findings suggest that a reciprocity effect exists between surgery faculty and resident evaluations. This effect warrants further exploration, such that efforts to mitigate the risks of providing inaccurate assessments may be developed. Providing trainees with accurate assessments is particularly important given the high-stakes use of these data for milestones, promotion, and graduation purposes, which currently do not account for this reciprocity effect. Results suggest that there is a reciprocity effect in the faculty and resident evaluation process. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Association of Hospital Critical Access Status With Surgical Outcomes and Expenditures Among Medicare Beneficiaries.

PubMed

Ibrahim, Andrew M; Hughes, Tyler G; Thumma, Jyothi R; Dimick, Justin B

2016-05-17

Critical access hospitals are a predominant source of care for many rural populations. Previous reports suggest these centers provide lower quality of care for common medical admissions. Little is known about the outcomes and costs of patients admitted for surgical procedures. To compare the surgical outcomes and associated Medicare payments at critical access hospitals vs non-critical access hospitals. Cross-sectional retrospective review of 1,631,904 Medicare beneficiary admissions to critical access hospitals (n = 828) and non-critical access hospitals (n = 3676) for 1 of 4 common types of surgical procedures-appendectomy, 3467 for critical access and 151,867 for non-critical access; cholecystectomy, 10,556 for critical access and 573,435 for non-critical access; colectomy, 10,198 for critical access and 577,680 for non-critical access; hernia repair, 4291 for critical access and 300,410 for non-critical access-between 2009 and 2013. We compared risk-adjusted outcomes using a multivariable logistical regression that adjusted for patient factors (age, sex, race, Elixhauser comorbidities), admission type (elective, urgent, emergency), and type of operation. Undergoing surgical procedures at critical access vs non-critical access hospitals. Thirty-day mortality, postoperative serious complications (eg, myocardial infarction, pneumonia, or acute renal failure and a length of stay >75th percentile). Hospital costs were assessed using price-standardized Medicare payments during hospitalization. Patients (mean age, 76.5 years; 56.2% women) undergoing surgery at critical access hospitals were less likely to have chronic medical problems, and they had lower rates of heart failure (7.7% vs 10.7%, P < .0001), diabetes (20.2% vs 21.7%, P < .001), obesity (6.5% vs 10.6%, P < .001), or multiple comorbid diseases (% of patients with ≥2 comorbidities; 60.4% vs 70.2%, P < .001). After adjustment for patient factors, critical access and non-critical access hospitals had no statistically significant differences in 30-day mortality rates (5.4% vs 5.6%; adjusted odds ratio [OR], 0.96; 95% confidence interval [CI], 0.89-1.03; P = .28). However, critical access vs non-critical access hospitals had significantly lower rates of serious complications (6.4% vs 13.9%; OR, 0.35; 95% CI, 0.32-0.39; P < .001). Medicare expenditures adjusted for patient factors and procedure type were lower at critical access hospitals than non-critical access hospitals ($14,450 vs $15,845; difference, -$1395, P < .001). Among Medicare beneficiaries undergoing common surgical procedures, patients admitted to critical access hospitals compared with non-critical access hospitals had no significant difference in 30-day mortality rates, decreased risk-adjusted serious complication rates, and lower-adjusted Medicare expenditures, but were less medically complex.

Otorhinolaryngological aspects of sleep-related breathing disorders

PubMed Central

Virk, Jagdeep S.

2016-01-01

Snoring and obstructive sleep apnoea (OSA) are disorders within a wide spectrum of sleep-related breathing disorders (SRBD). Given the obesity epidemic, these conditions will become increasingly prevalent and continue to serve as a large economic burden. A thorough clinical evaluation and appropriate investigations will allow stratification of patients into appropriate treatment groups. A multidisciplinary team is required to manage these patients. Patient selection is critical in ensuring successful surgical and non-surgical outcomes. A wide range of options are available and further long term prospective studies, with standardised data capture and outcome goals, are required to evaluate the most appropriate techniques and long term success rates. PMID:26904262

Problems associated with digital luminescence radiography in the neonate and young infant. Problems with digital radiography.

PubMed

Arthur, R J; Pease, J N

1992-01-01

An evaluation of the Siemens Digiscan has been undertaken to determine whether digital luminescence radiography (DLR) could replace conventional radiography in the examination of the neonate and young infant. Whilst the overall image quality of the digital radiograph was consistently higher than for conventional radiography the difference was less marked than we had expected. Furthermore, the potential for reduction in radiation dose by reducing the repeat rate due to incorrect exposure was limited. The potential advantages of DLR have been critically examined in relationship to neonatal radiography and a number of problems encountered during the evaluation have been highlighted.

A Quantitative Evaluation of Medication Histories and Reconciliation by Discipline

PubMed Central

Stewart, Michael R.; Fogg, Sarah M.; Schminke, Brandon C.; Zackula, Rosalee E.; Nester, Tina M.; Eidem, Leslie A.; Rosendale, James C.; Ragan, Robert H.; Bond, Jack A.; Goertzen, Kreg W.

2014-01-01

Abstract Background/Objective: Medication reconciliation at transitions of care decreases medication errors, hospitalizations, and adverse drug events. We compared inpatient medication histories and reconciliation across disciplines and evaluated the nature of discrepancies. Methods: We conducted a prospective cohort study of patients admitted from the emergency department at our 760-bed hospital. Eligible patients had their medication histories conducted and reconciled in order by the admitting nurse (RN), certified pharmacy technician (CPhT), and pharmacist (RPh). Discharge medication reconciliation was not altered. Admission and discharge discrepancies were categorized by discipline, error type, and drug class and were assigned a criticality index score. A discrepancy rating system systematically measured discrepancies. Results: Of 175 consented patients, 153 were evaluated. Total admission and discharge discrepancies were 1,461 and 369, respectively. The average number of medications per participant at admission was 8.59 (1,314) with 9.41 (1,374) at discharge. Most discrepancies were committed by RNs: 53.2% (777) at admission and 56.1% (207) at discharge. The majority were omitted or incorrect. RNs had significantly higher admission discrepancy rates per medication (0.59) compared with CPhTs (0.36) and RPhs (0.16) (P < .001). RPhs corrected significantly more discrepancies per participant than RNs (6.39 vs 0.48; P < .001); average criticality index reduction was 79.0%. Estimated prevented adverse drug events (pADEs) cost savings were $589,744. Conclusions: RPhs committed the fewest discrepancies compared with RNs and CPhTs, resulting in more accurate medication histories and reconciliation. RPh involvement also prevented the greatest number of medication errors, contributing to considerable pADE-related cost savings. PMID:25477614

Critical Mutation Rate Has an Exponential Dependence on Population Size in Haploid and Diploid Populations

PubMed Central

Aston, Elizabeth; Channon, Alastair; Day, Charles; Knight, Christopher G.

2013-01-01

Understanding the effect of population size on the key parameters of evolution is particularly important for populations nearing extinction. There are evolutionary pressures to evolve sequences that are both fit and robust. At high mutation rates, individuals with greater mutational robustness can outcompete those with higher fitness. This is survival-of-the-flattest, and has been observed in digital organisms, theoretically, in simulated RNA evolution, and in RNA viruses. We introduce an algorithmic method capable of determining the relationship between population size, the critical mutation rate at which individuals with greater robustness to mutation are favoured over individuals with greater fitness, and the error threshold. Verification for this method is provided against analytical models for the error threshold. We show that the critical mutation rate for increasing haploid population sizes can be approximated by an exponential function, with much lower mutation rates tolerated by small populations. This is in contrast to previous studies which identified that critical mutation rate was independent of population size. The algorithm is extended to diploid populations in a system modelled on the biological process of meiosis. The results confirm that the relationship remains exponential, but show that both the critical mutation rate and error threshold are lower for diploids, rather than higher as might have been expected. Analyzing the transition from critical mutation rate to error threshold provides an improved definition of critical mutation rate. Natural populations with their numbers in decline can be expected to lose genetic material in line with the exponential model, accelerating and potentially irreversibly advancing their decline, and this could potentially affect extinction, recovery and population management strategy. The effect of population size is particularly strong in small populations with 100 individuals or less; the exponential model has significant potential in aiding population management to prevent local (and global) extinction events. PMID:24386200

Measurement properties of disease-specific questionnaires in patients with neck pain: a systematic review.

PubMed

Schellingerhout, Jasper M; Verhagen, Arianne P; Heymans, Martijn W; Koes, Bart W; de Vet, Henrica C; Terwee, Caroline B

2012-05-01

To critically appraise and compare the measurement properties of the original versions of neck-specific questionnaires. Bibliographic databases were searched for articles concerning the development or evaluation of the measurement properties of an original version of a self-reported questionnaire, evaluating pain and/or disability, which was specifically developed or adapted for patients with neck pain. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using a checklist, specifically designed for evaluating studies on measurement properties. The search strategy resulted in a total of 3,641 unique hits, of which 25 articles, evaluating 8 different questionnaires, were included in our study. The Neck Disability Index is the most frequently evaluated questionnaire and shows positive results for internal consistency, content validity, structural validity, hypothesis testing, and responsiveness, but a negative result for reliability. The other questionnaires show positive results, but the evidence for each measurement property is mostly limited, and at least 50% of the information on measurement properties per questionnaire is lacking. Our findings imply that studies of high methodological quality are needed to properly assess the measurement properties of the currently available questionnaires. Until high quality studies are available, we recommend using these questionnaires with caution. There is no need for the development of new neck-specific questionnaires until the current questionnaires have been adequately assessed.

Benchmark Evaluation of Start-Up and Zero-Power Measurements at the High-Temperature Engineering Test Reactor

DOE PAGES

Bess, John D.; Fujimoto, Nozomu

2014-10-09

Benchmark models were developed to evaluate six cold-critical and two warm-critical, zero-power measurements of the HTTR. Additional measurements of a fully-loaded subcritical configuration, core excess reactivity, shutdown margins, six isothermal temperature coefficients, and axial reaction-rate distributions were also evaluated as acceptable benchmark experiments. Insufficient information is publicly available to develop finely-detailed models of the HTTR as much of the design information is still proprietary. However, the uncertainties in the benchmark models are judged to be of sufficient magnitude to encompass any biases and bias uncertainties incurred through the simplification process used to develop the benchmark models. Dominant uncertainties in themore » experimental keff for all core configurations come from uncertainties in the impurity content of the various graphite blocks that comprise the HTTR. Monte Carlo calculations of keff are between approximately 0.9 % and 2.7 % greater than the benchmark values. Reevaluation of the HTTR models as additional information becomes available could improve the quality of this benchmark and possibly reduce the computational biases. High-quality characterization of graphite impurities would significantly improve the quality of the HTTR benchmark assessment. Simulation of the other reactor physics measurements are in good agreement with the benchmark experiment values. The complete benchmark evaluation details are available in the 2014 edition of the International Handbook of Evaluated Reactor Physics Benchmark Experiments.« less

Aluminum Data Measurements and Evaluation for Criticality Safety Applications

NASA Astrophysics Data System (ADS)

Leal, L. C.; Guber, K. H.; Spencer, R. R.; Derrien, H.; Wright, R. Q.

2002-12-01

The Defense Nuclear Facility Safety Board (DNFSB) Recommendation 93-2 motivated the US Department of Energy (DOE) to develop a comprehensive criticality safety program to maintain and to predict the criticality of systems throughout the DOE complex. To implement the response to the DNFSB Recommendation 93-2, a Nuclear Criticality Safety Program (NCSP) was created including the following tasks: Critical Experiments, Criticality Benchmarks, Training, Analytical Methods, and Nuclear Data. The Nuclear Data portion of the NCSP consists of a variety of differential measurements performed at the Oak Ridge Electron Linear Accelerator (ORELA) at the Oak Ridge National Laboratory (ORNL), data analysis and evaluation using the generalized least-squares fitting code SAMMY in the resolved, unresolved, and high energy ranges, and the development and benchmark testing of complete evaluations for a nuclide for inclusion into the Evaluated Nuclear Data File (ENDF/B). This paper outlines the work performed at ORNL to measure, evaluate, and test the nuclear data for aluminum for applications in criticality safety problems.

Impact of cognitive-behavioral therapy for social anxiety disorder on the neural bases of emotional reactivity to and regulation of social evaluation.

PubMed

Goldin, Philippe R; Ziv, Michal; Jazaieri, Hooria; Weeks, Justin; Heimberg, Richard G; Gross, James J

2014-11-01

We examined whether Cognitive-Behavioral Therapy (CBT) for social anxiety disorder (SAD) would modify self-reported negative emotion and functional magnetic resonance imaging brain responses when reacting to and reappraising social evaluation, and tested whether changes would predict treatment outcome in 59 patients with SAD who completed CBT or waitlist groups. For reactivity, compared to waitlist, CBT resulted in (a) increased brain responses in right superior frontal gyrus (SFG), inferior parietal lobule (IPL), and middle occipital gyrus (MOG) when reacting to social praise, and (b) increases in right SFG and IPL and decreases in left posterior superior temporal gyrus (pSTG) when reacting to social criticism. For reappraisal, compared to waitlist, CBT resulted in greater (c) reductions in self-reported negative emotion, and (d) increases in brain responses in right SFG and MOG, and decreases in left pSTG. A linear regression found that after controlling for CBT-induced changes in reactivity and reappraisal negative emotion ratings and brain changes in reactivity to praise and criticism, reappraisal of criticism brain response changes predicted 24% of the unique variance in CBT-related reductions in social anxiety. Thus, one mechanism underlying CBT for SAD may be changes in reappraisal-related brain responses to social criticism. NCT00380731. http://www.clinicaltrials.gov/ct2/show/NCT00380731?term=social+anxiety+cognitive+behavioral+therapy+Stanford&rank=1. Copyright © 2014 Elsevier Ltd. All rights reserved.

Non-equilibrium relaxation in a stochastic lattice Lotka-Volterra model

NASA Astrophysics Data System (ADS)

Chen, Sheng; Täuber, Uwe C.

2016-04-01

We employ Monte Carlo simulations to study a stochastic Lotka-Volterra model on a two-dimensional square lattice with periodic boundary conditions. If the (local) prey carrying capacity is finite, there exists an extinction threshold for the predator population that separates a stable active two-species coexistence phase from an inactive state wherein only prey survive. Holding all other rates fixed, we investigate the non-equilibrium relaxation of the predator density in the vicinity of the critical predation rate. As expected, we observe critical slowing-down, i.e., a power law dependence of the relaxation time on the predation rate, and algebraic decay of the predator density at the extinction critical point. The numerically determined critical exponents are in accord with the established values of the directed percolation universality class. Following a sudden predation rate change to its critical value, one finds critical aging for the predator density autocorrelation function that is also governed by universal scaling exponents. This aging scaling signature of the active-to-absorbing state phase transition emerges at significantly earlier times than the stationary critical power laws, and could thus serve as an advanced indicator of the (predator) population’s proximity to its extinction threshold.

Iliac Artery Stent Placement Relieves Claudication in Patients with Iliac and Superficial Femoral Artery Lesions

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

Ichihashi, Shigeo, E-mail: shigeoichihashi@yahoo.co.jp; Higashiura, Wataru; Itoh, Hirofumi

Purpose. To evaluate the efficacy of iliac artery stent placement for relief of claudication in patients with both iliac and superficial femoral artery (SFA) lesions. Methods. Stent placement for only iliac artery occlusive disease was performed in 94 limbs (74 patients) with both iliac and SFA occlusive disease on the same limb. All procedures were performed because intermittent claudication did not improve after continuation of antiplatelet medication therapy and home-based exercise for 3 months. Rutherford classification was 2 in 20 limbs and 3 in 74 limbs. Patients with critical limb ischemia were excluded. Median duration of follow-up was 40 months.more » Primary patency rates of the iliac stent, clinical improvement rates, and risk factors for requiring additional SFA procedures were evaluated. Results. Primary patency rates of the iliac stent at 1, 3, 5, and 7 years were 97, 93, 79, and 79 %, respectively. The initial clinical improvement rate was 87 %. Continued clinical improvement rates at 1, 3, 5, and 7 years were 87, 81, 69, and 66 %, respectively. SFA Trans-Atlantic Inter-Society Consensus (TASC) II C/D lesion was a significant risk factor for requiring additional SFA procedures. Conclusion. Intermittent claudication was relieved by iliac stent placement in most patients with both iliac and SFA lesions. Thus, the indications for treatment of the SFA intended for claudicants should be evaluated after treatment of the iliac lesion.« less

Association of posterior EEG alpha with prioritization of religion or spirituality: a replication and extension at 20-year follow-up

PubMed Central

Tenke, Craig E.; Kayser, Jürgen; Svob, Connie; Miller, Lisa; Alvarenga, Jorge E.; Abraham, Karen; Warner, Virginia; Wickramaratne, Priya; Weissman, Myrna M.; Bruder, Gerard E.

2017-01-01

A prior report (Tenke et al. 2013 Biol. Psychol. 94:426–432) found that participants who rated religion or spirituality (R/S) highly important had greater posterior alpha after 10 years compared to those who did not. Participants who subsequently lowered their rating also had prominent alpha, while those who increased their rating did not. Here we report EEG findings 20 years after initial assessment. Clinical evaluations and R/S ratings were obtained from 73 (52 new) participants in a longitudinal study of family risk for depression. Frequency PCA of current source density transformed EEG concisely quantified posterior alpha. Those who initially rated R/S as highly important had greater alpha compared to those who did not, even if their R/S rating later increased. Furthermore, changes in religious denomination were associated with decreased alpha. Results suggest the possibility of a critical stage in the ontogenesis of R/S that is linked to posterior resting alpha. PMID:28119066

Raising awareness of learning disability needs in acute sector care: a reflective account of a workshop from the guest facilitator perspective.

PubMed

Marsham, Marian

2009-10-01

Nurse education has an essential role to play in reducing health inequality for people with learning disability [Michael, J., 2008. Healthcare for All: Report of the Independent Inquiry into Access to Healthcare for People with Learning Disabilities. Aldridge Press, London]. Many nurse education providers will need to use guest facilitators in order to raise awareness of best practice in caring for this client group for non learning disability branch students and their experiences as nurse educators will be of growing interest. This article critically reflects on an educational session for pre-registration adult branch nursing students which used a variety of teaching methods to facilitate a reflective, student centred, experiential learning approach. Self assessment based on the change between two self rating scales was used to assess learning, the session itself was evaluated by students using a feedback form and through the formal assessment of teaching by a nurse tutor. This article critically evaluates the preparation, delivery and evaluation of the session, emphasising the perspective of the guest facilitator - a practicing community learning disability nurse. The conclusion reflects on key learning from the teaching experience.

How perfectionism and ineffectiveness influence growth of eating disorder risk in young adolescent girls.

PubMed

Wade, Tracey D; Wilksch, Simon M; Paxton, Susan J; Byrne, Susan M; Austin, S Bryn

2015-03-01

While perfectionism is widely considered to influence risk for eating disorders, results of longitudinal studies are mixed. The goal of the current study was to investigate a more complex model of how baseline perfectionism (both high personal standards and self-critical evaluative concerns) might influence change in risk status for eating disorders in young adolescent girls, through its influence on ineffectiveness. The study was conducted with 926 girls (mean age of 13 years), and involved three waves of data (baseline, 6- and 12-month follow-up). Latent growth curve modelling, incorporating the average rate at which risk changed over time, the intercept (initial status) of ineffectiveness, and baseline perfectionism, was used to explore longitudinal mediation. Personal standards was not supported as contributing to risk but results indicated that the higher mean scores on ineffectiveness over the three waves mediated the relationship between higher baseline self-critical evaluative concerns and both measures of eating disorder risk. The relationship between concern over mistakes and change in risk was small and negative. These results suggest the usefulness of interventions related to self-criticism and ineffectiveness for decreasing risk for developing an eating disorder in young adolescent girls. Copyright © 2015 Elsevier Ltd. All rights reserved.

Adaptation and Evaluation of Online Self-learning Modules to Teach Critical Appraisal and Evidence-Based Practice in Nursing: An International Collaboration.

PubMed

Gagnon, Johanne; Gagnon, Marie-Pierre; Buteau, Rose-Anne; Azizah, Ginette Mbourou; Jetté, Sylvie; Lampron, Amélie; Simonyan, David; Asua, José; Reviriego, Eva

2015-07-01

Healthcare professionals need to update their knowledge and acquire skills to continually inform their practice based on scientific evidence. This study was designed to evaluate online self-learning modules on critical appraisal skills to promote the use of research in clinical practice among nurses from Quebec (Canada) and the Basque Country (Spain). The teaching material was developed in Quebec and adapted to the Basque Country as part of an international collaboration project. A prospective pre-post study was conducted with 36 nurses from Quebec and 47 from the Basque Country. Assessment comprised the administration of questionnaires before and after the course in order to explore the main intervention outcomes: knowledge acquisition and self-learning readiness. Satisfaction was also measured at the end of the course. Two of the three research hypotheses were confirmed: (1) participants significantly improved their overall knowledge score after the educational intervention; and (2) they were, in general, satisfied with the course, giving it a rating of seven out of 10. Participants also reported a greater readiness for self-directed learning after the course, but this result was not significant in Quebec. The study provides unique knowledge on the cultural adaptation of online self-learning modules for teaching nurses about critical appraisal skills and evidence-based practice.

A Porous Hydroxyapatite/Gelatin Nanocomposite Scaffold for Bone Tissue Repair: In Vitro and In Vivo Evaluation.

PubMed

Azami, Mahmoud; Tavakol, Shima; Samadikuchaksaraei, Ali; Hashjin, Mehran Solati; Baheiraei, Nafiseh; Kamali, Mehdi; Nourani, Mohammad Reza

2012-01-01

In this study, a nano-structured scaffold was designed for bone repair using hydroxapatite and gelatin as its main components. The scaffold was prepared via layer solvent casting combined with freeze-drying and lamination techniques and characterized by the commonly used bulk techniques. The biocompatibility and osteoconductivity of this scaffold and its capacity to promote bone healing were also evaluated. Osteoblast-like cells were seeded on these scaffolds and their proliferation rate, intracellular alkaline phosphatase (ALP) activity and ability to form mineralized bone nodules were compared with those osteoblasts grown on cell culture plastic surfaces. Also, the scaffolds were implanted in a critical bone defect created on rat calvarium. Engineering analyses show that the scaffold posses a three dimensional interconnected homogenous porous structure with a porosity of about 82% and pore sizes ranging from 300 to 500 μm. Mechanical indices are in the range of spongy bones. The results obtained from biological assessment show that this scaffold does not negatively affect osteoblasts proliferation rate and improves osteoblasts function as shown by increasing the ALP activity and calcium deposition and formation of mineralized bone nodules. In addition, the scaffold promoted healing of critical size calvarial bone defect in rats. It could be concluded that this scaffold fulfills all the main requirements to be considered as a bone substitute.

Robotic equipment malfunction during robotic prostatectomy: a multi-institutional study.

PubMed

Lavery, Hugh J; Thaly, Rahul; Albala, David; Ahlering, Thomas; Shalhav, Arieh; Lee, David; Fagin, Randy; Wiklund, Peter; Dasgupta, Prokar; Costello, Anthony J; Tewari, Ashutosh; Coughlin, Geoff; Patel, Vipul R

2008-09-01

Robotic-assisted laparoscopic prostatectomy (RALP) is growing in popularity as a treatment option for prostate cancer. As a new technology, little is known regarding the reliability of the da Vinci robotic system. Intraoperative robotic equipment malfunction may force the surgeon to convert the procedure to an open or pure laparoscopic procedure, or possibly even abort the procedure. We report the first large-scale, multi-institutional review of robotic equipment malfunction. A questionnaire was designed to evaluate the rate of perioperative robotic malfunction during RALP. High-volume, experienced surgeons were asked to complete this evaluation based on the analysis of their data. Questions included the overall number of RALPs performed, the number of equipment malfunctions, the number of procedures that had to be converted or aborted, and the part of the robotic system that malfunctioned. Eleven institutions participated in the study with a median surgeon volume of 700 cases, accounting for a total case volume of 8240. Critical failure occurred in 34 cases (0.4%) leading to the cancellation of 24 cases prior to the procedure, and the conversion to two laparoscopic and eight open procedures. The most common components of the robot to malfunction were the arms and optical system. Critical robotic equipment malfunction is extremely rare in institutions that perform high volumes of RALPs, with a nonrecoverable malfunction rate of only 0.4%.

Outcome and prognostic factors in critically ill patients with systemic lupus erythematosus: a retrospective study.

PubMed

Hsu, Chia-Lin; Chen, Kuan-Yu; Yeh, Pu-Sheng; Hsu, Yeong-Long; Chang, Hou-Tai; Shau, Wen-Yi; Yu, Chia-Li; Yang, Pan-Chyr

2005-06-01

Systemic lupus erythematosus (SLE) is an archetypal autoimmune disease, involving multiple organ systems with varying course and prognosis. However, there is a paucity of clinical data regarding prognostic factors in SLE patients admitted to the intensive care unit (ICU). From January 1992 to December 2000, all patients admitted to the ICU with a diagnosis of SLE were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using Acute Physiology and Chronic Health Evaluation II scores and variables that were at least moderately associated (P < 0.2) with survival in the univariate analysis. A total of 51 patients meeting the criteria were included. The mortality rate was 47%. The most common cause of admission was pneumonia with acute respiratory distress syndrome. Multivariate logistic regression analysis showed that intracranial haemorrhage occurring while the patient was in the ICU (relative risk = 18.68), complicating gastrointestinal bleeding (relative risk = 6.97) and concurrent septic shock (relative risk = 77.06) were associated with greater risk of dying, whereas causes of ICU admission and Acute Physiology and Chronic Health Evaluation II score were not significantly associated with death. The mortality rate in critically ill SLE patients was high. Gastrointestinal bleeding, intracranial haemorrhage and septic shock were significant prognostic factors in SLE patients admitted to the ICU.

Evaluation of software sensors for on-line estimation of culture conditions in an Escherichia coli cultivation expressing a recombinant protein.

PubMed

Warth, Benedikt; Rajkai, György; Mandenius, Carl-Fredrik

2010-05-03

Software sensors for monitoring and on-line estimation of critical bioprocess variables have mainly been used with standard bioreactor sensors, such as electrodes and gas analyzers, where algorithms in the software model have generated the desired state variables. In this article we propose that other on-line instruments, such as NIR probes and on-line HPLC, should be used to make more reliable and flexible software sensors. Five software sensor architectures were compared and evaluated: (1) biomass concentration from an on-line NIR probe, (2) biomass concentration from titrant addition, (3) specific growth rate from titrant addition, (4) specific growth rate from the NIR probe, and (5) specific substrate uptake rate and by-product rate from on-line HPLC and NIR probe signals. The software sensors were demonstrated on an Escherichia coli cultivation expressing a recombinant protein, green fluorescent protein (GFP), but the results could be extrapolated to other production organisms and product proteins. We conclude that well-maintained on-line instrumentation (hardware sensors) can increase the potential of software sensors. This would also strongly support the intentions with process analytical technology and quality-by-design concepts. 2010 Elsevier B.V. All rights reserved.

Evaluation of SEVIRI-Derived Rain Rates and Accumulated Rainfall with TRMM-TMI and Rain Gauge Data over West-Africa

NASA Astrophysics Data System (ADS)

Wolters, E. L. A.; Roebeling, R. A.; Stammes, P.; Wang, P.; Ali, A.; Brissebrat, G.

2009-11-01

Clouds are of paramount importance to the hydrological cycle, as they influence the surface energy balance, thereby constraining the amount of energy available for evaporation, and their contribution through precipitation. Especially in regions where water availability is critical, such as in West-Africa, accurate determination of various terms of the hydrological cycle is warranted. At the Royal Netherlands Meteorological Institute (KNMI), an algorithm to retrieve Cloud Physical Properties (CPP) from mainly visible and near-infrared spectral channel radiances from the Spinning Enhanced Visible and Infrared Imager (SEVIRI) onboard Meteosat-8 and -9 has been developed. Recently, this algorithm as been extended with a rain rate retrieval method. Evaluation of this geophysical quantity has been done with rain radar data over the Netherlands. This paper presents the first results of this rain rate retrieval over West-Africa for June 2006. In addition, the added value of the high temporal and spatial resolution of the SEVIRI instrument is shown. Over land, retrievals are compared with rain gauge observations performed during the African Monsoon Multidisciplinary Analyses (AMMA) project and with a kriged dataset of the Comite Inter-Estate pour la Lutte contre la Secheresse au Sahel (CILSS) rain gauge network, whereas rain rate retrievals over ocean are evaluated using Tropical Rainfall Measurement Mission (TRMM) Microwave Imager (TMI) data.

Molecular simulation of flow-enhanced nucleation in n-eicosane melts under steady shear and uniaxial extension.

PubMed

Nicholson, David A; Rutledge, Gregory C

2016-12-28

Non-equilibrium molecular dynamics is used to study crystal nucleation of n-eicosane under planar shear and, for the first time, uniaxial extension. A method of analysis based on the mean first-passage time is applied to the simulation results in order to determine the effect of the applied flow field type and strain rate on the steady-state nucleation rate and a characteristic growth rate, as well as the effects on kinetic parameters associated with nucleation: the free energy barrier, critical nucleus size, and monomer attachment pre-factor. The onset of flow-enhanced nucleation (FEN) occurs at a smaller critical strain rate in extension as compared to shear. For strain rates larger than the critical rate, a rapid increase in the nucleation rate is accompanied by decreases in the free energy barrier and critical nucleus size, as well as an increase in chain extension. These observations accord with a mechanism in which FEN is caused by an increase in the driving force for crystallization due to flow-induced entropy reduction. At high applied strain rates, the free energy barrier, critical nucleus size, and degree of stretching saturate, while the monomer attachment pre-factor and degree of orientational order increase steadily. This trend is indicative of a significant diffusive contribution to the nucleation rate under intense flows that is correlated with the degree of global orientational order in a nucleating system. Both flow fields give similar results for all kinetic quantities with respect to the reduced strain rate, which we define as the ratio of the applied strain rate to the critical rate. The characteristic growth rate increases with increasing strain rate, and shows a correspondence with the nucleation rate that does not depend on the type of flow field applied. Additionally, a structural analysis of the crystalline clusters indicates that the flow field suppresses the compaction and crystalline ordering of clusters, leading to the formation of large articulated clusters under strong flow fields, and compact well-ordered clusters under weak flow fields.

Evaluation of psychology practitioner competence in clinical supervision.

PubMed

Gonsalvez, Craig J; Crowe, Trevor P

2014-01-01

There is a growing consensus favouring the development, advancement, and implementation of a competency-based approach for psychology training and supervision. There is wide recognition that skills, attitude-values, and relationship competencies are as critical to a psychologist's competence as are knowledge capabilities, and that these key competencies are best measured during placements, leaving the clinical supervisor in an unparalleled position of advantage to provide formative and summative evaluations on the supervisee's progression towards competence. Paradoxically, a compelling body of literature from across disciplines indicates that supervisor ratings of broad domains of competence are systematically compromised by biases, including leniency error and halo effect. The current paper highlights key issues affecting summative competency evaluations by supervisors: what competencies should be evaluated, who should conduct the evaluation, how (tools) and when evaluations should be conducted, and process variables that affect evaluation. The article concludes by providing research recommendations to underpin and promote future progress and by offering practice recommendations to facilitate a more credible and meaningful evaluation of competence and competencies.

Nuclear criticality safety evaluation of SRS 9971 shipping package

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

Vescovi, P.J.

1993-02-01

This evaluation is requested to revise the criticality evaluation used to generate Chapter 6 (Criticality Evaluation) of the Safety Analysis Report for Packaging (SARP) for shipment Of UO{sub 3} product from the Uranium Solidification Facility (USF) in the SRS 9971 shipping package. The pertinent document requesting this evaluation is included as Attachment I. The results of the evaluation are given in Attachment II which is written as Chapter 6 of a NRC format SARP.

Association between mutations of critical pathway genes and survival outcomes according to the tumor location in colorectal cancer.

PubMed

Lee, Dae-Won; Han, Sae-Won; Cha, Yongjun; Bae, Jeong Mo; Kim, Hwang-Phill; Lyu, Jaemyun; Han, Hyojun; Kim, Hyoki; Jang, Hoon; Bang, Duhee; Huh, Iksoo; Park, Taesung; Won, Jae-Kyung; Jeong, Seung-Yong; Park, Kyu Joo; Kang, Gyeong Hoon; Kim, Tae-You

2017-09-15

Colorectal cancer (CRC) develops through the alteration of several critical pathways. This study was aimed at evaluating the influence of critical pathways on survival outcomes for patients with CRC. Targeted next-generation sequencing of 40 genes included in the 5 critical pathways of CRC (WNT, P53, RTK-RAS, phosphatidylinositol-4,5-bisphosphate 3-kinase [PI3K], and transforming growth factor β [TGF-β]) was performed for 516 patients with stage III or high-risk stage II CRC treated with surgery followed by adjuvant fluoropyrimidine and oxaliplatin chemotherapy. The associations between critical pathway mutations and relapse-free survival (RFS) and overall survival were analyzed. The associations were further analyzed according to the tumor location. The mutation rates for the WNT, P53, RTK-RAS, PI3K, and TGF-β pathways were 84.5%, 69.0%, 60.7%, 30.0%, and 28.9%, respectively. A mutation in the PI3K pathway was associated with longer RFS (adjusted hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.36-0.99), whereas a mutation in the RTK-RAS pathway was associated with shorter RFS (adjusted HR, 1.60; 95% CI, 1.01-2.52). Proximal tumors showed a higher mutation rate than distal tumors, and the mutation profile was different according to the tumor location. The mutation rates of Kirsten rat sarcoma viral oncogene homolog (KRAS), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit α (PIK3CA), and B-Raf proto-oncogene serine/threonine kinase (BRAF) were higher in proximal tumors, and the mutation rates of adenomatous polyposis coli (APC), tumor protein 53 (TP53), and neuroblastoma RAS viral oncogene homolog (NRAS) were higher in distal tumors. The better RFS with the PI3K pathway mutation was significant only for proximal tumors, and the worse RFS with the RTK-RAS pathway mutation was significant only for distal tumors. A PI3K pathway mutation was associated with better RFS for CRC patients treated with adjuvant chemotherapy, and an RTK-RAS pathway mutation was associated with worse RFS. The significance of the prognostic impact differed according to the tumor location. Cancer 2017;123:3513-23. © 2017 American Cancer Society. © 2017 American Cancer Society.

Biodegradability and platelets adhesion assessment of magnesium-based alloys using a microfluidic system

PubMed Central

Liu, Lumei; Koo, Youngmi; Collins, Boyce; Xu, Zhigang; Sankar, Jagannathan

2017-01-01

Magnesium (Mg)-based stents are extensively explored to alleviate atherosclerosis due to their biodegradability and relative hemocompatibility. To ensure the quality, safety and cost-efficacy of bioresorbable scaffolds and full utilization of the material tunability afforded by alloying, it is critical to access degradability and thrombosis potential of Mg-based alloys using improved in vitro models that mimic as closely as possible the in vivo microenvironment. In this study, we investigated biodegradation and initial thrombogenic behavior of Mg-based alloys at the interface between Mg alloys’ surface and simulated physiological environment using a microfluidic system. The degradation properties of Mg-based alloys WE43, AZ31, ZWEK-L, and ZWEK-C were evaluated in complete culture medium and their thrombosis potentials in platelet rich plasma, respectively. The results show that 1) physiological shear stress increased the corrosion rate and decreased platelets adhesion rate as compared to static immersion; 2) secondary phases and impurities in material composition induced galvanic corrosion, resulting in higher corrosion resistance and platelet adhesion rate; 3) Mg-based alloys with higher corrosion rate showed higher platelets adhesion rate. We conclude that a microfluidic-based in vitro system allows evaluation of biodegradation behaviors and platelets responses of Mg-based alloys under specific shear stress, and degradability is related to platelets adhesion. PMID:28797069

Estimation of hydrolysis rate constants for carbamates ...

EPA Pesticide Factsheets

Cheminformatics based tools, such as the Chemical Transformation Simulator under development in EPA’s Office of Research and Development, are being increasingly used to evaluate chemicals for their potential to degrade in the environment or be transformed through metabolism. Hydrolysis represents a major environmental degradation pathway; unfortunately, only a small fraction of hydrolysis rates for about 85,000 chemicals on the Toxic Substances Control Act (TSCA) inventory are in public domain, making it critical to develop in silico approaches to estimate hydrolysis rate constants. In this presentation, we compare three complementary approaches to estimate hydrolysis rates for carbamates, an important chemical class widely used in agriculture as pesticides, herbicides and fungicides. Fragment-based Quantitative Structure Activity Relationships (QSARs) using Hammett-Taft sigma constants are widely published and implemented for relatively simple functional groups such as carboxylic acid esters, phthalate esters, and organophosphate esters, and we extend these to carbamates. We also develop a pKa based model and a quantitative structure property relationship (QSPR) model, and evaluate them against measured rate constants using R square and root mean square (RMS) error. Our work shows that for our relatively small sample size of carbamates, a Hammett-Taft based fragment model performs best, followed by a pKa and a QSPR model. This presentation compares three comp

Evaluation of critical shear stresses for consolidated cohesive sediment depositions by using PIV compared with field measurements

NASA Astrophysics Data System (ADS)

Harb, Gabriele; Haun, Stefan

2013-04-01

Reservoir sedimentation is a common problem today. Due to the reduced flow velocities, turbulences and bed shear stresses the transported sediment load start to settle. These depositions reduce the worldwide average storage capacity in the range of about 1% per year. However, depending on the climate conditions and the geology in the catchment area this value may vary strongly. Therefore sediment management tasks, especially the removal of already accumulated sediments, have to be developed for each reservoir separately. The critical bed shear stress is a key parameter used to evaluate the different management tasks and depend strongly on the grain size distribution of the inflowing sediments. However, depositions which contain fine particles like clay and silt increase the critical bed shear stress due to occurring cohesive forces and the use of the Shield curve for evaluating the critical shear stress is no longer valid. Additional data is required for estimating the valid critical shear stress at the reservoir bed. In this study the critical shear stress was evaluated for cohesive sediment samples, taken from two different reservoirs, in a flume in the laboratory. The sediment samples were placed in an installed double bottom in the research flume and the discharge was increased stepwise until mass erosion took place (determined by visual inspection). A 2D PIV device was used to measure the flow conditions (velocities and turbulences) over the sediment sample. The obtained values were used to calculate the bed shear stress for the specific discharge rate by the gravity method and the Reynolds stress method. The results of both methods showed good agreement in the comparison of the values, what indicates that nearly uniform flow conditions occurred in the flume. The results from this study showed that the behaviour of natural cohesive sediments depend strongly on the natural conditions as a result of physical, chemical and biological processes. In this case especially the effect of the layer structure in the sediment samples was controlling the erosion mechanism. The results of the experiments showed also that the obtained average shear stress was above most of the values found in previous conducted studies, which may be explained by consolidation effects in the reservoirs. Additional conducted vane strength measurements have been carried out in situ. The in the field obtained vane strength values were set in relation to the critical shear stresses derived by the experimental tests from the laboratory and to data from a previous conducted study to develop a new relation function. This function may be used in future studies for a rough estimation of the critical shear stress, based on in situ measured vane strength values.

Microstructural Evaluation of Forging Parameters for Superalloy Disks

NASA Technical Reports Server (NTRS)

Falsey, John R.

2004-01-01

Forgings of nickel base superalloy were formed under several different strain rates and forging temperatures. Samples were taken from each forging condition to find the ASTM grain size, and the as large as grain (ALA). The specimens were mounted in bakelite, polished, etched and then optical microscopy was used to determine grain size. The specimens ASTM grain sizes from each forging condition were plotted against strain rate, forging temperature, and presoak time. Grain sizes increased with increasing forging temperature. Grain sizes also increased with decreasing strain rates and increasing forging presoak time. The ALA had been determined from each forging condition using the ASTM standard method. Each ALA was compared with the ASTM grain size of each forging condition to determine if the grain sizes were uniform or not. The forging condition of a strain rate of .03/sec and supersolvus heat treatment produced non uniform grains indicated by critical grain growth. Other anomalies are noted as well.

Human Rating the Orion Parachute System

NASA Technical Reports Server (NTRS)

Machin, Ricardo A.; Fisher, Timothy E.; Evans, Carol T.; Stewart, Christine E.

2011-01-01

Human rating begins with design. Converging on the requirements and identifying the risks as early as possible in the design process is essential. Understanding of the interaction between the recovery system and the spacecraft will in large part dictate the achievable reliability of the final design. Component and complete system full-scale flight testing is critical to assure a realistic evaluation of the performance and reliability of the parachute system. However, because testing is so often difficult and expensive, comprehensive analysis of test results and correlation to accurate modeling completes the human rating process. The National Aeronautics and Space Administration (NASA) Orion program uses parachutes to stabilize and decelerate the Crew Exploration Vehicle (CEV) spacecraft during subsonic flight in order to deliver a safe water landing. This paper describes the approach that CEV Parachute Assembly System (CPAS) will take to human rate the parachute recovery system for the CEV.

The relationship-based care model: evaluation of the impact on patient satisfaction, length of stay, and readmission rates.

PubMed

Cropley, Stacey

2012-06-01

The objective of this study was to assess the impact of the implementation of the relationship-based care (RBC) model on patient satisfaction, length of stay, and readmission rates in hospitalized patients. RBC model promotes organizational viability in critical areas that measure success, inclusive of clinical quality, patient satisfaction, and robust financial standing. A retrospective secondary analysis of aggregate patient satisfaction data, length of stay, and readmission rates at a rural Texas hospital was reviewed for the years 2009 and 2010. This study compared preimplementation data for year 2009 with postimplementation data for year 2010. Data support the positive influential impact of RBC model. A negative correlation was noted with readmission rates and a concomitant positive correlation with length of stay. Overall satisfaction with nursing did not reveal a significant correlation to the new care model. RBC model supports a patient-centered, collaborative care environment, maximizing potential reimbursement.

Perceived Criticism Predicts Outcome of Psychotherapy for Panic Disorder: Replication and Extension

PubMed Central

Chambless, Dianne L.; Allred, Kelly M.; Chen, Fang Fang; McCarthy, Kevin S.; Milrod, Barbara; Barber, Jacques P.

2016-01-01

Objective We tested the relation of perceived criticism from a parent or spouse/romantic partner to outcome of psychotherapy for panic disorder. Method Participants were 130 patients with panic disorder (79% with agoraphobia) who received 24 twice weekly sessions of Panic-Focused Psychodynamic Psychotherapy, Cognitive-Behavioral Therapy, or Applied Relaxation Therapy. Patients were predominantly White (75%), female (64%), and non-Hispanic (85%). At baseline, Week 5 of treatment, termination, and at 6- and 12-month follow-up, patients rated perceived criticism from the relative with whom they lived. Independent evaluators assessed the severity of panic disorder at baseline, Weeks 1, 5, and 9 of treatment, termination, and the two follow-up points. Data were analyzed with piecewise (treatment phase, follow-up phase) latent growth curve modeling. Results The latent intercept for perceived criticism at baseline predicted the latent slope for panic severity in the follow-up (p = .04) but not the active treatment phase (p = .50). In contrast, the latent intercept for panic disorder severity at baseline did not predict the latent slope on perceived criticism in either phase (ps ≥ .29). Nor did the slopes of perceived criticism and panic disorder severity covary across treatment (p = .31) or follow-up (p =.13). Indeed, perceived criticism did not change significantly across treatment (p =.45), showing the stability of this perception regardless of significant change in severity of patients’ panic disorder (p < .001). Conclusions Because perceived criticism predicts worse long-term treatment outcome for panic disorder, study findings argue for interventions to address perceived criticism in treatment. PMID:28045286

A critical view of the peripheral atherectomy data in the treatment of infrainguinal arterial disease.

PubMed

Quevedo, Henry C; Arain, Salman A; Ali, Gholam; Abi Rafeh, Nidal

2014-01-01

Revascularization of the peripheral arteries remains technically challenging. By decreasing the volume of the atherosclerotic plaque, debulking procedures may confer superior primary patency after revascularization. To assess the impact of atherectomy on primary patency rates at 12 months compared to balloon angioplasty and/or stent placement alone in patients with infrainguinal arterial disease. A database search for "directional," "orbital," "rotational," and "laser atherectomy" in peripheral arterial disease (PAD) was performed. Studies were screened according to the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) critical appraisal tool and summarized by population, methodology, and outcomes (primary patency and major adverse events). Only two randomized studies were found. Most of the data were obtained from single-arm studies and registries. The primary patency with directional atherectomy approaches 60% at 12 months as a stand-alone technique, whereas orbital atherectomy in conjunction with balloon angioplasty and stenting achieved primary patency rates of 90%. Laser atherectomy is universally employed with balloon angioplasty and stenting for in-stent restenosis lesions with a primary patency rate of 64%. Although there are data for the safe use of rotational atherectomy, robust data to support its effectiveness are lacking. The combination of drug-coated balloons and atherectomy for the treatment of heavily calcified lesions in patients with critical limb ischemia is under evaluation. Despite the successful procedural outcomes reported in clinical registries, the available data do not support the use of atherectomy alone in PAD. Larger randomized controlled studies are warranted to define its role in contemporary endovascular practice.

Controls on the variability of net infiltration to desert sandstone

USGS Publications Warehouse

Heilweil, Victor M.; McKinney, Tim S.; Zhdanov, Michael S.; Watt, Dennis E.

2007-01-01

As populations grow in arid climates and desert bedrock aquifers are increasingly targeted for future development, understanding and quantifying the spatial variability of net infiltration becomes critically important for accurately inventorying water resources and mapping contamination vulnerability. This paper presents a conceptual model of net infiltration to desert sandstone and then develops an empirical equation for its spatial quantification at the watershed scale using linear least squares inversion methods for evaluating controlling parameters (independent variables) based on estimated net infiltration rates (dependent variables). Net infiltration rates used for this regression analysis were calculated from environmental tracers in boreholes and more than 3000 linear meters of vadose zone excavations in an upland basin in southwestern Utah underlain by Navajo sandstone. Soil coarseness, distance to upgradient outcrop, and topographic slope were shown to be the primary physical parameters controlling the spatial variability of net infiltration. Although the method should be transferable to other desert sandstone settings for determining the relative spatial distribution of net infiltration, further study is needed to evaluate the effects of other potential parameters such as slope aspect, outcrop parameters, and climate on absolute net infiltration rates.

Evaluation of Flagging Criteria of United States Kidney Transplant Center Performance: How to Best Define Outliers?

PubMed

Schold, Jesse D; Miller, Charles M; Henry, Mitchell L; Buccini, Laura D; Flechner, Stuart M; Goldfarb, David A; Poggio, Emilio D; Andreoni, Kenneth A

2017-06-01

Scientific Registry of Transplant Recipients report cards of US organ transplant center performance are publicly available and used for quality oversight. Low center performance (LP) evaluations are associated with changes in practice including reduced transplant rates and increased waitlist removals. In 2014, Scientific Registry of Transplant Recipients implemented new Bayesian methodology to evaluate performance which was not adopted by Center for Medicare and Medicaid Services (CMS). In May 2016, CMS altered their performance criteria, reducing the likelihood of LP evaluations. Our aims were to evaluate incidence, survival rates, and volume of LP centers with Bayesian, historical (old-CMS) and new-CMS criteria using 6 consecutive program-specific reports (PSR), January 2013 to July 2015 among adult kidney transplant centers. Bayesian, old-CMS and new-CMS criteria identified 13.4%, 8.3%, and 6.1% LP PSRs, respectively. Over the 3-year period, 31.9% (Bayesian), 23.4% (old-CMS), and 19.8% (new-CMS) of centers had 1 or more LP evaluation. For small centers (<83 transplants/PSR), there were 4-fold additional LP evaluations (52 vs 13 PSRs) for 1-year mortality with Bayesian versus new-CMS criteria. For large centers (>183 transplants/PSR), there were 3-fold additional LP evaluations for 1-year mortality with Bayesian versus new-CMS criteria with median differences in observed and expected patient survival of -1.6% and -2.2%, respectively. A significant proportion of kidney transplant centers are identified as low performing with relatively small survival differences compared with expected. Bayesian criteria have significantly higher flagging rates and new-CMS criteria modestly reduce flagging. Critical appraisal of performance criteria is needed to assess whether quality oversight is meeting intended goals and whether further modifications could reduce risk aversion, more efficiently allocate resources, and increase transplant opportunities.

Acute exacerbations of chronic obstructive pulmonary disease: diagnosis, management, and prevention in critically ill patients.

PubMed

Dixit, Deepali; Bridgeman, Mary Barna; Andrews, Liza Barbarello; Narayanan, Navaneeth; Radbel, Jared; Parikh, Amay; Sunderram, Jag

2015-06-01

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and is a substantial source of disability in the United States. Moderate-to-severe acute exacerbations of COPD (AECOPD) can progress to respiratory failure, necessitating ventilator assistance in patients in the intensive care unit (ICU). Patients in the ICU with AECOPD requiring ventilator support have higher morbidity and mortality rates as well as costs compared with hospitalized patients not in the ICU. The mainstay of management for patients with AECOPD in the ICU includes ventilator support (noninvasive or invasive), rapid-acting inhaled bronchodilators, systemic corticosteroids, and antibiotics. However, evidence supporting these interventions for the treatment of AECOPD in critically ill patients admitted to the ICU is scant. Corticosteroids have gained widespread acceptance in the management of patients with AECOPD necessitating ventilator assistance, despite their lack of evaluation in clinical trials as well as controversies surrounding optimal dosage regimens and duration of treatment. Recent studies evaluating the safety and efficacy of corticosteroids have found that higher doses are associated with increased adverse effects, which therefore support lower dosing strategies, particularly for patients admitted to the ICU for COPD exacerbations. This review highlights recent findings from the current body of evidence on nonpharmacologic and pharmacologic treatment and prevention of AECOPD in critically ill patients. In addition, the administration of bronchodilators using novel delivery devices in the ventilated patient and the conflicting evidence surrounding antibiotic use in AECOPD in the critically ill is explored. Further clinical trials, however, are warranted to clarify the optimal pharmacotherapy management for AECOPD, particularly in critically ill patients admitted to the ICU. © 2015 Pharmacotherapy Publications, Inc.

The reliability of the German version of the Richards Campbell Sleep Questionnaire.

PubMed

Krotsetis, Susanne; Richards, Kathy C; Behncke, Anja; Köpke, Sascha

2017-07-01

The assessment of sleep quality in critically ill patients is a relevant factor of high-quality care. Despite the fact that sleep disturbances and insufficient sleep management contain an increased risk of severe morbidity for these patients, a translated and applicable instrument to evaluate sleep is not available for German-speaking intensive care settings. This study aimed to translate the Richards Campbell Sleep Questionnaire (RCSQ), a simple and validated instrument eligible for measuring sleep quality in critically ill patients, and subsequently to evaluate the internal consistency of the German version of the RCSQ. Furthermore, it also aimed to inquire into the perception of sleep in a sample of critically ill patients. The RCSQ was translated following established methodological standards. Data were collected cross-sectionally in a sample of 51 patients at 3 intensive care units at a university hospital in Germany. The German version of the RCSQ showed an overall internal consistency (Cronbach's alpha) of 0·88. The mean of the RSCQ in the sample was 47·00 (SD ± 27·57). Depth of sleep was rated the lowest and falling asleep again the highest of the RCSQ sleep items. The study demonstrated very good internal consistency of the German version of the RCSQ, allowing for its application in practice and research in German-speaking countries. Quality of sleep perception was generally low in this sample, emphasizing the need for enhanced care concepts regarding the sleep management of critically ill patients. Relevance to clinical practice Assessment of self-perception of sleep is crucial in order to plan an individually tailored care process. © 2017 British Association of Critical Care Nurses.

Multiscale Investigation on Biofilm Distribution and Its Impact on Macroscopic Biogeochemical Reaction Rates: BIOFILM DISTRIBUTION AND RATE SCALING

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

Yan, Zhifeng; Liu, Chongxuan; Liu, Yuanyuan

Biofilms are critical locations for biogeochemical reactions in the subsurface environment. The occurrence and distribution of biofilms at microscale as well as their impacts on macroscopic biogeochemical reaction rates are still poorly understood. This paper investigated the formation and distributions of biofilms in heterogeneous sediments using multiscale models, and evaluated the effects of biofilm heterogeneity on local and macroscopic biogeochemical reaction rates. Sediment pore structures derived from X-ray computed tomography were used to simulate the microscale flow dynamics and biofilm distribution in the sediment column. The response of biofilm formation and distribution to the variations in hydraulic and chemical propertiesmore » was first examined. One representative biofilm distribution was then utilized to evaluate its effects on macroscopic reaction rates using nitrate reduction as an example. The results revealed that microorganisms primarily grew on the surfaces of grains and aggregates near preferential flow paths where both electron donor and acceptor were readily accessible, leading to the heterogeneous distribution of biofilms in the sediments. The heterogeneous biofilm distribution decreased the macroscopic rate of biogeochemical reactions as compared with those in homogeneous cases. Operationally considering the heterogeneous biofilm distribution in macroscopic reactive transport models such as using dual porosity domain concept can significantly improve the prediction of biogeochemical reaction rates. Overall, this study provided important insights into the biofilm formation and distribution in soils and sediments as well as their impacts on the macroscopic manifestation of reaction rates.« less

Nuclear criticality safety evaluation of SRS 9971 shipping package. [SRS (Savannah River Site)

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

Vescovi, P.J.

1993-02-01

This evaluation is requested to revise the criticality evaluation used to generate Chapter 6 (Criticality Evaluation) of the Safety Analysis Report for Packaging (SARP) for shipment Of UO[sub 3] product from the Uranium Solidification Facility (USF) in the SRS 9971 shipping package. The pertinent document requesting this evaluation is included as Attachment I. The results of the evaluation are given in Attachment II which is written as Chapter 6 of a NRC format SARP.

Reconciling extreme branch length differences: decoupling time and rate through the evolutionary history of filmy ferns.

PubMed

Schuettpelz, Eric; Pryer, Kathleen M

2006-06-01

The rate of molecular evolution is not constant across the Tree of Life. Characterizing rate discrepancies and evaluating the relative roles of time and rate along branches through the past are both critical to a full understanding of evolutionary history. In this study, we explore the interactions of time and rate in filmy ferns (Hymenophyllaceae), a lineage with extreme branch length differences between the two major clades. We test for the presence of significant rate discrepancies within and between these clades, and we separate time and rate across the filmy fern phylogeny to simultaneously yield an evolutionary time scale of filmy fern diversification and reconstructions of ancestral rates of molecular evolution. Our results indicate that the branch length disparity observed between the major lineages of filmy ferns is indeed due to a significant difference in molecular evolutionary rate. The estimation of divergence times reveals that the timing of crown group diversification was not concurrent for the two lineages, and the reconstruction of ancestral rates of molecular evolution points to a substantial rate deceleration in one of the clades. Further analysis suggests that this may be due to a genome-wide deceleration in the rate of nucleotide substitution.

How to perform a critically appraised topic: part 2, appraise, evaluate, generate, and recommend.

PubMed

Kelly, Aine Marie; Cronin, Paul

2011-11-01

This article continues the discussion of a critically appraised topic started in Part 1. A critically appraised topic is a practical tool for learning and applying critical appraisal skills. This article outlines steps 4-7 involved in performing a critically appraised topic for studies of diagnostic tests: Appraise, Appraise the literature; Evaluate, evaluate the strength of the evidence from the literature; Generate, generate graphs of conditional probability; and Recommend, draw conclusions and make recommendations. For steps 4-7 of performing a critically appraised topic, the main study results are summarized and translated into clinically useful measures of accuracy, efficacy, or risk.

What is the evidence behind the evidence-base? The premature death of block-replace antithyroid drug regimens for Graves' disease.

PubMed

Razvi, Salman; Vaidya, Bijay; Perros, Petros; Pearce, Simon H S

2006-06-01

Block-replace and titration antithyroid drug regimens both give similar rates of medium- to long-term remission of hyperthyroid Graves' disease. Recent meta-analysis, however, has suggested that titration regimens may be preferable owing to a higher rate of adverse events seen in the block-replace arms of published comparative studies. This article critically re-evaluates the evidence upon which these meta-analyses were based. We suggest that there is little objective evidence that is pertinent to current clinical practice to separate block-replace from titration antithyroid drug regimens and that both remain satisfactory approaches to the medical management of hyperthyroid Graves' disease.

Strain energy release rate as a function of temperature and preloading history utilizing the edge delamination fatique test method

NASA Technical Reports Server (NTRS)

Zimmerman, Richard S.; Adams, Donald F.

1989-01-01

Static laminate and tension-tension fatigue tests of IM7/8551-7 composite materials was performed. The Edge Delamination Test (EDT) was utilized to evaluate the temperature and preloading history effect on the critical strain energy release rate. Static and fatigue testing was performed at room temperature and 180 F (82 C). Three preloading schemes were used to precondition fatigue test specimens prior to performing the normal tension-tension fatigue EDT testing. Computer software was written to perform all fatigue testing while monitoring the dynamic modulus to detect the onset of delamination and record the test information for later retrieval and reduction.

An evaluation of the effectiveness of a risk-based monitoring approach implemented with clinical trials involving implantable cardiac medical devices.

PubMed

Diani, Christopher A; Rock, Angie; Moll, Phil

2017-12-01

Background Risk-based monitoring is a concept endorsed by the Food and Drug Administration to improve clinical trial data quality by focusing monitoring efforts on critical data elements and higher risk investigator sites. BIOTRONIK approached this by implementing a comprehensive strategy that assesses risk and data quality through a combination of operational controls and data surveillance. This publication demonstrates the effectiveness of a data-driven risk assessment methodology when used in conjunction with a tailored monitoring plan. Methods We developed a data-driven risk assessment system to rank 133 investigator sites comprising 3442 subjects and identify those sites that pose a potential risk to the integrity of data collected in implantable cardiac device clinical trials. This included identification of specific risk factors and a weighted scoring mechanism. We conducted trend analyses for risk assessment data collected over 1 year to assess the overall impact of our data surveillance process combined with other operational monitoring efforts. Results Trending analyses of key risk factors revealed an improvement in the quality of data collected during the observation period. The three risk factors follow-up compliance rate, unavailability of critical data, and noncompliance rate correspond closely with Food and Drug Administration's risk-based monitoring guidance document. Among these three risk factors, 100% (12/12) of quantiles analyzed showed an increase in data quality. Of these, 67% (8/12) of the improving trends in worst performing quantiles had p-values less than 0.05, and 17% (2/12) had p-values between 0.05 and 0.06. Among the poorest performing site quantiles, there was a statistically significant decrease in subject follow-up noncompliance rates, protocol noncompliance rates, and incidence of missing critical data. Conclusion One year after implementation of a comprehensive strategy for risk-based monitoring, including a data-driven risk assessment methodology to target on-site monitoring visits, statistically significant improvement was seen in a majority of measurable risk factors at the worst performing site quantiles. For the three risk factors which are most critical to the overall compliance of cardiac rhythm management medical device studies: follow-up compliance rate, unavailability of critical data, and noncompliance rate, we measured significant improvement in data quality. Although the worst performing site quantiles improved but not significantly in some risk factors such as subject attrition, the data-driven risk assessment highlighted key areas on which to continue focusing both on-site and centralized monitoring efforts. Data-driven surveillance of clinical trial performance provides actionable observations that can improve site performance. Clinical trials utilizing risk-based monitoring by leveraging a data-driven quality assessment combined with specific operational procedures may lead to an improvement in data quality and resource efficiencies.

RNA-SeQC: RNA-seq metrics for quality control and process optimization.

PubMed

DeLuca, David S; Levin, Joshua Z; Sivachenko, Andrey; Fennell, Timothy; Nazaire, Marc-Danie; Williams, Chris; Reich, Michael; Winckler, Wendy; Getz, Gad

2012-06-01

RNA-seq, the application of next-generation sequencing to RNA, provides transcriptome-wide characterization of cellular activity. Assessment of sequencing performance and library quality is critical to the interpretation of RNA-seq data, yet few tools exist to address this issue. We introduce RNA-SeQC, a program which provides key measures of data quality. These metrics include yield, alignment and duplication rates; GC bias, rRNA content, regions of alignment (exon, intron and intragenic), continuity of coverage, 3'/5' bias and count of detectable transcripts, among others. The software provides multi-sample evaluation of library construction protocols, input materials and other experimental parameters. The modularity of the software enables pipeline integration and the routine monitoring of key measures of data quality such as the number of alignable reads, duplication rates and rRNA contamination. RNA-SeQC allows investigators to make informed decisions about sample inclusion in downstream analysis. In summary, RNA-SeQC provides quality control measures critical to experiment design, process optimization and downstream computational analysis. See www.genepattern.org to run online, or www.broadinstitute.org/rna-seqc/ for a command line tool.

Cervical necrotizing fasciitis of nonodontogenic origin: case report and review of literature.

PubMed

Suárez, Aldo; Vicente, Mario; Tomás, Jose A; Floría, Luis M; Delhom, José; Baquero, Mari C

2014-11-01

Cervical necrotizing fasciitis (CNF) is a potentially fatal infection characterized by generalized necrosis of the cervical fascia that progresses rapidly. The incidence of this entity corresponds to 2.6% of all infections of the head and neck. The most frequent primary origin is dental infection, although other causes exist that should be evaluated.Delay in the diagnosis of this entity may lead to rapid progression and fatal outcome. Patients often present immunosuppression or systemic diseases that predispose them to this pathology. Cervical necrotizing fasciitis is associated with mortality rates of 7% to 20% depending on the extension of the cervical lesion. The highest rates correspond to cases that progress to mediastinitis or septic shock, which are the main and most frequent complications. Early detection and adequate emergency treatment are critical in the management of these patients and may reduce morbimortality and improve survival. The emergency services should be prepared to manage such cases efficiently, through a multidisciplinary treatment by coordinating emergency surgery with critical support and clinical stabilization of patients.We present a case of CNF of non odontogenic origin managed in our hospital.

Stringent Mitigation Policy Implied By Temperature Impacts on Economic Growth

NASA Astrophysics Data System (ADS)

Moore, F.; Turner, D.

2014-12-01

Integrated assessment models (IAMs) compare the costs of greenhouse gas mitigation with damages from climate change in order to evaluate the social welfare implications of climate policy proposals and inform optimal emissions reduction trajectories. However, these models have been criticized for lacking a strong empirical basis for their damage functions, which do little to alter assumptions of sustained GDP growth, even under extreme temperature scenarios. We implement empirical estimates of temperature effects on GDP growth-rates in the Dynamic Integrated Climate and Economy (DICE) model via two pathways, total factor productivity (TFP) growth and capital depreciation. Even under optimistic adaptation assumptions, this damage specification implies that optimal climate policy involves the elimination of emissions in the near future, the stabilization of global temperature change below 2°C, and a social cost of carbon (SCC) an order of magnitude larger than previous estimates. A sensitivity analysis shows that the magnitude of growth effects, the rate of adaptation, and the dynamic interaction between damages from warming and GDP are three critical uncertainties and an important focus for future research.

Trajectories of change across outcomes in intensive treatment for adolescent panic disorder and agoraphobia.

PubMed

Gallo, Kaitlin P; Cooper-Vince, Christine E; Hardway, Christina L; Pincus, Donna B; Comer, Jonathan S

2014-01-01

Much remains to be learned about typical and individual growth trajectories across treatment for adolescent panic disorder with and without agoraphobia and about critical treatment points associated with key changes. The present study examined the rate and shape of change across an 8-day intensive cognitive behavioral therapy for adolescent panic disorder with and without agoraphobia (N = 56). Participants ranged in age from 12 to 17 (M = 15.14, SD = 1.70; 58.9% female, 78.6% Caucasian). Multilevel modeling evaluated within-treatment linear and nonlinear changes across three treatment outcomes: panic severity, fear, and avoidance. Overall panic severity showed linear change, decreasing throughout treatment. In contrast, fear and avoidance ratings both showed cubic change, peaking slightly at the first session of treatment, starting to decrease at the second session of treatment, and with large gains continuing then plateauing at the fourth session. Findings are considered with regard to the extent to which they may elucidate critical treatment components and sessions for adolescents with panic disorder with and without agoraphobia.

Critical Congenital Heart Disease Screening by Pulse Oximetry in a Neonatal Intensive Care Unit

PubMed Central

Manja, Veena; Mathew, Bobby; Carrion, Vivien; Lakshminrusimha, Satyan

2014-01-01

Critical congenital heart disease (CCHD) screening is effective in asymptomatic late preterm and term newborn infants with a low false positive rate (0.035%). Objective (1) To compare 2817 NICU discharges before and after implementation of CCHD screening; and (2) to evaluate CCHD screening at < 35 weeks gestation. Methods collection of results of CCHD screening including preductal and postductal SpO2 values. Results During the pre-CCHD screen period, 1247 infants were discharged from the NICU and one case of CCHD was missed. After 3/1/12, 1508 CCHD screens were performed among 1570 discharges and no CCHDs were missed. The preductal and postductal SpO2 values were 98.8±1.4% and 99±1.3% respectively in preterm and 98.9±1.3% and 98.9±1.4% in term infants. Ten infants had false positive screens (10/1508=0.66%). Conclusions Performing universal screening in the NICU is feasible but is associated with a higher false positive rate compared to asymptomatic newborn infants. PMID:25058746

Quantifying the Impacts of Timebased Rates, Enabling Technology, and Other Treatments in Consumer Behavior Studies: Protocols and Guidelines

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

Cappers, Peter; Todd, Annika; Perry, Michael

2013-06-27

This report offers guidelines and protocols for measuring the effects of time-based rates, enabling technology, and various other treatments on customers’ levels and patterns of electricity usage. Although the focus is on evaluating consumer behavior studies (CBS) that involve field trials and pilots, the methods can be extended to assessing the large-scale programs that may follow. CBSs are undertaken to resolve uncertainties and ambiguities about how consumers respond to inducements to modify their electricity demand. Those inducements include price structures; feedback and information; and enabling technologies embedded in programs such as: critical peak, time-of use, real-time pricing; peak time rebatemore » or critical peak rebate; home energy reports and in-home displays; and all manner of device controls for appliances and plug loads. Although the focus of this report is on consumer studies—where the subjects are households—the behavioral sciences principles discussed and many of the methods recommended apply equally to studying commercial and industrial customer electricity demand.« less

Childhood obesity and sleep: relatives, partners, or both?--a critical perspective on the evidence.

PubMed

Gozal, David; Kheirandish-Gozal, Leila

2012-08-01

In modern life, children are unlikely to obtain sufficient or regular sleep and waking schedules. Inadequate sleep affects the regulation of homeostatic and hormonal systems underlying somatic growth, maturation, and bioenergetics. Therefore, assessments of the obesogenic lifestyle, including as dietary and physical activity, need to be coupled with accurate evaluation of sleep quality and quantity, and coexistence of sleep apnea. Inclusion of sleep as an integral component of research studies on childhood obesity should be done as part of the study planning process. Although parents and health professionals have quantified normal patterns of activities in children, sleep has been almost completely overlooked. As sleep duration in children appears to have declined, reciprocal obesity rates have increased. Also, increases in pediatric obesity rates have markedly increased the risk of obstructive sleep apnea syndrome (OSAS) in children. Obesity and OSAS share common pathways underlying end-organ morbidity, potentially leading to reciprocal amplificatory effects. The relative paucity of data on the topics covered in the perspective below should serve as a major incentive toward future research on these critically important concepts. © 2012 New York Academy of Sciences.

Evolution of Multidisciplinary Translational Teams (MTTs): Insights for Accelerating Translational Innovations

PubMed Central

Calhoun, William J.; Bhavnani, Suresh; Rose, Robert M.; Ameredes, Bill; Brasier, Allan R.

2015-01-01

Abstract There is growing consensus about the factors critical for development and productivity of multidisciplinary teams, but few studies have evaluated their longitudinal changes. We present a longitudinal study of 10 multidisciplinary translational teams (MTTs), based on team process and outcome measures, evaluated before and after 3 years of CTSA collaboration. Using a mixed methods approach, an expert panel of five judges (familiar with the progress of the teams) independently rated team performance based on four process and four outcome measures, and achieved a rating consensus. Although all teams made progress in translational domains, other process and outcome measures were highly variable. The trajectory profiles identified four categories of team performance. Objective bibliometric analysis of CTSA‐supported MTTs with positive growth in process scores showed that these teams tended to have enhanced scientific outcomes and published in new scientific domains, indicating the conduct of innovative science. Case exemplars revealed that MTTs that experienced growth in both process and outcome evaluative criteria also experienced greater innovation, defined as publications in different areas of science. Of the eight evaluative criteria, leadership‐related behaviors were the most resistant to the interventions introduced. Well‐managed MTTs demonstrate objective productivity and facilitate innovation. PMID:25801998

Evolution of Multidisciplinary Translational Teams (MTTs): Insights for Accelerating Translational Innovations.

PubMed

Wooten, Kevin C; Calhoun, William J; Bhavnani, Suresh; Rose, Robert M; Ameredes, Bill; Brasier, Allan R

2015-10-01

There is growing consensus about the factors critical for development and productivity of multidisciplinary teams, but few studies have evaluated their longitudinal changes. We present a longitudinal study of 10 multidisciplinary translational teams (MTTs), based on team process and outcome measures, evaluated before and after 3 years of CTSA collaboration. Using a mixed methods approach, an expert panel of five judges (familiar with the progress of the teams) independently rated team performance based on four process and four outcome measures, and achieved a rating consensus. Although all teams made progress in translational domains, other process and outcome measures were highly variable. The trajectory profiles identified four categories of team performance. Objective bibliometric analysis of CTSA-supported MTTs with positive growth in process scores showed that these teams tended to have enhanced scientific outcomes and published in new scientific domains, indicating the conduct of innovative science. Case exemplars revealed that MTTs that experienced growth in both process and outcome evaluative criteria also experienced greater innovation, defined as publications in different areas of science. Of the eight evaluative criteria, leadership-related behaviors were the most resistant to the interventions introduced. Well-managed MTTs demonstrate objective productivity and facilitate innovation. © 2015 Wiley Periodicals, Inc.

Models, measurement, and strategies in developing critical-thinking skills.

PubMed

Brunt, Barbara A

2005-01-01

Health care professionals must use critical-thinking skills to solve increasingly complex problems. Educators need to help nurses develop their critical-thinking skills to maintain and enhance their competence. This article reviews various models of critical thinking, as well as methods used to evaluate critical thinking. Specific educational strategies to develop nurses' critical-thinking skills are discussed. Additional research studies are needed to determine how the process of nursing practice can nurture and develop critical-thinking skills, and which strategies are most effective in developing and evaluating critical thinking.

Evaluation of expressed emotion in schizophrenia: a comparison of Caucasians and Mexican-Americans.

PubMed

Kopelowicz, Alex; Zarate, Roberto; Gonzalez, Veronica; Lopez, Steven R; Ortega, Paula; Obregon, Nora; Mintz, Jim

2002-05-01

Social desirability, while a recognized source of respondent bias among Mexican-Americans, has not been evaluated as an explanation for the lower rate of high expressed emotion (EE) found in the family members of Mexican-Americans versus Caucasians with schizophrenia. In this study, we tested the hypothesis that the lower rate of high EE (hostility and criticism) among Mexican-Americans was the result of cultural factors impacting on how information was reported by the Mexican-American relative of a patient with schizophrenia. We compared the ratings of EE between Caucasian (N = 17) and Mexican-American (N = 44) patients with schizophrenia or schizoaffective disorder and their key relatives using the level of expressed emotion (LEE) scale (paper and pencil instrument rated by the patient and relative separately) and the Five Minute Speech Sample (observational experimenter rated). The ability of the various measures to predict relapse over two years was also examined. Contrary to our hypothesis, there were no differences between patient and family measures within ethnic group. Mexican-American patients and relatives reported lower rates of high EE than Caucasians across all measures. High EE predicted relapse across measures for Caucasian participants, but did not predict relapse for Mexican-Americans on any of the measurement instruments. We discuss the implications of these findings on cross-cultural research and family interventions for individuals with psychotic disorders.

The random coding bound is tight for the average code.

NASA Technical Reports Server (NTRS)

Gallager, R. G.

1973-01-01

The random coding bound of information theory provides a well-known upper bound to the probability of decoding error for the best code of a given rate and block length. The bound is constructed by upperbounding the average error probability over an ensemble of codes. The bound is known to give the correct exponential dependence of error probability on block length for transmission rates above the critical rate, but it gives an incorrect exponential dependence at rates below a second lower critical rate. Here we derive an asymptotic expression for the average error probability over the ensemble of codes used in the random coding bound. The result shows that the weakness of the random coding bound at rates below the second critical rate is due not to upperbounding the ensemble average, but rather to the fact that the best codes are much better than the average at low rates.

Systematic strategies for the third industrial accident prevention plan in Korea.

PubMed

Kang, Young-sig; Yang, Sung-hwan; Kim, Tae-gu; Kim, Day-sung

2012-01-01

To minimize industrial accidents, it's critical to evaluate a firm's priorities for prevention factors and strategies since such evaluation provides decisive information for preventing industrial accidents and maintaining safety management. Therefore, this paper proposes the evaluation of priorities through statistical testing of prevention factors with a cause analysis in a cause and effect model. A priority matrix criterion is proposed to apply the ranking and for the objectivity of questionnaire results. This paper used regression method (RA), exponential smoothing method (ESM), double exponential smoothing method (DESM), autoregressive integrated moving average (ARIMA) model and proposed analytical function method (PAFM) to analyze trends of accident data that will lead to an accurate prediction. This paper standardized the questionnaire results of workers and managers in manufacturing and construction companies with less than 300 employees, located in the central Korean metropolitan areas where fatal accidents have occurred. Finally, a strategy was provided to construct safety management for the third industrial accident prevention plan and a forecasting method for occupational accident rates and fatality rates for occupational accidents per 10,000 people.

Temperature impacts on economic growth warrant stringent mitigation policy

NASA Astrophysics Data System (ADS)

Moore, Frances C.; Diaz, Delavane B.

2015-02-01

Integrated assessment models compare the costs of greenhouse gas mitigation with damages from climate change to evaluate the social welfare implications of climate policy proposals and inform optimal emissions reduction trajectories. However, these models have been criticized for lacking a strong empirical basis for their damage functions, which do little to alter assumptions of sustained gross domestic product (GDP) growth, even under extreme temperature scenarios. We implement empirical estimates of temperature effects on GDP growth rates in the DICE model through two pathways, total factor productivity growth and capital depreciation. This damage specification, even under optimistic adaptation assumptions, substantially slows GDP growth in poor regions but has more modest effects in rich countries. Optimal climate policy in this model stabilizes global temperature change below 2 °C by eliminating emissions in the near future and implies a social cost of carbon several times larger than previous estimates. A sensitivity analysis shows that the magnitude of climate change impacts on economic growth, the rate of adaptation, and the dynamic interaction between damages and GDP are three critical uncertainties requiring further research. In particular, optimal mitigation rates are much lower if countries become less sensitive to climate change impacts as they develop, making this a major source of uncertainty and an important subject for future research.

Piloting case-based instruction in a didactic clinical immunology course.

PubMed

Hoag, Kathleen; Lillie, Janet; Hoppe, Ruth

2005-01-01

To assess (1) the effect of case-based instructional modules on student critical thinking, class attendance, and satisfaction and (2) student opinion of case formats. University-based upper division course in clinical immunology and serology. The course was taught by the same instructor for two consecutive semesters with the intervention introduced in the second semester. Sixty-seven students experienced the intervention and 56 students were in the baseline cohort. Nine cases were interspersed between lectures during the semester. Each case took one 50-minute class in which students worked in groups of five or six. Student performance on five critical thinking multiple-choice examination questions and percent student attendance on case days versus lecture days were analyzed using the Mann-Whitney test. Student ratings on course evaluations were analyzed using t-test comparing semesters with and without intervention. Student opinion of cases was obtained through surveys and a focus group. Student performance on critical thinking exam questions was similar in the two groups. Student attendance was significantly higher on case days (95.6%) versus lecture days (80.3%; p < 0.0001). Only composite ratings for instructor involvement, student-instructor interaction, and course organization were significantly improved in the semester with cases compared to the semester with lecture only (p < 0.0001 for all indices). Although case studies did not significantly improve student performance on critical thinking questions, they still proved to be a valuable instructional method. Student attendance, student-instructor interaction, and instructor involvement in the course were all positively affected by incorporation of case studies. Discussion of cases also helped to uncover student misconceptions of course material.

What we have learned about intrapartum fetal monitoring trials in the MFMU Network.

PubMed

Bloom, Steven L; Belfort, Michael; Saade, George

2016-08-01

The vast majority of pregnant women are subjected to electronic fetal heart monitoring during labor. There is limited evidence to support its benefit compared with intermittent auscultation. In addition, there is significant variability in interpretation and its false-positive rate is high. The latter may have contributed to the rise in operative deliveries. In order to address the critical need for better approaches to intrapartum monitoring, the MFMU Network has completed two large multisite randomized trials, one to evaluate fetal pulse oximetry and the other to evaluate fetal ECG ST segment analysis (STAN). Both of these technologies had been approved for clinical use in the United States based on prior smaller trials. These technologies were evaluated in laboring women near term and their primary outcomes were overall cesarean delivery for the oximetry trial and a composite adverse neonatal outcome for STAN. Both the trials failed to show a benefit of the technology, neither in the rates of operative deliveries nor in the rates of adverse neonatal outcomes. The experience with these trials, summarized in this report, highlights the need for rigorous evidence before introduction of new technology into clinical practice and provides a blueprint for future trials to address the need for better intrapartum monitoring approaches. Copyright © 2016 Elsevier Inc. All rights reserved.

Oral isotretinoin as the most effective treatment in folliculitis decalvans: a retrospective comparison of different treatment regimens in 28 patients.

PubMed

Tietze, J K; Heppt, M V; von Preußen, A; Wolf, U; Ruzicka, T; Wolff, H; Sattler, E C

2015-09-01

Folliculitis decalvans leads to scarring alopecia through inflammatory destruction of the hair follicle. Currently, antibiotics are most commonly used to treat this disease. However, treatment regimens with antibiotics feature a high relapse rate and encourage the development of resistant bacteria. To evaluate the outcome of different treatment options for folliculitis decalvans. Retrospective study to compare the efficacy of different treatment regimens in 28 patients with folliculitis decalvans. The success of treatment with clindamycin and rifampicin, clarithromycin, dapsone and isotretinoin was analysed. The evaluation of the combination of clindamycin and rifampicin showed the lowest success rate in achieving long-term remission, since 80% of the patients relapsed shortly after end of treatment. Clarithromycin and dapsone were more successful with long-term and stable remission rates of 33% and 43% respectively. Treatment with isotretinoin was the most successful oral treatment in our analysis with 90% of the patients experiencing stable remission during and up to two years after cessation of the treatment. The common use of antibiotics as first-line therapy in folliculitis decalvans needs to be re-evaluated critically and oral isotretinoin should be considered as valid treatment alternative. © 2015 European Academy of Dermatology and Venereology.

Ensemble of trees approaches to risk adjustment for evaluating a hospital's performance.

PubMed

Liu, Yang; Traskin, Mikhail; Lorch, Scott A; George, Edward I; Small, Dylan

2015-03-01

A commonly used method for evaluating a hospital's performance on an outcome is to compare the hospital's observed outcome rate to the hospital's expected outcome rate given its patient (case) mix and service. The process of calculating the hospital's expected outcome rate given its patient mix and service is called risk adjustment (Iezzoni 1997). Risk adjustment is critical for accurately evaluating and comparing hospitals' performances since we would not want to unfairly penalize a hospital just because it treats sicker patients. The key to risk adjustment is accurately estimating the probability of an Outcome given patient characteristics. For cases with binary outcomes, the method that is commonly used in risk adjustment is logistic regression. In this paper, we consider ensemble of trees methods as alternatives for risk adjustment, including random forests and Bayesian additive regression trees (BART). Both random forests and BART are modern machine learning methods that have been shown recently to have excellent performance for prediction of outcomes in many settings. We apply these methods to carry out risk adjustment for the performance of neonatal intensive care units (NICU). We show that these ensemble of trees methods outperform logistic regression in predicting mortality among babies treated in NICU, and provide a superior method of risk adjustment compared to logistic regression.

Towards a social discount rate for the economic evaluation of health technologies in Germany: an exploratory analysis.

PubMed

Schad, Mareike; John, Jürgen

2012-04-01

Over the last decades, methods for the economic evaluation of health care technologies were increasingly used to inform reimbursement decisions. For a short time, the German Statutory Health Insurance makes use of these methods to support reimbursement decisions on patented drugs. In this context, the discounting procedure emerges as a critical component of these methods, as discount rates can strongly affect the resulting incremental cost-effectiveness ratios. The aim of this paper is to identify the appropriate value of a social discount rate to be used by the German Statutory Health Insurance for the economic evaluation of health technologies. On theoretical grounds, we build on the widespread view of contemporary economists that the social rate of time preference (SRTP) is the adequate social discount rate. For quantifying the SRTP, we first apply the market behaviour approach, which assumes that the SRTP is reflected in observable market interest rates. As a second approach, we derive the SRTP from optimal growth theory by using the Ramsey equation. A major part of the paper is devoted to specify the parameters of this equation. Depending on various assumptions, our empirical findings result in the range of 1.75-4.2% for the SRTP. A reasonable base case discount rate for Germany, thus, would be about 3%. Furthermore, we deal with the much debated question whether a common discount rate for costs and health benefits or a lower rate for health should be applied in health economic evaluations. In the German social health insurance system, no exogenously fixed budget constraint does exist. When evaluating a new health technology, the health care decision maker is obliged to conduct an economic evaluation in order to examine whether there is an economically appropriate relation between the value of the health gains and the additional costs which are given by the value of the consumption losses due to the additional health care expenditures. Therefore, a discount rate lower than the SRTP for consumption should be applied if an increase in the consumption value of health is expected. However, given the limited empirical evidence on the relationship between consumption and the value of health, it is hardly possible to make reliable forecasts of this value. Regarding the practice of the German evaluation authority, it is not recommended to use differential discounting in the base case. Instead, the issue of differential discounting should be addressed in sensitivity analyses. Reducing the discount rate for health compared to the rate for costs by a figure in the range between near 0% and 3% may be considered to be appropriate for Germany.

Critical Issues in Evaluating National-Level Health Data Warehouses in LMICs: Kenya Case Study.

PubMed

Gesicho, Milka B; Babic, Ankica; Were, Martin C

2017-01-01

Low-Middle-Income-Countries (LMICs) are beginning to adopt national health data warehousing (NHDWs) for making strategic decisions and for improving health outcomes. Given the numerous challenges likely to be faced in establishment of NHDWs by LMICs, it is prudent that evaluations are done in relation to the data warehouses (DWs), in order to identify and mitigate critical issues that arise. When critic issues are not identified, DWs are prone to suboptimal implementation with compromised outcomes. Despite the fact that several publications exist on evaluating DWs, evaluations specific to health data warehouses are scanty, with almost none evaluating NHDWs more so in LMICs. This paper uses a systematic approach guided by an evaluation framework to identify critical issues to be considered in evaluating Kenya's NHDW.

Nonlinear Wave Process Hierarchies and the Cyclic Development of Quasi-Ordered Structures in Turbulent Shear Flows.

DTIC Science & Technology

1979-11-01

can be evaluated semi- analitically in both the strongly nonlinear inner (critical layer) region and the weakly nonlinear outer region, reproduce the...experimental evidence of Ref. 8 (Figure 3, stage 3). Whereas the exact s~lutions of the Schridinger equation (Ref. 13) predict that an arbitrary smooth...peaks and valleys, different from the comon rate predicted by linear theory) arise suddenly and at surpris- ingly low disturbance levels [(u’/U 10-2] as

Reducing Work Content in Early Stage Naval Ship Designs (Briefing Charts)

DTIC Science & Technology

2014-05-14

criticizes US naval ships for: • early design decisions that lock in density • poor arrangements of piping and ventilation 8 An overly dense ship with...Thresholds Update Save As Exit T45 #1 T45 #2 T45 #3 HPC Enables Exhaustive Exploration by: and Visualization Exploring The Space Evaluating The Space From...design points such as traditional design spiral method 30 SHIP AVG Weighted Qty (Qty) by Cost 1980s Reagan Build-up 14 10% 1% 1990/2000s Low Rate

Schizophrenic Patients' Perceptions of Stress, Expressed Emotion, and Sensitivity To Criticism

PubMed Central

Cutting, Linda P.; Aakre, Jennifer M.; Docherty, Nancy M.

2006-01-01

This study was designed to get an “insider's view” of expressed emotion (EE) from the perspective of schizophrenic patients. Thirty-two patient and “influential other” pairs participated in the study. Patients' perceptions of EE attitudes in influential others were examined to determine whether they corresponded with actual EE ratings. Patients also rated how “stressed” they felt when interacting with their influential others, and patients' general sensitivity to criticism (STC) was assessed. As predicted, patients' perceptions of critical attitudes were related to actual EE ratings of criticism, although patients' perceptions of emotional overinvolvement (EOI) were not related to EOI ratings. Patients reported feeling more stressed when interacting with high-EE influential others, supporting an “EE as stressor” hypothesis. Finally, patients' STC influenced the level of stress they reported. PMID:16731686

Do College Students Notice Errors in Evidence When Critically Evaluating Research Findings?

ERIC Educational Resources Information Center

Rodriguez, Fernando; Ng, Annalyn; Shah, Priti

2016-01-01

The authors examined college students' ability to critically evaluate scientific evidence, specifically, whether first- and second-year students noticed when poor interpretations were drawn from research evidence. Fifty students evaluated a set of eight psychological studies, first in an informal context, then again in a critical-thinking context.…

CCA Test Objectives

NASA Technical Reports Server (NTRS)

2005-01-01

Three sources have been considered to provide information allowing the evaluation of the Collision Conflict Avoidance (CCA) functional requirements: existing data, simulation, and flight test. The existing data sources that have been evaluated have been found to be lacking in two areas: The actual data that was recorded and missing elements to the system architecture. Many previous tests addressing collision avoidance were conducted without a remote operator. As such, they are missing critical elements that are required to assess the CCA functional requirements. Tests such as ERAST were conducted with all of the UAS elements. However, ERAST tests were conducted as a demonstration and the data recorded was of end-to-end performance. Many contributing elements of the system were not individually recorded or were recorded at a data rate insufficient for the purposes of evaluating the CCA functional requirements.

Association of day 4 cumulative fluid balance with mortality in critically ill patients with influenza: A multicenter retrospective cohort study in Taiwan.

PubMed

Chao, Wen-Cheng; Tseng, Chien-Hua; Chien, Ying-Chun; Sheu, Chau-Chyun; Tsai, Ming-Ju; Fang, Wen-Feng; Chen, Yu-Mu; Kao, Kuo-Chin; Hu, Han-Chung; Perng, Wann-Cherng; Yang, Kuang-Yao; Chen, Wei-Chih; Liang, Shinn-Jye; Wu, Chieh-Liang; Wang, Hao-Chien; Chan, Ming-Cheng

2018-01-01

Fluid balance is a fundamental management of patients with sepsis, and this study aimed to investigate the impact of cumulative fluid balance on critically ill patients with influenza admitted to an intensive care unit (ICU). This multicenter retrospective cohort study was conducted by the Taiwan Severe Influenza Research Consortium (TSIRC) which includes eight medical centers. Patients with virology-proven influenza infection admitted to ICUs between October 2015 and March 2016 were included for analysis. A total of 296 patients were enrolled (mean age: 61.4±15.6 years; 62.8% men), and 92.2% (273/296) of them required mechanical ventilation. In the survivors, the daily fluid balance was positive from day 1 to day 3, and then gradually became negative from day 4 to day 7, whereas daily fluid balance was continuously positive in the non-survivors. Using the cumulative fluid balance from day 1-4 as a cut-off point, we found that a negative cumulative day 1-4 fluid balance was associated with a lower 30-day mortality rate (log-rank test, P = 0.003). To evaluate the impact of shock on this association, we divided the patients into shock and non-shock groups. The positive correlation between negative day 1-4 fluid balance and mortality was significant in the non-shock group (log-rank test, P = 0.008), but not in the shock group (log-rank test, P = 0.396). In a multivariate Cox proportional hazard regression model adjusted for age, sex, cerebrovascular disease, and PaO2/FiO2, day 1-4 fluid balance was independently associated with a higher 30-day mortality rate (aHR 1.088, 95% CI: 1.007-1.174). A negative day 1-4 cumulative fluid balance was associated with a lower mortality rate in critically ill patients with influenza. Our findings indicate the critical role of conservative fluid strategy in the management of patients with complicated influenza.

Infrapopliteal stenting with silicon carbide-coated stents in critical limb ischemia: a 12 month follow-up study.

PubMed

Atar, Eli; Avrahami, Ram; Koganovich, Yuri; Litvin, Sergey; Knizhnik, Michael; Belenky, Alexander

2009-10-01

Critical limb ischemia is an increasingly common condition that has high surgical morbidity and limited non-surgical options. To evaluate the use of silicon carbide-coated Motion stents, as compared to reported data for bare metal stents, in elderly patients with infrapopliteal artery stenoses causing critical limb ischemia after failed or complicated percutaneous transluminal angioplasty. Between January 2003 and March 2004, 41 stents were inserted into 17 consecutive patients (11 males, 6 females, mean age 82 years, range 75-93) following unsuccessful or complicated PTA. Seven patients had one-vessel run-off, six had two-vessel and four had three vessel run-off. All patients suffered from CLI, had up to three lesions and more than one co-morbid condition, and were considered at high surgical risk. Silicon carbide-coated Motion coronary stents, 2.5-4 mm diameterand 25 and 30 mm length, were used. Pre-intervention assessment included clinical condition, ankle brachial index, Doppler ultrasound and digital subtracted angiography. Postintervention evaluation included clinical condition, ABI and Doppler ultrasound at 3, 6 and 12 months. The technical success rate per lesion was 100% (41/41). Two patients died of unrelated causes after 2 and 8 months respectively. Primary patency rates with duplex ultrasound were 68.7% (11/16) at 3 months, 43.7% (7/16) at 6 months and 40% (6/15) after 12 months. Nine patients developed complete occlusion in 13 stents; three of these patients underwent a below-knee amputation and two patients a partial foot amputation. Re-intervention (PTA only) was performed in 7 patients (43.7%). Secondary patency rate was 81.2% (13/16) at 6 months and 60% (9/15) at one year. Mean ABI index had improved at 6 months from 0.32 to 0.67, and to 0.53 at one year. Clinical improvement was evident in 87.5% (14/16) at 6 months and in 66.6% (10/15) at one year. Silicon carbide-coated stents are comparable to bare metal stents after 6 and 12 months in infrapopliteal interventions in CLI when stenting is indicated.

Rapid-Rate Compression Testing of Sheet Materials at High Temperatures

NASA Technical Reports Server (NTRS)

Bernett, E. C.; Gerberich, W. W.

1961-01-01

This Report describes the test equipment that was developed and the procedures that were used to evaluate structural sheet-material compression properties at preselected constant strain rates and/or loads. Electrical self-resistance was used to achieve a rapid heating rate of 200 F/sec. Four materials were tested at maximum temperatures which ranged from 600 F for the aluminum alloy to 2000 F for the Ni-Cr-Co iron-base alloy. Tests at 0.1, 0.001, and 0.00001 in./in./sec showed that strain rate has a major effect on the measured strength, especially at the high temperatures. The tests, under conditions of constant temperature and constant compression stress, showed that creep deformation can be a critical factor even when the time involved is on the order of a few seconds or less. The theoretical and practical aspects of rapid-rate compression testing are presented, and suggestions are made regarding possible modifications of the equipment which would improve the over-all capabilities.

GRAVITATIONAL WAVE BACKGROUND FROM BINARY MERGERS AND METALLICITY EVOLUTION OF GALAXIES

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

Nakazato, Ken’ichiro; Sago, Norichika; Niino, Yuu, E-mail: nakazato@artsci.kyushu-u.ac.jp

The cosmological evolution of the binary black hole (BH) merger rate and the energy density of the gravitational wave (GW) background are investigated. To evaluate the redshift dependence of the BH formation rate, BHs are assumed to originate from low-metallicity stars, and the relations between the star formation rate, metallicity and stellar mass of galaxies are combined with the stellar mass function at each redshift. As a result, it is found that when the energy density of the GW background is scaled with the merger rate at the local universe, the scaling factor does not depend on the critical metallicitymore » for the formation of BHs. Also taking into account the merger of binary neutron stars, a simple formula to express the energy spectrum of the GW background is constructed for the inspiral phase. The relation between the local merger rate and the energy density of the GW background will be examined by future GW observations.« less

Providing Nuclear Criticality Safety Analysis Education through Benchmark Experiment Evaluation

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

John D. Bess; J. Blair Briggs; David W. Nigg

2009-11-01

One of the challenges that today's new workforce of nuclear criticality safety engineers face is the opportunity to provide assessment of nuclear systems and establish safety guidelines without having received significant experience or hands-on training prior to graduation. Participation in the International Criticality Safety Benchmark Evaluation Project (ICSBEP) and/or the International Reactor Physics Experiment Evaluation Project (IRPhEP) provides students and young professionals the opportunity to gain experience and enhance critical engineering skills.

Evaluation of Neutron Poison Materials for DOE SNF Disposal Systems

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

Vinson, D.W.; Caskey, G.R. Jr.; Sindelar, R.L.

1998-09-01

Aluminum-based spent nuclear fuel (Al-SNF) from foreign and domestic research reactors is being consolidated at the Savannah River Site (SRS) for ultimate disposal in the Mined Geologic Disposal System (MGDS). Most of the aluminum-based fuel material contains highly enriched uranium (HEU) (more than 20 percent 235U), which challenges the preclusion of criticality events for disposal periods exceeding 10,000 years. Recent criticality analyses have shown that the addition of neutron absorbing materials (poisons) is needed in waste packages containing DOE SNF canisters fully loaded with Al-SNF under flooded and degraded configurations to demonstrate compliance with the requirement that Keff less thanmore » 0.95. Compatibility of poison matrix materials and the Al-SNF, including their relative degradation rate and solubility, are important to maintain criticality control. An assessment of the viability of poison and matrix materials has been conducted, and an experimental corrosion program has been initiated to provide data on degradation rates of poison and matrix materials and Al-SNF materials under repository relevant vapor and aqueous environments. Initial testing includes Al6061, Type 316L stainless steel, and A516Gr55 in synthesized J-13 water vapor at 50 degrees C, 100 degrees C, and 200 degrees C and in condensate water vapor at 100 degrees C. Preliminary results are presented herein.« less

Palliative and end-of-life educational practices in US pulmonary and critical care training programs.

PubMed

Richman, Paul S; Saft, Howard L; Messina, Catherine R; Berman, Andrew R; Selecky, Paul A; Mularski, Richard A; Ray, Daniel E; Ford, Dee W

2016-02-01

To describe educational features in palliative and end-of-life care (PEOLC) in pulmonary/critical care fellowships and identify the features associated with perceptions of trainee competence in PEOLC. A survey of educational features in 102 training programs and the perceived skill and comfort level of trainees in 6 PEOLC domains: communication, symptom control, ethical/legal, community/institutional resources, specific syndromes, and ventilator withdrawal. We evaluated associations between perceived trainee competence/comfort in PEOLC and training program features, using regression analyses. Fifty-five percent of program directors (PDs) reported faculty with training in PEOLC; 30% had a written PEOLC curriculum. Neither feature was associated with trainee competence/comfort. Program directors and trainees rated bedside PEOLC teaching highly. Only 20% offered PEOLC rotations; most trainees judged these valuable. Most PDs and trainees reported that didactic teaching was insufficient in communication, although sufficient teaching of this was associated with perceived trainee competence in communication. Perceived trainee competence in managing institutional resources was rated poorly. Program directors reporting significant barriers to PEOLC education also judged trainees less competent in PEOLC. Time constraint was the greatest barrier. This survey of PEOLC education in US pulmonary/critical care fellowships identified associations between certain program features and perceived trainee skill in PEOLC. These results generate hypotheses for further study. Copyright © 2015 Elsevier Inc. All rights reserved.

Nuclear Data Activities in Support of the DOE Nuclear Criticality Safety Program

NASA Astrophysics Data System (ADS)

Westfall, R. M.; McKnight, R. D.

2005-05-01

The DOE Nuclear Criticality Safety Program (NCSP) provides the technical infrastructure maintenance for those technologies applied in the evaluation and performance of safe fissionable-material operations in the DOE complex. These technologies include an Analytical Methods element for neutron transport as well as the development of sensitivity/uncertainty methods, the performance of Critical Experiments, evaluation and qualification of experiments as Benchmarks, and a comprehensive Nuclear Data program coordinated by the NCSP Nuclear Data Advisory Group (NDAG). The NDAG gathers and evaluates differential and integral nuclear data, identifies deficiencies, and recommends priorities on meeting DOE criticality safety needs to the NCSP Criticality Safety Support Group (CSSG). Then the NDAG identifies the required resources and unique capabilities for meeting these needs, not only for performing measurements but also for data evaluation with nuclear model codes as well as for data processing for criticality safety applications. The NDAG coordinates effort with the leadership of the National Nuclear Data Center, the Cross Section Evaluation Working Group (CSEWG), and the Working Party on International Evaluation Cooperation (WPEC) of the OECD/NEA Nuclear Science Committee. The overall objective is to expedite the issuance of new data and methods to the DOE criticality safety user. This paper describes these activities in detail, with examples based upon special studies being performed in support of criticality safety for a variety of DOE operations.

What makes the hedonic experience of a meal in a top restaurant special and retrievable in the long term? Meal-related, social and personality factors.

PubMed

Muñoz, Francisco; Hildebrandt, Andrea; Schacht, Annekathrin; Stürmer, Birgit; Bröcker, Felix; Martín-Loeches, Manuel; Sommer, Werner

2018-06-01

Knowing what makes a top gastronomy experience unique and retrievable in the long term is of interest for scientific and economic reasons. Recent attempts to isolate predictors of the hedonic evaluation of food have afforded several factors, such as individual and social attributes, or liking/disliking profiles. However, in these studies relevant variables have been examined in isolation without an integrative perspective. Here we investigated 80 guests enjoying a 23-course meal in a top gastronomy restaurant, in groups of four. Our main question concerned the factors driving the overall evaluation of the meal at its conclusion and after three months. To this aim we administered the Big Five Personality Inventory before the meal, dish-by-dish hedonic ratings, and a multi-dimensional Meal Experience Questionnaire (MEQ) at the end of the meal. Hedonic evaluations of the meal were collected immediately after the meal and three months later. Better immediate overall evaluations were predicted by both the number of peaks in dish-by-dish ratings and by positive ratings of the final dish. Both factors and the number of troughs were also critical for the long-term evaluation after three months. The MEQ dimensions overall interest, valence and distraction predicted immediate evaluations, while the long-term evaluations were determined by interest and high scores on the personality traits agreeableness and conscientiousness. High consistency of the hedonic ratings within quartets indicated the relevance of commensality for the meal experience. The present findings highlight the simultaneous relevance of food- and personality-related factors and commensality for a top gastronomy meal experience in the short and long-run. The uncovered relationships are of theoretical interest and for those involved in designing meals for consumers in various settings. Copyright © 2018 Elsevier Ltd. All rights reserved.

Process-Structure-Property Relationships of Micron Thick Gadolinium Oxide Films Deposited by Reactive Electron Beam-Physical Vapor Deposition (EB-PVD)

DTIC Science & Technology

2014-12-01

surface roughness on film properties must be considered. Stability at the interface between the film and the substrate becomes critical with...etc.). Addition of atoms to the growing surface creates additional surface energy. Therefore, nuclei of a critical size 23 must be formed in order... critical nuclei size and a lower nucleation rate. Higher deposition rates result in a decreased critical nuclei size which leads to an increase in

Development of a structural health monitoring system for the life assessment of critical transportation infrastructure.

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

Roach, Dennis Patrick; Jauregui, David Villegas; Daumueller, Andrew Nicholas

2012-02-01

Recent structural failures such as the I-35W Mississippi River Bridge in Minnesota have underscored the urgent need for improved methods and procedures for evaluating our aging transportation infrastructure. This research seeks to develop a basis for a Structural Health Monitoring (SHM) system to provide quantitative information related to the structural integrity of metallic structures to make appropriate management decisions and ensuring public safety. This research employs advanced structural analysis and nondestructive testing (NDT) methods for an accurate fatigue analysis. Metal railroad bridges in New Mexico will be the focus since many of these structures are over 100 years old andmore » classified as fracture-critical. The term fracture-critical indicates that failure of a single component may result in complete collapse of the structure such as the one experienced by the I-35W Bridge. Failure may originate from sources such as loss of section due to corrosion or cracking caused by fatigue loading. Because standard inspection practice is primarily visual, these types of defects can go undetected due to oversight, lack of access to critical areas, or, in riveted members, hidden defects that are beneath fasteners or connection angles. Another issue is that it is difficult to determine the fatigue damage that a structure has experienced and the rate at which damage is accumulating due to uncertain history and load distribution in supporting members. A SHM system has several advantages that can overcome these limitations. SHM allows critical areas of the structure to be monitored more quantitatively under actual loading. The research needed to apply SHM to metallic structures was performed and a case study was carried out to show the potential of SHM-driven fatigue evaluation to assess the condition of critical transportation infrastructure and to guide inspectors to potential problem areas. This project combines the expertise in transportation infrastructure at New Mexico State University with the expertise at Sandia National Laboratories in the emerging field of SHM.« less

Evaluating cloud retrieval algorithms with the ARM BBHRP framework

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

Mlawer,E.; Dunn,M.; Mlawer, E.

2008-03-10

Climate and weather prediction models require accurate calculations of vertical profiles of radiative heating. Although heating rate calculations cannot be directly validated due to the lack of corresponding observations, surface and top-of-atmosphere measurements can indirectly establish the quality of computed heating rates through validation of the calculated irradiances at the atmospheric boundaries. The ARM Broadband Heating Rate Profile (BBHRP) project, a collaboration of all the working groups in the program, was designed with these heating rate validations as a key objective. Given the large dependence of radiative heating rates on cloud properties, a critical component of BBHRP radiative closure analysesmore » has been the evaluation of cloud microphysical retrieval algorithms. This evaluation is an important step in establishing the necessary confidence in the continuous profiles of computed radiative heating rates produced by BBHRP at the ARM Climate Research Facility (ACRF) sites that are needed for modeling studies. This poster details the continued effort to evaluate cloud property retrieval algorithms within the BBHRP framework, a key focus of the project this year. A requirement for the computation of accurate heating rate profiles is a robust cloud microphysical product that captures the occurrence, height, and phase of clouds above each ACRF site. Various approaches to retrieve the microphysical properties of liquid, ice, and mixed-phase clouds have been processed in BBHRP for the ACRF Southern Great Plains (SGP) and the North Slope of Alaska (NSA) sites. These retrieval methods span a range of assumptions concerning the parameterization of cloud location, particle density, size, shape, and involve different measurement sources. We will present the radiative closure results from several different retrieval approaches for the SGP site, including those from Microbase, the current 'reference' retrieval approach in BBHRP. At the NSA, mixed-phase clouds and cloud with a low optical depth are prevalent; the radiative closure studies using Microbase demonstrated significant residuals. As an alternative to Microbase at NSA, the Shupe-Turner cloud property retrieval algorithm, aimed at improving the partitioning of cloud phase and incorporating more constrained, conditional microphysics retrievals, also has been evaluated using the BBHRP data set.« less

Natural gas flow through critical nozzles

NASA Technical Reports Server (NTRS)

Johnson, R. C.

1969-01-01

Empirical method for calculating both the mass flow rate and upstream volume flow rate through critical flow nozzles is determined. Method requires knowledge of the composition of natural gas, and of the upstream pressure and temperature.

Microstructure and critical strain of dynamic recrystallization of 6082 aluminum alloy in thermal deformation

NASA Astrophysics Data System (ADS)

Ren, W. W.; Xu, C. G.; Chen, X. L.; Qin, S. X.

2018-05-01

Using high temperature compression experiments, true stress true strain curve of 6082 aluminium alloy were obtained at the temperature 460°C-560°C and the strain rate 0.01 s-1-10 s-1. The effects of deformation temperature and strain rate on the microstructure are investigated; (‑∂lnθ/∂ε) ‑ ε curves are plotted based on σ-ε curve. Critical strains of dynamic recrystallization of 6082 aluminium alloy model were obtained. The results showed lower strain rates were beneficial to increase the volume fraction of recrystallization, the average recrystallized grain size was coarse; High strain rates are beneficial to refine average grain size, the volume fraction of dynamic recrystallized grain is less than that by using low strain rates. High temperature reduced the dislocation density and provided less driving force for recrystallization so that coarse grains remained. Dynamic recrystallization critical strain model and thermal experiment results can effectively predict recrystallization critical point of 6082 aluminium alloy during thermal deformation.

Critical care of tropical disease in low income countries: Report from the Task Force on Tropical Diseases by the World Federation of Societies of Intensive and Critical Care Medicine.

PubMed

Baker, Tim; Khalid, Karima; Acicbe, Ozlem; McGloughlin, Steve; Amin, Pravin

2017-12-01

Tropical disease results in a great burden of critical illness. The same life-saving and supportive therapies to maintain vital organ functions that comprise critical care are required by these patients as for all other diseases. In low income countries, the little available data points towards high mortality rates and big challenges in the provision of critical care. Improving critical care in low income countries requires a focus on hospital design, training, triage, monitoring & treatment modifications, the basic principles of critical care, hygiene and the involvement of multi-disciplinary teams. As a large proportion of critical illness from tropical disease is in low income countries, the impact and reductions in mortality rates of improved critical care in such settings could be substantial. Copyright © 2017. Published by Elsevier Inc.

Multiscale Investigation on Biofilm Distribution and Its Impact on Macroscopic Biogeochemical Reaction Rates

NASA Astrophysics Data System (ADS)

Yan, Zhifeng; Liu, Chongxuan; Liu, Yuanyuan; Bailey, Vanessa L.

2017-11-01

Biofilms are critical locations for biogeochemical reactions in the subsurface environment. The occurrence and distribution of biofilms at microscale as well as their impacts on macroscopic biogeochemical reaction rates are still poorly understood. This paper investigated the formation and distributions of biofilms in heterogeneous sediments using multiscale models and evaluated the effects of biofilm heterogeneity on local and macroscopic biogeochemical reaction rates. Sediment pore structures derived from X-ray computed tomography were used to simulate the microscale flow dynamics and biofilm distribution in the sediment column. The response of biofilm formation and distribution to the variations in hydraulic and chemical properties was first examined. One representative biofilm distribution was then utilized to evaluate its effects on macroscopic reaction rates using nitrate reduction as an example. The results revealed that microorganisms primarily grew on the surfaces of grains and aggregates near preferential flow paths where both electron donor and acceptor were readily accessible, leading to the heterogeneous distribution of biofilms in the sediments. The heterogeneous biofilm distribution decreased the macroscopic rate of biogeochemical reactions as compared with those in homogeneous cases. Operationally considering the heterogeneous biofilm distribution in macroscopic reactive transport models such as using dual porosity domain concept can significantly improve the prediction of biogeochemical reaction rates. Overall, this study provided important insights into the biofilm formation and distribution in soils and sediments as well as their impacts on the macroscopic manifestation of reaction rates.

Performance evaluation of the essential dimensions of the primary health care services in six localities of Bogota–Colombia: a cross-sectional study

PubMed Central

2013-01-01

Background The high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system. In 2004 the district government of Bogota decided to implement a Primary Health Care (PHC) strategy through the Home Health program. PHC was conceived as a model for transforming health care delivery within the network of the first-level public health care facilities. This study aims to evaluate the performance of the essential dimensions of the PHC strategy in six localities geographically distributed throughout Bogotá city. Methods The rapid assessment tool to measure PHC performance, validated in Brazil, was applied. The perception of participants (users, professionals, health managers) in public health facilities where the Home Health program was implemented was compared with the perception of participants in private health facilities not implementing the program. A global performance index and specific indices for each primary care dimension were calculated. A multivariate logistic regression analysis was conducted to determine possible associations between the performance of the PHC dimensions and the self-perceived health status of users. Results The global performance index was rated as good for all participants interviewed. In general, with the exception of professionals, the differences in most of the essential dimensions seemed to favor public health care facilities where the Home Health program was implemented. The weakest dimensions were the family focus and community orientation—rated as critical by users; the distribution of financial resources—rated as critical by health managers; and, accessibility—rated as intermediate by users. Conclusions The overall findings suggest that the Home Health program could be improving the performance of the network of the first-level public health care facilities in some PHC essential dimensions, but significant efforts to achieve its objectives and raise its visibility in the community are required. PMID:23947574

CRM Assessment: Determining the Generalization of Rater Calibration Training. Summary of Research Report: Gold Standards Training

NASA Technical Reports Server (NTRS)

Baker, David P.

2002-01-01

The extent to which pilot instructors are trained to assess crew resource management (CRM) skills accurately during Line-Oriented Flight Training (LOFT) and Line Operational Evaluation (LOE) scenarios is critical. Pilot instructors must make accurate performance ratings to ensure that proper feedback is provided to flight crews and appropriate decisions are made regarding certification to fly the line. Furthermore, the Federal Aviation Administration's (FAA) Advanced Qualification Program (AQP) requires that instructors be trained explicitly to evaluate both technical and CRM performance (i.e., rater training) and also requires that proficiency and standardization of instructors be verified periodically. To address the critical need for effective pilot instructor training, the American Institutes for Research (AIR) reviewed the relevant research on rater training and, based on "best practices" from this research, developed a new strategy for training pilot instructors to assess crew performance. In addition, we explored new statistical techniques for assessing the effectiveness of pilot instructor training. The results of our research are briefly summarized below. This summary is followed by abstracts of articles and book chapters published under this grant.

Critical Race Theory and Counselor Education Pedagogy: Creating Equitable Training

ERIC Educational Resources Information Center

Haskins, Natoya H.; Singh, Anneliese

2015-01-01

Infusing critical race theory, the authors discuss specific pedagogical strategies to enhance educational experiences of counselor trainees. The authors then provide an evaluative checklist to facilitate and evaluate curricular integration of critical race theory.

Impact of primary antibiotic resistance on the effectiveness of sequential therapy for Helicobacter pylori infection: lessons from a 5-year study on a large number of strains.

PubMed

Gatta, L; Scarpignato, C; Fiorini, G; Belsey, J; Saracino, I M; Ricci, C; Vaira, D

2018-05-01

The increasing prevalence of strains resistant to antimicrobial agents is a critical issue in the management of Helicobacter pylori (H. pylori) infection. (1) To evaluate the prevalence of primary resistance to clarithromycin, metronidazole and levofloxacin (2) to assess the effectiveness of sequential therapy on resistant strains (3) to identify the minimum number of subjects to enrol for evaluating the effectiveness of an eradication regimen in patients harbouring resistant strains. Consecutive 1682 treatment naïve H. pylori-positive patients referred for upper GI endoscopy between 2010 and 2015 were studied and resistances assessed by E-test. Sequential therapy was offered, effectiveness evaluated and analysed. H. pylori-primary resistance to antimicrobials tested was high, and increased between 2010 and 2015. Eradication rates were (estimates and 95% CIs): 97.3% (95.6-98.4) in strains susceptible to clarithromycin and metronidazole; 96.1% (91.7-98.2) in strains resistant to metronidazole but susceptible to clarithromycin; 93.4% (88.2-96.4) in strains resistant to clarithromycin but susceptible to metronidazole; 83.1% (77.7-87.3) in strains resistant to clarithromycin and metronidazole. For any treatment with a 75%-85% eradication rate, some 98-144 patients with resistant strains need to be studied to get reliable information on effectiveness in these patients. H. pylori-primary resistance is increasing and represents the most critical factor affecting effectiveness. Sequential therapy eradicated 83% of strains resistant to clarithromycin and metronidazole. Reliable estimates of the effectiveness of a given regimen in patients harbouring resistant strains can be obtained only by assessing a large number of strains. © 2018 John Wiley & Sons Ltd.

The analysis of critical cooling rate for high-rise building steel S460

NASA Astrophysics Data System (ADS)

Lu, Shiping; Chen, Xia; Li, Qun; Wang, Haibao; Gu, Linhao

2017-09-01

High-rise building steel S460 is an important structure steel.The product process of the steel is Quenching&Tempering. The critical cooling rate of steel is very important in heavy plate quenching process, and it is also the basis of the cooling process[1].The critical cooling rate of HSLA steel S460 is obtained from the Thermal simulation method,and the differences about the microstructure and properties of different cooling rate is also analyzed.In this article, the angle of the grain boundary and the average grain size are analyzed by EBSD under different cooling rate. The relationship between grain boundary angle and grain size with the cooling rate is obtained. According to the experiment,it provides the basis for the formulation of the quenching process of the industrial production.

Hazard detection in noise-related incidents - the role of driving experience with battery electric vehicles.

PubMed

Cocron, Peter; Bachl, Veronika; Früh, Laura; Koch, Iris; Krems, Josef F

2014-12-01

The low noise emission of battery electric vehicles (BEVs) has led to discussions about how to address potential safety issues for other road users. Legislative actions have already been undertaken to implement artificial sounds. In previous research, BEV drivers reported that due to low noise emission they paid particular attention to pedestrians and bicyclists. For the current research, we developed a hazard detection task to test whether drivers with BEV experience respond faster to incidents, which arise due to the low noise emission, than inexperienced drivers. The first study (N=65) revealed that BEV experience only played a minor role in drivers' response to hazards resulting from low BEV noise. The tendency to respond, reaction times and hazard evaluations were similar among experienced and inexperienced BEV drivers; only small trends in the assumed direction were observed. Still, both groups clearly differentiated between critical and non-critical scenarios and responded accordingly. In the second study (N=58), we investigated additionally if sensitization to low noise emission of BEVs had an effect on hazard perception in incidents where the noise difference is crucial. Again, participants in all groups differentiated between critical and non-critical scenarios. Even though trends in response rates and latencies occurred, experience and sensitization to low noise seemed to only play a minor role in detecting hazards due to low BEV noise. An additional global evaluation of BEV noise further suggests that even after a short test drive, the lack of noise is perceived more as a comfort feature than a safety threat. Copyright © 2014 Elsevier Ltd. All rights reserved.

Can we still stop the migration of physicians from Austria? : An evaluation of clinical internships by students of the Medical University of Vienna.

PubMed

Seitz, Tamara; Turk, Bela R; Löffler-Stastka, Henriette

2017-01-01

The increasing emigration of graduates of the Medical University of Vienna presents a serious problem. This study examined students' evaluation of clinical rotations, their self-rated performance, and where they felt the most deficits exist. Medical students answered an online questionnaire surveying the following aspects: an evaluation of their internship; supervision; integration in the team and improvement of field-specific knowledge; the qualities of taking a patient's medical history by empathy; patient-centeredness; structure; target orientation; and the ability to integrate field-specific knowledge into anamnesis. The data collected indicate that rotations in Austria, especially in Vienna, were evaluated significantly worse than those abroad. Particularly the lack of supervision and integration in the team were criticized. These data stress a dire need for the reform of curricular structures during clinical rotation in the latter years of medical education.

Developing Entrepreneurial Skills in Pharmacy Students

PubMed Central

Hanna, Lezley-Anne; Haughey, Sharon; Hughes, Carmel

2015-01-01

Objective. To create, implement, and evaluate a workshop that teaches undergraduate pharmacy students about entrepreneurship. Design. Workshops with 3 hours of contact time and 2 hours of self-study time were developed for final-year students. Faculty members and students evaluated peer assessment, peer development, communication, critical evaluation, creative thinking, problem solving, and numeracy skills, as well as topic understanding. Student evaluation of the workshops was done primarily via a self-administered, 9-item questionnaire. Assessment. One hundred thirty-four students completed the workshops. The mean score was 50.9 out of 65. Scores ranged from 45.9 to 54.1. The questionnaire had a 100% response rate. Many students agreed that workshops about entrepreneurship were a useful teaching method and that key skills were fostered. Conclusion. Workshops effectively delivered course content about entrepreneurship and helped develop relevant skills. This work suggests students value instruction on entrepreneurship. PMID:27168619

Developing Entrepreneurial Skills in Pharmacy Students.

PubMed

Laverty, Garry; Hanna, Lezley-Anne; Haughey, Sharon; Hughes, Carmel

2015-09-25

Objective. To create, implement, and evaluate a workshop that teaches undergraduate pharmacy students about entrepreneurship. Design. Workshops with 3 hours of contact time and 2 hours of self-study time were developed for final-year students. Faculty members and students evaluated peer assessment, peer development, communication, critical evaluation, creative thinking, problem solving, and numeracy skills, as well as topic understanding. Student evaluation of the workshops was done primarily via a self-administered, 9-item questionnaire. Assessment. One hundred thirty-four students completed the workshops. The mean score was 50.9 out of 65. Scores ranged from 45.9 to 54.1. The questionnaire had a 100% response rate. Many students agreed that workshops about entrepreneurship were a useful teaching method and that key skills were fostered. Conclusion. Workshops effectively delivered course content about entrepreneurship and helped develop relevant skills. This work suggests students value instruction on entrepreneurship.

Selective skepticism: American and Chinese children's reasoning about evaluative academic feedback.

PubMed

Heyman, Gail D; Fu, Genyue; Lee, Kang

2013-03-01

Children's reasoning about the credibility of positive and negative evaluations of academic performance was examined. Across 2 studies, 7- and 10-year-olds from the United States and China (N = 334) judged the credibility of academic evaluations that were directed toward an unfamiliar peer. In Study 1, participants from China responded that criticism should be accepted to a greater extent than did participants from the United States, and children from both countries demonstrated a selective skepticism effect by treating negative feedback more skeptically than positive feedback. Study 2 replicated the selective skepticism effect among children from both countries and ruled out the possibility that it can be explained as a rational analysis of perceived base rates. The results suggest that children are selective in their trust of evaluative feedback and that their credibility judgments may be influenced by the desirability of the information that is being conveyed or its anticipated consequences.

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

Brown, D. A.; Chadwick, M. B.; Capote, R.

We describe the new ENDF/B-VIII.0 evaluated nuclear reaction data library. ENDF/B-VIII.0 fully incorporates the new IAEA standards, includes improved thermal neutron scattering data and uses new evaluated data from the CIELO project for neutron reactions on 1H, 16O, 56Fe, 235U, 238U and 239Pu described in companion papers in the present issue of Nuclear Data Sheets. The evaluations benefit from recent experimental data obtained in the U.S. and Europe, and improvements in theory and simulation. Notable advances include updated evaluated data for light nuclei, structural materials, actinides, fission energy release, prompt fission neutron and γ-ray spectra, thermal neutron scattering data, andmore » charged-particle reactions. Integral validation testing is shown for a wide range of criticality, reaction rate, and neutron transmission benchmarks. In general, integral validation performance of the library is improved relative to the previous ENDF/B-VII.1 library.« less

Evaluation of Cryoprotectant and Cooling Rate for Sperm Cryopreservation in the Euryhaline Fish Medaka Oryzias latipes

PubMed Central

Yang, Huiping; Norris, Michelle; Winn, Richard; Tiersch, Terrence R.

2017-01-01

Medaka Oryzias latipes is a well-recognized biomedical fish model because of advantageous features such as small body size, transparency of embryos, and established techniques for gene knockout and modification. The goal of this study was to evaluate two critical factors, cryoprotectant and cooling rate, for sperm cryopreservation in 0.25-ml French straws. The objectives were to: 1) evaluate the acute toxicity of methanol, 2-methoxyethanol (ME), dimethyl sulfoxide (Me2SO), N, N- dimethylacetamide (DMA), N, N,-dimethyl formamide (DMF), and glycerol with concentrations of 5, 10, and 15% for 60 min of incubation at 4 °C; 2) evaluate cooling rates from 5 to 25 °C/min for freezing and their interaction with cryoprotectants, and 3) test fertility of thawed sperm cryopreserved with selected cryoprotectants and associated cooling rates. Evaluation of cryoprotectant toxicity showed that methanol and ME (5 and 10%) did not change the sperm motility after 30 min; Me2SO, DMA, and DMF (10 and 15%) and glycerol (5, 10 and 15%) significantly decreased the motility of sperm within 1 min after mixing. Based on these results, methanol and ME were selected as cryoprotectants (10%) to evaluate with different cooling rates (from 5 °C/min to 25 °C/min) and were compared to Me2SO and DMF (10%) (based on their use as cryoprotectants in previous publications). Post-thaw motility was affected by cryoprotectant, cooling rate, and their interaction (P ≤ 0.000). The highest post-thaw motility (50 ± 10%) was observed at a cooling rate of 10 °C/min with methanol as cryoprotectant. Comparable post-thaw motility (37 ± 12%) was obtained at a cooling rate of 15 °C/min with ME as cryoprotectant. With DMF, post-thaw motility at all cooling rates was ≤ 10% which was significantly lower than that of methanol and ME. With Me2SO, post-thaw motilities were less than 1% at all cooling rates, and significantly lower compared to the other three cryoprotectants (P ≤ 0.000). When sperm from individual males were cryopreserved with 10% methanol at a cooling rate of 10 °C/min and 10% ME with a rate of 15 °C/min, no difference was found in post-thaw motility. Fertility testing of thawed sperm cryopreserved with 10% methanol at a rate of 10 °C/min showed average hatching of 70 ± 30% which was comparable to that of fresh sperm (86 ± 15%). Overall, this study established a baseline for high-throughput sperm cryopreservation of medaka provides an outline for protocol standardization and use of automated processing equipment in the future. PMID:20654608

Identifying critical thinking indicators and critical thinker attributes in nursing practice.

PubMed

Chao, Shu-Yuan; Liu, Hsing-Yuan; Wu, Ming-Chang; Clark, Mary Jo; Tan, Jung-Ying

2013-09-01

Critical thinking is an essential skill in the nursing process. Although several studies have evaluated the critical thinking skills of nurses, there is limited information related to the indicators of critical thinking or evaluation of critical thinking in the context of the nursing process. This study investigated the potential indicators of critical thinking and the attributes of critical thinkers in clinical nursing practice. Knowledge of these indicators can aid the development of tools to assess nursing students' critical thinking skills. The study was conducted between September 2009 and August 2010. In phase 1, a literature review and four focus groups were conducted to identify the indicators of critical thinking in the context of nursing and the attributes of critical thinkers. In phase 2, 30 nursing professionals participated in a modified Delphi research survey to establish consensus and the appropriateness of each indicator and attribute identified in phase 1. We identified 37 indicators of critical thinking and 10 attributes of critical thinkers. The indicators were categorized into five subscales within the context of the nursing process toreflect nursing clinical practice: assessment, 16 indicators of ability to apply professional knowledge and skills to analyze and interpret patient problems; diagnosis, five indicators of ability to propose preliminary suppositions; planning, five indicators of ability to develop problem-solving strategies; implementation, five indicators of ability to implement planning; and evaluation, six indicators of ability to self-assess and reflect. The study operationalized critical thinking into a practical indicator suitable for nursing contexts in which critical thinking is required for clinical problem solving. Identified indicators and attributes can assist clinical instructors to evaluate student critical thought skills and development-related teaching strategies.

Influence of the hydrophilic head size and hydrophobic tail length of surfactants on the ability of micelles to stabilize citral.

PubMed

Hong, Chi Rac; Park, Sung Joon; Choi, Seung Jun

2016-07-01

Surfactant-made micelles can control the rate of chemical degradation of poorly water-soluble food flavors. To evaluate how the molecular structure of surfactant has an influence on the chemical decomposition rate of citral, micelles were prepared with polyoxyethylene alkyl ether-type surfactants that had similar molecular structures but various hydrophilic head sizes and hydrophobic tail lengths. At a critical 20× micelle concentration of surfactant, there was no significant difference in the chemical degradation rate of citral in micelles in neutral pH, regardless of the hydrophilic head size or hydrophobic tail length. In an acidic environment, the degradation rate constant of citral generally increased proportionally with increasing hydrophilic head size of surfactant (0.1563 and 0.2217 for surfactants with 23 and 100 oxyethylene units, respectively) but the length of hydrophobic tail did not affect the citral stability. Also, little difference (0.2217 and 0.2265 for surfactant having 100 oxyethylene units with and without Fe(3+) ) in degradation rate constant of citral between simple micellar solution and micellar solution containing iron suggested that iron ions could not accelerate citral degradation in micelles, regardless of the form of iron (Fe(2+) and Fe(3+) ). This work concludes that although the concentration of surfactant could be relevant, if its concentration could be controlled in the same manner as the critical micelle concentration, then a polyethylene alkyl ether-type surfactant with a small hydrophilic head could more efficiently stabilize citral at an acidic pH. © 2015 Society of Chemical Industry. © 2015 Society of Chemical Industry.

Primary weathering rates, water transit times, and concentration-discharge relations: A theoretical analysis for the critical zone

NASA Astrophysics Data System (ADS)

Ameli, Ali A.; Beven, Keith; Erlandsson, Martin; Creed, Irena F.; McDonnell, Jeffrey J.; Bishop, Kevin

2017-01-01

The permeability architecture of the critical zone exerts a major influence on the hydrogeochemistry of the critical zone. Water flow path dynamics drive the spatiotemporal pattern of geochemical evolution and resulting streamflow concentration-discharge (C-Q) relation, but these flow paths are complex and difficult to map quantitatively. Here we couple a new integrated flow and particle tracking transport model with a general reversible Transition State Theory style dissolution rate law to explore theoretically how C-Q relations and concentration in the critical zone respond to decline in saturated hydraulic conductivity (Ks) with soil depth. We do this for a range of flow rates and mineral reaction kinetics. Our results show that for minerals with a high ratio of equilibrium concentration (Ceq) to intrinsic weathering rate (Rmax), vertical heterogeneity in Ks enhances the gradient of weathering-derived solute concentration in the critical zone and strengthens the inverse stream C-Q relation. As CeqRmax decreases, the spatial distribution of concentration in the critical zone becomes more uniform for a wide range of flow rates, and stream C-Q relation approaches chemostatic behavior, regardless of the degree of vertical heterogeneity in Ks. These findings suggest that the transport-controlled mechanisms in the hillslope can lead to chemostatic C-Q relations in the stream while the hillslope surface reaction-controlled mechanisms are associated with an inverse stream C-Q relation. In addition, as CeqRmax decreases, the concentration in the critical zone and stream become less dependent on groundwater age (or transit time).

Determining the ventilation and aerosol deposition rates from routine indoor-air measurements.

PubMed

Halios, Christos H; Helmis, Costas G; Deligianni, Katerina; Vratolis, Sterios; Eleftheriadis, Konstantinos

2014-01-01

Measurement of air exchange rate provides critical information in energy and indoor-air quality studies. Continuous measurement of ventilation rates is a rather costly exercise and requires specific instrumentation. In this work, an alternative methodology is proposed and tested, where the air exchange rate is calculated by utilizing indoor and outdoor routine measurements of a common pollutant such as SO2, whereas the uncertainties induced in the calculations are analytically determined. The application of this methodology is demonstrated, for three residential microenvironments in Athens, Greece, and the results are also compared against ventilation rates calculated from differential pressure measurements. The calculated time resolved ventilation rates were applied to the mass balance equation to estimate the particle loss rate which was found to agree with literature values at an average of 0.50 h(-1). The proposed method was further evaluated by applying a mass balance numerical model for the calculation of the indoor aerosol number concentrations, using the previously calculated ventilation rate, the outdoor measured number concentrations and the particle loss rates as input values. The model results for the indoors' concentrations were found to be compared well with the experimentally measured values.

Student Practice Evaluation Form-Revised Edition online comment bank: development and reliability analysis.

PubMed

Rodger, Sylvia; Turpin, Merrill; Copley, Jodie; Coleman, Allison; Chien, Chi-Wen; Caine, Anne-Maree; Brown, Ted

2014-08-01

The reliable evaluation of occupational therapy students completing practice education placements along with provision of appropriate feedback is critical for both students and for universities from a quality assurance perspective. This study describes the development of a comment bank for use with an online version of the Student Practice Evaluation Form-Revised Edition (SPEF-R Online) and investigates its reliability. A preliminary bank of 109 individual comments (based on previous students' placement performance) was developed via five stages. These comments reflected all 11 SPEF-R domains. A purpose-designed online survey was used to examine the reliability of the comment bank. A total of 37 practice educators returned surveys, 31 of which were fully completed. Participants were asked to rate each individual comment using the five-point SPEF-R rating scale. One hundred and two of 109 comments demonstrated satisfactory agreement with their respective default ratings that were determined by the development team. At each domain level, the intra-class correlation coefficients (ranging between 0.86 and 0.96) also demonstrated good to excellent inter-rater reliability. There were only seven items that required rewording prior to inclusion in the final SPEF-R Online comment bank. The development of the SPEF-R Online comment bank offers a source of reliable comments (consistent with the SPEF-R rating scale across different domains) and aims to assist practice educators in providing reliable and timely feedback to students in a user-friendly manner. © 2014 Occupational Therapy Australia.

Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors.

PubMed

Schumacher, Jessica R; Taylor, Lauren J; Tucholka, Jennifer L; Poore, Samuel; Eggen, Amanda; Steiman, Jennifer; Wilke, Lee G; Greenberg, Caprice C; Neuman, Heather B

2017-10-01

Post-mastectomy reconstruction is a critical component of high-quality breast cancer care. Prior studies demonstrate socioeconomic disparity in receipt of reconstruction. Our objective was to evaluate trends in receipt of immediate reconstruction and examine socioeconomic factors associated with reconstruction in a contemporary cohort. Using the National Cancer Database, we identified women <75 years of age with stage 0-1 breast cancer treated with mastectomy (n = 297,121). Trends in immediate reconstruction rates (2004-2013) for the overall cohort and stratified by socioeconomic factors were examined using Join-point regression analysis, and annual percentage change (APC) was calculated. We then restricted our sample to a contemporary cohort (2010-2013, n = 145,577). Multivariable logistic regression identified socioeconomic factors associated with immediate reconstruction. Average adjusted predicted probabilities of receiving reconstruction were calculated. Immediate reconstruction rates increased from 27 to 48%. Although absolute rates of reconstruction for each stratification group increased, similar APCs across strata led to persistent gaps in receipt of reconstruction. On multivariable logistic regression using our contemporary cohort, race, income, education, and insurance type were all strongly associated with immediate reconstruction. Patients with the lowest predicted probability of receiving reconstruction were patients with Medicaid who lived in areas with the lowest rates of high-school graduation (Black 42.4% [95% CI 40.5-44.3], White 45.7% [95% CI 43.9-47.4]). Although reconstruction rates have increased dramatically over the past decade, lower rates persist for disadvantaged patients. Understanding how socioeconomic factors influence receipt of reconstruction, and identifying modifiable factors, are critical next steps towards identifying interventions to reduce disparities in breast cancer surgical care.

Safety and efficacy of autologous cell therapy in critical limb ischemia: a systematic review.

PubMed

Benoit, Eric; O'Donnell, Thomas F; Patel, Amit N

2013-01-01

Researchers have accumulated a decade of experience with autologous cell therapy in the treatment of critical limb ischemia (CLI). We conducted a systematic review of clinical trials in the literature to determine the safety and efficacy of cell therapy in CLI. We searched the literature for clinical trials of autologous cell therapy in CLI, including observational series of five or more patients to accrue a large pool of patients for safety analysis. Safety analysis included evaluation of death, cancer, unregulated angiogenesis, and procedural adverse events such as bleeding. Efficacy analysis included the clinical endpoints amputation and death as well as functional and surrogate endpoints. We identified 45 clinical trials, including seven RCTs, and 1,272 patients who received cell therapy. The overall adverse event rate was low (4.2%). Cell therapy patients did not have a higher mortality rate than control patients and demonstrated no increase in cancer incidence when analyzed against population rates. With regard to efficacy, cell therapy patients had a significantly lower amputation rate than control patients (OR 0.36, p = 0.0004). Cell therapy also demonstrated efficacy in a variety of functional and surrogate outcomes. Clinical trials differed in the proportion of patients with risk factors for clinical outcomes, and these influenced rates of amputation and death. Cell therapy presents a favorable safety profile with a low adverse event rate and no increase in severe events such as mortality and cancer and treatment with cell therapy decreases the risk of amputation. Cell therapy has a positive benefit-to-risk ratio in CLI and may be a valuable treatment option, particularly for those challenging patients who cannot undergo arterial reconstruction.

Assessing the influence of asymmeftry affecting the mandible and chin point on perceived attractiveness in the orthognathic patient, clinician, and layperson.

PubMed

Naini, Farhad B; Donaldson, Ana Nora A; McDonald, Fraser; Cobourne, Martyn T

2012-01-01

The purpose of this investigation was to undertake an objective and quantitative evaluation of how severity of asymmetries affecting the mandible and chin point influence perceived attractiveness. The mandible and chin point of idealized male and female frontal facial images were altered in 5-mm increments from 0 to 25 mm and to the left and right, to represent horizontal, vertical, and combined asymmetry affecting these regions. These images were rated on a 7-point Likert scale by a preselected group of orthognathic patients before treatment, clinicians, and laypeople. In relation to a 5-mm asymmetry, observers progressively decreased attractiveness ratings and increased the desire for surgery for greater asymmetries. Clinicians and patients were found to be more critical than laypeople. The desire for surgery decreased by 3% for each year increase in age, was 53% less for men, and 45% greater for white observers. Asymmetry of 10 mm is perceived as being significant; at 5 mm and below, it is largely unnoticed. The greater the degree of asymmetry greater than 10 mm, the more noticeable and the greater the desire was for correction. Clinician and patient ratings were similar and more critical than ratings of laypeople. A desire for surgery was negligible for 5 mm of asymmetry but increased considerably at 10 mm and continued to increase with greater degrees of asymmetry. The highest-rated images showed perfect bilateral symmetry, whereas the lowest-rated images showed significant degrees of mandibular and chin asymmetry. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Effects of an Integrative Nursing Intervention on Pain in Critically Ill Patients: A Pilot Clinical Trial.

PubMed

Papathanassoglou, Elizabeth D E; Hadjibalassi, Maria; Miltiadous, Panagiota; Lambrinou, Ekaterini; Papastavrou, Evridiki; Paikousis, Lefkios; Kyprianou, Theodoros

2018-05-01

Pain, a persistent problem in critically ill patients, adversely affects outcomes. Despite recommendations, no evidence-based nonpharmacological approaches for pain treatment in critically ill patients have been developed. To investigate the effects of a multimodal integrative intervention on the incidence of pain and on secondary outcomes: intensity of pain, hemodynamic indices (systolic and mean arterial pressure, heart rate), anxiety, fear, relaxation, optimism, and sleep quality. A randomized, controlled, double-blinded repeated-measures trial with predetermined eligibility criteria was conducted. The intervention included relaxation, guided imagery, moderate pressure massage, and listening to music. The primary outcome was incidence of pain (score on Critical Care Pain Observation Tool > 2). Other outcomes included pain ratings, hemodynamic measurements, self-reported psychological outcomes, and quality of sleep. Repeated-measures models with adjustments (baseline levels, confounders) were used. Among the 60 randomized critically ill adults in the sample, the intervention group experienced significant decreases in the incidence ( P = .003) and ratings of pain ( P < .001). Adjusted models revealed a significant trend for lower incidence ( P = .002) and ratings ( P < .001) of pain, systolic arterial pressure ( P < .001), anxiety ( P = .01), and improved quality of sleep ( P = .02). A multimodal integrative intervention may be effective in decreasing pain and improving pain-related outcomes in critically ill patients. © 2018 American Association of Critical-Care Nurses.

Model-supported estimation of mortality rates in Baltic cod (Gadus morhua callarias L.) larvae: the varying impact of 'critical periods'

PubMed Central

Voss, Rüdiger; Hinrichsen, Hans-Harald; Wieland, Kai

2001-01-01

Background Changes in the survival-rate during the larval phase may strongly influence the recruitment level in marine fish species. During the larval phase different 'critical periods' are discussed, e.g. the hatching period and the first-feeding period. No such information was available for the Baltic cod stock, a commercially important stock showing reproduction failure during the last years. We calculated field-based mortality rates for larval Baltic cod during these phases using basin-wide abundance estimates from two consecutive surveys. Survey information was corrected by three dimensional hydrodynamic model runs. Results The corrections applied for transport were of variable impact, depending on the prevailing circulation patterns. Especially at high wind forcing scenarios, abundance estimates have the potential to be biased without accounting for transport processes. In May 1988 mortality between hatch and first feeding amounted to approximately 20% per day. Mortality rates during the onset of feeding were considerably lower with only 7% per day. In August 1991 the situation was vice versa: Extremely low mortality rates of 0.08% per day were calculated between hatch and first feeding, while the period between the onset of feeding to the state of an established feeder was more critical with mortality rates of 22% per day. Conclusions Mortality rates during the different proposed 'critical periods' were found to be highly variable. Survival rates of Baltic cod are not only influenced by a single 'critical period', but can be limited at different points during the larval phase, depending on several biotic and abiotic factors. PMID:11737879

Evaluating the fundamental critical care support course in critical care education in Japan: a survey of Japanese fundamental critical care support course experience.

PubMed

Atagi, Kazuaki; Nishi, Shinichi; Fujitani, Shigeki; Kodama, Takamitsu; Ishikawa, Junya; Shimaoka, Hideki

2013-01-01

The Fundamental Critical Care Support (FCCS) course has been introduced after minimal adaptation according to Japanese clinical settings. The original course in the USA is often used to prepare residents for rotations in the intensive care unit (ICU). Therefore, the FCCS program can be appropriate for the basic training of critical care in Japan to standardize critical care management. The purpose of this study is to evaluate whether Japanese FCCS course is useful and has a possibility to deserve a basis of critical care management in Japan. The course program was provided with the form of lecture and skills stations. Pre- and post-training knowledge was assessed. After completion of the 2-day course, a questionnaire survey was administered to all course participants. Participants were asked to fill out the questions regarding socio-demographic characteristics. Participants were also asked to identify which lectures or skill stations they thought to be useful for clinical practice. Then, they were asked to rate their performance of each field: 'Assessment,' 'Diagnosis,' 'Recognition,' 'Response,' and 'Transfer'. The number of participants increased year after year and reached 1,804 during the past 4 years. Nearly 70% of the participants were physicians. Most of the others were nurses. In the established year, the percentage of physicians who had clinical experience more than 5 years exceeded 50%, however, this percentage gradually decreased. On the contrary, the percentages of residents and nurses increased. Regarding useful sessions, nearly half of the participants thought that mechanical ventilation was the most useful. With regard to the results of pre- and post-tests, the participants had already shown a high average mark (78.8 ± 14.1) at the pre-test. Furthermore, the score at the post-test was significantly improved (82.0 ± 6.6, p < 0.01). The participants' confidence in any field regarding critical care management was almost 4 points (5-point scale). It is considered that Japanese FCCS course is useful and has a promising basis of critical care management in Japan. Therefore, it is reasonable to think that Japanese FCCS mission has been successfully achieved.

Reaction of SO2 with OH in the atmosphere.

PubMed

Long, Bo; Bao, Junwei Lucas; Truhlar, Donald G

2017-03-15

The OH + SO 2 reaction plays a critical role in understanding the oxidation of SO 2 in the atmosphere, and its rate constant is critical for clarifying the fate of SO 2 in the atmosphere. The rate constant of the OH + SO 2 reaction is calculated here by using beyond-CCSDT correlation energy calculations for a benchmark, validated density functional methods for direct dynamics, canonical variational transition state theory with anharmonicity and multidimensional tunneling for the high-pressure rate constant, and system-specific quantum RRK theory for pressure effects; the combination of these methods can compete in accuracy with experiments. There has been a long-term debate in the literature about whether the OH + SO 2 reaction is barrierless, but our calculations indicate a positive barrier with an transition structure that has an enthalpy of activation of 0.27 kcal mol -1 at 0 K. Our results show that the high-pressure limiting rate constant of the OH + SO 2 reaction has a positive temperature dependence, but the rate constant at low pressures has a negative temperature dependence. The computed high-pressure limiting rate constant at 298 K is 1.25 × 10 -12 cm 3 molecule -1 s -1 , which agrees excellently with the value (1.3 × 10 -12 cm 3 molecule -1 s -1 ) recommended in the most recent comprehensive evaluation for atmospheric chemistry. We show that the atmospheric lifetime of SO 2 with respect to oxidation by OH depends strongly on altitude (in the range 0-50 km) due to the falloff effect. We introduce a new interpolation procedure for fitting the combined temperature and pressure dependence of the rate constant, and it fits the calculated rate constants over the whole range with a mean unsigned error of only 7%. The present results provide reliable kinetics data for this specific reaction, and also they demonstrate convenient theoretical methods that can be reliable for predicting rate constants of other gas-phase reactions.

Critical Transition in Critical Zone of Intensively Managed Landscapes

NASA Astrophysics Data System (ADS)

Kumar, P.

2017-12-01

Intensification of industrial agriculture has resulted in severe unintended global impacts, including degradation of arable land and eutrophication of receiving water bodies. Modern agricultural practices rely on significant direct and indirect human energy inputs, which have created imbalances between increased rates of biogeochemical processes related to production and background rates of natural processes. These imbalances have cascaded through the deep inter-dependencies between carbon, soil, water, nutrient and ecological processes, resulting in a critical transition of the Critical Zone and creating emergent dynamics and evolutionary trajectories. Understanding of these novel organization and function of the Critical Zone is vital for developing sustainable agricultural practices.

Groundwater Exploration for Rural Communities in Ghana, West Africa

NASA Astrophysics Data System (ADS)

McKay, W. A.

2001-05-01

Exploration for potable water in developing countries continues to be a major activity, as there are more than one billion people without access to safe drinking water. Exploration for groundwater becomes more critical in regions where groundwater movement and occurrence is controlled by secondary features such as fractures and faults. Drilling success rates in such geological settings are generally very low, but can be improved by integrating geological, hydrogeological, aerial photo interpretation with land-based geophysical technology in the selection of drilling sites. To help alleviate water supply problems in West Africa, the Conrad N. Hilton Foundation and other donors, since 1990, have funded the World Vision Ghana Rural Water Project (GRWP) to drill wells for potable water supplies in the Greater Afram Plains (GAP) of Ghana. During the first two years of the program, drilling success rates using traditional methods ranged from 35 to 80 percent, depending on the area. The average drilling success rate for the program was approximately 50 percent. In an effort to increase the efficiency of drilling operations, the Desert Research Institute evaluated and developed techniques for application to well-siting strategies in the GAP area of Ghana. A critical project element was developing technical capabilities of in-country staff to independently implement the new strategies. Simple cost-benefit relationships were then used to evaluate the economic advantages of developing water resources using advanced siting methods. The application of advanced methods in the GAP area reveal an increase of 10 to 15 percent in the success rate over traditional methods. Aerial photography has been found to be the most useful of the imagery products covering the GAP area. An effective approach to geophysical exploration for groundwater has been the combined use of EM and resistivity methods. Economic analyses showed that the use of advanced methods is cost-effective when success rates with traditional methods are less than 70 to 90 percent. Finally, with the focus of GRWP activities shifting to Ghana's northern regions, new challenges in drilling success rates are being encountered. In certain districts, success rates as low as 35 percent are observed, raising questions about the efficacy of existing well-siting strategies in the current physical setting, and the validity of traditional cost-benefit analyses for assessing the economic aspects of water exploration in drought-stricken areas.

Cost-Effectiveness of Histamine2 Receptor Antagonists Versus Proton Pump Inhibitors for Stress Ulcer Prophylaxis in Critically Ill Patients.

PubMed

Hammond, Drayton A; Kathe, Niranjan; Shah, Anuj; Martin, Bradley C

2017-01-01

To determine the cost-effectiveness of stress ulcer prophylaxis with histamine 2 receptor antagonists (H2RAs) versus proton pump inhibitors (PPIs) in critically ill and mechanically ventilated adults. A decision analytic model estimating the costs and effectiveness of stress ulcer prophylaxis (with H2RAs and PPIs) from a health care institutional perspective. Adult mixed intensive care unit (ICU) population who received an H2RA or PPI for up to 9 days. Effectiveness measures were mortality during the ICU stay and complication rate. Costs (2015 U.S. dollars) were combined to include medication regimens and untoward events associated with stress ulcer prophylaxis (pneumonia, Clostridium difficile infection, and stress-related mucosal bleeding). Costs and probabilities for complications and mortality from complications came from randomized controlled trials and observational studies. A base case scenario was developed with pooled data from an observational study and meta-analysis of randomized controlled trials. Scenarios based on observational and meta-analysis data alone were evaluated. Outcomes were expected and incremental costs, mortalities, and complication rates. Univariate sensitivity analyses were conducted to determine the influence of inputs on cost, mortality, and complication rates. Monte Carlo simulations evaluated second-order uncertainty. In the base case scenario, the costs, complication rates, and mortality rates were $9039, 17.6%, and 2.50%, respectively, for H2RAs and $11,249, 22.0%, and 3.34%, respectively, for PPIs, indicating that H2RAs dominated PPIs. The observational study-based model provided similar results; however, in the meta-analysis-based model, H2RAs had a cost of $8364 and mortality rate of 3.2% compared with $7676 and 2.0%, respectively, for PPIs. At a willingness-to-pay threshold of $100,000/death averted, H2RA therapy was superior or preferred 70.3% in the base case and 97.0% in the observational study-based scenario. PPI therapy was preferred 87.2% in the meta-analysis-based scenario. Providing stress ulcer prophylaxis with H2RA therapy may reduce costs, increase survival, and avoid complications compared with PPI therapy. This finding is highly sensitive to the pneumonia and stress-related mucosal bleeding rates and whether observational data are used to inform the model. © 2016 Pharmacotherapy Publications, Inc.

Communication skills training curriculum for pulmonary and critical care fellows.

PubMed

McCallister, Jennifer W; Gustin, Jillian L; Wells-Di Gregorio, Sharla; Way, David P; Mastronarde, John G

2015-04-01

The Accreditation Council for Graduate Medical Education requires physicians training in pulmonary and critical care medicine to demonstrate competency in interpersonal communication. Studies have shown that residency training is often insufficient to prepare physicians to provide end-of-life care and facilitate patient and family decision-making. Poor communication in the intensive care unit (ICU) can adversely affect outcomes for critically ill patients and their family members. Despite this, communication training curricula in pulmonary and critical care medicine are largely absent in the published literature. We evaluated the effectiveness of a communication skills curriculum during the first year of a pulmonary and critical care medicine fellowship using a family meeting checklist to provide formative feedback to fellows during ICU rotations. We hypothesized that fellows would demonstrate increased competence and confidence in the behavioral skills necessary for facilitating family meetings. We evaluated a 12-month communication skills curriculum using a pre-post, quasiexperimental design. Subjects for this study included 11 first-year fellows who participated in the new curriculum (intervention group) and a historical control group of five fellows who had completed no formal communication curriculum. Performance of communication skills and self-confidence in family meetings were assessed for the intervention group before and after the curriculum. The control group was assessed once at the beginning of their second year of fellowship. Fellows in the intervention group demonstrated significantly improved communication skills as evaluated by two psychologists using the Family Meeting Behavioral Skills Checklist, with an increase in total observed skills from 51 to 65% (P ≤ 0.01; Cohen's D effect size [es], 1.13). Their performance was also rated significantly higher when compared with the historical control group, who demonstrated only 49% of observed skills (P ≤ 0.01; es, 1.55). Fellows in the intervention group also showed significantly improved self-confidence scores upon completion of the curriculum, with an increase from 77 to 89% (P ≤ 0.01; es, 0.87) upon completion of the curriculum A structured curriculum that includes abundant opportunities for fellows to practice and receive feedback using a behavioral checklist during their ICU rotations helps to develop physicians with advanced communication skills.

Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports.

PubMed

Pène, Frédéric; Aubron, Cécile; Azoulay, Elie; Blot, François; Thiéry, Guillaume; Raynard, Bruno; Schlemmer, Benoît; Nitenberg, Gérard; Buzyn, Agnès; Arnaud, Philippe; Socié, Gérard; Mira, Jean-Paul

2006-02-01

Because the overall outcome of critically ill hematologic patients has improved, we evaluated the short-term and long-term outcomes of the poor risk subgroup of allogeneic hematopoietic stem-cell transplantation (HSCT) recipients requiring admission to the intensive care unit (ICU). This was a retrospective multicenter study of allogeneic HSCT recipients admitted to the ICU between 1997 and 2003. Two hundred nine critically ill allogeneic HSCT recipients were included in the study. Admission in the ICU occurred during the engraftment period (< or = 30 days after transplantation) for 70 of the patients and after the engraftment period for 139 patients. The overall in-ICU, in-hospital, 6-month, and 1-year survival rates were 48.3%, 32.5%, 27.2%, and 21%, respectively. Mechanical ventilation was required in 122 patients and led to a dramatic decrease in survival rates, resulting in in-ICU, in-hospital, 6-month, and 1-year survival rates of 18%, 15.6%, 14%, and 10.6%, respectively. Mechanical ventilation, elevated bilirubin level, and corticosteroid treatment for the indication of active graft-versus-host disease (GVHD) were independent predictors of death in the whole cohort. In the subgroup of patients requiring mechanical ventilation, associated organ failures, such as shock and liver dysfunction, were independent predictors of death. ICU admission during engraftment period was associated with acceptable outcome in mechanically ventilated patients, whereas patients with late complications of HSCT in the setting of active GVHD had a poor outcome. Extensive unlimited intensive care support is justified for allogeneic HSCT recipients with complications occurring during the engraftment period. Conversely, initiation or maintenance of mechanical ventilation is questionable in the setting of active GVHD.

Evaluating physical and biological influences on sedimentation in a tidal freshwater marsh with 7Be

NASA Astrophysics Data System (ADS)

Palinkas, Cindy M.; Engelhardt, Katharina A. M.; Cadol, Dan

2013-09-01

Key differences exist between tidal fresh- and saltwater marshes, such as the relative importance of mineral versus organic sedimentation and plant species diversity, that likely result in different drivers of sedimentation. In tidal freshwater marshes, we hypothesize that vegetation composition, along with physical marsh features (i.e., elevation and tidal channels), play a critical role in sedimentation. This hypothesis is evaluated in Dyke Marsh Preserve (Potomac River, VA, USA) by examining sediment character (grain size, organic content) and deposition rates across the marsh in spring and summer 2010 and 2011. 7Be is especially well suited to capture seasonal sedimentation patterns owing to its short half-life (53.3 d) and ability to assess both sediment deposition and erosion. However, its use in marshes can be challenging, especially due the presence of vegetation. In this study, 7Be-derived sedimentation rates are compared with sediment deposition observed on ceramic tiles to assess its utility in tidal freshwater marshes, and biophysical influences on sediment deposition are examined through statistical models. 7Be- and tile-derived sedimentation rates show similar spatial and temporal patterns, with highest rates occurring at sites closer to tidal channels, highlighting the importance of sediment availability. In addition, complex feedbacks between sedimentation and the plant community are discussed.

Performance analysis of 60-min to 1-min integration time rain rate conversion models in Malaysia

NASA Astrophysics Data System (ADS)

Ng, Yun-Yann; Singh, Mandeep Singh Jit; Thiruchelvam, Vinesh

2018-01-01

Utilizing the frequency band above 10 GHz is in focus nowadays as a result of the fast expansion of radio communication systems in Malaysia. However, rain fade is the critical factor in attenuation of signal propagation for frequencies above 10 GHz. Malaysia is located in a tropical and equatorial region with high rain intensity throughout the year, and this study will review rain distribution and evaluate the performance of 60-min to 1-min integration time rain rate conversion methods for Malaysia. Several conversion methods such as Segal, Chebil & Rahman, Burgeono, Emiliani, Lavergnat and Gole (LG), Simplified Moupfouma, Joo et al., fourth order polynomial fit and logarithmic model have been chosen to evaluate the performance to predict 1-min rain rate for 10 sites in Malaysia. After the completion of this research, the results show that Chebil & Rahman model, Lavergnat & Gole model, Fourth order polynomial fit and Logarithmic model have shown the best performances in 60-min to 1-min rain rate conversion over 10 sites. In conclusion, it is proven that there is no single model which can claim to perform the best across 10 sites. By averaging RMSE and SC-RMSE over 10 sites, Chebil and Rahman model is the best method.

Remote monitoring and prognosis of fatigue cracking in steel bridges with acoustic emission

NASA Astrophysics Data System (ADS)

Yu, Jianguo Peter; Ziehl, Paul; Pollock, Adrian

2011-04-01

Acoustic emission (AE) monitoring is desirable to nondestructively detect fatigue damage in steel bridges. Investigations of the relationship between AE signals and crack growth behavior are of paramount importance prior to the widespread application of passive piezoelectric sensing for monitoring of fatigue crack propagation in steel bridges. Tests have been performed to detect AE from fatigue cracks in A572G50 steel. Noise induced AE signals were filtered based on friction emission tests, loading pattern, and a combined approach involving Swansong II filters and investigation of waveforms. The filtering methods based on friction emission tests and load pattern are of interest to the field evaluation using sparse datasets. The combined approach is suitable for data filtering and interpretation of actual field tests. The pattern recognition program NOESIS (Envirocoustics) was utilized for the evaluation of AE data quality. AE parameters are associated with crack length, crack growth rate, maximum stress intensity and stress intensity range. It is shown that AE hits, counts, absolute energy, and signal strength are able to provide warnings at the critical cracking level where cracking progresses from stage II (stable propagation) to stage III (unstable propagation which may result in failure). Absolute energy rate and signal strength rate may be better than count rate to assess the remaining fatigue life of inservice steel bridges.

Evaluation of email alerts in practice: Part 2. Validation of the information assessment method.

PubMed

Pluye, Pierre; Grad, Roland M; Johnson-Lafleur, Janique; Bambrick, Tara; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Campbell, Craig

2010-12-01

The information assessment method (IAM) permits health professionals to systematically document the relevance, cognitive impact, use and health outcomes of information objects delivered by or retrieved from electronic knowledge resources. The companion review paper (Part 1) critically examined the literature, and proposed a 'Push-Pull-Acquisition-Cognition-Application' evaluation framework, which is operationalized by IAM. The purpose of the present paper (Part 2) is to examine the content validity of the IAM cognitive checklist when linked to email alerts. A qualitative component of a mixed methods study was conducted with 46 doctors reading and rating research-based synopses sent on email. The unit of analysis was a doctor's explanation of a rating of one item regarding one synopsis. Interviews with participants provided 253 units that were analysed to assess concordance with item definitions. The content relevance of seven items was supported. For three items, revisions were needed. Interviews suggested one new item. This study has yielded a 2008 version of IAM. © 2010 Blackwell Publishing Ltd.

[Comparative effects of ginkgo biloba extracts on psychomotor performances and memory in healthy subjects].

PubMed

Warot, D; Lacomblez, L; Danjou, P; Weiller, E; Payan, C; Puech, A J

1991-01-01

The effect on psychomotor and mnesic performances of acute oral dose (600 mg) of 2 Ginkgo biloba extracts were evaluated in twelve healthy female in a dummy placebo-controlled double blind study. Tests were performed comprising: objective measures of vigilance [critical flicker frequency (CFF), choice reaction time (CRT)], memory tasks (pictures and Sternberg scanning tests) and self-rating evaluation (visual analogue scales). Tests session took place before and 1 hour post-dosing. No statistically significant changes from placebo were observed on CFF, CRT or subjective rating of drug effects. No differences between treatment were evidenced on Sternberg scanning test and pictures recognition. Comparing to baseline, free recall score, while decreasing under placebo and Ginkgo, remained the same under Tanakan. As the differences between treatment are localized on one test, it appears important to examine the reproductility in healthy subjects. In order to verify the clinical relevance of these results, they need to be replicated in older healthy volunteers with age-associated memory impairment.

Pelvic fracture urethral injuries: evaluation of various methods of management.

PubMed

Koraitim, M M

1996-10-01

The results of various immediate treatments of urethral injuries complicating a fractured pelvis were evaluated. The records of 100 male patients with pelvic fracture urethral injury were reviewed, 73 of whom were treated by suprapubic cystostomy and delayed repair, 23 by primary realignment and 4 by primary suturing. Also, the findings of 771 patients reported in the literature were reviewed. Urethral stricture was an almost inevitable consequence (97% of the cases) after suprapubic cystostomy. Primary realignment decreased the incidence of stricture to 53% but produced a 36% impotence rate. Primary suturing also decreased the incidence of stricture to 49% but produced the greatest complication rates for impotence (56%) and incontinence (21%). Suprapubic cystostomy alone is indicated for incomplete urethral rupture, slight urethral distraction and critically unstable patients, and when there are inadequate facilities or inexperienced surgeons. Primary realignment is advised if there is wide separation of the urethral ends, or associated injury of the bladder neck or rectum. Primary suturing is not recommended for any condition.

Evaluation of Burning Test Rate Method for Flammable Solids to Increase air-Cargo Safety.

PubMed

Lukežič, Marjan; Marinšek, Marjan; Faganeli, Jadran

2010-03-01

This paper deals with a standard classification procedure for readily combustible solids and their assignment to the relevant packing groups according to international air-cargo legislation and regulations. The current International Air Transport Association and United Nations Orange Book regulations were used on chemically similar substances: hexamethylenetetramine and Dancook ignition briquettes, which are both assigned into the same Packing Group III. To critically evaluate the degree of hazard both chemicals present, a standard burning test rate as well as thermogravimetry, differential scanning calorimetry and evolved gas analysis measurements were performed. It was shown that relatively small changes in the chemical composition of the material may have essential influence on the package group determination. Taking into account all the facts collected in the experimental work, it was concluded that ignition briquettes will undergo spontaneous combustion if exposed to elevated temperatures and, from this point of view, represent higher risk than hexamethylenetetramine during air transportation. Therefore, ignition briquettes should be classified into Packing Group II.

Choked flow of fluid nitrogen with emphasis on the thermodynamic critical region

NASA Technical Reports Server (NTRS)

Hendricks, R. C.; Simoneau, R. J.; Ehlers, R. C.

1972-01-01

Experimental measurements of critical flow rate and pressure ratio for nitrogen flowing through a nozzle are presented. Data for selected stagnation isotherms from 87.5 to 234 K with pressures to 9.3 MN/m2 are compared to an equilibrium model with real fluid properties and also a nonequilibrium model. Critical flow pressure ratio along an isotherm tends to peak while the flow rate indicates an inflection. The point is closely associated with the transposed critical temperature and represents a change in the fluid structure.

Caring for critically ill oldest old patients: a clinical review.

PubMed

Vargas, Nicola; Tibullo, Loredana; Landi, Emanuela; Carifi, Giovanni; Pirone, Alfonso; Pippo, Antonio; Alviggi, Immacolata; Tizzano, Renato; Salsano, Elisa; Di Grezia, Francesco; Vargas, Maria

2017-10-01

Despite technological advances, the mortality rate for critically ill oldest old patients remains high. The intensive caring should be able to combine technology and a deep humanity considering that the patients are living the last part of their lives. In addition to the traditional goals of ICU of reducing morbidity and mortality, of maintaining organ functions and restoring health, caring for seriously oldest old patients should take into account their end-of-life preferences, the advance or proxy directives if available, the prognosis, the communication, their life expectancy and the impact of multimorbidity. The aim of this review was to focus on all these aspects with an emphasis on some intensive procedures such as mechanical ventilation, noninvasive mechanical ventilation, cardiopulmonary resuscitation, renal replacement therapy, hemodynamic support, evaluation of delirium and malnutrition in this heterogeneous frail ICU population.

Direct access to dithiobenzoate RAFT agent fragmentation rate coefficients by ESR spin-trapping.

PubMed

Ranieri, Kayte; Delaittre, Guillaume; Barner-Kowollik, Christopher; Junkers, Thomas

2014-12-01

The β-scission rate coefficient of tert-butyl radicals fragmenting off the intermediate resulting from their addition to tert-butyl dithiobenzoate-a reversible addition-fragmentation chain transfer (RAFT) agent-is estimated via the recently introduced electron spin resonance (ESR)-trapping methodology as a function of temperature. The newly introduced ESR-trapping methodology is critically evaluated and found to be reliable. At 20 °C, a fragmentation rate coefficient of close to 0.042 s(-1) is observed, whereas the activation parameters for the fragmentation reaction-determined for the first time-read EA = 82 ± 13.3 kJ mol(-1) and A = (1.4 ± 0.25) × 10(13) s(-1) . The ESR spin-trapping methodology thus efficiently probes the stability of the RAFT adduct radical under conditions relevant for the pre-equilibrium of the RAFT process. It particularly indicates that stable RAFT adduct radicals are indeed formed in early stages of the RAFT poly-merization, at least when dithiobenzoates are employed as controlling agents as stipulated by the so-called slow fragmentation theory. By design of the methodology, the obtained fragmentation rate coefficients represent an upper limit. The ESR spin-trapping methodology is thus seen as a suitable tool for evaluating the fragmentation rate coefficients of a wide range of RAFT adduct radicals. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Redesigning Orientation in an Intensive Care Unit Using 2 Theoretical Models.

PubMed

Kozub, Elizabeth; Hibanada-Laserna, Maribel; Harget, Gwen; Ecoff, Laurie

2015-01-01

To accommodate a higher demand for critical care nurses, an orientation program in a surgical intensive care unit was revised and streamlined. Two theoretical models served as a foundation for the revision and resulted in clear clinical benchmarks for orientation progress evaluation. The purpose of the project was to integrate theoretical frameworks into practice to improve the unit orientation program. Performance improvement methods served as a framework for the revision, and outcomes were measured before and after implementation. The revised orientation program increased 1- and 2-year nurse retention and decreased turnover. Critical care knowledge increased after orientation for both the preintervention and postintervention groups. Incorporating a theoretical basis for orientation has been shown to be successful in increasing the number of nurses completing orientation and improving retention, turnover rates, and knowledge gained.

Fungal model systems and the elucidation of pathogenicity determinants

PubMed Central

Perez-Nadales, Elena; Almeida Nogueira, Maria Filomena; Baldin, Clara; Castanheira, Sónia; El Ghalid, Mennat; Grund, Elisabeth; Lengeler, Klaus; Marchegiani, Elisabetta; Mehrotra, Pankaj Vinod; Moretti, Marino; Naik, Vikram; Oses-Ruiz, Miriam; Oskarsson, Therese; Schäfer, Katja; Wasserstrom, Lisa; Brakhage, Axel A.; Gow, Neil A.R.; Kahmann, Regine; Lebrun, Marc-Henri; Perez-Martin, José; Di Pietro, Antonio; Talbot, Nicholas J.; Toquin, Valerie; Walther, Andrea; Wendland, Jürgen

2014-01-01

Fungi have the capacity to cause devastating diseases of both plants and animals, causing significant harvest losses that threaten food security and human mycoses with high mortality rates. As a consequence, there is a critical need to promote development of new antifungal drugs, which requires a comprehensive molecular knowledge of fungal pathogenesis. In this review, we critically evaluate current knowledge of seven fungal organisms used as major research models for fungal pathogenesis. These include pathogens of both animals and plants; Ashbya gossypii, Aspergillus fumigatus, Candida albicans, Fusarium oxysporum, Magnaporthe oryzae, Ustilago maydis and Zymoseptoria tritici. We present key insights into the virulence mechanisms deployed by each species and a comparative overview of key insights obtained from genomic analysis. We then consider current trends and future challenges associated with the study of fungal pathogenicity. PMID:25011008

Association of posterior EEG alpha with prioritization of religion or spirituality: A replication and extension at 20-year follow-up.

PubMed

Tenke, Craig E; Kayser, Jürgen; Svob, Connie; Miller, Lisa; Alvarenga, Jorge E; Abraham, Karen; Warner, Virginia; Wickramaratne, Priya; Weissman, Myrna M; Bruder, Gerard E

2017-03-01

A prior report (Tenke et al., 2013 Biol. Psychol. 94:426-432) found that participants who rated religion or spirituality (R/S) highly important had greater posterior alpha after 10 years compared to those who did not. Participants who subsequently lowered their rating also had prominent alpha, while those who increased their rating did not. Here we report EEG findings 20 years after initial assessment. Clinical evaluations and R/S ratings were obtained from 73 (52 new) participants in a longitudinal study of family risk for depression. Frequency PCA of current source density transformed EEG concisely quantified posterior alpha. Those who initially rated R/S as highly important had greater alpha compared to those who did not, even if their R/S rating later increased. Furthermore, changes in religious denomination were associated with decreased alpha. Results suggest the possibility of a critical stage in the ontogenesis of R/S that is linked to posterior resting alpha. Copyright © 2017 Elsevier B.V. All rights reserved.

DSMC simulations of shock tube experiments for the dissociation rate of nitrogen

NASA Astrophysics Data System (ADS)

Bird, G. A.

2012-11-01

The DSMC method has been used to simulate the flow associated with several experiments that led to predictions of the dissociation rate in nitrogen. One involved optical interferometry to determine the density behind strong shock wave and the other involved the measurement of the shock tube end-wall pressure after the reflection of a similar shock wave. DSMC calculations for the un-reflected shock wave were made with the older TCE model that converts rate coefficients to reaction cross-sections, with the newer Q-K model that predicts the rates and with a set of reaction cross-sections for nitrogen dissociation from QCT calculations. A comparison of the resulting density profiles with the measured profile provides a test of the validity of the DSMC chemistry models. The DSMC reaction rates were sampled directly in the DSMC calculation, both far downstream where the flow is in equilibrium and in the non-equilibrium region immediately behind the shock. This permits a critical evaluation of data reduction procedures that were employed to deduce the dissociation rate from the measured quantities.

Mitochondrial DNA variations in ova and blastocyst: implications in assisted reproduction.

PubMed

Shamsi, Monis Bilal; Govindaraj, Periyasamy; Chawla, Latika; Malhotra, Neena; Singh, Neeta; Mittal, Suneeta; Talwar, Pankaj; Thangaraj, Kumarasamy; Dada, Rima

2013-03-01

Mitochondrial DNA (mtDNA) of oocyte is critical for its function, embryo quality and development. Analysis of complete mtDNA of 49 oocytes and 18 blastocysts from 67 females opting for IVF revealed 437 nucleotide variations. 40.29% samples had either disease associated or non-synonymous novel or pathogenic mutation in evolutionarily conserved regions. Samples with disease associated mtDNA mutations had low fertilization rate and poor embryo quality, however no difference in implantation or clinical pregnancy rate was observed. Screening mtDNA from oocyte/blastocyst is a simple, clinically reliable method for diagnostic evaluation of female infertility and may reduce risk of mtDNA disease transmission. Copyright © 2013 Elsevier B.V. and Mitochondria Research Society. All rights reserved.

Subjective and objective appearance of head and neck cancer patients following microsurgical reconstruction and associated quality of life─A cross-sectional study.

PubMed

Kansy, Katinka; Hoffmann, Jürgen; Alhalabi, Obada; Mistele, Nicole; Freier, Kolja; Mertens, Christian; Freudlsperger, Christian; Engel, Michael

2018-06-01

Depending on the site and size of head and neck cancer, the disease affects patients' appearance and subsequently their quality of life. The aim of this study was to correlate subjective and objective evaluation of facial appearance and associated quality of life following ablative tumor surgery and microsurgical reconstruction. A total of 99 patients with combined ablative and reconstructive microsurgical procedure for head and neck malignancy and seven patients with non-malignant disease were examined by three-dimensional (3D) (photogrammetry at least 6 months post-surgery and were evaluated by two-dimensional (2D) and 3D means for symmetry and facial proportions. Measurements were correlated with subjective reporting from the University of Washington Quality of Life Questionnaire and observer ratings. Of the 106 patients, three patients scored themselves as significantly disfigured (2.8%), 19 were bothered by their appearance (17.9%), 27 (25.5%) reported no change, and 57 (53.8%) reported minor changes in their appearance. On 2D evaluation, 10 patients (9.4%) showed severely abnormal facial proportions. On 3D analysis, 17 patients showed major asymmetry. There was a high correlation (0.67) between patient and observer subjective rating (p < 0.05). While 2D evaluation alone showed no significant correlation with subjective rating, 3D evaluation showed a moderate correlation (0.37; p < 0.05). The best results were achieved by combining 2D and 3D measurements (0.5; p < 0.05). Young female patients were most critical about their appearance. Following combined ablative and microsurgical reconstructive procedures, patients have a realistic perception of their appearance compared with observer ratings and a combination of 2D and 3D objective evaluation. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Modeling the cell-type dependence of diffusion-limited intracellular ice nucleation and growth during both vitrification and slow freezing

NASA Astrophysics Data System (ADS)

Yang, Geer; Zhang, Aili; Xu, Lisa X.; He, Xiaoming

2009-06-01

In this study, a set of models for predicting the diffusion-limited ice nucleation and growth inside biological cells were established. Both the heterogeneous and homogeneous nucleation mechanisms were considered in the models. Molecular mobility including viscosity and mutual diffusion coefficient of aqueous cryoprotectant (i.e., glycerol here) solutions was estimated using models derived from the free volume theory for glass transition, which makes it possible to predict the two most important physical properties (i.e., viscosity and mutual diffusion coefficient) over wide ranges of temperature and concentration as encountered in cryopreservation. After being verified using experimental data, the models were used to predict the critical cooling rate (defined as the cooling rate required so that the crystallized volume is less than 0.1% of the cell volume) as a function of the initial glycerol concentration in a number of cell types with different sizes. For slowing freezing, it was found that the required critical cooling rate is cell-type dependent with influences from cell size and the ice nucleation and water transport parameters. In general, the critical cooling rate does not change significantly with the initial glycerol concentration used and tends to be higher for smaller cells. For vitrification, the required critical cooling rate does change significantly with the initial glycerol concentration used and tends to decrease with the decrease in cell size. However, the required critical cooling rate can be similar for cells with very different sizes. It was further found that the thermodynamic and kinetic parameters for intracellular ice formation associated with different cells rather than the cell size per se significantly affect the critical cooling rates required for vitrification. For all cell types, it was found that homogeneous nucleation dominates at ultrafast cooling rates and/or high glycerol concentrations, whereas heterogeneous nucleation becomes important only during slow freezing with a low initial glycerol concentration (<1.5-2M), particularly for large cells such as mouse oocytes.

Familial expressed emotion: outcome and course of Israeli patients with schizophrenia.

PubMed

Marom, Sofi; Munitz, Hanan; Jones, Peter B; Weizman, Abraham; Hermesh, Haggai

2002-01-01

We investigated the validity of expressed emotion (EE) in Israel. The study sample consisted of 108 patients with schizophrenia and 15 with schizoaffective disorder, and their key relatives. EE was rated with the Five Minute Speech Sample (FMSS). Patient households were categorized by EE and its two components: criticism and emotional overinvolvement. Patients were rated with the Brief Psychiatric Rating Scale (BPRS) at admission, at discharge, and 6 months after discharge. Readmissions were determined over a 9-month period. High EE and particularly high criticism were significantly associated with poorer outcome (higher rate of and earlier readmissions, and higher BPRS score at followup) and worse illness course (higher annual number of prior psychiatric hospital admissions). Odds ratios between high EE and high criticism and readmission were 2.6 and 3.5, respectively. The strongest predictor of earlier readmission was the interaction of high criticism x poor compliance with medication. The results converge to further confirm the notion that familial EE is a valid crosscultural predictor of the clinical course of schizophrenia. Moreover, EE has predictive power in very chronic samples. Criticism appears to be the crucial EE component linked with short-term outcome. Treatment aimed at reducing high criticism is warranted. The FMSS appears to have predictive validity.

Analysis of limiting information characteristics of quantum-cryptography protocols

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

Sych, D V; Grishanin, Boris A; Zadkov, Viktor N

2005-01-31

The problem of increasing the critical error rate of quantum-cryptography protocols by varying a set of letters in a quantum alphabet for space of a fixed dimensionality is studied. Quantum alphabets forming regular polyhedra on the Bloch sphere and the continual alphabet equally including all the quantum states are considered. It is shown that, in the absence of basis reconciliation, a protocol with the tetrahedral alphabet has the highest critical error rate among the protocols considered, while after the basis reconciliation, a protocol with the continual alphabet possesses the highest critical error rate. (quantum optics and quantum computation)

Benchmark experiments at ASTRA facility on definition of space distribution of {sup 235}U fission reaction rate

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

Bobrov, A. A.; Boyarinov, V. F.; Glushkov, A. E.

2012-07-01

Results of critical experiments performed at five ASTRA facility configurations modeling the high-temperature helium-cooled graphite-moderated reactors are presented. Results of experiments on definition of space distribution of {sup 235}U fission reaction rate performed at four from these five configurations are presented more detail. Analysis of available information showed that all experiments on criticality at these five configurations are acceptable for use them as critical benchmark experiments. All experiments on definition of space distribution of {sup 235}U fission reaction rate are acceptable for use them as physical benchmark experiments. (authors)

Optimization and development of stable w/o/w cosmetic multiple emulsions by means of the Quality by Design approach.

PubMed

Kovács, A; Erős, I; Csóka, I

2016-04-01

The aim of our present work was to develop stable water-in-oil-in-water (w/o/w) cosmetic multiple emulsions that are proper for cosmetic use and can also be applied on the skin as pharmaceutical vehicles by means of Quality by Design (QbD) concept. This product design concept consists of a risk assessment step and also the 'predetermination' of the critical material attributes and process parameters of a stable multiple emulsion system. We have set up the hypothesis that the stability of multiple emulsions can be improved by the development based on such systematic planning - making a map of critical product parameters - so their industrial usage can be increased. The risk assessment and the determination of critical physical-chemical stability parameters of w/o/w multiple emulsions to define critical control points were performed by means of quality tools and the leanqbd(™) (QbD Works LLC, Fremont, CA, U.S.A.) software. Critical materials and process parameters: Based on the results of preformulation experiments, three factors, namely entrapped active agent, preparation methodology and shear rate, were found to be highly critical factors for critical quality attributes (CQAs) and for stability, whereas the nature of oil was found a medium level risk factor. The results of the risk assessment are the following: (i) droplet structure and size distribution should be evaluated together to be able to predict the stability issues, (ii) the presence of entrapped active agents had a great impact on droplet structure, (iii) the viscosity curves represent the structural changes during storage, if the decrease in relative viscosity is >15% the emulsion disintegrates, and (iv) it is enough to use the shear rate between 34g and 116g relative centrifugal force (RCF). CQAs: By risk assessment, we discovered that four factors should be considered to be high-risk variables as compared to others: droplet size, droplet structure, viscosity and multiple character were found to be highly critical attributes. The preformulation experiment is the part of a development plan. On the basis of these results, the control strategy can be defined and a stable multiple emulsion can be ensured that meets the relevant stakeholders' quality expectations. © 2015 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

The evaluation of research papers in the XXI century. The Open Peer Discussion system of the World Economics Association.

PubMed

Ietto-Gillies, Grazia

2012-01-01

The paper starts with a brief discussion of the traditional peer review (TPR) system of research evaluation, its role, and the criticisms levelled at it. An analysis of specific problems in economics leads to a full discussion of the Open Peer Review (OPR) system developed by the World Economics Association (WEA) and the principles behind it. The system is open in the following two respects: (a) disclosure of names of authors and reviewers; and (b) inclusivity of potential reviewers in terms of paradigmatic approaches, country, and community. The paper then discusses the applicability of the same system to other disciplines. In doing so, it stressed the aims of various evaluation systems and the possible pitfalls of rating systems. It also speculates on the future of journal publication.

Evaluation of products and services of a nursing library: user satisfaction.

PubMed

Cozin, Sheila Kátia; Turrini, Ruth Natalia Teresa

2008-01-01

The goal of the study was to evaluate the quality of the services provided by the library at the Nursing School of the University of São Paulo. A questionnaire evaluating users' satisfaction with the service was employed, covering five quality components: tangibles, reliability, responsiveness, assurance and empathy. The Satisfaction Rate was calculated through the degree of importance in relation to satisfaction. The analysis of the open-ended answers was quanti-qualitative. For Reliability and Empathy, the users showed dissatisfaction with the training for bibliographic research and the librarian's willingness to meet the clients' information needs, respectively. Responsiveness did not fully satisfy the users, disagreeing with the providers. However, both agreed that the archives are outdated. Among the tangible aspects, equipment and noise were criticized most often. The results show that the library offers good service quality to its users.

Evaluation of understanding levels of Indian dental students' knowledge and perceptions regarding older adults.

PubMed

Anehosur, Gouri Venkatesh; Nadiger, Ramesh K

2012-06-01

Increasing numbers of older people and decreasing rates of edentulism highlight the importance of dental education that focuses on oral health and ageing. Our evaluation study was carried out to assess the Indian dental graduate's geriatric knowledge, as well as their awareness, of the bio-psychosocial factors that are potential barriers to geriatric oral health care. A total of 98 students were evaluated during their rotational clinical posting in the fifth year of the dental education programme. The results suggest that general attitudes need to be changed by the inclusion of geriatric dentistry in the dental curriculum. Exposure of students to didactic and clinical setting appears to be a critical element towards positive knowledge and attitude of the elderly. © 2010 The Gerodontology Society and John Wiley & Sons A/S.

Reaction kinetics and critical phenomena: iodination of acetone in isobutyric acid + water near the consolute point.

PubMed

Hu, Baichuan; Baird, James K

2010-01-14

The rate of iodination of acetone has been measured as a function of temperature in the binary solvent isobutyric acid (IBA) + water near the upper consolute point. The reaction mixture was prepared by the addition of acetone, iodine, and potassium iodide to IBA + water at its critical composition of 38.8 mass % IBA. The value of the critical temperature determined immediately after mixing was 25.43 degrees C. Aliquots were extracted from the mixture at regular intervals in order to follow the time course of the reaction. After dilution of the aliquot with water to quench the reaction, the concentration of triiodide ion was determined by the measurement of the optical density at a wavelength of 565 nm. These measurements showed that the kinetics were zeroth order. When at the end of 24 h the reaction had come to equilibrium, the critical temperature was determined again and found to be 24.83 degrees C. An Arrhenius plot of the temperature dependence of the observed rate constant, k(obs), was linear over the temperature range 27.00-38.00 degrees C, but between 25.43 and 27.00 degrees C, the values of k(obs) fell below the extrapolation of the Arrhenius line. This behavior is evidence in support of critical slowing down. Our experimental method and results are significant in three ways: (1) In contrast to in situ measurements of optical density, the determination of the optical density of diluted aliquots avoided any interference from critical opalescence. (2) The measured reaction rate exhibited critical slowing down. (3) The rate law was pseudo zeroth order both inside and outside the critical region, indicating that the reaction mechanism was unaffected by the presence of the critical point.

GROWTH OF THE INTERNATIONAL CRITICALITY SAFETY AND REACTOR PHYSICS EXPERIMENT EVALUATION PROJECTS

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

J. Blair Briggs; John D. Bess; Jim Gulliford

2011-09-01

Since the International Conference on Nuclear Criticality Safety (ICNC) 2007, the International Criticality Safety Benchmark Evaluation Project (ICSBEP) and the International Reactor Physics Experiment Evaluation Project (IRPhEP) have continued to expand their efforts and broaden their scope. Eighteen countries participated on the ICSBEP in 2007. Now, there are 20, with recent contributions from Sweden and Argentina. The IRPhEP has also expanded from eight contributing countries in 2007 to 16 in 2011. Since ICNC 2007, the contents of the 'International Handbook of Evaluated Criticality Safety Benchmark Experiments1' have increased from 442 evaluations (38000 pages), containing benchmark specifications for 3955 critical ormore » subcritical configurations to 516 evaluations (nearly 55000 pages), containing benchmark specifications for 4405 critical or subcritical configurations in the 2010 Edition of the ICSBEP Handbook. The contents of the Handbook have also increased from 21 to 24 criticality-alarm-placement/shielding configurations with multiple dose points for each, and from 20 to 200 configurations categorized as fundamental physics measurements relevant to criticality safety applications. Approximately 25 new evaluations and 150 additional configurations are expected to be added to the 2011 edition of the Handbook. Since ICNC 2007, the contents of the 'International Handbook of Evaluated Reactor Physics Benchmark Experiments2' have increased from 16 different experimental series that were performed at 12 different reactor facilities to 53 experimental series that were performed at 30 different reactor facilities in the 2011 edition of the Handbook. Considerable effort has also been made to improve the functionality of the searchable database, DICE (Database for the International Criticality Benchmark Evaluation Project) and verify the accuracy of the data contained therein. DICE will be discussed in separate papers at ICNC 2011. The status of the ICSBEP and the IRPhEP will be discussed in the full paper, selected benchmarks that have been added to the ICSBEP Handbook will be highlighted, and a preview of the new benchmarks that will appear in the September 2011 edition of the Handbook will be provided. Accomplishments of the IRPhEP will also be highlighted and the future of both projects will be discussed. REFERENCES (1) International Handbook of Evaluated Criticality Safety Benchmark Experiments, NEA/NSC/DOC(95)03/I-IX, Organisation for Economic Co-operation and Development-Nuclear Energy Agency (OECD-NEA), September 2010 Edition, ISBN 978-92-64-99140-8. (2) International Handbook of Evaluated Reactor Physics Benchmark Experiments, NEA/NSC/DOC(2006)1, Organisation for Economic Co-operation and Development-Nuclear Energy Agency (OECD-NEA), March 2011 Edition, ISBN 978-92-64-99141-5.« less

Stress and burnout among critical care fellows: preliminary evaluation of an educational intervention.

PubMed

Kashani, Kianoush; Carrera, Perliveh; De Moraes, Alice Gallo; Sood, Amit; Onigkeit, James A; Ramar, Kannan

2015-01-01

Despite a demanding work environment, information on stress and burnout of critical care fellows is limited. To assess 1) levels of burnout, perceived stress, and quality of life in critical care fellows, and 2) the impact of a brief stress management training on these outcomes. In a tertiary care academic medical center, 58 critical care fellows of varying subspecialties and training levels were surveyed to assess baseline levels of stress and burnout. Twenty-one of the 58 critical care fellows who were in the first year of training at the time of this initial survey participated in a pre-test and 1-year post-test to determine the effects of a brief, 90-min stress management intervention. Based on responses (n=58) to the abbreviated Maslach Burnout Inventory, reported burnout was significantly lower in Asian fellows (p=0.04) and substantially higher among graduating fellows (versus new and transitioning fellows) (p=0.02). Among the intervention cohort, burnout did not significantly improve--though two-thirds of fellows reported using the interventional techniques to deal with stressful situations. Fellows who participated in the intervention rated the effectiveness of the course as 4 (IQR=3.75-5) using the 5-point Likert scale. In comparison with the new and transitioning trainees, burnout was highest among graduating critical care fellows. Although no significant improvements were found in first-year fellows' burnout scores following the single, 90-min training intervention, participants felt the training did provide them with tools to apply during stressful situations.

Assessing Critical Thinking Outcomes of Dental Hygiene Students Utilizing Virtual Patient Simulation: A Mixed Methods Study.

PubMed

Allaire, Joanna L

2015-09-01

Dental hygiene educators must determine which educational practices best promote critical thinking, a quality necessary to translate knowledge into sound clinical decision making. The aim of this small pilot study was to determine whether virtual patient simulation had an effect on the critical thinking of dental hygiene students. A pretest-posttest design using the Health Science Reasoning Test was used to evaluate the critical thinking skills of senior dental hygiene students at The University of Texas School of Dentistry at Houston Dental Hygiene Program before and after their experience with computer-based patient simulation cases. Additional survey questions sought to identify the students' perceptions of whether the experience had helped develop their critical thinking skills and improved their ability to provide competent patient care. A convenience sample of 31 senior dental hygiene students completed both the pretest and posttest (81.5% of total students in that class); 30 senior dental hygiene students completed the survey on perceptions of the simulation (78.9% response rate). Although the results did not show a significant increase in mean scores, the students reported feeling that the use of virtual patients was an effective teaching method to promote critical thinking, problem-solving, and confidence in the clinical realm. The results of this pilot study may have implications to support the use of virtual patient simulations in dental hygiene education. Future research could include a larger controlled study to validate findings from this study.

PROSPECTS FOR JOINT GRAVITATIONAL WAVE AND SHORT GAMMA-RAY BURST OBSERVATIONS

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

Clark, J.; Evans, H.; Fairhurst, S.

2015-08-10

We present a detailed evaluation of the expected rate of joint gravitational-wave (GW) and short gamma-ray burst (GRB) observations over the coming years. We begin by evaluating the improvement in distance sensitivity of the GW search that arises from using the GRB observation to restrict the time and sky location of the source. We argue that this gives a 25% increase in sensitivity when compared to an all-sky, all-time search, corresponding to more than double the number of detectable GW signals associated with GRBs. Using this, we present the expected rate of joint observations with the advanced LIGO and Virgomore » instruments, taking into account the expected evolution of the GW detector network. We show that in the early advanced GW detector observing runs, from 2015 to 2017, there is only a small chance of a joint observation. However, as the detectors approach their design sensitivities, there is a good chance of joint observations, provided wide field GRB satellites, such as Fermi and the Inter planetary Network, continue operation. The rate will also depend critically upon the nature of the progenitor, with neutron star-black hole systems observable to greater distances than double neutron star systems. The relative rate of binary mergers and GRBs will depend upon the jet opening angle of GRBs. Consequently, joint observations, as well as accurate measurement of both the GRB rate and binary merger rates, will allow for an improved estimation of the opening angle of GRBs.« less

Rating scales for musician's dystonia

PubMed Central

Berque, Patrice; Jabusch, Hans-Christian; Altenmüller, Eckart; Frucht, Steven J.

2013-01-01

Musician's dystonia (MD) is a focal adult-onset dystonia most commonly involving the hand. It has much greater relative prevalence than non-musician’s focal hand dystonias, exhibits task specificity at the level of specific musical passages, and is a particularly difficult form of dystonia to treat. For most MD patients, the diagnosis confirms the end of their music performance careers. Research on treatments and pathophysiology is contingent upon measures of motor function abnormalities. In this review, we comprehensively survey the literature to identify the rating scales used in MD and the distribution of their use. We also summarize the extent to which the scales have been evaluated for their clinical utility, including reliability, validity, sensitivity, specificity to MD, and practicality for a clinical setting. Out of 135 publications, almost half (62) included no quantitative measures of motor function. The remaining 73 studies used a variety of choices from among 10 major rating scales. Most used subjective scales involving either patient or clinician ratings. Only 25% (18) of the studies used objective scales. None of the scales has been completely and rigorously evaluated for clinical utility. Whether studies involved treatments or pathophysiologic assays, there was a heterogeneous choice of rating scales used with no clear standard. As a result, the collective interpretive value of those studies is limited because the results are confounded by measurement effects. We suggest that the development and widespread adoption of a new clinically useful rating scale is critical for accelerating basic and clinical research in MD. PMID:23884039

Mortality of adult intensive care units in Turkey using the APACHE II and SOFA systems (outcome assessment in Turkish intensive care units).

PubMed

Kaymak, Cetin; Sencan, Irfan; Izdes, Seval; Sari, Aydin; Yagmurdur, Hatice; Karadas, Derya; Oztuna, Derya

2018-04-01

The aim of this study was to evaluate intensive care unit (ICU) performance using risk-adjusted ICU mortality rates nationally, assessing patients who died or had been discharged from the ICU. For this purpose, this study analyzed the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) databases, containing detailed clinical and physiological information and mortality of mixed critically ill patients in a medical ICU at secondary and tertiary referral ICUs in Turkey. A total of 690 adult intensive care units in Turkey were included in the study. Among 690 ICUs evaluated, 39.7% were secondary and 60.3% were tertiary ICUs. A total of 4188 patients were enrolled in this study. Intensive care units of ministry, university, and private hospitals were evaluated all over Turkey. During the study period, clinical data that were collected concurrently for each patient contained demographic details and the diagnostic category leading to ICU admission. APACHE II and SOFA scores following ICU admission were calculated and recorded. Patients were followed up for outcome data until death or ICU discharge. The mean age of patients was 68.8 ±19 and 54% of them were male. The mean APACHE II score was 20 ±8.7. The ICUs' mortality rate was 46.3%, and mean predicted mortality was 37.2% for APACHE II. The standardized mortality ratio was 1.28 (95% confidence interval: 1.21-1.31). There was a wide difference in outcome for patients admitted to different ICUs and severity of illness using risk adjustment methods. The high mortality rate in patients could be related to comorbid diseases, high mechanical ventilation rates and older ages.

Evaluation of atmospheric nitrogen deposition model performance in the context of U.S. critical load assessments

NASA Astrophysics Data System (ADS)

Williams, Jason J.; Chung, Serena H.; Johansen, Anne M.; Lamb, Brian K.; Vaughan, Joseph K.; Beutel, Marc

2017-02-01

Air quality models are widely used to estimate pollutant deposition rates and thereby calculate critical loads and critical load exceedances (model deposition > critical load). However, model operational performance is not always quantified specifically to inform these applications. We developed a performance assessment approach designed to inform critical load and exceedance calculations, and applied it to the Pacific Northwest region of the U.S. We quantified wet inorganic N deposition performance of several widely-used air quality models, including five different Community Multiscale Air Quality Model (CMAQ) simulations, the Tdep model, and 'PRISM x NTN' model. Modeled wet inorganic N deposition estimates were compared to wet inorganic N deposition measurements at 16 National Trends Network (NTN) monitoring sites, and to annual bulk inorganic N deposition measurements at Mount Rainier National Park. Model bias (model - observed) and error (|model - observed|) were expressed as a percentage of regional critical load values for diatoms and lichens. This novel approach demonstrated that wet inorganic N deposition bias in the Pacific Northwest approached or exceeded 100% of regional diatom and lichen critical load values at several individual monitoring sites, and approached or exceeded 50% of critical loads when averaged regionally. Even models that adjusted deposition estimates based on deposition measurements to reduce bias or that spatially-interpolated measurement data, had bias that approached or exceeded critical loads at some locations. While wet inorganic N deposition model bias is only one source of uncertainty that can affect critical load and exceedance calculations, results demonstrate expressing bias as a percentage of critical loads at a spatial scale consistent with calculations may be a useful exercise for those performing calculations. It may help decide if model performance is adequate for a particular calculation, help assess confidence in calculation results, and highlight cases where a non-deterministic approach may be needed.

Impact of three task demand factors on simulated unmanned system intelligence, surveillance, and reconnaissance operations.

PubMed

Abich, Julian; Reinerman-Jones, Lauren; Matthews, Gerald

2017-06-01

The present study investigated how three task demand factors influenced performance, subjective workload and stress of novice intelligence, surveillance, and reconnaissance operators within a simulation of an unmanned ground vehicle. Manipulations were task type, dual-tasking and event rate. Participants were required to discriminate human targets within a street scene from a direct video feed (threat detection [TD] task) and detect changes in symbols presented in a map display (change detection [CD] task). Dual-tasking elevated workload and distress, and impaired performance for both tasks. However, with increasing event rate, CD task deteriorated, but TD improved. Thus, standard workload models provide a better guide to evaluating the demands of abstract symbols than to processing realistic human characters. Assessment of stress and workload may be especially important in the design and evaluation of systems in which human character critical signals must be detected in video images. Practitioner Summary: This experiment assessed subjective workload and stress during threat and CD tasks performed alone and in combination. Results indicated an increase in event rate led to significant improvements in performance during TD, but decrements during CD, yet both had associated increases in workload and engagement.

Methodological evaluation and comparison of five urinary albumin measurements.

PubMed

Liu, Rui; Li, Gang; Cui, Xiao-Fan; Zhang, Dong-Ling; Yang, Qing-Hong; Mu, Xiao-Yan; Pan, Wen-Jie

2011-01-01

Microalbuminuria is an indicator of kidney damage and a risk factor for the progression kidney disease, cardiovascular disease, and so on. Therefore, accurate and precise measurement of urinary albumin is critical. However, there are no reference measurement procedures and reference materials for urinary albumin. Nephelometry, turbidimetry, colloidal gold method, radioimmunoassay, and chemiluminescence immunoassay were performed for methodological evaluation, based on imprecision test, recovery rate, linearity, haemoglobin interference rate, and verified reference interval. Then we tested 40 urine samples from diabetic patients by each method, and compared the result between assays. The results indicate that nephelometry is the method with best analytical performance among the five methods, with an average intraassay coefficient of variation (CV) of 2.6%, an average interassay CV of 1.7%, a mean recovery of 99.6%, a linearity of R=1.00 from 2 to 250 mg/l, and an interference rate of <10% at haemoglobin concentrations of <1.82 g/l. The correlation (r) between assays was from 0.701 to 0.982, and the Bland-Altman plots indicated each assay provided significantly different results from each other. Nephelometry is the clinical urinary albumin method with best analytical performance in our study. © 2011 Wiley-Liss, Inc.

Fate of organic microcontaminants in wastewater treatment and river systems: An uncertainty assessment in view of sampling strategy, and compound consumption rate and degradability.

PubMed

Aymerich, I; Acuña, V; Ort, C; Rodríguez-Roda, I; Corominas, Ll

2017-11-15

The growing awareness of the relevance of organic microcontaminants on the environment has led to a growing number of studies on attenuation of these compounds in wastewater treatment plants (WWTP) and rivers. However, the effects of the sampling strategies (frequency and duration of composite samples) on the attenuation estimates are largely unknown. Our goal was to assess how frequency and duration of composite samples influence uncertainty of the attenuation estimates in WWTPs and rivers. Furthermore, we also assessed how compound consumption rate and degradability influence uncertainty. The assessment was conducted through simulating the integrated wastewater system of Puigcerdà (NE Iberian Peninsula) using a sewer pattern generator and a coupled model of WWTP and river. Results showed that the sampling strategy is especially critical at the influent of WWTP, particularly when the number of toilet flushes containing the compound of interest is small (≤100 toilet flushes with compound day -1 ), and less critical at the effluent of the WWTP and in the river due to the mixing effects of the WWTP. For example, at the WWTP, when evaluating a compound that is present in 50 pulses·d -1 using a sampling frequency of 15-min to collect a 24-h composite sample, the attenuation uncertainty can range from 94% (0% degradability) to 9% (90% degradability). The estimation of attenuation in rivers is less critical than in WWTPs, as the attenuation uncertainty was lower than 10% for all evaluated scenarios. Interestingly, the errors in the estimates of attenuation are usually lower than those of loads for most sampling strategies and compound characteristics (e.g. consumption and degradability), although the opposite occurs for compounds with low consumption and inappropriate sampling strategies at the WWTP. Hence, when designing a sampling campaign, one should consider the influence of compounds' consumption and degradability as well as the desired level of accuracy in attenuation estimations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Expansion of a compressible gas bubble in Stokes flow

NASA Astrophysics Data System (ADS)

Pozrikidis, C.

2001-09-01

The flow-induced deformation of an inviscid bubble occupied by a compressible gas and suspended in an ambient viscous liquid is considered at low Reynolds numbers with particular reference to the pressure developing inside the bubble. Ambient fluid motion alters the bubble pressure with respect to that established in the quiescent state, and requires the bubble to expand or contract according to an assumed equation of state. When changes in the bubble volume are prohibited by a global constraint on the total volume of the flow, the ambient pressure is modified while the bubble pressure remains constant during the deformation. A numerical method is developed for evaluating the pressure inside a two-dimensional bubble in an ambient Stokes flow on the basis of the normal component of the interfacial force balance involving the capillary pressure, the normal viscous stress, and the pressure at the free surface on the side of the liquid; the last is computed by evaluating a strongly singular integral. Dynamical simulations of bubble deformation are performed using the boundary integral method properly implemented to remove the multiplicity of solutions due to the a priori unknown rate of expansion, and three particular problems are discussed in detail: the shrinkage of a bubble at a specified rate, the deformation of a bubble subject to simple shear flow, and the deformation of a bubble subject to a purely elongational flow. In the case of shrinkage, it is found that the surface tension plays a critical role in determining the behaviour of the bubble pressure near the critical time when the bubble disappears. In the case of shear or elongational flow, it is found that the bubble contracts during an initial period of deformation from the circular shape, and then it expands to obtain a stationary shape whose area is higher than that assumed in the quiescent state. Expansion may destabilize the bubble by raising the capillary number above the critical threshold under which stationary shapes can be found.

Provider ambivalence about using forensic medical evaluation to respond to child abuse: A content and discourse analysis.

PubMed

Morris, Marian; Rivaux, Stephanie; Faulkner, Monica

2017-03-01

Forensic medical evaluation rates for child abuse victims in Texas are low relative to national rates. In exploring reasons, researchers collected quantitative and qualitative interview and focus group data from multidisciplinary child abuse response team members across the state. This paper presents results of a secondary analysis of (N=19) health care providers' interview and focus group transcripts, looking specifically at experiences with conducting forensic evaluations - thoughts, struggles, and ethical issues. The analysis was conducted from a critical realist perspective using content and discourse analysis. A theme of ambivalence was identified and explored. Three discursive themes were identified: ambivalence about the legal role, the health care role, and about unintended outcomes of evaluations. Extra-discursive elements related to the physical body, resource distribution, and funding policy were examined for their interaction with discursive patterns. Implications of findings include addressing issues in the current approach to responding to child abuse (e.g., uniting around common definitions of abuse; refining parameters for when FME is helpful; shoring up material resources for the abuse response infrastructure) and considering modification of providers' roles and activities relative to forensic work (e.g., deploying providers for prevention activities versus reactive activities). Copyright © 2017 Elsevier Ltd. All rights reserved.

Helping Students to Recognize and Evaluate an Assumption in Quantitative Reasoning: A Basic Critical-Thinking Activity with Marbles and Electronic Balance

ERIC Educational Resources Information Center

Slisko, Josip; Cruz, Adrian Corona

2013-01-01

There is a general agreement that critical thinking is an important element of 21st century skills. Although critical thinking is a very complex and controversial conception, many would accept that recognition and evaluation of assumptions is a basic critical-thinking process. When students use simple mathematical model to reason quantitatively…

Eruption mass estimation using infrasound waveform inversion and ash and gas measurements: Evaluation at Sakurajima Volcano, Japan [Comparison of eruption masses at Sakurajima Volcano, Japan calculated by infrasound waveform inversion and ground-based sampling

DOE PAGES

Fee, David; Izbekov, Pavel; Kim, Keehoon; ...

2017-10-09

Eruption mass and mass flow rate are critical parameters for determining the aerial extent and hazard of volcanic emissions. Infrasound waveform inversion is a promising technique to quantify volcanic emissions. Although topography may substantially alter the infrasound waveform as it propagates, advances in wave propagation modeling and station coverage permit robust inversion of infrasound data from volcanic explosions. The inversion can estimate eruption mass flow rate and total eruption mass if the flow density is known. However, infrasound-based eruption flow rates and mass estimates have yet to be validated against independent measurements, and numerical modeling has only recently been appliedmore » to the inversion technique. Furthermore we present a robust full-waveform acoustic inversion method, and use it to calculate eruption flow rates and masses from 49 explosions from Sakurajima Volcano, Japan.« less

Study on the thermodynamical and mechanical conditions for the generation of high operating pressures with liquefied gases for low and very low flow rates

NASA Astrophysics Data System (ADS)

Nieratschker, Willi

1989-12-01

An investigation of the thermodynamical and mechanical conditions for extending the flow rate range in the direction of low flow rates with regard to the delivery of liquefied gases at high operating pressures is presented. For low flow rates, the especially critical cavitation problem connected with the pumping of liquefied gases becomes more acute, since with decreasing volume the ratio of heat losses to the hydraulic power becomes ever more unfavorable. A first prototype is designed, produced and investigated to evaluate design-related heat loss and piston seal problems. An approach to the solution is indicated for both problem areas with the application of a new and patented pump principle, and through investigation of a second prototype modified in several respects. By reducing the pump mass when designing the second pump prototype, the nonstationary cooling phase is greatly shortened, so that intermittent pump operation becomes possible when the pump is housed external to the storage tank.

Eruption mass estimation using infrasound waveform inversion and ash and gas measurements: Evaluation at Sakurajima Volcano, Japan [Comparison of eruption masses at Sakurajima Volcano, Japan calculated by infrasound waveform inversion and ground-based sampling

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

Fee, David; Izbekov, Pavel; Kim, Keehoon

Eruption mass and mass flow rate are critical parameters for determining the aerial extent and hazard of volcanic emissions. Infrasound waveform inversion is a promising technique to quantify volcanic emissions. Although topography may substantially alter the infrasound waveform as it propagates, advances in wave propagation modeling and station coverage permit robust inversion of infrasound data from volcanic explosions. The inversion can estimate eruption mass flow rate and total eruption mass if the flow density is known. However, infrasound-based eruption flow rates and mass estimates have yet to be validated against independent measurements, and numerical modeling has only recently been appliedmore » to the inversion technique. Furthermore we present a robust full-waveform acoustic inversion method, and use it to calculate eruption flow rates and masses from 49 explosions from Sakurajima Volcano, Japan.« less

Training residents to be factually accurate and articulate: A case study using foetal heart rate monitoring nomenclature.

PubMed

Stohl, Hindi E; Miller, David A

2016-10-01

Careful communication between members of the obstetric team about intrapartum foetal heart rate is critical for clinical management and patient safety. This study evaluated the benefits of two testing modalities in assessing resident physician knowledge of the 2008 NICHD nomenclature. Multiple-choice (MC) and short-answer (SA) examinations were administered to Obstetrics and Gynecology resident physicians before an educational intervention and then immediately after the training, at 6 months and at 12 months. Test scores on both the MC and the SA examinations improved after the training session. The improvement was sustained over the course of the study. Residents performed higher on the MC examination than on the SA test. This study suggests that formalised teaching in foetal heart rate monitoring improves resident physician knowledge of the NICHD nomenclature and that SA examinations may better discriminate between residents who are and are not able to accurately articulate foetal heart rate monitoring terminology.

Breaking Up Is Hard to Count: The Rise of Divorce in the United States, 1980–2010

PubMed Central

Kennedy, Sheela; Ruggles, Steven

2014-01-01

This article critically evaluates the available data on trends in divorce in the United States. We find that both vital statistics and retrospective survey data on divorce after 1990 underestimate recent marital instability. These flawed data have led some analysts to conclude that divorce has been stable or declining for the past three decades. Using new data from the American Community Survey and controlling for changes in the age composition of the married population, we conclude that there was actually a substantial increase in age-standardized divorce rates between 1990 and 2008. Divorce rates have doubled over the past two decades among persons over age 35. Among the youngest couples, however, divorce rates are stable or declining. If current trends continue, overall age-standardized divorce rates could level off or even decline over the next few decades. We argue that the leveling of divorce among persons born since 1980 probably reflects the increasing selectivity of marriage. PMID:24399141

Breaking up is hard to count: the rise of divorce in the United States, 1980-2010.

PubMed

Kennedy, Sheela; Ruggles, Steven

2014-04-01

This article critically evaluates the available data on trends in divorce in the United States. We find that both vital statistics and retrospective survey data on divorce after 1990 underestimate recent marital instability. These flawed data have led some analysts to conclude that divorce has been stable or declining for the past three decades. Using new data from the American Community Survey and controlling for changes in the age composition of the married population, we conclude that there was actually a substantial increase in age-standardized divorce rates between 1990 and 2008. Divorce rates have doubled over the past two decades among persons over age 35. Among the youngest couples, however, divorce rates are stable or declining. If current trends continue, overall age-standardized divorce rates could level off or even decline over the next few decades. We argue that the leveling of divorce among persons born since 1980 probably reflects the increasing selectivity of marriage.

Neighborhood poverty rate and mortality in patients receiving critical care in the academic medical center setting.

PubMed

Zager, Sam; Mendu, Mallika L; Chang, Domingo; Bazick, Heidi S; Braun, Andrea B; Gibbons, Fiona K; Christopher, Kenneth B

2011-06-01

Poverty is associated with increased risk of chronic illness but its contribution to critical care outcome is not well defined. We performed a multicenter observational study of 38,917 patients, aged ≥ 18 years, who received critical care between 1997 and 2007. The patients were treated in two academic medical centers in Boston, Massachusetts. Data sources included 1990 US census and hospital administrative data. The exposure of interest was neighborhood poverty rate, categorized as < 5%, 5% to 10%, 10% to 20%, 20% to 40% and > 40%. Neighborhood poverty rate is the percentage of residents below the federal poverty line. Census tracts were used as the geographic units of analysis. Logistic regression examined death by days 30, 90, and 365 post-critical care initiation and in-hospital mortality. Adjusted ORs were estimated by multivariable logistic regression models. Sensitivity analysis was performed for 1-year postdischarge mortality among patients discharged to home. Following multivariable adjustment, neighborhood poverty rate was not associated with all-cause 30-day mortality: 5% to 10% OR, 1.05 (95% CI, 0.98-1.14; P = .2); 10% to 20% OR, 0.96 (95% CI, 0.87-1.06; P = .5); 20% to 40% OR, 1.08 (95% CI, 0.96-1.22; P = .2); > 40% OR, 1.20 (95% CI, 0.90-1.60; P = .2); referent in each is < 5%. Similar nonsignificant associations were noted at 90-day and 365-day mortality post-critical care initiation and in-hospital mortality. Among patients discharged to home, neighborhood poverty rate was not associated with 1-year-postdischarge mortality. Our study suggests that there is no relationship between the neighborhood poverty rate and mortality up to 1 year following critical care at academic medical centers.

Average-atom treatment of relaxation time in x-ray Thomson scattering from warm dense matter.

PubMed

Johnson, W R; Nilsen, J

2016-03-01

The influence of finite relaxation times on Thomson scattering from warm dense plasmas is examined within the framework of the average-atom approximation. Presently most calculations use the collision-free Lindhard dielectric function to evaluate the free-electron contribution to the Thomson cross section. In this work, we use the Mermin dielectric function, which includes relaxation time explicitly. The relaxation time is evaluated by treating the average atom as an impurity in a uniform electron gas and depends critically on the transport cross section. The calculated relaxation rates agree well with values inferred from the Ziman formula for the static conductivity and also with rates inferred from a fit to the frequency-dependent conductivity. Transport cross sections determined by the phase-shift analysis in the average-atom potential are compared with those evaluated in the commonly used Born approximation. The Born approximation converges to the exact cross sections at high energies; however, differences that occur at low energies lead to corresponding differences in relaxation rates. The relative importance of including relaxation time when modeling x-ray Thomson scattering spectra is examined by comparing calculations of the free-electron dynamic structure function for Thomson scattering using Lindhard and Mermin dielectric functions. Applications are given to warm dense Be plasmas, with temperatures ranging from 2 to 32 eV and densities ranging from 2 to 64 g/cc.

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

Johnson, W. R.; Nilsen, J.

Here, the influence of finite relaxation times on Thomson scattering from warm dense plasmas is examined within the framework of the average-atom approximation. Presently most calculations use the collision-free Lindhard dielectric function to evaluate the free-electron contribution to the Thomson cross section. In this work, we use the Mermin dielectric function, which includes relaxation time explicitly. The relaxation time is evaluated by treating the average atom as an impurity in a uniform electron gas and depends critically on the transport cross section. The calculated relaxation rates agree well with values inferred from the Ziman formula for the static conductivity andmore » also with rates inferred from a fit to the frequency-dependent conductivity. Transport cross sections determined by the phase-shift analysis in the average-atom potential are compared with those evaluated in the commonly used Born approximation. The Born approximation converges to the exact cross sections at high energies; however, differences that occur at low energies lead to corresponding differences in relaxation rates. The relative importance of including relaxation time when modeling x-ray Thomson scattering spectra is examined by comparing calculations of the free-electron dynamic structure function for Thomson scattering using Lindhard and Mermin dielectric functions. Applications are given to warm dense Be plasmas, with temperatures ranging from 2 to 32 eV and densities ranging from 2 to 64 g/cc.« less

Average-atom treatment of relaxation time in x-ray Thomson scattering from warm dense matter

DOE PAGES

Johnson, W. R.; Nilsen, J.

2016-03-14

Here, the influence of finite relaxation times on Thomson scattering from warm dense plasmas is examined within the framework of the average-atom approximation. Presently most calculations use the collision-free Lindhard dielectric function to evaluate the free-electron contribution to the Thomson cross section. In this work, we use the Mermin dielectric function, which includes relaxation time explicitly. The relaxation time is evaluated by treating the average atom as an impurity in a uniform electron gas and depends critically on the transport cross section. The calculated relaxation rates agree well with values inferred from the Ziman formula for the static conductivity andmore » also with rates inferred from a fit to the frequency-dependent conductivity. Transport cross sections determined by the phase-shift analysis in the average-atom potential are compared with those evaluated in the commonly used Born approximation. The Born approximation converges to the exact cross sections at high energies; however, differences that occur at low energies lead to corresponding differences in relaxation rates. The relative importance of including relaxation time when modeling x-ray Thomson scattering spectra is examined by comparing calculations of the free-electron dynamic structure function for Thomson scattering using Lindhard and Mermin dielectric functions. Applications are given to warm dense Be plasmas, with temperatures ranging from 2 to 32 eV and densities ranging from 2 to 64 g/cc.« less

Evaluation of rapid methods for in-situ characterization of organic contaminant load and biodegradation rates in winery wastewater.

PubMed

Carvallo, M J; Vargas, I; Vega, A; Pizarro, G; Pizarr, G; Pastén, P

2007-01-01

Rapid methods for the in-situ evaluation of the organic load have recently been developed and successfully implemented in municipal wastewater treatment systems. Their direct application to winery wastewater treatment is questionable due to substantial differences between municipal and winery wastewater. We critically evaluate the use of UV-VIS spectrometry, buffer capacity testing (BCT), and respirometry as rapid methods to determine organic load and biodegradation rates of winery wastewater. We tested three types of samples: actual and treated winery wastewater, synthetic winery wastewater, and samples from a biological batch reactor. Not surprisingly, respirometry gave a good estimation of biodegradation rates for substrate of different complexities, whereas UV-VIS and BCT did not provide a quantitative measure of the easily degradable sugars and ethanol, typically the main components of the COD in the influent. However, our results strongly suggest that UV-VIS and BCT can be used to identify and estimate the concentration of complex substrates in the influent and soluble microbial products (SMP) in biological reactors and their effluent. Furthermore, the integration of UV-VIS spectrometry, BCT, and mathematical modeling was able to differentiate between the two components of SMPs: substrate utilization associated products (UAP) and biomass associated products (BAP). Since the effluent COD in biologically treated wastewaters is composed primarily by SMPs, the quantitative information given by these techniques may be used for plant control and optimization.

Factors affecting consent in pediatric critical care research.

PubMed

Menon, Kusum; Ward, Roxanne E; Gaboury, Isabelle; Thomas, Margot; Joffe, Ari; Burns, Karen; Cook, Deborah

2012-01-01

Consent for research is a difficult and unpredictable process in pediatric critical care populations. The objectives of this study were to describe consent rates in pediatric critical care research and their association with patient, legal guardian, consent process, and study design-related factors. A prospective, cohort study was conducted from 2009 to 2010 in six tertiary care pediatric intensive care units (PICU) in Canada with legal guardians of patients who were approached for consent for any ongoing PICU research study. Data were recorded on details of the consent process for all consent encounters. We recorded 271 consent encounters. The overall consent rate was 80.1% (217/271). We observed higher consent rates when the research assistant was introduced by a member of the clinical team prior to approaching the family (89.7 vs. 77.7%; P = 0.04). Legal guardians of cardiac surgery patients were less likely to provide consent than those of all other patients (75.3 vs. 86.0%; P = 0.03). There was no difference in consent rates between therapeutic (117/145, 80.7%) versus non-therapeutic studies (100/126, 79.4%; P = 0.88). This study provides future researchers with consent data for determination of recruitment rates, sample sizes, budget estimations, and study timelines. Future pediatric critical care studies should consider incorporating the lower consent rates in cardiac surgery patients and routine introduction of the research assistant to the family by a member of the patient's care team into their study designs. The potential influence of parental factors on consent rates in pediatric critical care studies requires further research.

Critical thinking in physics education

NASA Astrophysics Data System (ADS)

Sadidi, Farahnaz

2016-07-01

We agree that training the next generation of leaders of the society, who have the ability to think critically and form a better judgment is an important goal. It is a long-standing concern of Educators and a long-term desire of teachers to establish a method in order to teach to think critically. To this end, many questions arise on three central aspects: the definition, the evaluation and the design of the course: What is Critical Thinking? How can we define Critical Thinking? How can we evaluate Critical Thinking? Therefore, we want to implement Critical Thinking in physics education. How can we teach for Critical Thinking in physics? What should the course syllabus and materials be? We present examples from classical physics and give perspectives for astro-particle physics. The main aim of this paper is to answer the questions and provide teachers with the opportunity to change their classroom to an active one, in which students are encouraged to ask questions and learn to reach a good judgment. Key words: Critical Thinking, evaluation, judgment, design of the course.

An evaluation of the critical care assistant role within an acute NHS Trust Critical Care Unit.

PubMed

McGloin, Sarah; Knowles, Judie

2005-01-01

This study provides an evaluation of a training programme designed for developing six critical care assistants to work alongside registered nurses to care for patients within the critical care environment. The programme was run as a pilot funded from the Department of Health's 'critical care bid'. At 18 months long, the programme incorporated a foundation programme, and National Vocational Qualification (NVQ) level 3 in care and adapted Operating Department Practitioner (ODP) NVQ units. Six critical care assistants successfully completed the programme; however, they all then left the unit to undertake further study for pre-registration nursing qualifications. Upon evaluation, a number of key issues were identified. Clear definition of the critical care assistants's role is essential as are dedicated practice development staff, who focus purely on developing the critical care assistant role. More importantly, however, with such key changes in the staffing structure within critical care units, appropriate change management techniques should be employed, ensuring that all staff contributing to the training and development are fully involved from the start.

In-vitro development of vitrified-warmed bovine oocytes after activation may be predicted based on mathematical modelling of cooling and warming rates during vitrification, storage and sample removal.

PubMed

Sansinena, Marina; Santos, Maria Victoria; Chirife, Jorge; Zaritzky, Noemi

2018-05-01

Heat transfer during cooling and warming is difficult to measure in cryo-devices; mathematical modelling is an alternative method that can describe these processes. In this study, we tested the validity of one such model by assessing in-vitro development of vitrified and warmed bovine oocytes after parthenogenetic activation and culture. The viability of oocytes vitrified in four different cryo-devices was assessed. Consistent with modelling predictions, oocytes vitrified using cryo-devices with the highest modelled cooling rates had significantly (P < 0.05) better cleavage and blastocyst formation rates. We then evaluated a two-step sample removal process, in which oocytes were held in nitrogen vapour for 15 s to simulate sample identification during clinical application, before being removed completely and warmed. Oocytes exposed to this procedure showed reduced developmental potential, according to the model, owing to thermodynamic instability and devitrification at relatively low temperatures. These findings suggest that cryo-device selection and handling, including method of removal from nitrogen storage, are critical to survival of vitrified oocytes. Limitations of the study include use of parthenogenetically activated rather than fertilized ova and lack of physical measurement of recrystallization. We suggest mathematical modelling could be used to predict the effect of critical steps in cryopreservation. Copyright © 2018 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program.

PubMed

Anderson, Wendy G; Puntillo, Kathleen; Cimino, Jenica; Noort, Janice; Pearson, Diana; Boyle, Deborah; Grywalski, Michelle; Meyer, Jeannette; O'Neil-Page, Edith; Cain, Julia; Herman, Heather; Barbour, Susan; Turner, Kathleen; Moore, Eric; Liao, Solomon; Ferrell, Bruce; Mitchell, William; Edmonds, Kyle; Fairman, Nathan; Joseph, Denah; MacMillan, John; Milic, Michelle M; Miller, Monica; Nakagawa, Laura; O'Riordan, David L; Pietras, Christopher; Thornberry, Kathryn; Pantilat, Steven Z

2017-09-01

Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. To implement and evaluate a palliative care professional development program for ICU bedside nurses. From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds. Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them. Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs. ©2017 American Association of Critical-Care Nurses.

Biophysical model for assessment of risk of acute exposures in combination with low level chronic irradiation

NASA Astrophysics Data System (ADS)

Smirnova, O. A.

A biophysical model is developed which describes the mortality dynamics in mammalian populations unexposed and exposed to radiation The model relates statistical biometric functions mortality rate life span probability density and life span probability with statistical characteristics and dynamics of a critical body system in individuals composing the population The model describing the dynamics of thrombocytopoiesis in nonirradiated and irradiated mammals is also developed this hematopoietic line being considered as the critical body system under exposures in question The mortality model constructed in the framework of the proposed approach was identified to reproduce the irradiation effects on populations of mice The most parameters of the thrombocytopoiesis model were determined from the data available in the literature on hematology and radiobiology the rest parameters were evaluated by fitting some experimental data on the dynamics of this system in acutely irradiated mice The successful verification of the thrombocytopoiesis model was fulfilled by the quantitative juxtaposition of the modeling predictions and experimental data on the dynamics of this system in mice exposed to either acute or chronic irradiation at wide ranges of doses and dose rates It is important that only experimental data on the mortality rate in nonirradiated population and the relevant statistical characteristics of the thrombocytopoiesis system in mice which are also available in the literature on radiobiology are needed for the final identification of

Radiotherapy for Vestibular Schwannomas: A Critical Review

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

Murphy, Erin S., E-mail: murphye3@ccf.or; Suh, John H.

2011-03-15

Vestibular schwannomas are slow-growing tumors of the myelin-forming cells that cover cranial nerve VIII. The treatment options for patients with vestibular schwannoma include active observation, surgical management, and radiotherapy. However, the optimal treatment choice remains controversial. We have reviewed the available data and summarized the radiotherapeutic options, including single-session stereotactic radiosurgery, fractionated conventional radiotherapy, fractionated stereotactic radiotherapy, and proton beam therapy. The comparisons of the various radiotherapy modalities have been based on single-institution experiences, which have shown excellent tumor control rates of 91-100%. Both stereotactic radiosurgery and fractionated stereotactic radiotherapy have successfully improved cranial nerve V and VII preservation tomore » >95%. The mixed data regarding the ideal hearing preservation therapy, inherent biases in patient selection, and differences in outcome analysis have made the comparison across radiotherapeutic modalities difficult. Early experience using proton therapy for vestibular schwannoma treatment demonstrated local control rates of 84-100% but disappointing hearing preservation rates of 33-42%. Efforts to improve radiotherapy delivery will focus on refined dosimetry with the goal of reducing the dose to the critical structures. As future randomized trials are unlikely, we suggest regimented pre- and post-treatment assessments, including validated evaluations of cranial nerves V, VII, and VIII, and quality of life assessments with long-term prospective follow-up. The results from such trials will enhance the understanding of therapy outcomes and improve our ability to inform patients.« less

Thermal Analysis of the ILC Superconductin Quadrupole

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

Ross, Ian; /Rose-Hulman Inst., Terre Haute /SLAC

2006-09-13

Critical to a particle accelerator's functioning, superconducting magnets serve to focus and aim the particle beam. The Stanford Linear Accelerator Center (SLAC) has received a prototype superconducting quadrupole designed and built by the Centro de Investigaciones Energ{acute e}ticas, Medioambientales y Tecnol{acute o}gicas (CIEMAT) to be evaluated for the International Linear Collider (ILC) project. To ensure proper functioning of the magnet, the device must be maintained at cryogenic temperatures by use of a cooling system containing liquid nitrogen and liquid helium. The cool down period of a low temperature cryostat is critical to the success of an experiment, especially a prototypemore » setup such as this one. The magnet and the dewar each contain unique heat leaks and material properties. These differences can lead to tremendous thermal stresses. The system was analyzed mathematically, leading to ideal liquid helium and liquid nitrogen flow rates during the magnet's cool-down to 4.2 K, along with a reasonable estimate of how long this cool-down will take. With a flow rate of ten gaseous liters of liquid nitrogen per minute, the nitrogen shield will take approximately five hours to cool down to 77 K. With a gaseous helium flow rate of sixty liters per minute, the magnet will take at least nineteen hours to cool down to a temperature of 4.2 K.« less

Summary of ORSphere critical and reactor physics measurements

NASA Astrophysics Data System (ADS)

Marshall, Margaret A.; Bess, John D.

2017-09-01

In the early 1970s Dr. John T. Mihalczo (team leader), J.J. Lynn, and J.R. Taylor performed experiments at the Oak Ridge Critical Experiments Facility (ORCEF) with highly enriched uranium (HEU) metal (called Oak Ridge Alloy or ORALLOY) to recreate GODIVA I results with greater accuracy than those performed at Los Alamos National Laboratory in the 1950s. The purpose of the Oak Ridge ORALLOY Sphere (ORSphere) experiments was to estimate the unreflected and unmoderated critical mass of an idealized sphere of uranium metal corrected to a density, purity, and enrichment such that it could be compared with the GODIVA I experiments. This critical configuration has been evaluated. Preliminary results were presented at ND2013. Since then, the evaluation was finalized and judged to be an acceptable benchmark experiment for the International Criticality Safety Benchmark Experiment Project (ICSBEP). Additionally, reactor physics measurements were performed to determine surface button worths, central void worth, delayed neutron fraction, prompt neutron decay constant, fission density and neutron importance. These measurements have been evaluated and found to be acceptable experiments and are discussed in full detail in the International Handbook of Evaluated Reactor Physics Benchmark Experiments. The purpose of this paper is to summarize all the evaluated critical and reactor physics measurements evaluations.

Validation of light water reactor calculation methods and JEF-1-based data libraries by TRX and BAPL critical experiments

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

Paratte, J.M.; Pelloni, S.; Grimm, P.

1991-04-01

This paper analyzes the capability of various code systems and JEF-1-based nuclear data libraries to compute light water reactor lattices by comparing calculations with results from thermal reactor benchmark experiments TRX and BAPL and with previously published values. With the JEF-1 evaluation, eigenvalues are generally well predicted within 8 mk (1 mk = 0.001) or less by all code systems, and all methods give reasonable results for the measured reaction rate ratios within, or not too far from, the experimental uncertainty.

Positioning of patients with acute respiratory distress syndrome: combining prone and upright makes sense.

PubMed

Richard, Jean-Christophe M; Lefebvre, Jean-Claude

2011-01-01

Positional strategies have been proposed for mechanically ventilated patients with acute respiratory distress syndrome. Despite different physiological mechanisms involved, oxygenation improvement has been demonstrated with both prone and upright positions. In the previous issue of Critical Care, Robak and colleagues reported the first study evaluating the short-term effects of combining prone and upright positioning. The combined positioning enhanced the response rate in terms of oxygenation. Other benefits, such as a reduction in ventilator-associated pneumonia and better enteral feeding tolerance, can potentially be expected.

Patient perceptions of a remote monitoring intervention for chronic disease management.

PubMed

Wakefield, Bonnie J; Holman, John E; Ray, Annette; Scherubel, Melody

2011-04-01

Use of telecommunications technology to provide remote monitoring for people with chronic disease is becoming increasingly accepted as a means to improve patient outcomes and reduce resource use. The purpose of this project was to evaluate patient perceptions of a nurse-managed remote monitoring intervention to improve outcomes in veterans with comorbid diabetes and hypertension. Postintervention evaluation data were collected using a 12-item questionnaire and an open-ended question. Participants rated the program as generally positive on the questionnaire, but responses to the open-ended question revealed criticisms and suggestions for improvement not captured on the questionnaire. Interviewing participants in these programs may offer richer data for identifying areas for program improvement. Copyright 2011, SLACK Incorporated.

Efficiency and Accuracy in Thermal Simulation of Powder Bed Fusion of Bulk Metallic Glass

NASA Astrophysics Data System (ADS)

Lindwall, J.; Malmelöv, A.; Lundbäck, A.; Lindgren, L.-E.

2018-05-01

Additive manufacturing by powder bed fusion processes can be utilized to create bulk metallic glass as the process yields considerably high cooling rates. However, there is a risk that reheated material set in layers may become devitrified, i.e., crystallize. Therefore, it is advantageous to simulate the process to fully comprehend it and design it to avoid the aforementioned risk. However, a detailed simulation is computationally demanding. It is necessary to increase the computational speed while maintaining accuracy of the computed temperature field in critical regions. The current study evaluates a few approaches based on temporal reduction to achieve this. It is found that the evaluated approaches save a lot of time and accurately predict the temperature history.

A prospective audit of a nurse independent prescribing within critical care.

PubMed

Carberry, Martin; Connelly, Sarah; Murphy, Jennifer

2013-05-01

To determine the prescribing activity of different staff groups within intensive care unit (ICU) and combined high dependency unit (HDU), namely trainee and consultant medical staff and advanced nurse practitioners in critical care (ANPCC); to determine the number and type of prescription errors; to compare error rates between prescribing groups and to raise awareness of prescribing activity within critical care. The introduction of government legislation has led to the development of non-medical prescribing roles in acute care. This has facilitated an opportunity for the ANPCC working in critical care to develop a prescribing role. The audit was performed over 7 days (Monday-Sunday), on rolling days over a 7-week period in September and October 2011 in three ICUs. All drug entries made on the ICU prescription by the three groups, trainee medical staff, ANPCCs and consultant anaesthetists, were audited once for errors. Data were collected by reviewing all drug entries for errors namely, patient data, drug dose, concentration, rate and frequency, legibility and prescriber signature. A paper data collection tool was used initially; data was later entered onto a Microsoft Access data base. A total of 1418 drug entries were audited from 77 patient prescription Cardexes. Error rates were reported as, 40 errors in 1418 prescriptions (2·8%): ANPCC errors, n = 2 in 388 prescriptions (0·6%); trainee medical staff errors, n = 33 in 984 (3·4%); consultant errors, n = 5 in 73 (6·8%). The error rates were significantly different for different prescribing groups (p < 0·01). This audit shows that prescribing error rates were low (2·8%). Having the lowest error rate, the nurse practitioners are at least as effective as other prescribing groups within this audit, in terms of errors only, in prescribing diligence. National data is required in order to benchmark independent nurse prescribing practice in critical care. These findings could be used to inform research and role development within the critical care. © 2012 The Authors. Nursing in Critical Care © 2012 British Association of Critical Care Nurses.

Decreased rates of hypoglycemia following implementation of a comprehensive computerized insulin order set and titration algorithm in the inpatient setting.

PubMed

Sinha Gregory, Naina; Seley, Jane Jeffrie; Gerber, Linda M; Tang, Chin; Brillon, David

2016-12-01

More than one-third of hospitalized patients have hyperglycemia. Despite evidence that improving glycemic control leads to better outcomes, achieving recognized targets remains a challenge. The objective of this study was to evaluate the implementation of a computerized insulin order set and titration algorithm on rates of hypoglycemia and overall inpatient glycemic control. A prospective observational study evaluating the impact of a glycemic order set and titration algorithm in an academic medical center in non-critical care medical and surgical inpatients. The initial intervention was hospital-wide implementation of a comprehensive insulin order set. The secondary intervention was initiation of an insulin titration algorithm in two pilot medicine inpatient units. Point of care testing blood glucose reports were analyzed. These reports included rates of hypoglycemia (BG < 70 mg/dL) and hyperglycemia (BG >200 mg/dL in phase 1, BG > 180 mg/dL in phase 2). In the first phase of the study, implementation of the insulin order set was associated with decreased rates of hypoglycemia (1.92% vs 1.61%; p < 0.001) and increased rates of hyperglycemia (24.02% vs 27.27%; p < 0.001) from 2010 to 2011. In the second phase, addition of a titration algorithm was associated with decreased rates of hypoglycemia (2.57% vs 1.82%; p = 0.039) and increased rates of hyperglycemia (31.76% vs 41.33%; p < 0.001) from 2012 to 2013. A comprehensive computerized insulin order set and titration algorithm significantly decreased rates of hypoglycemia. This significant reduction in hypoglycemia was associated with increased rates of hyperglycemia. Hardwiring the algorithm into the electronic medical record may foster adoption.

Automated Processing of Plasma Samples for Lipoprotein Separation by Rate-Zonal Ultracentrifugation.

PubMed

Peters, Carl N; Evans, Iain E J

2016-12-01

Plasma lipoproteins are the primary means of lipid transport among tissues. Defining alterations in lipid metabolism is critical to our understanding of disease processes. However, lipoprotein measurement is limited to specialized centers. Preparation for ultracentrifugation involves the formation of complex density gradients that is both laborious and subject to handling errors. We created a fully automated device capable of forming the required gradient. The design has been made freely available for download by the authors. It is inexpensive relative to commercial density gradient formers, which generally create linear gradients unsuitable for rate-zonal ultracentrifugation. The design can easily be modified to suit user requirements and any potential future improvements. Evaluation of the device showed reliable peristaltic pump accuracy and precision for fluid delivery. We also demonstrate accurate fluid layering with reduced mixing at the gradient layers when compared to usual practice by experienced laboratory personnel. Reduction in layer mixing is of critical importance, as it is crucial for reliable lipoprotein separation. The automated device significantly reduces laboratory staff input and reduces the likelihood of error. Overall, this device creates a simple and effective solution to formation of complex density gradients. © 2015 Society for Laboratory Automation and Screening.

Wildfire in the Critical Zone: Pyro-Geomorphic Feedbacks in Upland Forests

NASA Astrophysics Data System (ADS)

Sheridan, G. J.; Inbar, A.; Metzen, D.; Van der Sant, R.; Lane, P. N. J.; Nyman, P.

2017-12-01

Wildfire often triggers a dramatic geomorphic response, with erosion rates several orders of magnitude greater than background rates. The fact that wildfire is linked to increased soil erosion is well established, but could it also work the other way around? Is it possible that, over time, soil erosion could lead to an increase in wildfire? The proposed mechanism for this is a potential positive feedback between post-fire soil erosion, soil depth, and forest flammability. More fire-related erosion may, over time, lead to less soil water holding capacity, more open vegetation with drier fuels, more fire, and in turn more fire related erosion. These pyro-geomorphic feedbacks may help explain the co-evolved soil-vegetation-fire systems that are observed in the landscape. More broadly, the concept of "wildfire in the critical zone", with a greater emphasis on the interactions between fire, vegetation, hydrology, and geomorphology, may help us understand and predict the trajectory of change as the vegetation-soil-fire system responds and adjusts to the new climate forcing. This presentation will combine an extensive soil, vegetation, and post fire erosion experimental dataset, with conceptual and numerical modelling, to evaluate the significance of the potential pyro-geomorphic feedbacks described above.

Is heart rate variability (HRV) an adequate tool for evaluating human emotions? - A focus on the use of the International Affective Picture System (IAPS).

PubMed

Choi, Kwang-Ho; Kim, Junbeom; Kwon, O Sang; Kim, Min Ji; Ryu, Yeon Hee; Park, Ji-Eun

2017-05-01

Because human emotion varies greatly among individuals and is a qualitative factor, measuring it with any degree of accuracy is very difficult. Heart rate variability (HRV), which is used in evaluations of the autonomic nervous system (ANS), is used to evaluate human emotions. This study examines the validity of HRV as a tool to evaluate emotions using the International Affective Picture System (IAPS). For experimentation, five photos were selected for each of the categories of "happy," "unhappy", and "neutral" from among the images provided by the IAPS. The subjects were required to complete the Self-Assessment Manikin (SAM) after being shown each picture. We extracted the R-R interval (RRI) value of each photo from the PPG, as well as the valence, arousal, and dominance value of each photo from the SAM to analyze their correlation. As results, there was significant positive correlation with valence and significant negative correlation with dominance in the photo simulation associated with the "unhappy" emotion, only when the arousal value exceeded a critical value. Therefore, the findings of this study suggest that it is possible to use an HRV-based evaluation only when a high level of emotion is induced by visual stimulation. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Knowledge retention after an online tutorial: a randomized educational experiment among resident physicians.

PubMed

Bell, Douglas S; Harless, Charles E; Higa, Jerilyn K; Bjork, Elizabeth L; Bjork, Robert A; Bazargan, Mohsen; Mangione, Carol M

2008-08-01

The time course of physicians' knowledge retention after learning activities has not been well characterized. Understanding the time course of retention is critical to optimizing the reinforcement of knowledge. Educational follow-up experiment with knowledge retention measured at 1 of 6 randomly assigned time intervals (0-55 days) after an online tutorial covering 2 American Diabetes Association guidelines. Internal and family medicine residents. Multiple-choice knowledge tests, subject characteristics including critical appraisal skills, and learner satisfaction. Of 197 residents invited, 91 (46%) completed the tutorial and were randomized; of these, 87 (96%) provided complete follow-up data. Ninety-two percent of the subjects rated the tutorial as "very good" or "excellent." Mean knowledge scores increased from 50% before the tutorial to 76% among those tested immediately afterward. Score gains were only half as great at 3-8 days and no significant retention was measurable at 55 days. The shape of the retention curve corresponded with a 1/4-power transformation of the delay interval. In multivariate analyses, critical appraisal skills and participant age were associated with greater initial learning, but no participant characteristic significantly modified the rate of decline in retention. Education that appears successful from immediate posttests and learner evaluations can result in knowledge that is mostly lost to recall over the ensuing days and weeks. To achieve longer-term retention, physicians should review or otherwise reinforce new learning after as little as 1 week.

Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions

PubMed Central

Jensen, Gordon L.; Koletzko, Berthold V.; Singer, Pierre; Wanten, Geert J. A.

2010-01-01

Background Energy deficit is a common and serious problem in intensive care units and is associated with increased rates of complications, length of stay, and mortality. Parenteral nutrition (PN), either alone or in combination with enteral nutrition, can improve nutrient delivery to critically ill patients. Lipids provide a key source of calories within PN formulations, preventing or correcting energy deficits and improving outcomes. Discussion In this article, we review the role of parenteral lipid emulsions (LEs) in the management of critically ill patients and highlight important biologic activities associated with lipids. Soybean-oil-based LEs with high contents of polyunsaturated fatty acids (PUFA) were the first widely used formulations in the intensive care setting. However, they may be associated with increased rates of infection and lipid peroxidation, which can exacerbate oxidative stress. More recently developed parenteral LEs employ partial substitution of soybean oil with oils providing medium-chain triglycerides, ω-9 monounsaturated fatty acids or ω-3 PUFA. Many of these LEs have demonstrated reduced effects on oxidative stress, immune responses, and inflammation. However, the effects of these LEs on clinical outcomes have not been extensively evaluated. Conclusions Ongoing research using adequately designed and well-controlled studies that characterize the biologic properties of LEs should assist clinicians in selecting LEs within the critical care setting. Prescription of PN containing LEs should be based on available clinical data, while considering the individual patient’s physiologic profile and therapeutic requirements. PMID:20072779

Evaluating the Quality of Competency Assessment in Pharmacy: A Framework for Workplace Learning.

PubMed

Shah, Shailly; McLaughlin, Jacqueline E; Eckel, Stephen F; Mangun, Jesica; Hawes, Emily

2016-01-19

Demonstration of achieved competencies is critical in the pharmacy workplace. The purpose of this study was to evaluate the quality of the competency assessment program for pharmacy residents at an academic medical center. The competency assessment program (CAP) survey is a validated, 48-item instrument that evaluates the quality of an assessment program based on 12 criteria, each measured by four questions on a scale of 0 to 100. The CAP was completed by residents ( n = 23) and preceptors ( n = 28) from the pharmacy residency program between 2010 and 2013. Results were analyzed using descriptive statistics, Cronbach's alpha, and non-parametric tests. Educational Consequences was the only quality criteria falling below the standard for "good quality." Participants that completed residency training elsewhere rated the Comparability (0.04) and Meaningfulness (0.01) of the assessment program higher than those that completed residency at the academic medical center. There were no significant differences between resident and preceptor scores. Overall, the quality of the assessment program was rated highly by residents and preceptors. The process described here provides a useful framework for understanding the quality of workplace learning assessments in pharmacy practice.

Fault tolerant testbed evaluation, phase 1

NASA Technical Reports Server (NTRS)

Caluori, V., Jr.; Newberry, T.

1993-01-01

In recent years, avionics systems development costs have become the driving factor in the development of space systems, military aircraft, and commercial aircraft. A method of reducing avionics development costs is to utilize state-of-the-art software application generator (autocode) tools and methods. The recent maturity of application generator technology has the potential to dramatically reduce development costs by eliminating software development steps that have historically introduced errors and the need for re-work. Application generator tools have been demonstrated to be an effective method for autocoding non-redundant, relatively low-rate input/output (I/O) applications on the Space Station Freedom (SSF) program; however, they have not been demonstrated for fault tolerant, high-rate I/O, flight critical environments. This contract will evaluate the use of application generators in these harsh environments. Using Boeing's quad-redundant avionics system controller as the target system, Space Shuttle Guidance, Navigation, and Control (GN&C) software will be autocoded, tested, and evaluated in the Johnson (Space Center) Avionics Engineering Laboratory (JAEL). The response of the autocoded system will be shown to match the response of the existing Shuttle General Purpose Computers (GPC's), thereby demonstrating the viability of using autocode techniques in the development of future avionics systems.

Relationship between neighborhood poverty rate and bloodstream infections in the critically ill.

PubMed

Mendu, Mallika L; Zager, Sam; Gibbons, Fiona K; Christopher, Kenneth B

2012-05-01

Poverty is associated with increased risk of chronic illness, but its contribution to bloodstream infections is not well-defined. We performed a multicenter observational study of 14,657 patients, aged 18 yrs or older, who received critical care and had blood cultures drawn between 1997 and 2007 in two hospitals in Boston, Massachusetts. Data sources included 1990 U.S. Census and hospital administrative data. Census tracts were used as the geographic units of analysis. The exposure of interest was neighborhood poverty rate categorized as <5%, 5%-10%, 10%-20%, 20%-40%, and >40%. Neighborhood poverty rate is the percentage of residents with income below the federal poverty line. The primary end point was bloodstream infection occurring 48 hrs before critical care initiation to 48 hrs after. Associations between neighborhood poverty rate and bloodstream infection were estimated by logistic regression models. Adjusted odds ratios were estimated by multivariable logistic regression models. Two thousand four-hundred thirty-five patients had bloodstream infections. Neighborhood poverty rate was a strong predictor of risk of bloodstream infection, with a significant risk gradient across neighborhood poverty rate quintiles. After multivariable analysis, neighborhood poverty rate in the highest quintiles (20%-40% and >40%) were associated with a 26% and 49% increase in bloodstream infection risk, respectively, relative to patients with neighborhood poverty rate of <5%. Within the limitations of our study design, increased neighborhood poverty rate, a proxy for decreased socioeconomic status, appears to be associated with risk of bloodstream infection among patients who receive critical care.

Predicting invasive fungal disease due to Candida species in non-neutropenic, critically ill, adult patients in United Kingdom critical care units.

PubMed

Shahin, Jason; Allen, Elizabeth J; Patel, Krishna; Muskett, Hannah; Harvey, Sheila E; Edgeworth, Jonathan; Kibbler, Christopher C; Barnes, Rosemary A; Biswas, Sharmistha; Soni, Neil; Rowan, Kathryn M; Harrison, David A

2016-09-09

Given the predominance of invasive fungal disease (IFD) amongst the non-immunocompromised adult critically ill population, the potential benefit of antifungal prophylaxis and the lack of generalisable tools to identify high risk patients, the aim of the current study was to describe the epidemiology of IFD in UK critical care units, and to develop and validate a clinical risk prediction tool to identify non-neutropenic, critically ill adult patients at high risk of IFD who would benefit from antifungal prophylaxis. Data on risk factors for, and outcomes from, IFD were collected for consecutive admissions to adult, general critical care units in the UK participating in the Fungal Infection Risk Evaluation (FIRE) Study. Three risk prediction models were developed to model the risk of subsequent Candida IFD based on information available at three time points: admission to the critical care unit, at the end of 24 h and at the end of calendar day 3 of the critical care unit stay. The final model at each time point was evaluated in the three external validation samples. Between July 2009 and April 2011, 60,778 admissions from 96 critical care units were recruited. In total, 359 admissions (0.6 %) were admitted with, or developed, Candida IFD (66 % Candida albicans). At the rate of candidaemia of 3.3 per 1000 admissions, blood was the most common Candida IFD infection site. Of the initial 46 potential variables, the final admission model and the 24-h model both contained seven variables while the end of calendar day 3 model contained five variables. The end of calendar day 3 model performed the best with a c index of 0.709 in the full validation sample. Incidence of Candida IFD in UK critical care units in this study was consistent with reports from other European epidemiological studies, but lower than that suggested by previous hospital-wide surveillance in the UK during the 1990s. Risk modeling using classical statistical methods produced relatively simple risk models, and associated clinical decision rules, that provided acceptable discrimination for identifying patients at 'high risk' of Candida IFD. The FIRE Study was reviewed and approved by the Bolton NHS Research Ethics Committee (reference: 08/H1009/85), the Scotland A Research Ethics Committee (reference: 09/MRE00/76) and the National Information Governance Board (approval number: PIAG 2-10(f)/2005).

A Critical Analysis of HRD Evaluation Models from a Decision-Making Perspective

ERIC Educational Resources Information Center

Holton, Elwood F., III; Naquin, Sharon

2005-01-01

HRD evaluation models are recommended for use by organizations to improve decisions made about HRD interventions. However, the organizational decision-making literature has been virtually ignored by evaluation researchers. In this article, we review the organizational decision-making literature and critically review HRD evaluation research through…

Evaluation of kinesthetic-tactual displays using a critical tracking task

NASA Technical Reports Server (NTRS)

Jagacinski, R. J.; Miller, D. P.; Gilson, R. D.; Ault, R. T.

1977-01-01

The study sought to investigate the feasibility of applying the critical tracking task paradigm to the evaluation of kinesthetic-tactual displays. Four subjects attempted to control a first-order unstable system with a continuously decreasing time constant by using either visual or tactual unidimensional displays. Display aiding was introduced in both modalities in the form of velocity quickening. Visual tracking performance was better than tactual tracking, and velocity aiding improved the critical tracking scores for visual and tactual tracking about equally. The results suggest that the critical task methodology holds considerable promise for evaluating kinesthetic-tactual displays.

Rating Pregnancy Wheel Applications Using the APPLICATIONS Scoring System.

PubMed

Chyjek, Kathy; Farag, Sara; Chen, Katherine T

2015-06-01

To identify the top-rated pregnancy wheel applications (apps) using a newly developed APPLICATIONS scoring system. A list of pregnancy wheel apps was identified. Consumer-based and inaccurate apps were excluded. The APPLICATIONS scoring system was developed to rate the remaining apps. Application comprehensiveness was evaluated. Objective rating components included price, paid subscription, literature used, in-app purchases, connectivity to the Internet, advertisements, text search field, interdevice compatibility, and other components such as images or figures, videos, and special features. Subjective rating components were ease of navigation and subjective presentation. A complete list of 55 pregnancy wheel apps was created from three sources. Thirty-nine (71%) were consumer-based, inaccurate, or both, leaving 16 (29%) for analysis using the APPLICATIONS scoring system. More than two thirds of pregnancy wheel apps were excluded from our study secondary to being consumer-based, inaccurate, or both. This highlights the importance of identifying systematically, reviewing critically, and rating the thousands of available apps to health care providers to ensure accuracy and applicability. We propose that our APPLICATIONS scoring system be used to rate apps in all specialties with the goal of improving health care provider performance and thereby patient outcomes. III.

Effect of flow rate on environmental variables and phytoplankton dynamics: results from field enclosures

NASA Astrophysics Data System (ADS)

Zhang, Haiping; Chen, Ruihong; Li, Feipeng; Chen, Ling

2015-03-01

To investigate the effects of flow rate on phytoplankton dynamics and related environment variables, a set of enclosure experiments with different flow rates were conducted in an artificial lake. We monitored nutrients, temperature, dissolved oxygen, pH, conductivity, turbidity, chlorophyll- a and phytoplankton levels. The lower biomass in all flowing enclosures showed that flow rate significantly inhibited the growth of phytoplankton. A critical flow rate occurred near 0.06 m/s, which was the lowest relative inhibitory rate. Changes in flow conditions affected algal competition for light, resulting in a dramatic shift in phytoplankton composition, from blue-green algae in still waters to green algae in flowing conditions. These findings indicate that critical flow rate can be useful in developing methods to reduce algal bloom occurrence. However, flow rate significantly enhanced the inter-relationships among environmental variables, in particular by inducing higher water turbidity and vegetative reproduction of periphyton ( Spirogyra). These changes were accompanied by a decrease in underwater light intensity, which consequently inhibited the photosynthetic intensity of phytoplankton. These results warn that a universal critical flow rate might not exist, because the effect of flow rate on phytoplankton is interlinked with many other environmental variables.

The Federal Government Debt: Its Size and Economic Significance

DTIC Science & Technology

2010-02-03

growth rate of the federal debt and the overall rate of economic growth is critical to economic stability . As long as the debt grows more rapidly than...most, as far as economic stability is concerned, is what investors believe to be the long-run outlook for the debt-to-GDP ratio. If large deficits...between the growth rate of the federal debt and the overall rate of economic growth is critical to economic stability . As long as the debt grows more

Technical note: Evaluation of a wireless pulse oximeter for measuring arterial oxygen saturation and pulse rate in newborn Holstein Friesian calves.

PubMed

Kanz, P; Krieger, S; Drillich, M; Iwersen, M

2018-07-01

Pulse oximetry is a well-established technique in human and veterinary medicine. In farm animals, it could also be a useful tool for the detection of critical conditions relating to oxygen supply and the cardiovascular system. Among other uses, an innovative application could be the monitoring of fetuses during birth. This could help in the early identification of critical situations and support farmers and veterinarians in their decision to start obstetric or life-support interventions. Until now, however, its use in ruminant medicine was still limited to experimental applications. The objective of this study was to evaluate the accuracy of the Radius-7 Wearable Pulse CO-Oximeter (Masimo Corporation, Irvine, CA) for monitoring vital parameters in newborn calves. All measurements were conducted on animals in the lying down position. The sensor of the pulse oximeter was placed in the interdigital space of the calves' front legs and fixed with a homemade latex hoof cover. The pulsoximetric measurements of arterial oxygen saturation (SpO 2 ) in 40 newborn calves were compared with the corresponding results (SaO 2 ) from a portable blood gas analyzer (VetScan iStat1, Abaxis Inc., Union City, CA), which served as the reference. For this, an arterial blood sample was taken from the medial intermediate branch of the caudal auricular artery. In addition, the pulse rate was measured in 10 calves aged between 0 and 7 d with the pulse oximeter and simultaneously with a heart rate belt (Polar Equine Belt, Polar Electro Oy, Kempele, Finland) to determine their level of agreement. Spearman correlation coefficient for oxygen saturation was 93.8% for the pulse oximeter and the blood gas analyzer, and 97.7% for the pulse rate measured with the pulse oximeter and the heart rate belt. Bland-Altman plots revealed an overestimation of SaO 2 by 2.95 ± 6.39% and an underestimation of the pulse rate by -0.41 ± 3.18 beats per minute compared with the corresponding reference methods. In summary, the pulse oximeter is suitable for continuous monitoring of arterial oxygen saturation and pulse in newborn Holstein Friesian calves. For practical use, purpose-built technical equipment is required to attach the sensor to the calves' legs. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

SU-F-T-50: Evaluation of Monte Carlo Simulations Performance for Pediatric Brachytherapy Dosimetry

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

Chatzipapas, C; Kagadis, G; Papadimitroulas, P

Purpose: Pediatric tumors are generally treated with multi-modal procedures. Brachytherapy can be used with pediatric tumors, especially given that in this patient population low toxicity on normal tissues is critical as is the suppression of the probability for late malignancies. Our goal is to validate the GATE toolkit on realistic brachytherapy applications, and evaluate brachytherapy plans on pediatrics for accurate dosimetry on sensitive and critical organs of interest. Methods: The GATE Monte Carlo (MC) toolkit was used. Two High Dose Rate (HDR) 192Ir brachytherapy sources were simulated (Nucletron mHDR-v1 and Varian VS2000), and fully validated using the AAPM and ESTROmore » protocols. A realistic brachytherapy plan was also simulated using the XCAT anthropomorphic computational model .The simulated data were compared to the clinical dose points. Finally, a 14 years old girl with vaginal rhabdomyosarcoma was modelled based on clinical procedures for the calculation of the absorbed dose per organ. Results: The MC simulations resulted in accurate dosimetry in terms of dose rate constant (Λ), radial dose gL(r) and anisotropy function F(r,θ) for both sources.The simulations were executed using ∼1010 number of primaries resulting in statistical uncertainties lower than 2%.The differences between the theoretical values and the simulated ones ranged from 0.01% up to 3.3%, with the largest discrepancy (6%) being observed in the dose rate constant calculation.The simulated DVH using an adult female XCAT model was also compared to a clinical one resulting in differences smaller than 5%. Finally, a realistic pediatric brachytherapy simulation was performed to evaluate the absorbed dose per organ and to calculate DVH with respect to heterogeneities of the human anatomy. Conclusion: GATE is a reliable tool for brachytherapy simulations both for source modeling and for dosimetry in anthropomorphic voxelized models. Our project aims to evaluate a variety of pediatric brachytherapy schemes using a population of pediatric phantoms for several pathological cases. This study is part of a project that has received funding from the European Union Horizon2020 research and innovation programme under the MarieSklodowska-Curiegrantagreement.No691203.The results published in this study reflect only the authors view and the Research Executive Agency (REA) and the European Commission is not responsible for any use that may be madeof the information it contains.« less

Lower extremity revascularization using directional atherectomy: 12-month prospective results of the DEFINITIVE LE study.

PubMed

McKinsey, James F; Zeller, Thomas; Rocha-Singh, Krishna J; Jaff, Michael R; Garcia, Lawrence A

2014-08-01

The aim of this study was to assess the safety and effectiveness of directional atherectomy (DA) for endovascular treatment of peripheral arterial disease (PAD) in infrainguinal arteries in patients with claudication or critical limb ischemia. To date, no prospective, multicenter, independently-adjudicated study has evaluated the effectiveness and durability of DA in the treatment of PAD. Previous DA studies have not been prospectively powered to evaluate any differences in outcomes in patients with and without diabetes. DEFINITIVE LE (Determination of EFfectiveness of the SilverHawk(®) PerIpheral Plaque ExcisioN System (SIlverHawk Device) for the Treatment of Infrainguinal VEssels / Lower Extremities) prospectively enrolled subjects at 47 multinational centers with an infrainguinal lesion length up to 20 cm. Primary endpoints were defined as primary patency at 12 months for claudicants and freedom from major unplanned amputation for critical limb ischemia (CLI) subjects. A pre-specified statistical hypothesis evaluated noninferiority of primary patency in diabetic versus nondiabetic claudicants. Independent angiographic and sonographic core laboratories assessed outcomes, and events were adjudicated by a clinical events committee. A total of 800 subjects were enrolled. The 12-month primary patency was 78% (95% confidence interval: 74.0% to 80.6%) in claudicants, with a 77% rate in the diabetic subgroup versus 78% in the nondiabetic subgroup (noninferior, p < 0.001). The rate of freedom from major unplanned amputation of the target limb at 12 months in CLI subjects was 95% (95% confidence interval: 90.7% to 97.4%). Periprocedural adverse events included embolization (3.8%), perforation (5.3%), and abrupt closure (2.0%). The bail-out stent rate was 3.2%. The DEFINITIVE LE study demonstrated that DA is a safe and effective treatment modality at 12 months for a diverse patient population with either claudication or CLI. Furthermore, DA was shown to be noninferior for treating PAD in patients with diabetes compared with those without diabetes. (Study of SilverHawk/TurboHawk in Lower Extremity Vessels [DEFINITIVE LE]; NCT00883246). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs.

PubMed

Halpern, Neil A; Pastores, Stephen M

2010-01-01

To analyze the evolving role, patterns of use, and costs of critical care medicine in the United States from 2000 to 2005. Retrospective study of data from the Hospital Cost Report Information System (Centers for Medicare and Medicaid Services, Baltimore, Maryland). Nonfederal, acute care hospitals with critical care medicine beds in the United States. None. None. We analyzed hospital and critical care medicine beds, bed types, days, occupancy rates, payer mix (Medicare and Medicaid), and costs. Critical care medicine costs were compared with national cost indexes. Between 2000 and 2005, the total number of U.S. hospitals with critical care medicine beds decreased by 12.2% (from 3,586 to 3,150). Although the number of hospital beds decreased by 4.2% (from 655,785 to 628,409), both hospital days and occupancy rates increased by 5.1% (from 145.1 to 152.5 million) and 13.7% (from 59% to 67%), respectively. Critical care medicine beds increased by 6.5% (from 88,252 to 93,955), days by 10.6% (from 21.0 to 23.2 million), and occupancy rates by 4.5% (from 65% to 68%). The majority (90%) of critical care medicine beds were classified as intensive care, premature/neonatal, and coronary care unit beds. The percentage of critical care medicine days used by Medicare decreased by 3.8% (from 37.9% to 36.5%) compared with an increase of 15.5% (from 14.5% to 16.8%) by Medicaid. From 2000 to 2005, critical care medicine costs per day increased by 30.4% (from $2698 to $3518). Although annual critical care medicine costs increased by 44.2% (from $56.6 to $81.7 billion), the proportion of hospital costs and national health expenditures allocated to critical care medicine decreased by 1.6% and 1.8%, respectively. However, the proportion of the gross domestic product used by critical care medicine increased by 13.7%. In 2005, critical care medicine costs represented 13.4% of hospital costs, 4.1% of national health expenditures, and 0.66% of the gross domestic product. Critical care medicine continues to grow in a shrinking U.S. hospital system. The critical care medicine payer mix is evolving, with Medicaid increasing in its percentage of critical care medicine use. Critical care medicine is more cost controlled than other healthcare indexes, but is still using an increasing percentage of the gross domestic product. Our updated and comprehensive critical care medicine use and cost analysis provides a contemporary benchmark for the strategic planning of critical care medicine services within the U.S. healthcare system.

Using consumption rate to assess potential predators for biological control of white perch

USGS Publications Warehouse

Gosch, N.J.C.; Pope, K.L.

2011-01-01

Control of undesirable fishes is important in aquatic systems, and using predation as a tool for biological control is an attractive option to fishery biologists. However, determining the appropriate predators for biological control is critical for success. The objective of this study was to evaluate the utility of consumption rate as an index to determine the most effective predators for biological control of an invasive fish. Consumption rate values were calculated for nine potential predators that prey on white perch Morone americana in Branched Oak and Pawnee reservoirs, Nebraska. The consumption rate index provided a unique and insightful means of determining the potential effectiveness of each predator species in controlling white perch. Cumulative frequency distributions facilitated interpretation by providing a graphical presentation of consumption rates by all individuals within each predator species. Largemouth bass Micropterus salmoides, walleye Sander vitreus and sauger S. canadensis were the most efficient white perch predators in both reservoirs; however, previous attempts to increase biomass of these predators have failed suggesting that successful biological control is unlikely using existing predator species in these Nebraska reservoirs. ?? 2011 ONEMA.

Tropical fish in a warming world: thermal tolerance of Nile perch Lates niloticus (L.) in Lake Nabugabo, Uganda.

PubMed

Chrétien, Emmanuelle; Chapman, Lauren J

2016-01-01

Key to predicting the response of fishes to climate change is quantifying how close fish are to their critical thermal limits in nature and their ability to adjust their thermal sensitivity to maintain performance. Here, we evaluated the effects of body size and habitat on aerobic scope (AS) and thermal tolerance of Nile perch Lates niloticus (L.), a fish of great economic and food security importance in East Africa, using respirometry and critical thermal maximum (CTmax) trials. Juvenile Nile perch from distinct habitats (high or low dissolved oxygen concentrations) of Lake Nabugabo, Uganda were exposed for 4.6 ± 0.55 days to a temperature treatment (25.5, 27.5, 29.5 or 31.5°C) prior to experimentation, with the lowest temperature corresponding to the mean annual daytime temperature in Lake Nabugabo and the highest temperature being 3°C higher than the maximal monthly average. As expected, metabolic rates increased with body mass. Although resting metabolic rate increased with temperature, maximal metabolic rate showed no change. Likewise, AS did not vary across treatments. The CTmax increased with acclimation temperature. There was no effect of habitat on maximal metabolic rate, AS or CTmax; however, there was a trend towards a lower resting metabolic rate for Nile perch captured in the low-dissolved oxygen habitat than in well-oxygenated waters. This study shows that juvenile Nile perch maintain a large AS at temperatures near the upper limit of their natural thermal range and provides evidence that Nile perch have physiological mechanisms to deal with acute exposure to thermal stress.

Kleiber's Law: How the Fire of Life ignited debate, fueled theory, and neglected plants as model organisms

PubMed Central

Niklas, Karl J; Kutschera, Ulrich

2015-01-01

Size is a key feature of any organism since it influences the rate at which resources are consumed and thus affects metabolic rates. In the 1930s, size-dependent relationships were codified as “allometry” and it was shown that most of these could be quantified using the slopes of log-log plots of any 2 variables of interest. During the decades that followed, physiologists explored how animal respiration rates varied as a function of body size across taxa. The expectation was that rates would scale as the 2/3 power of body size as a reflection of the Euclidean relationship between surface area and volume. However, the work of Max Kleiber (1893–1976) and others revealed that animal respiration rates apparently scale more closely as the 3/4 power of body size. This phenomenology, which is called “Kleiber's Law,” has been described for a broad range of organisms, including some algae and plants. It has also been severely criticized on theoretical and empirical grounds. Here, we review the history of the analysis of metabolism, which originated with the works of Antoine L. Lavoisier (1743–1794) and Julius Sachs (1832–1897), and culminated in Kleiber's book The Fire of Life (1961; 2. ed. 1975). We then evaluate some of the criticisms that have been leveled against Kleiber's Law and some examples of the theories that have tried to explain it. We revive the speculation that intracellular exo- and endocytotic processes are resource delivery-systems, analogous to the supercellular systems in multicellular organisms. Finally, we present data that cast doubt on the existence of a single scaling relationship between growth and body size in plants. PMID:26156204

Tropical fish in a warming world: thermal tolerance of Nile perch Lates niloticus (L.) in Lake Nabugabo, Uganda

PubMed Central

Chrétien, Emmanuelle; Chapman, Lauren J.

2016-01-01

Key to predicting the response of fishes to climate change is quantifying how close fish are to their critical thermal limits in nature and their ability to adjust their thermal sensitivity to maintain performance. Here, we evaluated the effects of body size and habitat on aerobic scope (AS) and thermal tolerance of Nile perch Lates niloticus (L.), a fish of great economic and food security importance in East Africa, using respirometry and critical thermal maximum (CTmax) trials. Juvenile Nile perch from distinct habitats (high or low dissolved oxygen concentrations) of Lake Nabugabo, Uganda were exposed for 4.6 ± 0.55 days to a temperature treatment (25.5, 27.5, 29.5 or 31.5°C) prior to experimentation, with the lowest temperature corresponding to the mean annual daytime temperature in Lake Nabugabo and the highest temperature being 3°C higher than the maximal monthly average. As expected, metabolic rates increased with body mass. Although resting metabolic rate increased with temperature, maximal metabolic rate showed no change. Likewise, AS did not vary across treatments. The CTmax increased with acclimation temperature. There was no effect of habitat on maximal metabolic rate, AS or CTmax; however, there was a trend towards a lower resting metabolic rate for Nile perch captured in the low-dissolved oxygen habitat than in well-oxygenated waters. This study shows that juvenile Nile perch maintain a large AS at temperatures near the upper limit of their natural thermal range and provides evidence that Nile perch have physiological mechanisms to deal with acute exposure to thermal stress. PMID:27990290

Antigen Potency and Maximal Efficacy Reveal a Mechanism of Efficient T Cell Activation

PubMed Central

Wheeler, Richard J.; Zhang, Hao; Cordoba, Shaun-Paul; Peng, Yan-Chun; Chen, Ji-Li; Cerundolo, Vincenzo; Dong, Tao; Coombs, Daniel; van der Merwe, P. Anton

2014-01-01

T cell activation, a critical event in adaptive immune responses, follows productive interactions between T cell receptors (TCRs) and antigens, in the form of peptide-bound major histocompatibility complexes (pMHCs) on the surfaces of antigen-presenting-cells. Upon activation, T cells can lyse infected cells, secrete cytokines, such as interferon-γ (IFN-γ), and perform other effector functions with various efficiencies that directly depend on the binding parameters of the TCR-pMHC complex. The mechanism that relates binding parameters to the efficiency of activation of the T cell remains controversial; some studies suggest that the dissociation constant (KD) determines the response (the “affinity model”), whereas others suggest that the off-rate (koff) is critical (the “productive hit rate model”). Here, we used mathematical modeling to show that antigen potency, as determined by the EC50, the functional correlate that is used to support KD-based models, could not be used to discriminate between the affinity and productive hit rate models. Our theoretical work showed that both models predicted a correlation between antigen potency and KD, but only the productive hit rate model predicted a correlation between maximal efficacy (Emax) and koff. We confirmed the predictions made by the productive hit rate model in experiments with cytotoxic T cell clones and a panel of pMHC variants. Therefore, we suggest that the activity of an antigen is determined by both its potency and maximal efficacy. We discuss the implications of our findings to the practical evaluation of T cell activation, for example in adoptive immunotherapies, and relate our work to the pharmacological theory of dose-response. PMID:21653229

Kleiber's Law: How the Fire of Life ignited debate, fueled theory, and neglected plants as model organisms.

PubMed

Niklas, Karl J; Kutschera, Ulrich

2015-01-01

Size is a key feature of any organism since it influences the rate at which resources are consumed and thus affects metabolic rates. In the 1930s, size-dependent relationships were codified as "allometry" and it was shown that most of these could be quantified using the slopes of log-log plots of any 2 variables of interest. During the decades that followed, physiologists explored how animal respiration rates varied as a function of body size across taxa. The expectation was that rates would scale as the 2/3 power of body size as a reflection of the Euclidean relationship between surface area and volume. However, the work of Max Kleiber (1893-1976) and others revealed that animal respiration rates apparently scale more closely as the 3/4 power of body size. This phenomenology, which is called "Kleiber's Law," has been described for a broad range of organisms, including some algae and plants. It has also been severely criticized on theoretical and empirical grounds. Here, we review the history of the analysis of metabolism, which originated with the works of Antoine L. Lavoisier (1743-1794) and Julius Sachs (1832-1897), and culminated in Kleiber's book The Fire of Life (1961; 2. ed. 1975). We then evaluate some of the criticisms that have been leveled against Kleiber's Law and some examples of the theories that have tried to explain it. We revive the speculation that intracellular exo- and endocytotic processes are resource delivery-systems, analogous to the supercellular systems in multicellular organisms. Finally, we present data that cast doubt on the existence of a single scaling relationship between growth and body size in plants.

Reliable Collection of Real-Time Patient Physiologic Data from less Reliable Networks: a "Monitor of Monitors" System (MoMs).

PubMed

Hu, Peter F; Yang, Shiming; Li, Hsiao-Chi; Stansbury, Lynn G; Yang, Fan; Hagegeorge, George; Miller, Catriona; Rock, Peter; Stein, Deborah M; Mackenzie, Colin F

2017-01-01

Research and practice based on automated electronic patient monitoring and data collection systems is significantly limited by system down time. We asked whether a triple-redundant Monitor of Monitors System (MoMs) to collect and summarize key information from system-wide data sources could achieve high fault tolerance, early diagnosis of system failure, and improve data collection rates. In our Level I trauma center, patient vital signs(VS) monitors were networked to collect real time patient physiologic data streams from 94 bed units in our various resuscitation, operating, and critical care units. To minimize the impact of server collection failure, three BedMaster® VS servers were used in parallel to collect data from all bed units. To locate and diagnose system failures, we summarized critical information from high throughput datastreams in real-time in a dashboard viewer and compared the before and post MoMs phases to evaluate data collection performance as availability time, active collection rates, and gap duration, occurrence, and categories. Single-server collection rates in the 3-month period before MoMs deployment ranged from 27.8 % to 40.5 % with combined 79.1 % collection rate. Reasons for gaps included collection server failure, software instability, individual bed setting inconsistency, and monitor servicing. In the 6-month post MoMs deployment period, average collection rates were 99.9 %. A triple redundant patient data collection system with real-time diagnostic information summarization and representation improved the reliability of massive clinical data collection to nearly 100 % in a Level I trauma center. Such data collection framework may also increase the automation level of hospital-wise information aggregation for optimal allocation of health care resources.

Hot Deformation and Dynamic Recrystallization Behavior of the Cu-Cr-Zr-Y Alloy

NASA Astrophysics Data System (ADS)

Zhang, Yi; Huili, Sun; Volinsky, Alex A.; Tian, Baohong; Chai, Zhe; Liu, Ping; Liu, Yong

2016-03-01

To study the workability and to optimize the hot deformation processing parameters of the Cu-Cr-Zr-Y alloy, the strain hardening effect and dynamic softening behavior of the Cu-Cr-Zr-Y alloy were investigated. The flow stress increases with the strain rate and stress decreases with deformation temperature. The critical conditions, including the critical strain and stress for the occurrence of dynamic recrystallization, were determined based on the alloy strain hardening rate. The critical stress related to the onset of dynamic recrystallization decreases with temperature. The evolution of DRX microstructure strongly depends on the deformation temperature and the strain rate. Dynamic recrystallization appears at high temperatures and low strain rates. The addition of Y can refine the grain and effectively accelerate dynamic recrystallization. Dislocation generation and multiplication are the main hot deformation mechanisms for the alloy. The deformation temperature increase and the strain rate decrease can promote dynamic recrystallization of the alloy.

Research on criticality analysis method of CNC machine tools components under fault rate correlation

NASA Astrophysics Data System (ADS)

Gui-xiang, Shen; Xian-zhuo, Zhao; Zhang, Ying-zhi; Chen-yu, Han

2018-02-01

In order to determine the key components of CNC machine tools under fault rate correlation, a system component criticality analysis method is proposed. Based on the fault mechanism analysis, the component fault relation is determined, and the adjacency matrix is introduced to describe it. Then, the fault structure relation is hierarchical by using the interpretive structure model (ISM). Assuming that the impact of the fault obeys the Markov process, the fault association matrix is described and transformed, and the Pagerank algorithm is used to determine the relative influence values, combined component fault rate under time correlation can obtain comprehensive fault rate. Based on the fault mode frequency and fault influence, the criticality of the components under the fault rate correlation is determined, and the key components are determined to provide the correct basis for equationting the reliability assurance measures. Finally, taking machining centers as an example, the effectiveness of the method is verified.

Impact of entrainment and impingement on fish populations in the Hudson River Estuary. Volume II. Impingement impact analyses, evaluations of alternative screening devices, and critiques of utility testimony relating to density-dependent growth, the age-composition of the striped bass spawning stock, and the LMS real-time life cycle model

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

Barnthouse, L. W.; Van Winkle, W.; Golumbek, J.

1982-04-01

This volume includes a series of four exhibits relating to impacts of impingement on fish populations, together with a collection of critical evaluations of testimony prepared for the utilities by their consultants. The first exhibit is a quantitative evaluation of four sources of bias (collection efficiency, reimpingement, impingement on inoperative screens, and impingement survival) affecting estimates of the number of fish killed at Hudson River power plants. The two following exhibits contain, respectively, a detailed assessment of the impact of impingement on the Hudson River white perch population and estimates of conditional impingement mortality rates for seven Hudson River fishmore » populations. The fourth exhibit is an evaluation of the engineering feasibility and potential biological effectiveness of several types of modified intake structures proposed as alternatives to cooling towers for reducing impingement impacts. The remainder of Volume II consists of critical evaluations of the utilities' empirical evidence for the existence of density-dependent growth in young-of-the-year striped bass and white perch, of their estimate of the age-composition of the striped bass spawning stock in the Hudson River, and of their use of the Lawler, Matusky, and Skelly (LMS) Real-Time Life Cycle Model to estimate the impact of entrainment and impingement on the Hudson River striped bass population.« less