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  1. Chronic critical illness: the price of survival.

    PubMed

    Marchioni, Alessandro; Fantini, Riccardo; Antenora, Federico; Clini, Enrico; Fabbri, Leonardo

    2015-12-01

    The evolution of the techniques used in the intensive care setting over the past decades has led on one side to better survival rates in patients with acute conditions and severely impaired vital functions. On the other side, it has resulted in a growing number of patients who survive an acute event, but who then become dependent on one or more life support techniques. Such patients are called chronically critically ill patients. No absolute definition of the disease is currently available, although most patients are characterized by the need for prolonged mechanical ventilation. Mortality rates are still high even after dismissal from intensive care unit (ICU) and transfer to specialized rehabilitation care settings. In recent years, some studies have tried to clarify the pathophysiological characteristics underlying chronic critical illness (CCI), a disease that is also characterized by severe endocrine and inflammatory impairments, partly accounting for the almost constant set of symptoms. Currently, no specific treatment is available. However, a strategic early therapeutic approach on ICU admission might try to prevent the progress of the acute disease towards chronic critical illness. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

  2. Time Critical

    NASA Technical Reports Server (NTRS)

    Covault, Craig

    2005-01-01

    NASA's decision to slip launch of the space shuttle return-to-flight mission to no earlier than May 22 will provide engineers more time to complete final, rigorous assessments before the orbiter Discovery's final Flight Readiness Review (FRR). That FRR is now planned for May 10-11. It will be used by NASA and contractor managers to reaffirm the readiness of all program elements to support the new target to return the U.S. space program to manned launch operations. It will also enable them to better raise any final issues that could slip the target again, if necessary, to complete more work and documentation.

  3. Tracheostomy in the critically ill: the myth of dead space.

    PubMed

    Joseph, M J; Khoury, A; Mendoza, A E; Adams, S; Short, K A; Charles, A G

    2013-03-01

    Benefits and advantages of tracheostomy have been vigorously debated. There is a lack of consensus as to whether perceived clinical improvement is attributable to fundamental changes in respiratory dynamics. We compare the effect of tracheostomy versus endotracheal tube on dead space, airway resistance and other lung parameters in critically ill ventilated patients. Data collected included patients who were admitted to surgical, burn and neurosurgical intensive care units at the University of North Carolina. Twenty-four intubated patients were included in our analysis with various aetiologies of respiratory failure. Tracheostomy was deemed necessary either for severe neurological devastation or failure to wean from the ventilator. The diameter of the endotracheal tubes ranged from 6-8 mm and the tracheostomy tube diameters were from 6.4-8.9 mm. Internal diameters between endotracheal tube and tracheostomy tubes, ventilator settings and sedation were kept consistent throughout the study. Respiratory parameters were measured using the Respironics' non-invasive cardiac output 2 device (Phillips, Andover, MA) immediately prior to tracheostomy and repeated within 24 hours of tracheostomy. Only two (8%) of the patients had slight improvement (>6% decrease in dead space). The average dead space of endotracheal versus tracheostomy tubes was 41±12.6% and 40±14.6%, respectively (P=0.75). The remaining 22 patients (92%) had no significant change in dead space, compliance or other respiratory parameters. This study shows that there is no significant difference in respiratory mechanics and dead space with a tracheostomy versus endotracheal tube.

  4. Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress!

    PubMed Central

    Srinivasan, Vijay

    2012-01-01

    Stress hyperglycemia (SH) commonly occurs during critical illness in children. The historical view that SH is beneficial has been questioned in light of evidence that demonstrates the association of SH with worse outcomes. In addition to intrinsic changes in glucose metabolism and development of insulin resistance, specific intensive care unit (ICU) practices may influence the development of SH during critical illness. Mechanical ventilation, vasoactive infusions, renal replacement therapies, cardiopulmonary bypass and extracorporeal life support, therapeutic hypothermia, prolonged immobility, nutrition support practices, and the use of medications are all known to mediate development of SH in critical illness. Tight glucose control (TGC) to manage SH has emerged as a promising therapy to improve outcomes in critically ill adults, but results have been inconclusive. Large variations in ICU practices across studies likely resulted in inconsistent results. Future studies of TGC need to take into account the impact of commonly used ICU practices and, ideally, standardize protocols in an attempt to improve the accuracy of conclusions from such studies. PMID:22401321

  5. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit.

    PubMed

    Vincent, Jean-Louis; Marshall, John C; Namendys-Silva, Silvio A; François, Bruno; Martin-Loeches, Ignacio; Lipman, Jeffrey; Reinhart, Konrad; Antonelli, Massimo; Pickkers, Peter; Njimi, Hassane; Jimenez, Edgar; Sakr, Yasser

    2014-05-01

    Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality. 730 participating centres in 84 countries prospectively collected data on all adult (>16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country. 10,069 patients were included from ICUs in Europe (5445 patients; 54·1%), Asia (1928; 19·2%), the Americas (1723; 17·1%), Oceania (439; 4·4%), the Middle East (393; 3·9%), and Africa (141; 1·4%). Overall, 2973 patients (29·5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16·2% (95% CI 15·5-16·9) across the whole population and 25·8% (24·2-27·4) in patients with sepsis. Hospital mortality rates were 22·4% (21·6-23·2) in the whole population and 35·3% (33·5-37·1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested significant between-country variations (var=0·19, p=0·002) and between-hospital variations (var=0·43, p<0·0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income. This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our findings also show a significant association between the risk of death and the global national income and

  6. Time-Critical Volume Rendering

    NASA Technical Reports Server (NTRS)

    Kaufman, Arie

    1998-01-01

    For the past twelve months, we have conducted and completed a joint research entitled "Time- Critical Volume Rendering" with NASA Ames. As expected, High performance volume rendering algorithms have been developed by exploring some new faster rendering techniques, including object presence acceleration, parallel processing, and hierarchical level-of-detail representation. Using our new techniques, initial experiments have achieved real-time rendering rates of more than 10 frames per second of various 3D data sets with highest resolution. A couple of joint papers and technique reports as well as an interactive real-time demo have been compiled as the result of this project.

  7. Erik Erikson: critical times, critical theory.

    PubMed

    Douvan, E

    1997-01-01

    The work and legacy of Erik Erikson are described in this brief outline of his career, his theories, and his impact on psychoanalysis, psychology, history, and the broader culture. His conception of the adolescent task-weaving internal tastes, talents, and values together with elements of one's life history and the demands of one's culture into a coherent identity-has had profound effects on developmental psychology and the way in which sophisticated youth construct and describe their lives. His extension of development through adulthood and old age established the field of life course development. His emphasis on the impact of history and culture on development was a critical element in the developing field of ego psychology. Many of his major contributions can be fruitfully understood in the context of his personal history and individual qualities.

  8. A "Critical" Time for HRD?

    ERIC Educational Resources Information Center

    Sambrook, Sally

    2004-01-01

    Human resource development (HRD) is a concept associated with human resource management, and, by this association, one component of the broader concept of management. Much work has examined management practices from a critical stance and this article provides a brief review. However, HRD is a more recent concept, still emerging and finding space…

  9. Teacher Time: Education's Critical Resource.

    ERIC Educational Resources Information Center

    LeBlanc, Clarence

    1994-01-01

    Examines educational reform efforts and other variables that result in increased demand on teachers' task time and energy. Advocates the use of a teacher work-year model that acknowledges the limited time of teachers and that encourages teacher input about the resources required for new programs and priorities. (LP)

  10. Stimulated Whole Blood Cytokine Release as a Biomarker of Immunosuppression in the Critically Ill: The Need for a Standardized Methodology

    PubMed Central

    Segre, Elisabetta; Fullerton, James N.

    2016-01-01

    ABSTRACT Objective: Reduced ex vivo lipopolysaccharide (LPS) stimulated whole blood pro-inflammatory cytokine release is a hallmark of immunosuppression in the critically ill and predicts adverse clinical outcomes. No standard technique for performing the assay currently exists. The impact of methodological heterogeneity was determined. Design, Setting, Subjects, and Interventions: Clinical experimental study set in a research laboratory. Venous blood from 5 to 10 healthy volunteers/experiment (total participant group: 18 subjects, 72% men, mean age 32) was stimulated ex vivo to evaluate the effect of variables identified via literature review on tumor necrosis factor-α (TNFα) release. These included sample handling, stimulation technique, and incubation conditions. Reporting convention was additionally assessed. Main Results: Measured TNFα release was significantly altered by source of LPS, concentration of LPS employed, duration and temperature of incubation prior to supernatant aspiration, and predilution of blood (repeated measures ANOVA, all P < 0.01). Sample handling prior to stimulation (anticoagulant employed, time to LPS addition, and storage temperature) also caused significant alterations in TNFα release. Considerable interindividual variation was observed (range 1,024–4,649 pg/mL, mean 2,339 pg/mL). Normalization by monocyte count and pretreatment with a cyclooxygenase inhibitor (indomethacin 10 μM) reduced the coefficient of variation from 47.17% to 32.09%. Conclusions: Inconsistency in interlaboratory methodology and reporting impairs interpretation, comparability, and reproducibility of the ex vivo LPS-stimulated whole blood cytokine release assay. A standardized validated technique is required. The advent of trials of immunoadjuvant agents renders this a clinical imperative. PMID:27089173

  11. Doubt and belief in physicians' ability to prognosticate during critical illness: the perspective of surrogate decision makers.

    PubMed

    Zier, Lucas S; Burack, Jeffrey H; Micco, Guy; Chipman, Anne K; Frank, James A; Luce, John M; White, Douglas B

    2008-08-01

    Although discussing a prognosis is a duty of physicians caring for critically ill patients, little is known about surrogate decision-makers' beliefs about physicians' ability to prognosticate. We sought to determine: 1) surrogates' beliefs about whether physicians can accurately prognosticate for critically ill patients; and 2) how individuals use prognostic information in their role as surrogate decision-makers. Multicenter study in intensive care units of a public hospital, a tertiary care hospital, and a veterans' hospital. We conducted semistructured interviews with 50 surrogate decision-makers of critically ill patients. We analyzed the interview transcripts using grounded theory methods to inductively develop a framework to describe surrogates' beliefs about physicians' ability to prognosticate. Validation methods included triangulation by multidisciplinary analysis and member checking. Overall, 88% (44 of 50) of surrogates expressed doubt about physicians' ability to prognosticate for critically ill patients. Four distinct themes emerged that explained surrogates' doubts about prognostic accuracy: a belief that God could alter the course of the illness, a belief that predicting the future is inherently uncertain, prior experiences where physicians' prognostications were inaccurate, and experiences with prognostication during the patient's intensive care unit stay. Participants also identified several factors that led to belief in physicians' prognostications, such as receiving similar prognostic estimates from multiple physicians and prior experiences with accurate prognostication. Surrogates' doubts about prognostic accuracy did not prevent them from wanting prognostic information. Instead, most surrogate decision-makers view physicians' prognostications as rough estimates that are valuable in informing decisions, but are not determinative. Surrogates identified the act of prognostic disclosure as a key step in preparing emotionally and practically for the

  12. Understanding the Global Epidemiology of Pediatric Critical Illness: The Power, Pitfalls, and Practicalities of Point Prevalence Studies

    PubMed Central

    Faustino, Edward Vincent; Festa, Marino S.; Fink, Ericka L.; Jouvet, Philippe; Bush, Jenny L.; Kissoon, Niranjan; Marshall, John; Nadkarni, Vinay M.; Thomas, Neal J.

    2014-01-01

    Objective The point prevalence methodology is a valuable epidemiological study design that can optimize patient enrollment, prospectively gather individual-level data, and measure practice variability across a large number of geographic regions and health care settings. The objective of this manuscript is to review the design, implementation, and analysis of recent point prevalence studies investigating the global epidemiology of pediatric critical illness. Data Sources Literature review and primary datasets. Study Selection Multicenter, international point prevalence studies performed in pediatric intensive care units since 2007. Data Extraction Study topic, number of sites, number of study days, patients screened, prevalence of disease, use of specified therapies, and outcomes. Data Synthesis Since 2007, five point prevalence studies have been performed on acute lung injury, neurological disease, thromboprophylaxis, fluid resuscitation, and sepsis in pediatric intensive care units. These studies were performed in 59 to 120 sites in seven to 28 countries. All studies accounted for seasonal variation in pediatric disease by collecting data over multiple study days. Studies screened up to 6,317 patients and reported data on prevalence and therapeutic variability. Three studies also reported short-term outcomes, a valuable but atypical data element in point prevalence studies. Using these five studies as examples, the advantages and disadvantages and approach to designing, implementing, and analyzing point prevalence studies are reviewed. Conclusions Point prevalence studies in pediatric critical care can efficiently provide valuable insight on the global epidemiology of disease and practice patterns for critically ill children. PMID:24751790

  13. Natural time analysis of critical phenomena

    PubMed Central

    Varotsos, Panayiotis; Sarlis, Nicholas V.; Skordas, Efthimios S.; Uyeda, Seiya; Kamogawa, Masashi

    2011-01-01

    A quantity exists by which one can identify the approach of a dynamical system to the state of criticality, which is hard to identify otherwise. This quantity is the variance of natural time χ, where and pk is the normalized energy released during the kth event of which the natural time is defined as χk = k/N and N stands for the total number of events. Then we show that κ1 becomes equal to 0.070 at the critical state for a variety of dynamical systems. This holds for criticality models such as 2D Ising and the Bak–Tang–Wiesenfeld sandpile, which is the standard example of self-organized criticality. This condition of κ1 = 0.070 holds for experimental results of critical phenomena such as growth of rice piles, seismic electric signals, and the subsequent seismicity before the associated main shock. PMID:21700886

  14. Designing and conducting a randomized trial for pandemic critical illness: the 2009 H1N1 influenza pandemic.

    PubMed

    Annane, Djillali; Antona, Marion; Lehmann, Blandine; Kedzia, Cecile; Chevret, Sylvie

    2012-01-01

    To analyze the hurdles in implementing a randomized trial of corticosteroids for severe 2009 H1N1 influenza infections. This was an investigator-led, multicenter, randomized, placebo-controlled, double-blind trial of corticosteroids in ICU patients with 2009 H1N1 influenza pneumonia requiring mechanical ventilation. The feasibility of and hurdles in designing and initiating a phase III trial in a short-lived pandemic crisis were analyzed. The regulatory agency and ethics committee approved the study's scientific, financial, and ethical aspects within 4 weeks. Hydrocortisone and placebo were prepared centrally and shipped to participating hospitals within 6 weeks. The inclusion period started on November 9, 2009. From August 1, 2009 to March 8, 2010, only 205/224 ICU patients with H1N1 infections required mechanical ventilation. The peak of the wave was missed by 2-3 weeks and only 26 patients were randomized. The two main reasons for non-inclusion were patients' admission before the beginning of the trial and ICU personnel overwhelmed by clinical duties. Parallel rather than sequential regulatory and ethics approval, and preparation and masking of study drugs by local pharmacists would have allowed the study to start 1 month earlier and before the peak of the "flu" wave. A dedicated research team in each participating center would have increased the ratio of screened to randomized patients. This report highlights the main hurdles in implementing a randomized trial for a pandemic critical illness and proposes solutions for future trials.

  15. Parity-time-symmetric quantum critical phenomena

    PubMed Central

    Ashida, Yuto; Furukawa, Shunsuke; Ueda, Masahito

    2017-01-01

    Synthetic non-conservative systems with parity-time (PT) symmetric gain–loss structures can exhibit unusual spontaneous symmetry breaking that accompanies spectral singularity. Recent studies on PT symmetry in optics and weakly interacting open quantum systems have revealed intriguing physical properties, yet many-body correlations still play no role. Here by extending the idea of PT symmetry to strongly correlated many-body systems, we report that a combination of spectral singularity and quantum criticality yields an exotic universality class which has no counterpart in known critical phenomena. Moreover, we find unconventional low-dimensional quantum criticality, where superfluid correlation is anomalously enhanced owing to non-monotonic renormalization group flows in a PT-symmetry-broken quantum critical phase, in stark contrast to the Berezinskii–Kosterlitz–Thouless paradigm. Our findings can be experimentally tested in ultracold atoms and predict critical phenomena beyond the Hermitian paradigm of quantum many-body physics. PMID:28593991

  16. Universal short-time quantum critical dynamics in imaginary time

    NASA Astrophysics Data System (ADS)

    Yin, Shuai; Mai, Peizhi; Zhong, Fan

    2014-04-01

    We propose a scaling theory for the universal imaginary-time quantum critical dynamics for both short and long times. We discover that there exists a universal critical initial slip related to a small initial order parameter M0. In this stage, the order parameter M increases with the imaginary time τ as M ∝M0τθ with a universal initial-slip exponent θ. For the one-dimensional transverse-field Ising model, we estimate θ to be 0.373, which is markedly distinct from its classical counterpart. Apart from the local order parameter, we also show that the entanglement entropy exhibits universal behavior in the short-time region. As the critical exponents in the early stage and in equilibrium are identical, we apply the short-time dynamics method to determine quantum critical properties. The method is generally applicable in both the Landau-Ginzburg-Wilson paradigm and topological phase transitions.

  17. Bridging Fields at a Critical Time

    ERIC Educational Resources Information Center

    Baggaley, Jon

    2014-01-01

    The launch of the "Journal of Learning for Development" occurs at a critical time for the education and development field. The "massive open online course" concept currently being implemented by Western educators is considered as a potential cost-saver in developing nations also. MOOCs based on reliable pedagogical principles…

  18. Non-Time-Critical Removal Actions

    EPA Pesticide Factsheets

    Removal responses are used to address contamination that poses an immediate threat to human health and the environment. The documents below are a partial list of EPA's guidance for removals, with a focus on Non-Time-Critical Removal Actions (NTCRA).

  19. Critical Time Crystals in Dipolar Systems

    NASA Astrophysics Data System (ADS)

    Ho, Wen Wei; Choi, Soonwon; Lukin, Mikhail D.; Abanin, Dmitry A.

    2017-07-01

    We analyze the quantum dynamics of periodically driven, disordered systems in the presence of long-range interactions. Focusing on the stability of discrete time crystalline (DTC) order in such systems, we use a perturbative procedure to evaluate its lifetime. For 3D systems with dipolar interactions, we show that the corresponding decay is parametrically slow, implying that robust, long-lived DTC order can be obtained. We further predict a sharp crossover from the stable DTC regime into a regime where DTC order is lost, reminiscent of a phase transition. These results are in good agreement with the recent experiments utilizing a dense, dipolar spin ensemble in diamond [Nature (London) 543, 221 (2017), 10.1038/nature21426]. They demonstrate the existence of a novel, critical DTC regime that is stabilized not by many-body localization but rather by slow, critical dynamics. Our analysis shows that the DTC response can be used as a sensitive probe of nonequilibrium quantum matter.

  20. Critical Time Crystals in Dipolar Systems.

    PubMed

    Ho, Wen Wei; Choi, Soonwon; Lukin, Mikhail D; Abanin, Dmitry A

    2017-07-07

    We analyze the quantum dynamics of periodically driven, disordered systems in the presence of long-range interactions. Focusing on the stability of discrete time crystalline (DTC) order in such systems, we use a perturbative procedure to evaluate its lifetime. For 3D systems with dipolar interactions, we show that the corresponding decay is parametrically slow, implying that robust, long-lived DTC order can be obtained. We further predict a sharp crossover from the stable DTC regime into a regime where DTC order is lost, reminiscent of a phase transition. These results are in good agreement with the recent experiments utilizing a dense, dipolar spin ensemble in diamond [Nature (London) 543, 221 (2017)NATUAS0028-083610.1038/nature21426]. They demonstrate the existence of a novel, critical DTC regime that is stabilized not by many-body localization but rather by slow, critical dynamics. Our analysis shows that the DTC response can be used as a sensitive probe of nonequilibrium quantum matter.

  1. Clock genes control cortical critical period timing.

    PubMed

    Kobayashi, Yohei; Ye, Zhanlei; Hensch, Takao K

    2015-04-08

    Circadian rhythms control a variety of physiological processes, but whether they may also time brain development remains largely unknown. Here, we show that circadian clock genes control the onset of critical period plasticity in the neocortex. Within visual cortex of Clock-deficient mice, the emergence of circadian gene expression was dampened, and the maturation of inhibitory parvalbumin (PV) cell networks slowed. Loss of visual acuity in response to brief monocular deprivation was concomitantly delayed and rescued by direct enhancement of GABAergic transmission. Conditional deletion of Clock or Bmal1 only within PV cells recapitulated the results of total Clock-deficient mice. Unique downstream gene sets controlling synaptic events and cellular homeostasis for proper maturation and maintenance were found to be mis-regulated by Clock deletion specifically within PV cells. These data demonstrate a developmental role for circadian clock genes outside the suprachiasmatic nucleus, which may contribute mis-timed brain plasticity in associated mental disorders. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Discrete Time Crystals: Rigidity, Criticality, and Realizations

    NASA Astrophysics Data System (ADS)

    Yao, N. Y.; Potter, A. C.; Potirniche, I.-D.; Vishwanath, A.

    2017-01-01

    Despite being forbidden in equilibrium, spontaneous breaking of time translation symmetry can occur in periodically driven, Floquet systems with discrete time-translation symmetry. The period of the resulting discrete time crystal is quantized to an integer multiple of the drive period, arising from a combination of collective synchronization and many body localization. Here, we consider a simple model for a one-dimensional discrete time crystal which explicitly reveals the rigidity of the emergent oscillations as the drive is varied. We numerically map out its phase diagram and compute the properties of the dynamical phase transition where the time crystal melts into a trivial Floquet insulator. Moreover, we demonstrate that the model can be realized with current experimental technologies and propose a blueprint based upon a one dimensional chain of trapped ions. Using experimental parameters (featuring long-range interactions), we identify the phase boundaries of the ion-time-crystal and propose a measurable signature of the symmetry breaking phase transition.

  3. Discrete Time Crystals: Rigidity, Criticality, and Realizations.

    PubMed

    Yao, N Y; Potter, A C; Potirniche, I-D; Vishwanath, A

    2017-01-20

    Despite being forbidden in equilibrium, spontaneous breaking of time translation symmetry can occur in periodically driven, Floquet systems with discrete time-translation symmetry. The period of the resulting discrete time crystal is quantized to an integer multiple of the drive period, arising from a combination of collective synchronization and many body localization. Here, we consider a simple model for a one-dimensional discrete time crystal which explicitly reveals the rigidity of the emergent oscillations as the drive is varied. We numerically map out its phase diagram and compute the properties of the dynamical phase transition where the time crystal melts into a trivial Floquet insulator. Moreover, we demonstrate that the model can be realized with current experimental technologies and propose a blueprint based upon a one dimensional chain of trapped ions. Using experimental parameters (featuring long-range interactions), we identify the phase boundaries of the ion-time-crystal and propose a measurable signature of the symmetry breaking phase transition.

  4. Time Critical Conventional Strike from Strategic Standoff

    DTIC Science & Technology

    2009-03-01

    work began on space based chemical lasers and ground based exciter and free electron lasers . Other energy weapons work, such as the nuclear pumped x ... ray laser , space based neutral particle beams, and high power microwave weapons also received funding, but the major support from industry advocates...Fiber Lasers ........................................................................................... 42 Figure E-7. Scenario 1 Time Parameter

  5. A Combined Early Cognitive and Physical Rehabilitation Program for People Who Are Critically Ill: The Activity and Cognitive Therapy in the Intensive Care Unit (ACT-ICU) Trial

    PubMed Central

    Jackson, James C.; Girard, Timothy D.; Pandharipande, Pratik P.; Schiro, Elena; Work, Brittany; Pun, Brenda T.; Boehm, Leanne; Gill, Thomas M.; Ely, E. Wesley

    2012-01-01

    Background In the coming years, the number of survivors of critical illness is expected to increase. These survivors frequently develop newly acquired physical and cognitive impairments. Long-term cognitive impairment is common following critical illness and has dramatic effects on patients' abilities to function autonomously. Neuromuscular weakness affects similar proportions of patients and leads to equally profound life alterations. As knowledge of these short-term and long-term consequences of critical illness has come to light, interventions to prevent and rehabilitate these devastating consequences have been sought. Physical rehabilitation has been shown to improve functional outcomes in people who are critically ill, but subsequent studies of physical rehabilitation after hospital discharge have not. Post-hospital discharge cognitive rehabilitation is feasible in survivors of critical illness and is commonly used in people with other forms of acquired brain injury. The feasibility of early cognitive therapy in people who are critically ill remains unknown. Objective The purpose of this novel protocol trial will be to determine the feasibility of early and sustained cognitive rehabilitation paired with physical rehabilitation in patients who are critically ill from medical and surgical intensive care units. Design This is a randomized controlled trial. Setting The setting for this trial will be medical and surgical intensive care units of a large tertiary care referral center. Patients The participants will be patients who are critically ill with respiratory failure or shock. Intervention Patients will be randomized to groups receiving usual care, physical rehabilitation, or cognitive rehabilitation plus physical rehabilitation. Twice-daily cognitive rehabilitation sessions will be performed with patients who are noncomatose and will consist of orientation, memory, and attention exercises (eg, forward and reverse digit spans, matrix puzzles, letter

  6. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial.

    PubMed

    Brummel, Nathan E; Jackson, James C; Girard, Timothy D; Pandharipande, Pratik P; Schiro, Elena; Work, Brittany; Pun, Brenda T; Boehm, Leanne; Gill, Thomas M; Ely, E Wesley

    2012-12-01

    In the coming years, the number of survivors of critical illness is expected to increase. These survivors frequently develop newly acquired physical and cognitive impairments. Long-term cognitive impairment is common following critical illness and has dramatic effects on patients' abilities to function autonomously. Neuromuscular weakness affects similar proportions of patients and leads to equally profound life alterations. As knowledge of these short-term and long-term consequences of critical illness has come to light, interventions to prevent and rehabilitate these devastating consequences have been sought. Physical rehabilitation has been shown to improve functional outcomes in people who are critically ill, but subsequent studies of physical rehabilitation after hospital discharge have not. Post-hospital discharge cognitive rehabilitation is feasible in survivors of critical illness and is commonly used in people with other forms of acquired brain injury. The feasibility of early cognitive therapy in people who are critically ill remains unknown. The purpose of this novel protocol trial will be to determine the feasibility of early and sustained cognitive rehabilitation paired with physical rehabilitation in patients who are critically ill from medical and surgical intensive care units. This is a randomized controlled trial. The setting for this trial will be medical and surgical intensive care units of a large tertiary care referral center. The participants will be patients who are critically ill with respiratory failure or shock. Patients will be randomized to groups receiving usual care, physical rehabilitation, or cognitive rehabilitation plus physical rehabilitation. Twice-daily cognitive rehabilitation sessions will be performed with patients who are noncomatose and will consist of orientation, memory, and attention exercises (eg, forward and reverse digit spans, matrix puzzles, letter-number sequences, pattern recognition). Daily physical

  7. The Hobart Time Ball and Time Gun: a Critical Review

    NASA Astrophysics Data System (ADS)

    Kinns, Roger

    2011-07-01

    Discussion at the Royal Society in Hobart in 1865 and acoustic experiments in 1868 led to a combined time ball and time gun service in Hobart from March 1875. Complaints from residents led to relocation of the gun a month later, but it was then fired from Queen's Battery in the Domain for half a century. The drop of the ball at Battery Point was always the master signal; the gun was fired when the ball was seen to drop. During the early years, private citizens in Hobart provided the time reference. From September 1886, an electric telegraph signal from Hobart Observatory was used to provide correct time to the ball operator, but signals were of questionable accuracy. During February 1910, the source of the telegraph signal was changed from Hobart Observatory to Melbourne Observatory, but the service was still unreliable and there was pressure to re-equip Hobart Observatory. Finally, automatic dropping of the time ball by telegraph from Melbourne was introduced in November 1910. The time ball service ended in February 1927. The time gun had probably ceased to operate by the end of 1923, but before that date there were sometimes long gaps in the time gun service, particularly on Sundays.

  8. Generalized dynamic scaling for quantum critical relaxation in imaginary time.

    PubMed

    Zhang, Shuyi; Yin, Shuai; Zhong, Fan

    2014-10-01

    We study the imaginary-time relaxation critical dynamics of a quantum system with a vanishing initial correlation length and an arbitrary initial order parameter M0. We find that in quantum critical dynamics, the behavior of M0 under scale transformations deviates from a simple power law, which was proposed for very small M0 previously. A universal characteristic function is then suggested to describe the rescaled initial magnetization, similar to classical critical dynamics. This characteristic function is shown to be able to describe the quantum critical dynamics in both short- and long-time stages of the evolution. The one-dimensional transverse-field Ising model is employed to numerically determine the specific form of the characteristic function. We demonstrate that it is applicable as long as the system is in the vicinity of the quantum critical point. The universality of the characteristic function is confirmed by numerical simulations of models belonging to the same universality class.

  9. Gapped quantum criticality gains long-time quantum correlations

    NASA Astrophysics Data System (ADS)

    Jafari, R.; Akbari, Alireza

    2015-07-01

    We show that gapped critical environment could remarkably prevent an enhanced decay of decoherence factor and quantum correlations at the critical point, which is non-trivially different from the ones in a gapless critical environment (Quan H. T. et al., Phys. Rev. Lett., 96 (2006) 140604). The quantum correlations display very fast decaying to their local minimum at the critical point while maximum decaying occurs away from this point. In particular, our results imply that the collapse of the decoherence factor is not an indicator of a quantum phase transition of the environment as opposed to what happens in a gapless criticality. In the weak-coupling regime, the relaxation time, at which the quantum correlations touch rapidly local minima, shows a power-law singularity as a function of the gap. Furthermore, quantum correlations decay exponentially with the second power of the relaxation time. Our results are important for a better understanding and characterisation of the gap critical environment and its ability as entangler in open quantum systems.

  10. Scheduling time-critical graphics on multiple processors

    NASA Technical Reports Server (NTRS)

    Meyer, Tom W.; Hughes, John F.

    1995-01-01

    This paper describes an algorithm for the scheduling of time-critical rendering and computation tasks on single- and multiple-processor architectures, with minimal pipelining. It was developed to manage scientific visualization scenes consisting of hundreds of objects, each of which can be computed and displayed at thousands of possible resolution levels. The algorithm generates the time-critical schedule using progressive-refinement techniques; it always returns a feasible schedule and, when allowed to run to completion, produces a near-optimal schedule which takes advantage of almost the entire multiple-processor system.

  11. Compressive sampling for time critical microwave imaging applications

    PubMed Central

    O'Halloran, Martin; McGinley, Brian; Conceicao, Raquel C.; Kilmartin, Liam; Jones, Edward; Glavin, Martin

    2014-01-01

    Across all biomedical imaging applications, there is a growing emphasis placed on reducing data acquisition and imaging times. This research explores the use of a technique, known as compressive sampling or compressed sensing (CS), as an efficient technique to minimise the data acquisition time for time critical microwave imaging (MWI) applications. Where a signal exhibits sparsity in the time domain, the proposed CS implementation allows for sub-sampling acquisition in the frequency domain and consequently shorter imaging times, albeit at the expense of a slight degradation in reconstruction quality of the signals as the compression increases. This Letter focuses on ultra wideband (UWB) radar MWI applications where reducing acquisition is of critical importance therefore a slight degradation in reconstruction quality may be acceptable. The analysis demonstrates the effectiveness and suitability of CS with UWB applications. PMID:26609368

  12. Critical conversations: a call for a nonprocedural "time out".

    PubMed

    Sehgal, Niraj L; Fox, Michael; Sharpe, Bradley A; Vidyarthi, Arpana R; Blegen, Mary; Wachter, Robert M

    2011-04-01

    Communication failures are an ongoing threat to patient safety. Procedural "time outs" were developed as a method to enhance communication and mitigate patient harm. Nonprocedural settings generate equal risks for communication failure, yet lack a similar communication tool or practice that can be applied, particularly with a patient-driven focus. Rapidly changing clinical states and care plans are common in the hospital setting, placing patients at risk for adverse events. Certain junctures allow for the highest potential of patient harm-at the time of admission, at a change in clinical condition, and at the time of discharge. Direct communication among healthcare providers at these junctures, which we have dubbed Critical Conversations, can provide an opportunity to clarify plans of care, address or anticipate concerns, and foster greater teamwork. Information exchanged during Critical Conversations includes a combination of checklist-type items and more open-ended questions but they ultimately create a structure and expectation for communication. Integration of Critical Conversations into practice requires provider education and buy-in, as well as expectations for them to occur. Monitoring adherence, capturing stories of success, and demonstrating effectiveness may enhance implementation and continuous improvement in the process. Communication tools designed to reduce the likelihood of patient harm remain a focus of patient safety efforts. Critical Conversations are an innovative communication tool, intervention, and policy that potentially limits communication failures at critical junctures to ensure high quality and safe patient care. Copyright © 2011 Society of Hospital Medicine.

  13. Time-critical multirate scheduling using contemporary real-time operating system services

    NASA Technical Reports Server (NTRS)

    Eckhardt, D. E., Jr.

    1983-01-01

    Although real-time operating systems provide many of the task control services necessary to process time-critical applications (i.e., applications with fixed, invariant deadlines), it may still be necessary to provide a scheduling algorithm at a level above the operating system in order to coordinate a set of synchronized, time-critical tasks executing at different cyclic rates. The scheduling requirements for such applications and develops scheduling algorithms using services provided by contemporary real-time operating systems.

  14. Managing critically Ill hematology patients: Time to think differently.

    PubMed

    Azoulay, Elie; Pène, Frédéric; Darmon, Michael; Lengliné, Etienne; Benoit, Dominique; Soares, Marcio; Vincent, Francois; Bruneel, Fabrice; Perez, Pierre; Lemiale, Virginie; Mokart, Djamel

    2015-11-01

    The number of patients living with hematological malignancies (HMs) has increased steadily over time. This is the result of intensive and effective treatments that also increase the probability of infiltrative, infectious or toxic life threatening event. Over the last two decades, the number of patients with HMs admitted to the ICU increased and their mortality has dropped sharply. ICU patients with HMs require an extensive diagnostic workup and the optimal use of ICU treatments to identify the reason for ICU admission and the nature of the complication that explains organ dysfunctions. Mortality of ARDS or septic shock is up to 50%, respectively. In this review, the authors share their experience with managing critically ill patients with HMs. They discuss the main aspects of the diagnostic and therapeutic management of critically ill patients with HMs and argue that outcomes have improved over time and that many classic determinants of mortality have become irrelevant.

  15. Critical Timing without a Timer for Embryonic Development.

    PubMed

    Tufcea, Daniel E; François, Paul

    2015-10-20

    Timing of embryonic development is precisely controlled, but the mechanisms underlying biological timers are still unclear. Here, a validated model for timing under control of Sonic Hedgehog is revisited and generalized to an arbitrary number of genes. The developmental dynamics where a temporal sequence of gene expression recapitulates a steady-state spatial pattern can be realized through a simple network close to criticality, controlled by the duration of exposure to a morphogen. Criticality simultaneously accounts for many observed biological properties, such as timing, multistability, and canalization of genetic expression. This process can be parsimoniously generalized in many dimensions with a minimum number of genes, all repressing each other with asymmetrical strengths, which also explains sequential activation of different fates. Separation of timescales allows for a simple analytical interpretation. Finally, it is shown that even in the presence of noise, coupling between cells preserves criticality and robust patterning. The model offers a simple theoretical framework for the study of emergent developmental timers. Copyright © 2015 Biophysical Society. Published by Elsevier Inc. All rights reserved.

  16. Critical Timing without a Timer for Embryonic Development

    PubMed Central

    Tufcea, Daniel E.; François, Paul

    2015-01-01

    Timing of embryonic development is precisely controlled, but the mechanisms underlying biological timers are still unclear. Here, a validated model for timing under control of Sonic Hedgehog is revisited and generalized to an arbitrary number of genes. The developmental dynamics where a temporal sequence of gene expression recapitulates a steady-state spatial pattern can be realized through a simple network close to criticality, controlled by the duration of exposure to a morphogen. Criticality simultaneously accounts for many observed biological properties, such as timing, multistability, and canalization of genetic expression. This process can be parsimoniously generalized in many dimensions with a minimum number of genes, all repressing each other with asymmetrical strengths, which also explains sequential activation of different fates. Separation of timescales allows for a simple analytical interpretation. Finally, it is shown that even in the presence of noise, coupling between cells preserves criticality and robust patterning. The model offers a simple theoretical framework for the study of emergent developmental timers. PMID:26488664

  17. Real Time Free Cortisol Quantification Among Critically Ill Children

    PubMed Central

    Zimmerman, Jerry J.; Donaldson, Amy; Barker, Ruth M.; Meert, Kathleen L.; Harrison, Rick; Carcillo, Joseph A.; Anand, Kanwaljeet J. S.; Newth, Christopher J. L.; Berger, John; Willson, Douglas F.; Jack, Rhona; Nicholson, Carol; Dean, J. Michael

    2013-01-01

    Objectives Ascertainment of adrenal function assessing free (FC) rather that total (TC) cortisol may be beneficial for the diagnosis of critical illness related cortisol insufficiency (CIRCI). We hypothesized that centrifugal ultrafiltration (CUF) would provide timely FC data that highly correlated with the gold standard, but logistically cumbersome, equilibrium dialysis (EQD) technique when the FC fractions were identically quantified by chemiluminescence immunoassay. We also hypothesized that FC would correlate with illness severity in a large cohort of critically ill children. Design Prospective, multi-institutional, observational cohort investigation. Setting Seven pediatric intensive care units (PICUs) within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Patients 165 critically ill children across the spectrum of illness severity. Interventions Blood sampling. Measurements and main results Time to derive plasma FC concentrations following CUF or EQD fractionation with chemiluminescence immunoassay was ~2 versus ~24 hours, respectively. Utilizing CUF, mean plasma FC was 4.1 ± 6.7 ug/dL (median 1.6, range 0.2-43.6), representing an average of 15.2 ± 9.4% of total cortisol. Nearly 60% of subjects exhibited FC < 2 and 30% < 0.8 ug/dL, previously suggested threshold concentrations for defining CIRCI. Plasma FC concentrations comparing CUF versus EQD fractionation demonstrated a strong correlation (R2 = 0.97). For FC < 2 ug/dL Bland-Altman analysis revealed minimal negative bias for the CUF technique. Illness severity assessed by PRISM III correlated moderately with FC and percent TC as FC. Conclusions Determination of CUF fractionated FC was fast and results correlated highly with EQD fractionated FC. Many children exhibited FC < 2 and < 0.8 ug/dL, but did not demonstrate clinical evidence of CIRCI. This study ascertains that real time FC quantification is feasible to

  18. Short-Time Behavior and Criticality of Driven Lattice Gases

    NASA Astrophysics Data System (ADS)

    Basu, Urna; Volpati, Valerio; Caracciolo, Sergio; Gambassi, Andrea

    2017-02-01

    The nonequilibrium short-time critical behaviors of driven and undriven lattice gases are investigated via Monte Carlo simulations in two spatial dimensions starting from a fully disordered initial configuration. In particular, we study the time evolution of suitably defined order parameters, which account for the strong anisotropy introduced by the homogeneous drive. We demonstrate that, at short times, the dynamics of all these models is unexpectedly described by an effective continuum theory in which transverse fluctuations, i.e., fluctuations averaged along the drive, are Gaussian, irrespective of this being actually the case in the stationary state. Strong numerical evidence is provided, in remarkable agreement with that theory, both for the driven and undriven lattice gases, which therefore turn out to display the same short-time dynamics.

  19. Exploring Gigabyte Datasets in Real Time: Architectures, Interfaces and Time-Critical Design

    NASA Technical Reports Server (NTRS)

    Bryson, Steve; Gerald-Yamasaki, Michael (Technical Monitor)

    1998-01-01

    Architectures and Interfaces: The implications of real-time interaction on software architecture design: decoupling of interaction/graphics and computation into asynchronous processes. The performance requirements of graphics and computation for interaction. Time management in such an architecture. Examples of how visualization algorithms must be modified for high performance. Brief survey of interaction techniques and design, including direct manipulation and manipulation via widgets. talk discusses how human factors considerations drove the design and implementation of the virtual wind tunnel. Time-Critical Design: A survey of time-critical techniques for both computation and rendering. Emphasis on the assignment of a time budget to both the overall visualization environment and to each individual visualization technique in the environment. The estimation of the benefit and cost of an individual technique. Examples of the modification of visualization algorithms to allow time-critical control.

  20. Exploring Gigabyte Datasets in Real Time: Architectures, Interfaces and Time-Critical Design

    NASA Technical Reports Server (NTRS)

    Bryson, Steve; Gerald-Yamasaki, Michael (Technical Monitor)

    1998-01-01

    Architectures and Interfaces: The implications of real-time interaction on software architecture design: decoupling of interaction/graphics and computation into asynchronous processes. The performance requirements of graphics and computation for interaction. Time management in such an architecture. Examples of how visualization algorithms must be modified for high performance. Brief survey of interaction techniques and design, including direct manipulation and manipulation via widgets. talk discusses how human factors considerations drove the design and implementation of the virtual wind tunnel. Time-Critical Design: A survey of time-critical techniques for both computation and rendering. Emphasis on the assignment of a time budget to both the overall visualization environment and to each individual visualization technique in the environment. The estimation of the benefit and cost of an individual technique. Examples of the modification of visualization algorithms to allow time-critical control.

  1. Critical time scales for advection-diffusion-reaction processes

    NASA Astrophysics Data System (ADS)

    Ellery, Adam J.; Simpson, Matthew J.; McCue, Scott W.; Baker, Ruth E.

    2012-04-01

    The concept of local accumulation time (LAT) was introduced by Berezhkovskii and co-workers to give a finite measure of the time required for the transient solution of a reaction-diffusion equation to approach the steady-state solution [A. M. Berezhkovskii, C. Sample, and S. Y. Shvartsman, Biophys. J.BIOJAU0006-349510.1016/j.bpj.2010.07.045 99, L59 (2010); A. M. Berezhkovskii, C. Sample, and S. Y. Shvartsman, Phys. Rev. EPLEEE81539-375510.1103/PhysRevE.83.051906 83, 051906 (2011)]. Such a measure is referred to as a critical time. Here, we show that LAT is, in fact, identical to the concept of mean action time (MAT) that was first introduced by McNabb [A. McNabb and G. C. Wake, IMA J. Appl. Math.IJAMDM0272-496010.1093/imamat/47.2.193 47, 193 (1991)]. Although McNabb's initial argument was motivated by considering the mean particle lifetime (MPLT) for a linear death process, he applied the ideas to study diffusion. We extend the work of these authors by deriving expressions for the MAT for a general one-dimensional linear advection-diffusion-reaction problem. Using a combination of continuum and discrete approaches, we show that MAT and MPLT are equivalent for certain uniform-to-uniform transitions; these results provide a practical interpretation for MAT by directly linking the stochastic microscopic processes to a meaningful macroscopic time scale. We find that for more general transitions, the equivalence between MAT and MPLT does not hold. Unlike other critical time definitions, we show that it is possible to evaluate the MAT without solving the underlying partial differential equation (pde). This makes MAT a simple and attractive quantity for practical situations. Finally, our work explores the accuracy of certain approximations derived using MAT, showing that useful approximations for nonlinear kinetic processes can be obtained, again without treating the governing pde directly.

  2. Critical Slowing Down in Time-to-Extinction: An Example of Critical Phenomena in Ecology

    NASA Technical Reports Server (NTRS)

    Gandhi, Amar; Levin, Simon; Orszag, Steven

    1998-01-01

    We study a model for two competing species that explicitly accounts for effects due to discreteness, stochasticity and spatial extension of populations. The two species are equally preferred by the environment and do better when surrounded by others of the same species. We observe that the final outcome depends on the initial densities (uniformly distributed in space) of the two species. The observed phase transition is a continuous one and key macroscopic quantities like the correlation length of clusters and the time-to-extinction diverge at a critical point. Away from the critical point, the dynamics can be described by a mean-field approximation. Close to the critical point, however, there is a crossover to power-law behavior because of the gross mismatch between the largest and smallest scales in the system. We have developed a theory based on surface effects, which is in good agreement with the observed behavior. The course-grained reaction-diffusion system obtained from the mean-field dynamics agrees well with the particle system.

  3. Critical Time Intervention: Model Description and Implications for the Significance of Timing in Social Work Interventions

    ERIC Educational Resources Information Center

    Herman, Daniel B.; Mandiberg, James M.

    2010-01-01

    Relatively little attention has been paid to the dimension of time in the design of social work interventions. Critical time intervention (CTI), an empirically supported psychosocial intervention intended to reduce the risk of homelessness by enhancing continuity of support for individuals with severe mental illness (SMI) during the transition…

  4. Concept Mapping for Critical Thinking: Efficacy, Timing, & Type

    ERIC Educational Resources Information Center

    Harris, Charles M.; Zha, Shenghua

    2017-01-01

    Many college students are not progressing in the development of their critical thinking skills. Concept mapping is a technique for facilitating validation of one's critical thinking by graphically depicting the structure of complex concepts. Each of our three studies of concept mapping involved approximately 240 students enrolled in four sections…

  5. Critical source times for nutrient loss in agricultural catchment streams

    NASA Astrophysics Data System (ADS)

    Melland, Alice; Shore, Mairead; Mellander, Per-Erik; McDonald, Noeleen; Shortle, Ger; Murphy, Paul; Jordan, Phil

    2014-05-01

    Identifying periods of the year when there is a high risk of incidental nutrient loss from farms via runoff to streams underpins current nutrient management legislation in Europe. This research explored high-temporal resolution nutrient transfer patterns relative to the time that manure and fertiliser are prohibited from being spread (the mandatory spreading 'closed' period) in five Irish agricultural catchments. Catchment nutrient losses during the 12 week closed periods in 2009-10, 2010-11 and 2011-12 were compared with losses during the remainder of the year, and with losses in the two week 'shoulder' periods immediately before and after the closed period. The closed period losses were assumed to be residual from soil nutrient stores and the 'shoulder' periods were considered to also include incidental losses. Nutrient loss was measured at sub-hourly frequency as total phosphorus (P) and total oxidised nitrogen (mostly nitrate-N) fluxes in streamflow. The streamflow fluxes showed that the proportion of the annual nitrate-N loss occurring during the closed periods (33-61%) was high compared with the remainder of the year. Six to ten times more nitrate-N loss occurred in the two weeks after, compared with the two weeks before, the closed period. These two week 'shoulder' period losses were, on average, less than or equal to 2.5 kg nitrate-N/ha and 9% of total annual nitrate-N loss in streamflow. On average, 40-53% of the annual P loss occurred during the closed periods but in a runoff-prone catchment in a year with a wet summer, the closed period was the less risky period. Similar to nitrate-N, two to twenty times more P loss occurred in the two weeks after, compared with the two weeks before, the closed period. These shoulder period losses were, on average, less than or equal to 0.027 kg/ha and 4.2% of total annual P loss in streamflow. The proportion of the shoulder period loss that could be attributed to recently spread nutrients was not known but can be

  6. A Kairos of the Critical: Teaching Critically in a Time of Compliance

    ERIC Educational Resources Information Center

    Drabinski, Emily

    2017-01-01

    The promise of critical pedagogy lies in its capacity to change lives as librarians try new ways of thinking and teaching that challenge systems of power that privilege some and not others. In the last ten years, critical pedagogy has moved from the margins to the center, most clearly in its influence on the new "Framework for Information…

  7. Timing of critical genetic changes in human breast disease.

    PubMed

    Ellsworth, Rachel E; Ellsworth, Darrell L; Deyarmin, Brenda; Hoffman, Laurel R; Love, Brad; Hooke, Jeffrey A; Shriver, Craig D

    2005-12-01

    Breast cancer development has been characterized as a nonobligatory sequence of histological changes from normal epithelium through invasive malignancy. Although genetic alterations are thought to accumulate stochastically during tumorigenesis, little is known about the timing of critical mutations. This study examined allelic imbalance (AI) in tissue samples representing a continuum of breast cancer development to examine the evolution of genomic instability. Laser-microdissected DNA samples were collected from histologically normal breast specimens (n = 25), atypical ductal hyperplasia (ADH, n = 16), ductal carcinoma-in-situ (DCIS, n = 37), and stage I to III invasive carcinomas (n = 72). Fifty-two microsatellite markers representing 26 chromosomal regions commonly deleted in breast cancer were used to assess patterns of AI. AI frequencies were <5% in histologically normal and ADH specimens, 20% in DCIS lesions, and approximately 25% in invasive tumors. Mann-Whitney tests showed (1) that levels of AI in ADH samples did not differ significantly from those in histologically normal tissues and (2) that AI frequencies in DCIS lesions were not significantly different from those in invasive carcinomas. ADH and DCIS samples, however, differed significantly (P < .0001). DCIS lesions contain levels of genomic instability that are characteristic of advanced invasive tumors, and this suggests that the biology of a developing carcinoma may already be predetermined by the in situ stage. Observations that levels of AI in ADH lesions are similar to those in disease-free tissues provide a genomic rationale for why prevention strategies at the ADH level are successful and why cases with ADH involving surgical margins do not require further resection.

  8. Scheduling Real-Time Mixed-Criticality Jobs

    NASA Astrophysics Data System (ADS)

    Baruah, Sanjoy K.; Bonifaci, Vincenzo; D'Angelo, Gianlorenzo; Li, Haohan; Marchetti-Spaccamela, Alberto; Megow, Nicole; Stougie, Leen

    Many safety-critical embedded systems are subject to certification requirements; some systems may be required to meet multiple sets of certification requirements, from different certification authorities. Certification requirements in such "mixed-criticality" systems give rise to interesting scheduling problems, that cannot be satisfactorily addressed using techniques from conventional scheduling theory. In this paper, we study a formal model for representing such mixed-criticality workloads. We demonstrate first the intractability of determining whether a system specified in this model can be scheduled to meet all its certification requirements, even for systems subject to two sets of certification requirements. Then we quantify, via the metric of processor speedup factor, the effectiveness of two techniques, reservation-based scheduling and priority-based scheduling, that are widely used in scheduling such mixed-criticality systems, showing that the latter of the two is superior to the former. We also show that the speedup factors are tight for these two techniques.

  9. Applying Cognitive Work Analysis to Time Critical Targeting Functionality

    DTIC Science & Technology

    2004-10-01

    Target List/Dynamic Target Queue (DTL/ DTQ ) in the same place. Figure 4-27 shows the task steps involved in achieving Goal 7. 4- 30 Figure 4-27...GUI WG to brainstorm the order of columns in the DTL/ DTQ Table, a critical component of the TCTF CUI, with successful results, which were...Cognitive Work Analysis DTD Display Task Description DTL/ DTQ Dynamic Target List/Dynamic Target Queue FDO Fighter Duty Officer FEBA Forward Edge

  10. Time for Teacher Learning, Planning Critical for School Reform

    ERIC Educational Resources Information Center

    Merritt, Eileen G.

    2017-01-01

    Teachers are dedicated, wise, and thoughtful change agents who need more time to identify problems they see in their schools or classrooms and work individually and collectively on solutions. They need both more time for individual planning and time to collaborate with colleagues who teach the same grades or the same subjects. A productive day of…

  11. Time for Teacher Learning, Planning Critical for School Reform

    ERIC Educational Resources Information Center

    Merritt, Eileen G.

    2017-01-01

    Teachers are dedicated, wise, and thoughtful change agents who need more time to identify problems they see in their schools or classrooms and work individually and collectively on solutions. They need both more time for individual planning and time to collaborate with colleagues who teach the same grades or the same subjects. A productive day of…

  12. Accessible high performance computing solutions for near real-time image processing for time critical applications

    NASA Astrophysics Data System (ADS)

    Bielski, Conrad; Lemoine, Guido; Syryczynski, Jacek

    2009-09-01

    High Performance Computing (HPC) hardware solutions such as grid computing and General Processing on a Graphics Processing Unit (GPGPU) are now accessible to users with general computing needs. Grid computing infrastructures in the form of computing clusters or blades are becoming common place and GPGPU solutions that leverage the processing power of the video card are quickly being integrated into personal workstations. Our interest in these HPC technologies stems from the need to produce near real-time maps from a combination of pre- and post-event satellite imagery in support of post-disaster management. Faster processing provides a twofold gain in this situation: 1. critical information can be provided faster and 2. more elaborate automated processing can be performed prior to providing the critical information. In our particular case, we test the use of the PANTEX index which is based on analysis of image textural measures extracted using anisotropic, rotation-invariant GLCM statistics. The use of this index, applied in a moving window, has been shown to successfully identify built-up areas in remotely sensed imagery. Built-up index image masks are important input to the structuring of damage assessment interpretation because they help optimise the workload. The performance of computing the PANTEX workflow is compared on two different HPC hardware architectures: (1) a blade server with 4 blades, each having dual quad-core CPUs and (2) a CUDA enabled GPU workstation. The reference platform is a dual CPU-quad core workstation and the PANTEX workflow total computing time is measured. Furthermore, as part of a qualitative evaluation, the differences in setting up and configuring various hardware solutions and the related software coding effort is presented.

  13. Time-Limited Trials of Intensive Care for Critically Ill Patients With Cancer

    PubMed Central

    Shrime, Mark G.; Ferket, Bart S.; Scott, Daniel J.; Lee, Joon; Barragan-Bradford, Diana; Pollard, Tom; Arabi, Yaseen M.; Al-Dorzi, Hasan M.; Baron, Rebecca M.; Hunink, M. G. Myriam; Celi, Leo A.; Lai, Peggy S.

    2015-01-01

    IMPORTANCE Time-limited trials of intensive care are commonly used in patients perceived to have a poor prognosis. The optimal duration of such trials is unknown. Factors such as a cancer diagnosis are associated with clinician pessimism and may affect the decision to limit care independent of a patient’s severity of illness. OBJECTIVE To identify the optimal duration of intensive care for short-term mortality in critically ill patients with cancer. DESIGN, SETTING, AND PARTICIPANTS Decision analysis using a state-transition microsimulation model was performed to simulate the hospital course of patients with poor-prognosis primary tumors, metastatic disease, or hematologic malignant neoplasms admitted to medical and surgical intensive care units. Transition probabilities were derived from 920 participants stratified by sequential organ failure assessment (SOFA) scores to identify severity of illness. The model was validated in 3 independent cohorts with 349, 158, and 117 participants from quaternary care academic hospitals. Monte Carlo microsimulation was performed, followed by probabilistic sensitivity analysis. Outcomes were assessed in the overall cohort and in solid tumors alone. INTERVENTIONS Time-unlimited vs time-limited trials of intensive care. MAIN OUTCOMES AND MEASURES 30-day all-cause mortality and mean survival duration. RESULTS The SOFA scores at ICU admission were significantly associated with mortality. A 3-, 8-, or 15-day trial of intensive care resulted in decreased mean 30-day survival vs aggressive care in all but the sickest patients (SOFA score, 5–9: 48.4% [95% CI, 48.0%–48.8%], 60.6% [95% CI, 60.2%–61.1%], and 66.8% [95% CI, 66.4%–67.2%], respectively, vs 74.6% [95% CI, 74.3%–75.0%] with time-unlimited aggressive care; SOFA score, 10–14: 36.2% [95% CI, 35.8%–36.6%], 44.1% [95% CI, 43.6%–44.5%], and 46.1% [95% CI, 45.6%–46.5%], respectively, vs 48.4% [95% CI, 48.0%–48.8%] with aggressive care; SOFA score, ≥15: 5.8% [95

  14. Oral transit time: a critical review of the literature

    PubMed Central

    SOARES, Thais Jacóe; MORAES, Danielle Pedroni; de MEDEIROS, Gisele Chagas; SASSI, Fernanda Chiarion; ZILBERSTEIN, Bruno; de ANDRADE, Claudia Regina Furquim

    2015-01-01

    Introduction Oral transit time is one of the parameters observed during the clinical assessment of the swallowing function. The importance of this parameter is due to its impact on the total duration of a meal, whose consequence can be an unfavorable nutritional prognostic. Objective To document scientific papers that measure oral transit time in healthy subjects. Method The review followed the steps proposed by the Cochrane Handbook. The search was done via the PubMed database through the use of descriptors related to the oral phase of swallowing, as well as to types of food consistency. Results The articles on the theme had different definitions for oral transit time, as well as heterogeneity of tested volumes, age and gender of the participants. The times found varied from 0.35 s to 1.54 s for liquids, from 0.39 s to 1.05 s for pasty foods and from 1 s to 12.8 s for solid foods. Also, regardless of volume or consistency, oral transit time in elderly people is significantly longer than in adults. Conclusion There's no consensus in the literature about oral transit time in healthy subjects. However, this parameter should be valued during the assessment of the swallowing function due to its negative impact on the dynamics of swallowing, which can cause high energy expenditure during feeding. PMID:26176255

  15. Time Trials versus Time to Exhaustion Tests: Effects on Critical Power, W' and Oxygen Uptake Kinetics.

    PubMed

    Karsten, Bettina; Baker, Jonathan; Naclerio, Fernando; Klose, Andreas; Bianco, Antonino; Nimmerichter, Alfred

    2017-05-22

    To investigate single-day time-to-exhaustion (TTE) and time trial (TT) based laboratory tests values of critical power (CP), Wprime (W') and respective oxygen kinetics responses. Twelve cyclists performed a maximal ramp test followed by three TTE and three TT efforts interspersed by a 60-min recovery between efforts. Oxygen uptake was measured during all trials. The mean response time (MRT) was calculated as a description of the overall V̇O2 kinetic response from the onset to 2 min of exercise. TTE determined CP was 279 ± 52W and TT determined CP was 276 ± 50W (P = 0.237). Values of W' were 14.3 ± 3.4 kJ (TTE W') and 16.5± 4.2 kJ (TT W') (P = 0.028). Whilst a high level of agreement (-12 to 17 W) and a low prediction error of 2.7% was established for CP, for W' limits of agreements were markedly lower (-8 to 3.7 kJ) with a prediction error of 18.8%. The mean standard error for TTE CP values was significantly higher than that for TT CP values (2.4 ± 1.9% vs. 1.2 ± 0.7% W). The standard error for TTE W' and TT W' were 11.2 ± 8.1% and 5.6 ± 3.6%, respectively. The V̇O2 response was significantly faster during TT (~22 s) than TTE (~28 s). The time-trial protocol with a 60-min recovery period offers a valid, time-saving and less error containing alternative to conventional and more recent testing methods. Results however cannot be transferred to W'.

  16. Advancing critical care: time to kiss the right frog

    PubMed Central

    2013-01-01

    The greatest advances in critical care over the past two decades have been achieved through doing less to the patient. We have learnt through salutary experience that our burgeoning Master-of-the-Universe capabilities and the oh-so-obvious stratagems instilled in us from youth were often ineffective or even deleterious. This re-education process, however, is far from complete. We are now rightly agonizing over the need for better characterization of pathophysiology, earlier identification of disease processes and a more directed approach to therapeutic intervention. We need to delineate the point at which intrinsic and protective adaptation ends and true harmful pathology begins, and how our iatrogenic meddling either helps or hinders. We need to improve trial design in the heterogeneous populations we treat, and to move away from syndromic fixations that, while offering convenience, have generally proved counterproductive. Importantly, we need to discover a far more holistic approach to patient care, evolving from the prevailing overmedicalized, number-crunching perspective towards a true multidisciplinary effort that embraces psychological as well as physiological well-being, with appropriate pharmacological minimization or supplementation. Complacency, with an unfair apportion of blame on the patient for not getting better, is the biggest threat to continued improvement. PMID:23514321

  17. Long-range temporal correlations in neural narrowband time-series arise due to critical dynamics.

    PubMed

    Blythe, Duncan A J; Nikulin, Vadim V

    2017-01-01

    We show theoretically that the hypothesis of criticality as a theory of long-range fluctuation in the human brain may be distinguished from the theory of passive filtering on the basis of macroscopic neuronal signals such as the electroencephalogram, using novel theory of narrowband amplitude time-series at criticality. Our theory predicts the division of critical activity into meta-universality classes. As a consequence our analysis shows that experimental electroencephalography data favours the hypothesis of criticality in the human brain.

  18. Time Critical Targeting Concept of Operations (CONOPS) Interactions

    DTIC Science & Technology

    2011-05-01

    video.  1 Low Earth Orbit (LEO) SBR constellation overhead 40-80% of time with SAR and GMTI.  1 Rivet Joint orbit or Signals Intelligence (SIGINT...1217, Springer -Verlag 1997, 203-208. Keithley, H, “Space Based Radar Utility Analysis”, DSC FY02 Study Task 1 (DSC 02-1), Volume III Tracking

  19. Global Positioning System Timing Criticality Assessment - Preliminary Performance Results

    DTIC Science & Technology

    2008-12-01

    average person doesn’t realize how much infrastructure is based on GPS and how vulnerable it is,” said Brent Ledvina of Virginia Tech, who helped...incorrect time or location appears on the intended receiver. “It looks exactly like a real GPS signal,” said Ledvina . “Everything looks completely

  20. A Critical Analysis of Time Allocation in Psychoeducational Evaluations

    ERIC Educational Resources Information Center

    Taub, Gordon E.; Valentine, Jennifer

    2014-01-01

    This study provides results form a national survey examining school psychologists' allocation of time in psychoeducational evaluations. A total of 177 participants with an average of 13.45 years professional experience in school psychology, representing 39 states, participated in the survey. The results indicate that school psychologists spend the…

  1. Automatic Verification of Timing Constraints for Safety Critical Space Systems

    NASA Astrophysics Data System (ADS)

    Fernandez, Javier; Parra, Pablo; Sanchez Prieto, Sebastian; Polo, Oscar; Bernat, Guillem

    2015-09-01

    In this paper is presented an automatic process of verification. We focus in the verification of scheduling analysis parameter. This proposal is part of process based on Model Driven Engineering to automate a Verification and Validation process of the software on board of satellites. This process is implemented in a software control unit of the energy particle detector which is payload of Solar Orbiter mission. From the design model is generated a scheduling analysis model and its verification model. The verification as defined as constraints in way of Finite Timed Automatas. When the system is deployed on target the verification evidence is extracted as instrumented points. The constraints are fed with the evidence, if any of the constraints is not satisfied for the on target evidence the scheduling analysis is not valid.

  2. Application of queueing models to multiprogrammed computer systems operating in a time-critical environment

    NASA Technical Reports Server (NTRS)

    Eckhardt, D. E., Jr.

    1979-01-01

    A model of a central processor (CPU) which services background applications in the presence of time critical activity is presented. The CPU is viewed as an M/M/1 queueing system subject to periodic interrupts by deterministic, time critical process. The Laplace transform of the distribution of service times for the background applications is developed. The use of state of the art queueing models for studying the background processing capability of time critical computer systems is discussed and the results of a model validation study which support this application of queueing models are presented.

  3. Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study.

    PubMed

    Sprung, Charles L; Truog, Robert D; Curtis, J Randall; Joynt, Gavin M; Baras, Mario; Michalsen, Andrej; Briegel, Josef; Kesecioglu, Jozef; Efferen, Linda; De Robertis, Edoardo; Bulpa, Pierre; Metnitz, Philipp; Patil, Namrata; Hawryluck, Laura; Manthous, Constantine; Moreno, Rui; Leonard, Sara; Hill, Nicholas S; Wennberg, Elisabet; McDermid, Robert C; Mikstacki, Adam; Mularski, Richard A; Hartog, Christiane S; Avidan, Alexander

    2014-10-15

    Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate. Country coordinators were identified and draft statements were developed for major end-of-life issues and translated into six languages. Multidisciplinary responses using a web-based survey assessed agreement or disagreement with definitions and statements linked to anonymous demographic information. Consensus was prospectively defined as >80% agreement. Definitions and statements not obtaining consensus were revised based on comments of respondents, and then translated and redistributed. Of the initial 1,283 responses from 32 countries, consensus was found for 66 (81%) of the 81 definitions and statements; 26 (32%) had >90% agreement. With 83 additional responses to the original questionnaire (1,366 total) and 604 responses to the revised statements, consensus could be obtained for another 11 of the 15 statements. Consensus was obtained for informed consent, withholding and withdrawing life-sustaining treatment, legal requirements, intensive care unit therapies, cardiopulmonary resuscitation, shared decision making, medical and nursing consensus, brain death, and palliative care. Consensus was obtained for 77 of 81 (95%) statements. Worldwide consensus could be developed for the majority of definitions and statements about end-of-life practices. Statements achieving consensus provide standards of practice for end-of-life care; statements without consensus identify important areas for future research.

  4. Universal short-time quantum critical dynamics of finite-size systems

    NASA Astrophysics Data System (ADS)

    Shu, Yu-Rong; Yin, Shuai; Yao, Dao-Xin

    2017-09-01

    We investigate the short-time quantum critical dynamics in the imaginary-time relaxation processes of finite-size systems. Universal scaling behaviors exist in the imaginary-time evolution. In particular, the system undergoes a critical initial slip stage characterized by an exponent θ , in which an initial power-law increase emerges in the imaginary-time correlation function when the initial state has a zero order parameter and a vanishing correlation length. Under different initial conditions, the quantum critical point and critical exponents can be determined from the universal scaling behaviors. We apply the method to the one- and two-dimensional transverse field Ising models using quantum Monte Carlo (QMC) simulations. In the one-dimensional case, we locate the quantum critical point at (h/J ) c=1.000 03 (8 ) in the thermodynamic limit, and we estimate the critical initial slip exponent θ =0.3734 (2 ) and the static exponent β /ν =0.1251 (2 ) by analyzing data on chains of length L =32 -256 and 48-256, respectively. For the two-dimensional square-lattice system, the critical coupling ratio is given by 3.044 51 (7 ) in the thermodynamic limit, while the critical exponents are θ =0.209 (4 ) and β /ν =0.518 (1 ) estimated by data on systems of size L =24 -64 and 32-64, respectively. Remarkably, the critical initial slip exponents obtained in both models are notably distinct from their classical counterparts due to the essential differences between classical and quantum dynamics. The short-time critical dynamics and the imaginary-time relaxation QMC approach can be readily adapted to various models.

  5. Long-range temporal correlations in neural narrowband time-series arise due to critical dynamics

    PubMed Central

    Blythe, Duncan A. J.; Nikulin, Vadim V.

    2017-01-01

    We show theoretically that the hypothesis of criticality as a theory of long-range fluctuation in the human brain may be distinguished from the theory of passive filtering on the basis of macroscopic neuronal signals such as the electroencephalogram, using novel theory of narrowband amplitude time-series at criticality. Our theory predicts the division of critical activity into meta-universality classes. As a consequence our analysis shows that experimental electroencephalography data favours the hypothesis of criticality in the human brain. PMID:28472078

  6. Notification: Evaluation of Time-Critical Removal Actions for Superfund Sites

    EPA Pesticide Factsheets

    Project #OPE-FY15-0019, February 4, 2015. The EPA OIG plans to begin preliminary research on the evaluation of the effectiveness of time-critical removal actions for Superfund sites on February 24, 2015.

  7. Memo: Request for Approval of a Time-Critical Removal Action and $2 Million

    EPA Pesticide Factsheets

    The purpose of this Action Memorandum is to request and document approval of a time-critical removal action described herein for the Mississippi Phosphates Corporation Site (Site) located at 601 Industrial Road, Pascagoula, Jackson County, Mississippi.

  8. Incubation time for sub-critical crack propagation in SiC-SiC composites

    SciTech Connect

    El-Azab, A.; Ghoniem, N.M.

    1995-04-01

    The objective of this work is to investigate the time for sub-critical crack propagation is SiC-SiC composites at high temperatures. The effects of fiber thermal creep on the relaxation of crack bridging tractions in SiC-SiC ceramic matrix composites (CMCs) is considered in the present work, with the objective of studying the time-to propagation of sub-critical matrix cracks in this material at high temperatures. Under the condition of fiber stress relaxation in the bridiging zone, it is found that the crack opening and the stress intensity factor increase with time for sub-critical matrix cracks. The time elapsed before the stress intensity reaches the critical value for crack propagation is calculated as a function of the initial crack length, applied stress and temperature. Stability domains for matrix cracks are defined, which provide guidelines for conducting high-temperature crack propagation experiments.

  9. Methods for Detecting Early Warnings of Critical Transitions in Time Series Illustrated Using Simulated Ecological Data

    PubMed Central

    Dakos, Vasilis; Carpenter, Stephen R.; Brock, William A.; Ellison, Aaron M.; Guttal, Vishwesha; Ives, Anthony R.; Kéfi, Sonia; Livina, Valerie; Seekell, David A.; van Nes, Egbert H.; Scheffer, Marten

    2012-01-01

    Many dynamical systems, including lakes, organisms, ocean circulation patterns, or financial markets, are now thought to have tipping points where critical transitions to a contrasting state can happen. Because critical transitions can occur unexpectedly and are difficult to manage, there is a need for methods that can be used to identify when a critical transition is approaching. Recent theory shows that we can identify the proximity of a system to a critical transition using a variety of so-called ‘early warning signals’, and successful empirical examples suggest a potential for practical applicability. However, while the range of proposed methods for predicting critical transitions is rapidly expanding, opinions on their practical use differ widely, and there is no comparative study that tests the limitations of the different methods to identify approaching critical transitions using time-series data. Here, we summarize a range of currently available early warning methods and apply them to two simulated time series that are typical of systems undergoing a critical transition. In addition to a methodological guide, our work offers a practical toolbox that may be used in a wide range of fields to help detect early warning signals of critical transitions in time series data. PMID:22815897

  10. Critical Issue Bibliography (CRIB) Sheet: Part-Time and Adjunct Faculty.

    ERIC Educational Resources Information Center

    ERIC Clearinghouse on Higher Education, Washington, DC.

    This CRitical Issue Bibliography (CRIB) Sheet focuses on issues related to part-time and adjunct faculty. It is clear that part-time faculty are now a substantial entity within academe and need to be understood better. This CRIB sheet lists resources that address: (1) trends in contracts, numbers, or conditions of part-time faculty; (2) issues…

  11. Developmental critical windows and sensitive periods as three-dimensional constructs in time and space.

    PubMed

    Burggren, Warren W; Mueller, Casey A

    2015-01-01

    A critical window (sensitive period) represents a period during development when an organism's phenotype is responsive to intrinsic or extrinsic (environmental) factors. Such windows represent a form of developmental phenotypic plasticity and result from the interaction between genotype and environment. Critical windows have typically been defined as comprising discrete periods in development with a distinct starting time and end time, as identified by experiments following an on and an off protocol. Yet in reality, periods of responsiveness during development are likely more ambiguous that depicted. Our goal is to extend the concept of the developmental critical window by introducing a three-dimensional construct in which time during development, dose of the stressor applied, and the resultant phenotypic modification can be utilized to more realistically define a critical window. Using the example of survival of the brine shrimp (Artemia franciscana) during exposure to different salinity levels during development, we illustrate that it is not just stressor dose or exposure time but the interaction of these two factors that results in the measured phenotypic change, which itself may vary within a critical window. We additionally discuss a systems approach to critical windows, in which the components of a developing system--whether they be molecular, physiological, or morphological--may show differing responses with respect to time and dose. Thus, the plasticity of each component may contribute to a broader overall system response.

  12. Critical short-time dynamics in a system with interacting static and diffusive populations

    NASA Astrophysics Data System (ADS)

    Argolo, C.; Quintino, Yan; Gleria, Iram; Lyra, M. L.

    2012-01-01

    We study the critical short-time dynamical behavior of a one-dimensional model where diffusive individuals can infect a static population upon contact. The model presents an absorbing phase transition from an active to an inactive state. Previous calculations of the critical exponents based on quasistationary quantities have indicated an unusual crossover from the directed percolation to the diffusive contact process universality classes. Here we show that the critical exponents governing the slow short-time dynamic evolution of several relevant quantities, including the order parameter, its relative fluctuations, and correlation function, reinforce the lack of universality in this model. Accurate estimates show that the critical exponents are distinct in the regimes of low and high recovery rates.

  13. The general critical analysis for continuous-time UPPAM recurrent neural networks.

    PubMed

    Qiao, Chen; Jing, Wen-Feng; Fang, Jian; Wang, Yu-Ping

    2016-01-29

    The uniformly pseudo-projection-anti-monotone (UPPAM) neural network model, which can be considered as the unified continuous-time neural networks (CNNs), includes almost all of the known CNNs individuals. Recently, studies on the critical dynamics behaviors of CNNs have drawn special attentions due to its importance in both theory and applications. In this paper, we will present the analysis of the UPPAM network under the general critical conditions. It is shown that the UPPAM network possesses the global convergence and asymptotical stability under the general critical conditions if the network satisfies one quasi-symmetric requirement on the connective matrices, which is easy to be verified and applied. The general critical dynamics have rarely been studied before, and this work is an attempt to gain an meaningful assurance of general critical convergence and stability of CNNs. Since UPPAM network is the unified model for CNNs, the results obtained here can generalize and extend the existing critical conclusions for CNNs individuals, let alone those non-critical cases. Moreover, the easily verified conditions for general critical convergence and stability can further promote the applications of CNNs.

  14. The general critical analysis for continuous-time UPPAM recurrent neural networks*

    PubMed Central

    Qiao, Chen; Jing, Wen-Feng; Fang, Jian; Wang, Yu-Ping

    2015-01-01

    The uniformly pseudo-projection-anti-monotone (UPPAM) neural network model, which can be considered as the unified continuous-time neural networks (CNNs), includes almost all of the known CNNs individuals. Recently, studies on the critical dynamics behaviors of CNNs have drawn special attentions due to its importance in both theory and applications. In this paper, we will present the analysis of the UPPAM network under the general critical conditions. It is shown that the UPPAM network possesses the global convergence and asymptotical stability under the general critical conditions if the network satisfies one quasi-symmetric requirement on the connective matrices, which is easy to be verified and applied. The general critical dynamics have rarely been studied before, and this work is an attempt to gain an meaningful assurance of general critical convergence and stability of CNNs. Since UPPAM network is the unified model for CNNs, the results obtained here can generalize and extend the existing critical conclusions for CNNs individuals, let alone those non-critical cases. Moreover, the easily verified conditions for general critical convergence and stability can further promote the applications of CNNs. PMID:26858512

  15. Aircraft Alerting Systems Standardization Study. Volume I. Candidate System Validation and Time-Critical Display Evaluation.

    DTIC Science & Technology

    1981-01-01

    provided by John Hendrickson, ARD 340, the contract monitor. V & VI TABLE OF CONTENTS legal... No. Tite Pegs No. L l s tort............................ vii...102 5.2.2-1 Summary Table for Time-Critical Response Time.................. 104 uWil LIST OF ABBREVIATIONS ADI Attitude Director Indicator ALPA

  16. Supervisory-level interruption recovery in time-critical control tasks.

    PubMed

    Sasangohar, Farzan; Scott, Stacey D; Cummings, M L

    2014-07-01

    This paper investigates the effectiveness of providing interruption recovery assistance in the form of an interactive visual timeline of historical events on a peripheral display in support of team supervision in time-critical settings. As interruptions can have detrimental effects on task performance, particularly in time-critical work environments, there is growing interest in the design of tools to assist people in resuming their pre-interruption activity. A user study was conducted to evaluate the use of an interactive event timeline that provides assistance to human supervisors in time-critical settings. The study was conducted in an experimental platform that emulated a team of operators and a mission commander performing a time-critical unmanned aerial vehicle (UAV) mission. The study results showed that providing interruption assistance enabled people to recover from interruptions faster and more accurately. These results have implications for interface design that could be adopted in similar time-critical environments such as air-traffic control, process control, and first responders.

  17. Natural time analysis of critical phenomena: The case of pre-fracture electromagnetic emissions

    SciTech Connect

    Potirakis, S. M.; Karadimitrakis, A.; Eftaxias, K.

    2013-06-15

    Criticality of complex systems reveals itself in various ways. One way to monitor a system at critical state is to analyze its observable manifestations using the recently introduced method of natural time. Pre-fracture electromagnetic (EM) emissions, in agreement to laboratory experiments, have been consistently detected in the MHz band prior to significant earthquakes. It has been proposed that these emissions stem from the fracture of the heterogeneous materials surrounding the strong entities (asperities) distributed along the fault, preventing the relative slipping. It has also been proposed that the fracture of heterogeneous material could be described in analogy to the critical phase transitions in statistical physics. In this work, the natural time analysis is for the first time applied to the pre-fracture MHz EM signals revealing their critical nature. Seismicity and pre-fracture EM emissions should be two sides of the same coin concerning the earthquake generation process. Therefore, we also examine the corresponding foreshock seismic activity, as another manifestation of the same complex system at critical state. We conclude that the foreshock seismicity data present criticality features as well.

  18. Universal time-dependent dispersion properties for diffusion in a one-dimensional critically tilted potential

    NASA Astrophysics Data System (ADS)

    Guérin, T.; Dean, D. S.

    2017-01-01

    We consider the time-dependent dispersion properties of overdamped tracer particles diffusing in a one-dimensional periodic potential under the influence of an additional constant tilting force F . The system is studied in the region where the force is close to the critical value Fc at which the barriers separating neighboring potential wells disappear. We show that, when F crosses the critical value, the shape of the mean-square displacement (MSD) curves is strongly modified. We identify a diffusive regime at intermediate-time scales with an effective diffusion coefficient which is much larger than the late-time diffusion coefficient for F >Fc , whereas for F time and intermediate-time diffusive regimes are indistinguishable. Explicit asymptotic regimes for the MSD curves are identified at all time scales.

  19. Real-time Determination of F-region Critical Frequencies Using SuperDARN

    NASA Astrophysics Data System (ADS)

    Hughes, J. M.; Bristow, W. A.

    2004-12-01

    In addition to detecting backscatter from ionospheric field-aligned irregularities, SuperDARN radars are sensitive to ground scatter returns. The profiles of these returns vary in a systematic manner with frequency and can be used to determine HF propagation characteristics and ionospheric critical frequencies. The large spatial coverage and good time resolution provided by the SuperDARN network make it possible to produce maps of high-latitude critical frequencies approximately every 15 minutes. Recent upgrades to the SuperDARN operating software provide the capability to receive the ground scatter profiles and angle of arrival information in real-time via the internet and we use these data to construct near real-time maps of F-region critical frequencies. In this paper, the technique will be described and representative data will be discussed.

  20. Modeling, Evaluation and Detection of Jamming Attacks in Time-Critical Wireless Applications

    DTIC Science & Technology

    2014-08-01

    the delivery of a time-critical message and the behavior of a gambler who intends to win a gambling game. Therefore, by gambling -based modeling and...attempts to disrupt the delivery of a time-critical message and the behavior of a gambler who intends to win a gambling game. Therefore, by gambling -based...as the behavior of a gambler who intends to win each play in a game to collect enough fortune to achieve his gambling goal of σ dollars. Motivated by

  1. Time-Critical Cooperative Path Following of Multiple UAVs over Time-Varying Networks

    DTIC Science & Technology

    2011-01-01

    Contract No. W911NF-06-1-0330. †PhD Candidate, Department of Mechanical Science & Engineering, University of Illinois at Urbana-Champaign; xar- gay ...vehicle is allowed to exchange only its coordination parameter ξi(t) with its neigh- bors Gi, which are defined by the possibly time-varying communications

  2. Critical ischemia time in a model of spinal cord section. A study performed on dogs

    PubMed Central

    Garcia Martinez, David; Rosales Corral, Sergio A.; Flores Soto, Mario E.; Velarde Silva, Gustavo; Portilla de Buen, Eliseo

    2006-01-01

    Vascular changes after acute spinal cord trauma are important factors that predispose quadriplegia, in most cases irreversible. Repair of the spinal blood flow helps the spinal cord recovery. The average time to arrive and perform surgery is 3 h in most cases. It is important to determine the critical ischemia time in order to offer better functional prognosis. A spinal cord section and vascular clamping of the spinal anterior artery at C5–C6 model was used to determine critical ischemia time. The objective was to establish a critical ischemia time in a model of acute spinal cord section. Four groups of dogs were used, anterior approach and vascular clamp of spinal anterior artery with 1, 2, 3, and 4 h of ischemia and posterior hemisection of spinal cord at C5–C6 was performed. Clinical evaluation was made during 12 weeks and morphological evaluation at the end of this period. We obtained a maximal neurological coordination at 23 days average. Two cases showed sequels of right upper limb paresis at 1 and 3 ischemia hours. There was nerve conduction delay of 56% at 3 h of ischemia. Morphological examination showed 25% of damaged area. The VIII and IX Rexed’s laminae were the most affected. The critical ischemia time was 3 h. Dogs with 4 h did not exhibit any recovery. PMID:17024402

  3. Critical time delay of the pineal melatonin rhythm in humans due to weak electromagnetic exposure.

    PubMed

    Halgamuge, Malka N

    2013-08-01

    Electromagnetic fields (EMFs) can increase free radicals, activate the stress response and alter enzyme reactions. Intracellular signalling is mediated by free radicals and enzyme kinetics is affected by radical pair recombination rates. The magnetic field component of an external EMF can delay the "recombination rate" of free radical pairs. Magnetic fields thus increase radical life-times in biological systems. Although measured in nanoseconds, this extra time increases the potential to do more damage. Melatonin regulates the body's sleep-wake cycle or circadian rhythm. The World Health Organization (WHO) has confirmed that prolonged alterations in sleep patterns suppress the body's ability to make melatonin. Considerable cancer rates have been attributed to the reduction of melatonin production as a result of jet lag and night shift work. In this study, changes in circadian rhythm and melatonin concentration are observed due to the external perturbation of chemical reaction rates. We further analyze the pineal melatonin rhythm and investigate the critical time delay or maturation time of radical pair recombination rates, exploring the impact of the mRNA degradation rate on the critical time delay. The results show that significant melatonin interruption and changes to the circadian rhythm occur due to the perturbation of chemical reaction rates, as also reported in previous studies. The results also show the influence of the mRNA degradation rate on the circadian rhythm's critical time delay or maturation time. The results support the hypothesis that exposure to weak EMFs via melatonin disruption can adversely affect human health.

  4. Pedagogy in Catastrophic Times: Giroux and the Tasks of Critical Public Intellectuals

    ERIC Educational Resources Information Center

    Morris, Doug

    2012-01-01

    This article reflects on Henry Giroux's work as a critical public intellectual and the important role his work plays in fostering educated hope and insurgent possibilities during our present times of daily and longer term catastrophes. In addition to attempting to capture the experience of what it means and how it feels to read Giroux along with…

  5. Identifying the Critical Time Period for Information Extraction when Recognizing Sequences of Play

    ERIC Educational Resources Information Center

    North, Jamie S.; Williams, A. Mark

    2008-01-01

    The authors attempted to determine the critical time period for information extraction when recognizing play sequences in soccer. Although efforts have been made to identify the perceptual information underpinning such decisions, no researchers have attempted to determine "when" this information may be extracted from the display. The authors…

  6. Individual Differences and Time-Sharing Ability: A Critical Review and Analysis.

    ERIC Educational Resources Information Center

    Ackerman, Phillip L.; And Others

    Statistical methods employed to test individual differences in dual-task performance and the existence of a general time-sharing ability are reviewed and critiqued. Specifically, both the types of data being collected and the types of data analysis procedures have been inadequate to the critical evaluation of a hypothetical…

  7. Pedagogy in Catastrophic Times: Giroux and the Tasks of Critical Public Intellectuals

    ERIC Educational Resources Information Center

    Morris, Doug

    2012-01-01

    This article reflects on Henry Giroux's work as a critical public intellectual and the important role his work plays in fostering educated hope and insurgent possibilities during our present times of daily and longer term catastrophes. In addition to attempting to capture the experience of what it means and how it feels to read Giroux along with…

  8. Online versus Face-to-Face Training of Critical Time Intervention: A Matching Cluster Randomized Trial

    ERIC Educational Resources Information Center

    Olivet, Jeffrey; Zerger, Suzanne; Greene, R. Neil; Kenney, Rachael R.; Herman, Daniel B.

    2016-01-01

    This study examined the effectiveness of online education to providers who serve people experiencing homelessness, comparing online and face-to-face training of Critical Time Intervention (CTI), an evidence-based case management model. The authors recruited 184 staff from nineteen homeless service agencies to participate in one of two training…

  9. Online versus Face-to-Face Training of Critical Time Intervention: A Matching Cluster Randomized Trial

    ERIC Educational Resources Information Center

    Olivet, Jeffrey; Zerger, Suzanne; Greene, R. Neil; Kenney, Rachael R.; Herman, Daniel B.

    2016-01-01

    This study examined the effectiveness of online education to providers who serve people experiencing homelessness, comparing online and face-to-face training of Critical Time Intervention (CTI), an evidence-based case management model. The authors recruited 184 staff from nineteen homeless service agencies to participate in one of two training…

  10. Identifying the Critical Time Period for Information Extraction when Recognizing Sequences of Play

    ERIC Educational Resources Information Center

    North, Jamie S.; Williams, A. Mark

    2008-01-01

    The authors attempted to determine the critical time period for information extraction when recognizing play sequences in soccer. Although efforts have been made to identify the perceptual information underpinning such decisions, no researchers have attempted to determine "when" this information may be extracted from the display. The authors…

  11. Burst wait time simulation of CALIBAN reactor at delayed super-critical state

    SciTech Connect

    Humbert, P.; Authier, N.; Richard, B.; Grivot, P.; Casoli, P.

    2012-07-01

    In the past, the super prompt critical wait time probability distribution was measured on CALIBAN fast burst reactor [4]. Afterwards, these experiments were simulated with a very good agreement by solving the non-extinction probability equation [5]. Recently, the burst wait time probability distribution has been measured at CEA-Valduc on CALIBAN at different delayed super-critical states [6]. However, in the delayed super-critical case the non-extinction probability does not give access to the wait time distribution. In this case it is necessary to compute the time dependent evolution of the full neutron count number probability distribution. In this paper we present the point model deterministic method used to calculate the probability distribution of the wait time before a prescribed count level taking into account prompt neutrons and delayed neutron precursors. This method is based on the solution of the time dependent adjoint Kolmogorov master equations for the number of detections using the generating function methodology [8,9,10] and inverse discrete Fourier transforms. The obtained results are then compared to the measurements and Monte-Carlo calculations based on the algorithm presented in [7]. (authors)

  12. Critical moments in time: reflections on the development of orthogonal acceleration time-of-flight mass spectrometry.

    PubMed

    Sheil, Margaret M

    2012-08-01

    This paper reflects on the historical development of orthogonal acceleration time-of-flight analyzers that have been used routinely for high sensitivity analyses of biological molecules for more than a decade. In particular, the role of the late Michael Guilhaus from the University of New South Wales in Australia is highlighted. This account shows that like most advances in science, successful commercialization of new technology is not straightforward and is often the result of critical contributions of different people and organizations at different points in time.

  13. Critical capacity, travel time delays and travel time distribution of rapid mass transit systems

    NASA Astrophysics Data System (ADS)

    Legara, Erika Fille; Monterola, Christopher; Lee, Kee Khoon; Hung, Gih Guang

    2014-07-01

    We set up a mechanistic agent-based model of a rapid mass transit system. Using empirical data from Singapore's unidentifiable smart fare card, we validate our model by reconstructing actual travel demand and duration of travel statistics. We subsequently use this model to investigate two phenomena that are known to significantly affect the dynamics within the RTS: (1) overloading in trains and (2) overcrowding in the RTS platform. We demonstrate that by varying the loading capacity of trains, a tipping point emerges at which an exponential increase in the duration of travel time delays is observed. We also probe the impact on the rail system dynamics of three types of passenger growth distribution across stations: (i) Dirac delta, (ii) uniform and (iii) geometric, which is reminiscent of the effect of land use on transport. Under the assumption of a fixed loading capacity, we demonstrate the dependence of a given origin-destination (OD) pair on the flow volume of commuters in station platforms.

  14. Cyber-Critical Infrastructure Protection Using Real-Time Payload-Based Anomaly Detection

    NASA Astrophysics Data System (ADS)

    Düssel, Patrick; Gehl, Christian; Laskov, Pavel; Bußer, Jens-Uwe; Störmann, Christof; Kästner, Jan

    With an increasing demand of inter-connectivity and protocol standardization modern cyber-critical infrastructures are exposed to a multitude of serious threats that may give rise to severe damage for life and assets without the implementation of proper safeguards. Thus, we propose a method that is capable to reliably detect unknown, exploit-based attacks on cyber-critical infrastructures carried out over the network. We illustrate the effectiveness of the proposed method by conducting experiments on network traffic that can be found in modern industrial control systems. Moreover, we provide results of a throughput measuring which demonstrate the real-time capabilities of our system.

  15. Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department

    PubMed Central

    Nadir, Nur-Ain; Bentley, Suzanne; Papanagnou, Dimitrios; Bajaj, Komal; Rinnert, Stephan; Sinert, Richard

    2017-01-01

    Introduction Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). Methods We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining >100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. Results The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. Conclusion This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing

  16. Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department.

    PubMed

    Nadir, Nur-Ain; Bentley, Suzanne; Papanagnou, Dimitrios; Bajaj, Komal; Rinnert, Stephan; Sinert, Richard

    2017-01-01

    Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining >100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency

  17. Service oriented architecture to support real-time implementation of artifact detection in critical care monitoring.

    PubMed

    Nizami, Shermeen; Green, James Robert; McGregor, Carolyn

    2011-01-01

    The quality of automated real-time critical care monitoring is impacted by the degree of signal artifact present in clinical data. This is further complicated when different clinical rules applied for disease detection require source data at different frequencies and different signal quality. This paper proposes a novel multidimensional framework based on service oriented architecture to support real-time implementation of clinical artifact detection in critical care settings. The framework is instantiated through a Neonatal Intensive Care case study which assesses signal quality of physiological data streams prior to detection of late-onset neonatal sepsis. In this case study requirements and provisions of artifact and clinical event detection are determined for real-time clinical implementation, which forms the second important contribution of this paper.

  18. Universal time fluctuations in near-critical out-of-equilibrium quantum dynamics.

    PubMed

    Campos Venuti, Lorenzo; Zanardi, Paolo

    2014-02-01

    Out-of-equilibrium quantum systems display complex temporal patterns. Such time fluctuations are generically exponentially small in the system volume and therefore can be safely ignored in most of the cases. However, if one consider small quench experiments, time fluctuations can be greatly enhanced. We show that time fluctuations may become stronger than other forms of equilibrium quantum fluctuations if the quench is performed close to a critical point. For sufficiently relevant operators the full distribution function of dynamically evolving observable expectation values becomes a universal function uniquely characterized by the critical exponents and the boundary conditions. At regular points of the phase diagram and for nonsufficiently relevant operators the distribution becomes Gaussian. Our predictions are confirmed by an explicit calculation on the quantum Ising model.

  19. Spinodals and critical point using short-time dynamics for a simple model of liquid.

    PubMed

    Loscar, Ernesto S; Ferrara, C Gastón; Grigera, Tomás S

    2016-04-07

    We have applied the short-time dynamics method to the gas-liquid transition to detect the supercooled gas instability (gas spinodal) and the superheated liquid instability (liquid spinodal). Using Monte Carlo simulation, we have obtained the two spinodals for a wide range of pressure in sub-critical and critical conditions and estimated the critical temperature and pressure. Our method is faster than previous approaches and allows studying spinodals without needing equilibration of the system in the metastable region. It is thus free of the extrapolation problems present in other methods, and in principle could be applied to systems such as glass-forming liquids, where equilibration is very difficult even far from the spinodal. We have also done molecular dynamics simulations, where we find the method again able to detect the both spinodals. Our results are compared with different previous results in the literature and show a good agreement.

  20. Relaxation time and critical slowing down of a spin-torque oscillator

    NASA Astrophysics Data System (ADS)

    Taniguchi, Tomohiro; Ito, Takahiro; Tsunegi, Sumito; Kubota, Hitoshi; Utsumi, Yasuhiro

    2017-07-01

    The relaxation phenomena of spin-torque oscillators consisting of nanostructured ferromagnets are interesting research targets in magnetism. A theoretical study on the relaxation time of a spin-torque oscillator from one self-oscillation state to another is investigated. By solving the Landau-Lifshitz-Gilbert equation both analytically and numerically, it is shown that the oscillator relaxes to the self-oscillation state exponentially within a few nanoseconds, except when magnetization is close to a critical point. The relaxation rate, which is an inverse of relaxation time, is proportional to the current. On the other hand, a critical slowing down appears near the critical point, where relaxation is inversely proportional to time, and the relaxation time becomes on the order of hundreds of nanoseconds. These conclusions are primarily obtained for a spin-torque oscillator consisting of a perpendicularly magnetized free layer and an in-plane magnetized pinned layer, and are further developed for application to arbitrary types of spin-torque oscillators.

  1. Time-resolved spectral density of interacting fermions following a quench to a superconducting critical point

    NASA Astrophysics Data System (ADS)

    Lemonik, Yonah; Mitra, Aditi

    2017-09-01

    Results are presented for the time evolution of fermions initially in a nonzero temperature normal phase, following the switch on of an attractive interaction. The dynamics are studied in the disordered phase close to the critical point, where the superfluid fluctuations are large. The analysis is conducted within a two-particle irreducible, large N approximation. The system is considered from the perspective of critical quenches where it is shown that the fluctuations follow universal model A dynamics. A signature of this universality is found in a singular correction to the fermion lifetime, given by a scaling form t(3 -d )/2Sd(ɛ2t ) , where d is the spatial dimension, t is the time since the quench, and ɛ is the fermion energy. The singular behavior of the spectral density is interpreted as arising due to incoherent Andreev reflections off superfluid fluctuations.

  2. Impact of duration of structured observations on measurement of handwashing behavior at critical times

    PubMed Central

    2013-01-01

    Background Structured observation is frequently used to measure handwashing at critical events, such as after fecal contact and before eating, but it is time-consuming. We aimed to assess the impact of reducing the duration of structured observation on the number and type of critical events observed. Methods The study recruited 100 randomly selected households, 50 for short 90-minute observations and 50 for long 5-hour observations, in six rural Bangladeshi villages. Based on the first 90 minutes in the long observation households, we estimated the number of critical events for handwashing expected, and compared the expected number to the number of events actually observed in the short observation households. In long observation households, we compared soap use at critical events observed during the first 90 minutes to soap use at events observed during the latter 210 minutes of the 5-hour duration. Results In short 90-minute observation households, the mean number of events observed was lower than the number of events expected: before eating (observed 0.25, expected 0.45, p < 0.05) and after defecation (observed 0.0, expected 0.03, p = 0.06). However, the mean number observed was higher than the expected for food preparation, food serving, and child feeding events. In long 5-hour observation households, soap was used more frequently at critical events observed in the first 90 minutes than in the remaining 210 minutes, but this difference was not significant (p = 0.29). Conclusions Decreasing the duration of handwashing significantly reduced the observation of critical events of interest to evaluators of handwashing programs. Researchers seeking to measure observed handwashing behavior should continue with prolonged duration of structured observation. Future research should develop and evaluate novel models to reduce reactivity to observation and improve the measurement of handwashing behavior. PMID:23915098

  3. Using Six Sigma methodology to reduce patient transfer times from floor to critical-care beds.

    PubMed

    Silich, Stephan J; Wetz, Robert V; Riebling, Nancy; Coleman, Christine; Khoueiry, Georges; Abi Rafeh, Nidal; Bagon, Emma; Szerszen, Anita

    2012-01-01

    In response to concerns regarding delays in transferring critically ill patients to intensive care units (ICU), a quality improvement project, using the Six Sigma process, was undertaken to correct issues leading to transfer delay. To test the efficacy of a Six Sigma intervention to reduce transfer time and establish a patient transfer process that would effectively enhance communication between hospital caregivers and improve the continuum of care for patients. The project was conducted at a 714-bed tertiary care hospital in Staten Island, New York. A Six Sigma multidisciplinary team was assembled to assess areas that needed improvement, manage the intervention, and analyze the results. The Six Sigma process identified eight key steps in the transfer of patients from general medical floors to critical care areas. Preintervention data and a root-cause analysis helped to establish the goal transfer-time limits of 3 h for any individual transfer and 90 min for the average of all transfers. The Six Sigma approach is a problem-solving methodology that resulted in almost a 60% reduction in patient transfer time from a general medical floor to a critical care area. The Six Sigma process is a feasible method for implementing healthcare related quality of care projects, especially those that are complex. © 2011 National Association for Healthcare Quality.

  4. The Role of Time-Limited Trials in Dialysis Decision Making in Critically Ill Patients.

    PubMed

    Scherer, Jennifer S; Holley, Jean L

    2016-02-05

    Technologic advances, such as continuous RRT, provide lifesaving therapy for many patients. AKI in the critically ill patient, a fatal diagnosis in the past, is now often a survivable condition. Dialysis decision making for the critically ill patient with AKI is complex. What was once a question solely of survival now is nuanced by an individual's definition of quality of life, personal values, and short- and long-term prognoses. Clinical evaluation of AKI in the critically ill is multifaceted. Treatment decision making requires consideration of the natural evolution of the patient's AKI within the context of the global prognosis. Situations are often marked by prognostic uncertainty and clinical unknowns. In the face of these uncertainties, establishment of patient-directed therapies is imperative. A time-limited trial of continuous RRT in this setting is often appropriate but difficult to execute. Using patient preferences as a clinical guide, a proper time-limited trial requires assessment of prognosis, elicitation of patient values, strong communication skills, clear documentation, and often, appropriate integration of palliative care services. A well conducted time-limited trial can avoid interprofessional conflict and provide support for the patient, family, and staff. Copyright © 2016 by the American Society of Nephrology.

  5. Real time monitoring of reticle etch process tool to investigate and predict critical dimension performance

    NASA Astrophysics Data System (ADS)

    Deming, Rick; Yung, Karmen; Guglielmana, Mark; Bald, Dan; Baik, Kiho; Abboud, Frank

    2007-03-01

    As mask pattern feature sizes shrink the need for tighter control of factors affecting critical dimensions (CD) increases at all steps in the mask manufacturing process. To support this requirement Intel Mask Operation is expanding its process and equipment monitoring capability. We intend to better understand the factors affecting the process and enhance our ability to predict reticle health and critical dimension performance. This paper describes a methodology by which one can predict the contribution of the dry etch process equipment to overall CD performance. We describe the architecture used to collect critical process related information from various sources both internal and external to the process equipment and environment. In addition we discuss the method used to assess the significance of each parameter and to construct the statistical model used to generate the predictions. We further discuss the methodology used to turn this model into a functioning real time prediction of critical dimension performance. Further, these predictions will be used to modify the manufacturing decision support system to provide early detection for process excursion.

  6. Inadequate critical appraisal of studies in systematic reviews of time to diagnosis.

    PubMed

    Launay, Elise; Cohen, Jérémie F; Morfouace, Michèle; Gras-Le Guen, Christèle; Ravaud, Philippe; Chalumeau, Martin

    2016-10-01

    To analyze tools used to critically appraise primary studies included in systematic reviews (SRs) of time to diagnosis (TTD). We systematically searched MEDLINE via PubMed and Web of Science for SRs of TTD published up to the end of February 2015; we identified and characterized tools used for critical appraisal and classified their items. From 1,936 articles identified, we included 45 SRs that aimed to summarize the available information on the length (n = 16), determinants (n = 31), and/or consequences (n = 14) of TTD. For the 23 SRs (51%) reporting a critical appraisal process, 21 different tools were used, with 232 items assessing quality of reporting (64%), risk of bias or threats to generalizability (43%), statistical issues (5%), and/or an unclear domain (0.5%); 11% were specific to TTD issues. Overall, 36% of the 45 SRs assessed risk of bias and/or threats to generalizability. Assessment of risk of bias and threats to generalizability in primary studies included in SRs of TTD is infrequent, nonstandardized and rarely concerns TTD study specificities. These findings highlight the need for guidance on critical appraisal of studies of TTD. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Time delay of critical images of a point source near the gravitational lens fold-caustic

    NASA Astrophysics Data System (ADS)

    Alexandrov, A.; Zhdanov, V.

    2016-06-01

    Within the framework of the analytical theory of the gravitational lensing we derive asymptotic formula for the time delay of critical images of apoint source, which is situated near a fold-caustic. We found corrections of the first and second order in powers of a parameter, which describescloseness of the source to the caustic. Our formula modifies earlier result by Congdon, Keeton &Nordgren (MNRAS, 2008) obtained in zero-orderapproximation. We have proved the hypothesis put forward by these authors that the first-order correction to the relative time delay of two criticalmages is identically zero. The contribution of the corrections is illustrated in model example by comparison with exact expression.

  8. Fairness of channel access for non-time-critical traffic using the FDDI token ring protocol

    NASA Technical Reports Server (NTRS)

    Johnson, M. J.

    1986-01-01

    The Fiber Distributed Data Interface (FDDI) is an ANSI draft proposed standard for a 100 megabit per second fiber optic token ring. FDDI supports two types of traffic, synchronous and asynchronous. Synchronous traffic is time critical traffic; stations are assigned guaranteed bandwidth to support their synchronous needs. Asynchronous traffic is lower priority and is sent only if time permits. It is proved analytically that the FDDI access protocol provides all stations on the ring with equal access to the channel to transmit asynchronous frames, regardless of the relative sizes of synchronous bandwidth allocations for individual stations. Analytic results are supported with data from simulation runs.

  9. Time-Critical Cooperative Path Following of Multiple UAVs: Case Studies

    DTIC Science & Technology

    2012-10-30

    control algorithm for UAVs in 3D space. Section IV derives a strategy for time-critical cooperative path following of multiple UAVs that relies on the...UAVs in 3D space, in which a fleet of UAVs is tasked to converge to and follow a set of desired feasible paths so as to meet spatial and temporal...cooperative trajectory generation is not addressed in this paper. In fact, it is assumed that a set of desired 3D time trajectories pd,i(td) : R → R3

  10. Self-organized criticality, long-time correlations, and the standard transport paradigm

    SciTech Connect

    Krommes, J.A.

    2000-02-11

    Some aspects of low-frequency, long-wavelength fluctuations are considered. A stochastic model is used to show that power-law time correlations need not arise from self-organized criticality. A formula for the frequency spectrum of uncorrelated, overlapping avalanches is shown to be a special case of the spectral balance equation of renormalized statistical turbulence theory. It is argued that there need be no contradiction between the presence of long-time correlations and the existence of local transport coefficients.

  11. National survey of pediatric critical care medicine fellowship clinical and research time allocation.

    PubMed

    Morrison, Wynne E; Helfaer, Mark A; Nadkarni, Vinay M

    2009-05-01

    Pediatric critical care medicine (PCCM) fellowship programs vary in the number of fellows per program and experiences offered. We evaluated whether program size and rotation distribution affect clinical and research time allocation. : We surveyed directors of all Accreditation Council of Graduate Medical Education-accredited PCCM training programs in 2006. Forty-six of 60 (77%) responded. Twenty-seven programs (59%) have dedicated cardiac intensive care unit rotations (median 4 months, range 1-9). Median research time is 18 months (range 12-24). Median intensive care unit (ICU) clinical time over 3 years is 14 months (interquartile range 12.5-18). Programs with dedicated cardiac intensive care unit rotations have more total ICU time (16 months vs. 13 months, p = 0.0006), but not less research time (17.5 months vs. 18 months, p = 0.1), indicating fewer non-ICU experiences. Larger programs were less likely to have night call during research time and more likely to have in-hospital fellow call, but otherwise program size did not affect clinical time allocation. Data on clinical and research time allocation of U.S. PCCM fellowships can help program directors benchmark their program training time and content. Fellowship size and unit structure do not influence overall allocation of clinical and research time or night call, but impact the number of non-ICU rotations and elective exposures.

  12. Impact of Machine Virtualization on Timing Precision for Performance-critical Tasks

    NASA Astrophysics Data System (ADS)

    Karpov, Kirill; Fedotova, Irina; Siemens, Eduard

    2017-07-01

    In this paper we present a measurement study to characterize the impact of hardware virtualization on basic software timing, as well as on precise sleep operations of an operating system. We investigated how timer hardware is shared among heavily CPU-, I/O- and Network-bound tasks on a virtual machine as well as on the host machine. VMware ESXi and QEMU/KVM have been chosen as commonly used examples of hypervisor- and host-based models. Based on statistical parameters of retrieved distributions, our results provide a very good estimation of timing behavior. It is essential for real-time and performance-critical applications such as image processing or real-time control.

  13. Critical Spaces for Critical Times: Global Conversations in Literacy Research as an Open Professional Development and Practices Resource

    ERIC Educational Resources Information Center

    Albers, Peggy; Cho, A. Ram; Shin, Ji Hye; Pang, Myoung Eun; Angay-Crowder, Tuba; Jung, Jin Kyeong; Pace, Christi L.; Sena, Mandi; Turnbull, Sarah

    2015-01-01

    This paper reflects an OER (Open Educational Resources) critical literacy project, Global Conversations in Literacy Research (GCLR), (www.globalconversationsinliteracy.wordpress.com), now in its fourth year. GCLR annually hosts seven web seminars presented by internationally recognized literacy and education scholars. We outline key dimensions of…

  14. An equivalence between adaptive dynamic programming with a critic and backpropagation through time.

    PubMed

    Fairbank, Michael; Alonso, Eduardo; Prokhorov, Danil

    2013-12-01

    We consider the adaptive dynamic programming technique called Dual Heuristic Programming (DHP), which is designed to learn a critic function, when using learned model functions of the environment. DHP is designed for optimizing control problems in large and continuous state spaces. We extend DHP into a new algorithm that we call Value-Gradient Learning, VGL(λ), and prove equivalence of an instance of the new algorithm to Backpropagation Through Time for Control with a greedy policy. Not only does this equivalence provide a link between these two different approaches, but it also enables our variant of DHP to have guaranteed convergence, under certain smoothness conditions and a greedy policy, when using a general smooth nonlinear function approximator for the critic. We consider several experimental scenarios including some that prove divergence of DHP under a greedy policy, which contrasts against our proven-convergent algorithm.

  15. Real-time monitoring of hydrophobic aggregation reveals a critical role of cooperativity in hydrophobic effect

    NASA Astrophysics Data System (ADS)

    Jiang, Liguo; Cao, Siqin; Cheung, Peter Pak-Hang; Zheng, Xiaoyan; Leung, Chris Wai Tung; Peng, Qian; Shuai, Zhigang; Tang, Ben Zhong; Yao, Shuhuai; Huang, Xuhui

    2017-05-01

    The hydrophobic interaction drives nonpolar solutes to aggregate in aqueous solution, and hence plays a critical role in many fundamental processes in nature. An important property intrinsic to hydrophobic interaction is its cooperative nature, which is originated from the collective motions of water hydrogen bond networks surrounding hydrophobic solutes. This property is widely believed to enhance the formation of hydrophobic core in proteins. However, cooperativity in hydrophobic interactions has not been successfully characterized by experiments. Here, we quantify cooperativity in hydrophobic interactions by real-time monitoring the aggregation of hydrophobic solute (hexaphenylsilole, HPS) in a microfluidic mixer. We show that association of a HPS molecule to its aggregate in water occurs at sub-microsecond, and the free energy change is -5.8 to -13.6 kcal mol-1. Most strikingly, we discover that cooperativity constitutes up to 40% of this free energy. Our results provide quantitative evidence for the critical role of cooperativity in hydrophobic interactions.

  16. Critical Keller-Segel meets Burgers on {{{S}}^{1}} : large-time smooth solutions

    NASA Astrophysics Data System (ADS)

    Burczak, Jan; Granero-Belinchón, Rafael

    2016-12-01

    We show that solutions to the parabolic-elliptic Keller-Segel system on {{{S}}1} with critical fractional diffusion (- Δ ){{}\\frac{1{2}}} remain smooth for any initial data and any positive time. This disproves, at least in the periodic setting, the large-data-blowup conjecture by Bournaveas and Calvez [15]. As a tool, we show smoothness of solutions to a modified critical Burgers equation via a generalization of the ingenious method of moduli of continuity by Kiselev, Nazarov and Shterenberg [35] over a setting where the considered equation has no scaling. This auxiliary result may be interesting by itself. Finally, we study the asymptotic behavior of global solutions corresponding to small initial data, improving the existing results.

  17. Real-time reinforcement learning by sequential Actor-Critics and experience replay.

    PubMed

    Wawrzyński, Paweł

    2009-12-01

    Actor-Critics constitute an important class of reinforcement learning algorithms that can deal with continuous actions and states in an easy and natural way. This paper shows how these algorithms can be augmented by the technique of experience replay without degrading their convergence properties, by appropriately estimating the policy change direction. This is achieved by truncated importance sampling applied to the recorded past experiences. It is formally shown that the resulting estimation bias is bounded and asymptotically vanishes, which allows the experience replay-augmented algorithm to preserve the convergence properties of the original algorithm. The technique of experience replay makes it possible to utilize the available computational power to reduce the required number of interactions with the environment considerably, which is essential for real-world applications. Experimental results are presented that demonstrate that the combination of experience replay and Actor-Critics yields extremely fast learning algorithms that achieve successful policies for non-trivial control tasks in considerably short time. Namely, the policies for the cart-pole swing-up [Doya, K. (2000). Reinforcement learning in continuous time and space. Neural Computation, 12(1), 219-245] are obtained after as little as 20 min of the cart-pole time and the policy for Half-Cheetah (a walking 6-degree-of-freedom robot) is obtained after four hours of Half-Cheetah time.

  18. Forchheimer flow to a well considering time-dependent critical radius

    NASA Astrophysics Data System (ADS)

    Wang, Q.; Zhan, H.; Tang, Z.

    2013-11-01

    Previous studies on the non-Darcian flow into a pumping well assumed that critical radius (RCD) was a constant or infinity, where RCD represents the location of the interface between the non-Darcian flow region and Darcian flow region. In this study, a two-region model considering time-dependent RCD was established, where the non-Darcian flow was described by the Forchheimer equation. A new iteration method was proposed to estimate RCD based on the finite-difference method. The results showed that RCD increased with time until reaching the quasi-steady state flow, and the asymptotic value of RCD only depended on the critical specific discharge beyond which flow became non-Darcian. A larger inertial force would reduce the change rate of RCD with time, and resulted in a smaller RCD at a specific time during the transient flow. The difference between the new solution and previous solutions were obvious in the early pumping stage. The new solution agreed very well with the solution of previous two-region model with a constant RCD under quasi-steady flow. It agreed with the solution of the fully Darcian flow model in the Darcian flow region, and with the solution of the fully non-Darcian flow model in the non-Darcian flow region near the well.

  19. Forchheimer flow to a well-considering time-dependent critical radius

    NASA Astrophysics Data System (ADS)

    Wang, Q.; Zhan, H.; Tang, Z.

    2014-06-01

    Previous studies on the non-Darcian flow into a pumping well assumed that critical radius (RCD) was a constant or infinity, where RCD represents the location of the interface between the non-Darcian flow region and Darcian flow region. In this study, a two-region model considering time-dependent RCD was established, where the non-Darcian flow was described by the Forchheimer equation. A new iteration method was proposed to estimate RCD based on the finite-difference method. The results showed that RCD increased with time until reaching the quasi steady-state flow, and the asymptotic value of RCD only depended on the critical specific discharge beyond which flow became non-Darcian. A larger inertial force would reduce the change rate of RCD with time, and resulted in a smaller RCD at a specific time during the transient flow. The difference between the new solution and previous solutions were obvious in the early pumping stage. The new solution agreed very well with the solution of the previous two-region model with a constant RCD under quasi steady flow. It agreed with the solution of the fully Darcian flow model in the Darcian flow region.

  20. Influence of time-dependent factors in the evaluation of critical infrastructure protection measures.

    SciTech Connect

    Buehring, W. A.; Samsa, M. E.; Decision and Information Sciences

    2008-03-28

    The examination of which protective measures are the most appropriate to be implemented in order to prevent, protect against, respond to, and recover from attacks on critical infrastructures and key resources typically involves a comparison of the consequences that could occur when the protective measure is implemented to those that could occur when it is not. This report describes a framework for evaluation that provides some additional capabilities for comparing optional protective measures. It illustrates some potentially important time-dependent factors, such as the implementation rate, that affect the relative pros and cons associated with widespread implementation of protective measures. It presents example results from the use of protective measures, such as detectors and pretrained responders, for an illustrative biological incident. Results show that the choice of an alternative measure can depend on whether or not policy and financial support can be maintained for extended periods of time. Choice of a time horizon greatly influences the comparison of alternatives.

  1. Automated implementation of rule-based expert systems with neural networks for time-critical applications

    NASA Technical Reports Server (NTRS)

    Ramamoorthy, P. A.; Huang, Song; Govind, Girish

    1991-01-01

    In fault diagnosis, control and real-time monitoring, both timing and accuracy are critical for operators or machines to reach proper solutions or appropriate actions. Expert systems are becoming more popular in the manufacturing community for dealing with such problems. In recent years, neural networks have revived and their applications have spread to many areas of science and engineering. A method of using neural networks to implement rule-based expert systems for time-critical applications is discussed here. This method can convert a given rule-based system into a neural network with fixed weights and thresholds. The rules governing the translation are presented along with some examples. We also present the results of automated machine implementation of such networks from the given rule-base. This significantly simplifies the translation process to neural network expert systems from conventional rule-based systems. Results comparing the performance of the proposed approach based on neural networks vs. the classical approach are given. The possibility of very large scale integration (VLSI) realization of such neural network expert systems is also discussed.

  2. Recognition of critical situations from time series of laboratory results by case-based reasoning.

    PubMed

    Fritsche, Lutz; Schlaefer, Alexander; Budde, Klemens; Schroeter, Kay; Neumayer, Hans-Hellmut

    2002-01-01

    To develop a technique for recognizing critical situations based on laboratory results in settings in which a normal range cannot be defined, because what is "normal" differs widely from patient to patient. To assess the potential of this approach for kidney transplant recipients, where recognition of acute rejections is based on the pattern of changes in serum creatinine. We developed a case-based reasoning algorithm using dynamic time-warping as the measure of similarity which allows comparison of series of infrequent measurements at irregular intervals for retrieval of the most similar historical cases for the assessment of a new situation. The ability to recognize creatinine courses associated with an acute rejection was tested for a set of cases from a database of transplant patient records and compared with the diagnostic performance of experienced physicians. Tests were performed with case bases of various sizes. The accuracy of the algorithm increased steadily with the size of the available case base. With the largest case bases, the case-based algorithm reached an accuracy of 78 +/- 2%, which is significantly higher than the performance of experienced physicians (69 +/- 5.3%) (p < 0.001). The new case-based reasoning algorithm with dynamic time warping as the measure of similarity allows extension of the use of automatic laboratory alerting systems to conditions in which abnormal laboratory results are the norm and critical states can be detected only by recognition of pathological changes over time.

  3. The education of health practitioners supporting breastfeeding women: time for critical reflection.

    PubMed

    Dykes, Fiona

    2006-10-01

    The protection, promotion and support of breastfeeding has now become a major international priority as emphasized in the Global Strategy for Infant and Young Child Feeding. Health practitioners, such as midwives, nurses and doctors, have a key role to play in providing support to breastfeeding women. This paper provides a critical discussion of educational requirements of health practitioners to equip them for their supportive role. The effective integration of embodied, vicarious, practice-based and theoretical knowledge requires opportunities for deep critical reflection. This approach should facilitate personal reflection and critical engagement with broader socio-political issues, thus allowing for collective understandings and change. Practitioners also need to understand breastfeeding as a biopsychosocial process that is dynamic, relational and changes over time. Recommendations are outlined with regards to multidisciplinary undergraduate education; mentorship schemes with knowledgeable role models supporting student practitioners; involvement of voluntary and peer supporters; post-registration education; setting of national standards for breastfeeding education; tailored education for specific groups; designated funding; and involvement of breastfeeding specialists.

  4. Time-domain pumping a quantum-critical charge density wave ordered material

    NASA Astrophysics Data System (ADS)

    Matveev, O. P.; Shvaika, A. M.; Devereaux, T. P.; Freericks, J. K.

    2016-09-01

    We determine the exact time-resolved photoemission spectroscopy for a nesting driven charge density wave (described by the spinless Falicov-Kimball model within dynamical mean-field theory). The pump-probe experiment involves two light pulses: the first is an ultrashort intense pump pulse that excites the system into nonequilibrium, and the second is a lower amplitude, higher frequency probe pulse that photoexcites electrons. We examine three different cases: the strongly correlated metal, the quantum-critical charge density wave, and the critical Mott insulator. Our results show that the quantum critical charge density wave has an ultraefficient relaxation channel that allows electrons to be de-excited during the pump pulse, resulting in little net excitation. In contrast, the metal and the Mott insulator show excitations that are closer to what one expects from these systems. In addition, the pump field produces spectral band narrowing, peak sharpening, and a spectral gap reduction, all of which rapidly return to their field free values after the pump is over.

  5. Target of Opportunity and Time Critical Queue Observations at Gemini Observatory

    NASA Astrophysics Data System (ADS)

    Roth, Kathy; Carrasco, Rodrigo; Miller, Bryan; Stephens, Andrew; Adamson, Andy; Jorgensen, Inger; Rodgers, Bernadette

    2011-03-01

    Gemini Observatory has been primarily supporting multi-instrument queue observing for more than 5 years, with target of opportunity and time critical programs fully integrated into queue operations. We review the different categories of ToOs supported (including rapid response) and discuss the criteria used to determine their priority and nightly scheduling in the Gemini queue. These rules lend themselves naturally to automatic algorithms that can be used to interrupt on-going observations and dynamically adapt the observing queue at a remotely / robotically operated queue based observatory.

  6. Predicting critical transitions in dynamical systems from time series using nonstationary probability density modeling.

    PubMed

    Kwasniok, Frank

    2013-11-01

    A time series analysis method for predicting the probability density of a dynamical system is proposed. A nonstationary parametric model of the probability density is estimated from data within a maximum likelihood framework and then extrapolated to forecast the future probability density and explore the system for critical transitions or tipping points. A full systematic account of parameter uncertainty is taken. The technique is generic, independent of the underlying dynamics of the system. The method is verified on simulated data and then applied to prediction of Arctic sea-ice extent.

  7. Predicting critical transitions in dynamical systems from time series using nonstationary probability density modeling

    NASA Astrophysics Data System (ADS)

    Kwasniok, Frank

    2013-11-01

    A time series analysis method for predicting the probability density of a dynamical system is proposed. A nonstationary parametric model of the probability density is estimated from data within a maximum likelihood framework and then extrapolated to forecast the future probability density and explore the system for critical transitions or tipping points. A full systematic account of parameter uncertainty is taken. The technique is generic, independent of the underlying dynamics of the system. The method is verified on simulated data and then applied to prediction of Arctic sea-ice extent.

  8. Critical care in the near future: patient-centered, beyond space and time boundaries.

    PubMed

    Cabrini, L; Landoni, G; Antonelli, M; Bellomo, R; Colombo, S; Negro, A; Pelosi, P; Zangrillo, A

    2015-10-16

    Modern Critical Care aims at improving patient-centered outcomes, not limited to survival. Recently, along with traditional research evaluating single drugs or procedures, more elusive elements have been evaluated, like organizational and teamwork aspects, delivery of critical care before Intensive Care Unit (ICU) admission and after discharge. The aim of this review is to offer an up-to-date, comprehensive, and maybe "visionary" big picture of Critical Care in the near future beyond its traditional boundaries. In particular, we wish to suggest key elements that will allow a leap forward in terms of quality of care. Patient-centeredness will be the main issue, taking the patient's wishes into account more than in the past. This means improving communication with patients and their relatives, and pursuing a holistic approach: we should pay more attention to natural light, noise reduction, music, prevention of sleep fragmentation, soft colors for walls, privacy, psychological support. An open visiting policy should be the standard. End-of-Life practices should become centered on patient wishes and dignity. Rapid response teams will bring timely critical care services to patients outside ICUs, preventing avoidable adverse events and unplanned ICU admission. In ICU, standardized protocols, checklists, daily goals sheets, advanced information technology and multidisciplinary rounds will improve quality of care and safety. Multicenter studies will be made easier and research should become part of daily practice in most ICU. Finally, the post ICU syndrome should be prevented and treated by a well-designed longitudinal care model taking care of patients from the ICU to the outpatient setting.

  9. Reinforcement learning using a continuous time actor-critic framework with spiking neurons.

    PubMed

    Frémaux, Nicolas; Sprekeler, Henning; Gerstner, Wulfram

    2013-04-01

    Animals repeat rewarded behaviors, but the physiological basis of reward-based learning has only been partially elucidated. On one hand, experimental evidence shows that the neuromodulator dopamine carries information about rewards and affects synaptic plasticity. On the other hand, the theory of reinforcement learning provides a framework for reward-based learning. Recent models of reward-modulated spike-timing-dependent plasticity have made first steps towards bridging the gap between the two approaches, but faced two problems. First, reinforcement learning is typically formulated in a discrete framework, ill-adapted to the description of natural situations. Second, biologically plausible models of reward-modulated spike-timing-dependent plasticity require precise calculation of the reward prediction error, yet it remains to be shown how this can be computed by neurons. Here we propose a solution to these problems by extending the continuous temporal difference (TD) learning of Doya (2000) to the case of spiking neurons in an actor-critic network operating in continuous time, and with continuous state and action representations. In our model, the critic learns to predict expected future rewards in real time. Its activity, together with actual rewards, conditions the delivery of a neuromodulatory TD signal to itself and to the actor, which is responsible for action choice. In simulations, we show that such an architecture can solve a Morris water-maze-like navigation task, in a number of trials consistent with reported animal performance. We also use our model to solve the acrobot and the cartpole problems, two complex motor control tasks. Our model provides a plausible way of computing reward prediction error in the brain. Moreover, the analytically derived learning rule is consistent with experimental evidence for dopamine-modulated spike-timing-dependent plasticity.

  10. Reinforcement Learning Using a Continuous Time Actor-Critic Framework with Spiking Neurons

    PubMed Central

    Frémaux, Nicolas; Sprekeler, Henning; Gerstner, Wulfram

    2013-01-01

    Animals repeat rewarded behaviors, but the physiological basis of reward-based learning has only been partially elucidated. On one hand, experimental evidence shows that the neuromodulator dopamine carries information about rewards and affects synaptic plasticity. On the other hand, the theory of reinforcement learning provides a framework for reward-based learning. Recent models of reward-modulated spike-timing-dependent plasticity have made first steps towards bridging the gap between the two approaches, but faced two problems. First, reinforcement learning is typically formulated in a discrete framework, ill-adapted to the description of natural situations. Second, biologically plausible models of reward-modulated spike-timing-dependent plasticity require precise calculation of the reward prediction error, yet it remains to be shown how this can be computed by neurons. Here we propose a solution to these problems by extending the continuous temporal difference (TD) learning of Doya (2000) to the case of spiking neurons in an actor-critic network operating in continuous time, and with continuous state and action representations. In our model, the critic learns to predict expected future rewards in real time. Its activity, together with actual rewards, conditions the delivery of a neuromodulatory TD signal to itself and to the actor, which is responsible for action choice. In simulations, we show that such an architecture can solve a Morris water-maze-like navigation task, in a number of trials consistent with reported animal performance. We also use our model to solve the acrobot and the cartpole problems, two complex motor control tasks. Our model provides a plausible way of computing reward prediction error in the brain. Moreover, the analytically derived learning rule is consistent with experimental evidence for dopamine-modulated spike-timing-dependent plasticity. PMID:23592970

  11. Timing of (supplemental) parenteral nutrition in critically ill patients: a systematic review.

    PubMed

    Bost, Rianne Bc; Tjan, Dave Ht; van Zanten, Arthur Rh

    2014-01-01

    Supplemental parenteral nutrition (SPN) is used in a step-up approach when full enteral support is contraindicated or fails to reach caloric targets. Recent nutrition guidelines present divergent advices regarding timing of SPN in critically ill patients ranging from early SPN (<48 h after admission; EPN) to postponing initiation of SPN until day 8 after Intensive Care Unit (ICU) admission (LPN). This systematic review summarizes results of prospective studies among adult ICU patients addressing the best timing of (supplemental) parenteral nutrition (S)PN. A structured PubMed search was conducted to identify eligible articles. Articles were screened and selected using predetermined criteria and appraised for relevance and validity. After critical appraisal, four randomized controlled trials (RCTs) and two prospective observational studies remained. One RCT found a higher percentage of alive discharge from the ICU at day 8 in the LPN group compared to EPN group (p = 0.007) but no differences in ICU and in-hospital mortality. None of the other RCTs found differences in ICU or in-hospital mortality rates. Contradicting or divergent results on other secondary outcomes were found for ICU length of stay, hospital length of stay, infection rates, nutrition targets, duration of mechanical ventilation, glucose control, duration of renal replacement therapy, muscle wasting and fat loss. Although the heterogeneity in quality and design of relevant studies precludes firm conclusions, it is reasonable to assume that in adult critically ill patients, there are no clinically relevant benefits of EPN compared with LPN with respect to morbidity or mortality end points, when full enteral support is contraindicated or fails to reach caloric targets. However, considering that infectious morbidity and resolution of organ failure may be negatively affected through mechanisms not yet clearly understood and acquisition costs of parenteral nutrition are higher, the early

  12. Self-organized criticality in COADS temperature time series: Implications for climate prediction

    SciTech Connect

    Selvam, A.M.; Joshi, R.R.; Vijayakumar, R.

    1994-12-31

    Continuous periodogram spectral analyses of global COADS seasonal (Sept.--Nov.) mean surface (air and sea) temperature time series for the 28-year period 1961--1988 show that the spectra follow the universal inverse power law form of the statistical normal distribution. The inverse power law form for power spectra of temporal fluctuations is ubiquitous to real-world dynamical systems and was recently identified as the temporal signature of self-organized criticality. Self-organized criticality implies long range temporal correlations (persistence or memory). The periodogram analyses also give the following results: (1) Periodicities up to 5 years contribute up to 50% of the total variance. (2) The spectra are broad-band with embedded dominant wavebands, the dominant bandwidth increasing with period length. (3) Spiral-like structure of atmospheric flows is seen in the continuous smooth rotation of the phase angle with increase in period length. The above results are consistent with a recently developed nondeterministic cell dynamical system model for atmospheric flows. Identification of a universal spectrum for temperature time series rules out linear secular trends in global surface (air and sea) temperatures The man-made greenhouse gas warming effect will result in energy propagation to all scales of weather and will be manifested immediately in the intensification of high-frequency fluctuations such as the quasi-biennial oscillation (QBO) and El Nino-Southern Oscillation (ENSO) cycles.

  13. A Phosphorus Index that Combines Critical Source Areas and Transport Pathways using a Travel Time Approach

    NASA Astrophysics Data System (ADS)

    Buchanan, B. P.; Walter, T.; Shaw, S. B.; Easton, Z. M.

    2012-12-01

    Spatially distributed nonpoint source (NPS) pollution indices are used to identify areas in a watershed where potential pollutant loading coincides with runoff generating areas. However, most such indices either ignore the degree of hydrologic connectivity to the stream network or they estimate it based simply on the distance of the pollution generating area from an open channel. We propose an NPS pollution index based on runoff travel times from saturated variable source areas (VSA) to the natural stream network as a means for including hydrologic connectivity between source areas and streams. Although this method could be generalized to any pollutant transported by storm runoff, here we focus on phosphorus and refer to the index as the travel-time phosphorus index (TTPI). The TTPI was applied to a 38 km2 agricultural watershed in central New York and shown to yield realistic, spatially explicit predictions of critical phosphorus loading areas and routing pathways. One interesting finding is the potential role of man-made drainage networks (e.g., road- or agricultural-ditches) in NPS pollution and the possibilities of targeting water quality protection practices around or within these networks. Because the technique is GIS-based, relatively simple to apply, uses readily available geospatial data, and the theoretical underpinnings are transparent, it can provide a useful screening tool for water resource managers charged with the identification and remediation of critical NPS pollution source areas.

  14. A phosphorus index that combines critical source areas and transport pathways using a travel time approach

    NASA Astrophysics Data System (ADS)

    Buchanan, Brian P.; Archibald, Josephine A.; Easton, Zachary M.; Shaw, Stephen B.; Schneider, Rebecca L.; Todd Walter, M.

    2013-04-01

    SummarySpatially distributed nonpoint source (NPS) pollution indices are used to identify areas in a watershed where potential pollutant loading coincides with runoff generating areas. However, most such indices either ignore the degree of hydrologic connectivity to the stream network or they estimate it based simply on the distance of the pollution generating area from an open channel. We propose an NPS pollution index based on runoff travel times from saturated variable source areas (VSAs) to the natural stream network as a means for including hydrologic connectivity between source areas and streams. Although this method could be generalized to any pollutant transported by storm runoff, here we focus on phosphorus and refer to the index as the travel-time phosphorus index (TTPI). The TTPI was applied to a 38 km2 agricultural watershed in central New York and shown to yield realistic, spatially explicit predictions of critical phosphorus loading areas and routing pathways. One interesting finding is the potential role of man-made drainage networks (e.g., road- or agricultural-ditches) in NPS pollution and the possibilities of targeting water quality protection practices around or within these networks. Because the technique is GIS-based, relatively simple to apply, uses readily available geospatial data, and the theoretical underpinnings are transparent, it can provide a useful screening tool for water resource managers charged with the identification and remediation of critical NPS pollution source areas.

  15. Time delay of critical images in the vicinity of cusp point of gravitational-lens systems

    NASA Astrophysics Data System (ADS)

    Alexandrov, A.; Zhdanov, V.

    2016-12-01

    We consider approximate analytical formulas for time-delays of critical images of a point source in the neighborhood of a cusp-caustic. We discuss zero, first and second approximations in powers of a parameter that defines the proximity of the source to the cusp. These formulas link the time delay with characteristics of the lens potential. The formula of zero approximation was obtained by Congdon, Keeton & Nordgren (MNRAS, 2008). In case of a general lens potential we derived first order correction thereto. If the potential is symmetric with respect to the cusp axis, then this correction is identically equal to zero. For this case, we obtained second order correction. The relations found are illustrated by a simple model example.

  16. A perception experiment with time-critical graphics animation on the World-Wide Web.

    PubMed

    Hecht, H; Oesker, M; Kaiser, A; Civelek, H; Stecker, T

    1999-08-01

    The World-Wide Web offers a potentially interesting tool to collect data from a large and heterogeneous audience. While questionnaires have become rather common on the Internet, its potential reaches far beyond text processing. In principle, it is possible not only to perform interactive, dynamic experiments on the Web, but also to include graphical animation and time-critical responses, such as reaction times. We implemented a visual motion extrapolation task on the Web using the programming language Java, which can be interpreted by standard Web browsers such as Netscape or Internet Explorer. The data collected with this method turned out to be reliable and differed little from data obtained in a controlled laboratory setting, with the exception of conditions with fixation instruction. Thus, the Web can, generally speaking, be used for data collection of large sample sizes. The strengths and weaknesses of dynamic visual simulation experiments on the Internet are discussed.

  17. A Time-Critical Adaptive Approach for Visualizing Natural Scenes on Different Devices

    PubMed Central

    Dong, Tianyang; Liu, Siyuan; Xia, Jiajia; Fan, Jing; Zhang, Ling

    2015-01-01

    To automatically adapt to various hardware and software environments on different devices, this paper presents a time-critical adaptive approach for visualizing natural scenes. In this method, a simplified expression of a tree model is used for different devices. The best rendering scheme is intelligently selected to generate a particular scene by estimating the rendering time of trees based on their visual importance. Therefore, this approach can ensure the reality of natural scenes while maintaining a constant frame rate for their interactive display. To verify its effectiveness and flexibility, this method is applied in different devices, such as a desktop computer, laptop, iPad and smart phone. Applications show that the method proposed in this paper can not only adapt to devices with different computing abilities and system resources very well but can also achieve rather good visual realism and a constant frame rate for natural scenes. PMID:25723177

  18. Finite Time Extinction for Stochastic Sign Fast Diffusion and Self-Organized Criticality

    NASA Astrophysics Data System (ADS)

    Gess, Benjamin

    2015-04-01

    We prove finite time extinction for stochastic sign fast diffusion equations driven by linear multiplicative space-time noise, corresponding to the Bak-Tang-Wiesenfeld model for self-organized criticality. This solves a problem posed and left open in several works: (Barbu, Methods Appl Sci 36:1726-1733, 2013; Röckner and Wang, J Lond Math Soc (2) 87:545-560, 2013; Barbu et al. J Math Anal Appl 389:147-164, 2012; Barbu and Röckner, Comm Math Phys 311:539-555, 2012; Barbu et al., Comm Math Phys 285:901-923, 2009, C R Math Acad Sci Paris 347(1-2):81-84, 2009). The highly singular-degenerate nature of the drift in interplay with the stochastic perturbation causes the need for new methods in the analysis of mass diffusion, and several new estimates and techniques are introduced.

  19. Study time within pre-registration nurse education: A critical review of the literature.

    PubMed

    Barker, Caroline; King, Nigel; Snowden, Michael; Ousey, Karen

    2016-06-01

    Pre-registration nursing students throughout the United Kingdom (UK) are required to complete a minimum number of theory hours within the course. Anecdotal evidence suggests that students are required to attend campus for approximately fifty percent of the theory hours. The remaining theory hours are often labelled as 'study time' in which students are not required to attend campus. There is a general assumption amongst many academics that all students are prepared and motivated to direct their learning and therefore use this time to study. However some students chose to work during this time and many have dependents. Considering the increasing cost of nurse education combined with the government cuts to student bursaries in England it is timely to review the literature to determine how study time is used within pre-registration nurse education. To present a critical review of the literature pertaining to study time in pre-registration nurse education. An integrative review of the literature. A search of electronic databases: Cumulative Index to Nursing and Allied Health (CINAHL); Cochrane; Medline; Science Direct; Blackwell Synergy; Electronic Journals Service (EJS); Scopus; Taylor & Francis, Eric and Routledge Wiley was undertaken. The inclusion criteria consisted of peer reviewed primary research, discussion papers, unpublished doctoral theses' and editorial papers directly related to the key words and nurse education published in English. Twelve papers were included in the review. Analysis of the papers led to the development of two themes: orientation to self-directed learning (SDL) and preparation for SDL. The literature demonstrates that pre-registration nursing students lack the necessary skills for SDL. There is a lack of research on how study time is used within pre-registration nurse education. This calls for empirical research to fully explore how nursing students and lecturers perceive study time within pre-registration nursing curricula. Crown

  20. Real-time data system: Incorporating new technology in mission critical environments

    NASA Technical Reports Server (NTRS)

    Muratore, John F.; Heindel, Troy A.

    1990-01-01

    If the Space Station Freedom is to remain viable over its 30-year life span, it must be able to incorporate new information systems technologies. These technologies are necessary to enhance mission effectiveness and to enable new NASA missions, such as supporting the Lunar-Mars Initiative. Hi-definition television (HDTV), neural nets, model-based reasoning, advanced languages, CPU designs, and computer networking standards are areas which have been forecasted to make major strides in the next 30 years. A major challenge to NASA is to bring these technologies online without compromising mission safety. In past programs, NASA managers have been understandably reluctant to rely on new technologies for mission critical activities until they are proven in noncritical areas. NASA must develop strategies to allow inflight confidence building and migration of technologies into the trusted tool base. NASA has successfully met this challenge and developed a winning strategy in the Space Shuttle Mission Control Center. This facility, which is clearly among NASA's most critical, is based on 1970's mainframe architecture. Changes to the mainframe are very expensive due to the extensive testing required to prove that changes do not have unanticipated impact on critical processes. Systematic improvement efforts in this facility have been delayed due to this 'risk to change.' In the real-time data system (RTDS) we have introduced a network of engineering computer workstations which run in parallel to the mainframe system. These workstations are located next to flight controller operating positions in mission control and, in some cases, the display units are mounted in the traditional mainframe consoles. This system incorporates several major improvements over the mainframe consoles including automated fault detection by real-time expert systems and color graphic animated schematics of subsystems driven by real-time telemetry. The workstations have the capability of recording

  1. Light-scattering signal may indicate critical time zone to rescue brain tissue after hypoxia

    NASA Astrophysics Data System (ADS)

    Kawauchi, Satoko; Sato, Shunichi; Uozumi, Yoichi; Nawashiro, Hiroshi; Ishihara, Miya; Kikuchi, Makoto

    2011-02-01

    A light-scattering signal, which is sensitive to cellular/subcellular structural integrity, is a potential indicator of brain tissue viability because metabolic energy is used in part to maintain the structure of cells. We previously observed a unique triphasic scattering change (TSC) at a certain time after oxygen/glucose deprivation for blood-free rat brains; TSC almost coincided with the cerebral adenosine triphosphate (ATP) depletion. We examine whether such TSC can be observed in the presence of blood in vivo, for which transcranial diffuse reflectance measurement is performed for rat brains during hypoxia induced by nitrogen gas inhalation. At a certain time after hypoxia, diffuse reflectance intensity in the near-infrared region changes in three phases, which is shown by spectroscopic analysis to be due to scattering change in the tissue. During hypoxia, rats are reoxygenated at various time points. When the oxygen supply is started before TSC, all rats survive, whereas no rats survive when the oxygen supply is started after TSC. Survival is probabilistic when the oxygen supply is started during TSC, indicating that the period of TSC can be regarded as a critical time zone for rescuing the brain. The results demonstrate that light scattering signal can be an indicator of brain tissue reversibility.

  2. Analysis of locality-sensitive hashing for fast critical event prediction on physiological time series.

    PubMed

    Kim, Yongwook Bryce; O'Reilly, Una-May

    2016-08-01

    We apply the sublinear time, scalable locality-sensitive hashing (LSH) and majority discrimination to the problem of predicting critical events based on physiological waveform time series. Compared to using the linear exhaustive k-nearest neighbor search, our proposed method vastly speeds up prediction time up to 25 times while sacrificing only 1% of accuracy when demonstrated on an arterial blood pressure dataset extracted from the MIMIC2 database. We compare two widely used variants of LSH, the bit sampling based (L1LSH) and the random projection based (E2LSH) methods to measure their direct impact on retrieval and prediction accuracy. We experimentally show that the more sophisticated E2LSH performs worse than L1LSH in terms of accuracy, correlation, and the ability to detect false negatives. We attribute this to E2LSH's simultaneous integration of all dimensions when hashing the data, which actually makes it more impotent against common noise sources such as data misalignment. We also demonstrate that the deterioration of accuracy due to approximation at the retrieval step of LSH has a diminishing impact on the prediction accuracy as the speed up gain accelerates.

  3. Critical Time Intervention for Homeless People Making the Transition to Community Living: A Randomized Controlled Trial.

    PubMed

    de Vet, Renée; Beijersbergen, Mariëlle D; Jonker, Irene E; Lako, Danielle A M; van Hemert, Albert M; Herman, Daniel B; Wolf, Judith R L M

    2017-09-01

    To help create an evidence base in Europe for effective interventions that improve the well-being of homeless people, we tested whether critical time intervention (CTI), a time-limited intervention developed to support vulnerable people during times of transition, is effective outside the United States. For this multicenter, parallel-group randomized controlled trial, 183 adults who were moving from shelters in the Netherlands to supported or independent housing were allocated to CTI or care-as-usual. The primary outcome was number of days rehoused, which was assessed by interviewing participants four times during a 9-month follow-up. Outcomes were analyzed with three-level mixed-effects models. The primary outcome did not differ between groups. CTI had a significant effect on family support and, for people experiencing less social support, psychological distress. Groups did not differ significantly on social support, fulfillment of care needs, quality of life, self-esteem, excessive alcohol use, or cannabis use. Because few participants were homeless at 9 months, more research is needed to establish whether CTI can prevent long-term recurrent homelessness. Given recent emphasis on informal support in public services and positive effects of CTI on family support and psychological distress, CTI is a fitting intervention for Dutch shelter services. © 2017 The Authors. American Journal of Community Psychology published by Wiley Periodicals, Inc. on behalf of Society for Community Research and Action.

  4. Light-scattering signal may indicate critical time zone to rescue brain tissue after hypoxia.

    PubMed

    Kawauchi, Satoko; Sato, Shunichi; Uozumi, Yoichi; Nawashiro, Hiroshi; Ishihara, Miya; Kikuchi, Makoto

    2011-02-01

    A light-scattering signal, which is sensitive to cellular/subcellular structural integrity, is a potential indicator of brain tissue viability because metabolic energy is used in part to maintain the structure of cells. We previously observed a unique triphasic scattering change (TSC) at a certain time after oxygen/glucose deprivation for blood-free rat brains; TSC almost coincided with the cerebral adenosine triphosphate (ATP) depletion. We examine whether such TSC can be observed in the presence of blood in vivo, for which transcranial diffuse reflectance measurement is performed for rat brains during hypoxia induced by nitrogen gas inhalation. At a certain time after hypoxia, diffuse reflectance intensity in the near-infrared region changes in three phases, which is shown by spectroscopic analysis to be due to scattering change in the tissue. During hypoxia, rats are reoxygenated at various time points. When the oxygen supply is started before TSC, all rats survive, whereas no rats survive when the oxygen supply is started after TSC. Survival is probabilistic when the oxygen supply is started during TSC, indicating that the period of TSC can be regarded as a critical time zone for rescuing the brain. The results demonstrate that light scattering signal can be an indicator of brain tissue reversibility.

  5. Actor-critic-based optimal tracking for partially unknown nonlinear discrete-time systems.

    PubMed

    Kiumarsi, Bahare; Lewis, Frank L

    2015-01-01

    This paper presents a partially model-free adaptive optimal control solution to the deterministic nonlinear discrete-time (DT) tracking control problem in the presence of input constraints. The tracking error dynamics and reference trajectory dynamics are first combined to form an augmented system. Then, a new discounted performance function based on the augmented system is presented for the optimal nonlinear tracking problem. In contrast to the standard solution, which finds the feedforward and feedback terms of the control input separately, the minimization of the proposed discounted performance function gives both feedback and feedforward parts of the control input simultaneously. This enables us to encode the input constraints into the optimization problem using a nonquadratic performance function. The DT tracking Bellman equation and tracking Hamilton-Jacobi-Bellman (HJB) are derived. An actor-critic-based reinforcement learning algorithm is used to learn the solution to the tracking HJB equation online without requiring knowledge of the system drift dynamics. That is, two neural networks (NNs), namely, actor NN and critic NN, are tuned online and simultaneously to generate the optimal bounded control policy. A simulation example is given to show the effectiveness of the proposed method.

  6. Time-critical cooperative path-following control of multiple unmanned aerial vehicles

    NASA Astrophysics Data System (ADS)

    Xargay Mata, Enric

    This thesis addresses the problem of steering a fleet of unmanned aerial vehicles (UAVs) along desired 3D spatial paths while meeting stringent relative temporal constraints. A representative example is the challenging mission scenario where the UAVs are tasked to cooperatively execute collision-free maneuvers and arrive at their final destinations at the same time, or at different times so as to meet a desired inter-vehicle schedule. In the proposed framework, the UAVs are assigned nominal spatial paths and speed profiles along those, and then the vehicles are requested to execute cooperative path following, rather than "open-loop" trajectory-tracking maneuvers. This strategy yields robust behavior against external disturbances by allowing the UAVs to negotiate their speeds along the paths in response to information exchanged over a supporting inter-vehicle communications network. The proposed approach addresses explicitly the situation where each vehicle transmits coordination-relevant information to only a subset of the other vehicles, as determined by the time-varying communications topology. Furthermore, the thesis considers the case where the graph that captures the underlying communications topology is disconnected during some interval of time or even fails to be connected at all times. Conditions are given under which the complete time-critical cooperative path-following closed-loop system is stable and yields convergence of a conveniently defined cooperation error to a neighborhood of the origin. The thesis also derives lower bounds on the convergence rate of the coordination dynamics as a function of the quality of service of the supporting network, and proposes a coordination algorithm to improve the rate of convergence of the coordination dynamics in low-connectivity scenarios. Moreover, motivated by the exchange of information over networks with finite-rate communication links, the effect of quantization on vehicle coordination is also analyzed

  7. Static Analysis of Run-Time Errors in Embedded Critical Parallel C Programs

    NASA Astrophysics Data System (ADS)

    Miné, Antoine

    We present a static analysis by Abstract Interpretation to check for run-time errors in parallel C programs. Following our work on Astrée, we focus on embedded critical programs without recursion nor dynamic memory allocation, but extend the analysis to a static set of threads. Our method iterates a slightly modified non-parallel analysis over each thread in turn, until thread interferences stabilize. We prove the soundness of the method with respect to a sequential consistent semantics and a reasonable weakly consistent memory semantics. We then show how to take into account mutual exclusion and thread priorities through partitioning over the scheduler state. We present preliminary experimental results analyzing a real program with our prototype, Thésée, and demonstrate the scalability of our approach.

  8. Role of Context, Resources, and Target Population in the Fidelity of Critical Time Intervention.

    PubMed

    Barrenger, Stacey L; Kriegel, Liat S; Angell, Beth; Draine, Jeffrey

    2016-01-01

    The goal of this study was to understand departures from a model program, critical time intervention (CTI), when used with a population of men with mental illness who were leaving prison, a new population for the intervention. A fidelity study was conducted with the CTI Fidelity Scale Manual, and six program staff participated in semistructured interviews. Thematic analysis of interviews supplemented information on departures from the model. The overall fidelity score indicated a well-implemented program, but low scores on early engagement, early linking with community resources, monitoring the transfer of services from CTI to community services, and nine-month follow-up were related to the context of the prison setting, the population of men leaving prison, and environmental resources. The setting in which evidence-based practices are applied, the environmental resources available, and the target population may affect program fidelity.

  9. Time scales of critical events around the Cretaceous-Paleogene boundary.

    PubMed

    Renne, Paul R; Deino, Alan L; Hilgen, Frederik J; Kuiper, Klaudia F; Mark, Darren F; Mitchell, William S; Morgan, Leah E; Mundil, Roland; Smit, Jan

    2013-02-08

    Mass extinctions manifest in Earth's geologic record were turning points in biotic evolution. We present (40)Ar/(39)Ar data that establish synchrony between the Cretaceous-Paleogene boundary and associated mass extinctions with the Chicxulub bolide impact to within 32,000 years. Perturbation of the atmospheric carbon cycle at the boundary likely lasted less than 5000 years, exhibiting a recovery time scale two to three orders of magnitude shorter than that of the major ocean basins. Low-diversity mammalian fauna in the western Williston Basin persisted for as little as 20,000 years after the impact. The Chicxulub impact likely triggered a state shift of ecosystems already under near-critical stress.

  10. High critical temperature nodal superconductors as building block for time-reversal invariant topological superconductivity

    NASA Astrophysics Data System (ADS)

    Trani, F.; Campagnano, G.; Tagliacozzo, A.; Lucignano, P.

    2016-10-01

    We study possible applications of high critical temperature nodal superconductors for the search for Majorana bound states in the DIII class. We propose a microscopic analysis of the proximity effect induced by d -wave superconductors on a semiconductor wire with strong spin-orbit coupling. We characterize the induced superconductivity on the wire employing a numerical self-consistent tight-binding Bogoliubov-de Gennes approach, and analytical considerations on the Green's function. The order parameter induced on the wire, the pair correlation function, and the renormalization of the Fermi points are analyzed in detail, as well as the topological phase diagram in the case of weak coupling. We highlight optimal Hamiltonian parameters to access the nontrivial topological phase which could display time-reversal invariant Majorana doublets at the boundaries of the wire.

  11. Infrared Sensor on Unmanned Aircraft Transmits Time-Critical Wildfire Data

    NASA Technical Reports Server (NTRS)

    Pestana, Mark

    2010-01-01

    Since 2006, NASA fs Dryden Flight Research Center (DFRC) and Ames Research Center have been perfecting and demonstrating a new capability for geolocation of wildfires and the real-time delivery of data to firefighters. Managed for the Western States Fire Mission, the Ames-developed Autonomous Modular Scanner (AMS), mounted beneath a wing of DFRC fs MQ-9 Ikhana remotely piloted aircraft, contains an infrared sensor capable of discriminating temperatures within 0.5 F (approx. = 0.3 C), up to 1,000 F (approx. = 540 C). The AMS operates like a digital camera with specialized filters to detect light energy at visible, infrared, and thermal wavelengths. By placing the AMS aboard unmanned aircraft, one can gather information and imaging for thousands of square miles, and provide critical information about the location, size, and terrain around fires to commanders in the field. In the hands of operational agencies, the benefits of this NASA research and development effort can support nationwide wildfire fighting efforts. The sensor also provides data for post-burn and vegetation regrowth analyses. The MQ-9 Unmanned Aircraft System (UAS), a version of the Predator-B, can operate over long distances, staying aloft for over 24 hours, and controlled via a satellite-linked command and control system. This same link is used to deliver the fire location data directly to fire incident commanders, in less than 10 minutes from the time of overflight. In the current method, similarly equipped short-duration manned aircraft, with limited endurance and range, must land, hand-carry, and process data, and then deliver information to the firefighters, sometimes taking several hours in the process. Meanwhile, many fires would have moved over great distances and changed direction. Speed is critical. The fire incident commanders must assess a very dynamic situation, and task resources such as people, ground equipment, and retardant-dropping aircraft, often in mountainous terrain obscured by

  12. Report: EPA Is Documenting How It Addresses Time-Critical Public Health Risks Under Its Superfund Authority

    EPA Pesticide Factsheets

    Report #16-P-0059, December 9, 2015. We found that the EPA can provide documentation that imminent and substantial endangerment threats to public health at Superfund time-critical removal sites have been addressed.

  13. The Efficacy of a Restart Break for Recycling with Optimal Performance Depends Critically on Circadian Timing

    PubMed Central

    Van Dongen, Hans P.A.; Belenky, Gregory; Vila, Bryan J.

    2011-01-01

    deficits. Conclusions: The 34-hour restart break was adequate for maintaining performance in the case of optimal circadian placement of sleep and duty periods (control condition) but was inadequate (and perhaps even detrimental) for maintaining performance in a simulated nighttime duty schedule (experimental condition). Current US transportation hours-of-service regulations mandate time off duty but do not consider the circadian aspects of shift scheduling. Reinforcing a recent trend of applying sleep science to inform policymaking for duty and rest times, our findings indicate that restart provisions in hours-of-service regulations could be improved by taking the circadian timing of the duty schedules into account. Citation: Van Dongen HPA; Belenky G; Vila BJ. The efficacy of a restart break for recycling with optimal performance depends critically on circadian timing. SLEEP 2011;34(7):917-929. PMID:21731142

  14. The role of buoyancy orientation on bubble residence times and the related critical heat flux

    SciTech Connect

    Brusstar, M.J.; Merte, H. Jr.; Keller, R.B.

    1995-12-31

    Measurements of the effects of buoyancy orientation on the critical heat flux (CHF) in subcooled forced convection boiling of R113 are presented, examining the motion of the vapor above the heater surface and its possible influence on the feed of liquid to the surface. At the low flow velocity of 4 cm/s used, the buoyancy force acting on the vapor dominates over the flow inertia, and the measured CHF values show a strong dependence on the orientation of the heater surface with respect to gravity. The transient and time-averaged behavior of the vapor above the surface at heat flux levels close to the CHF is characterized using hot wire anemometry. Through this, a description of the behavior of the largest vapor bubbles is obtained, which is considered to be of primary importance to the processes by which liquid is fed to the heater surface at these high heat flux levels. The mean residence time of the largest bubbles above the heater surface at a given heater orientation is also determined from the hot wire data. The reciprocal of the mean residence time is found to correlate directly with the measured CHF values for the different orientations and subcoolings, showing that the amount of energy absorbed in the vapor formation process during the bubble residence time is constant for all heater orientations at a given subcooling, and demonstrates that the motion of the largest bubbles determines the CHF. This suggests that the relative effects of buoyancy orientation on the CHF can be modeled by considering only the motion of the largest bubbles in the immediate vicinity of the heater surface.

  15. Analyzing the waiting time pattern for non-critical patients in the emergency department using six sigma approach

    NASA Astrophysics Data System (ADS)

    Majid, Noriza; Mohd Suradi, Nur Riza; Ahmad Sabri, Safura

    2013-04-01

    This study was conducted to examine the waiting time of non-critical patients in the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using the approach of six sigma (6σ). The define phase is completed by obtaining customers' critical to quality in UKMMC using survey. In measure phase, data on patients to the ED of UKMMC in May 2009 were gathered. Subsequently, analysis phase is performed using cause-and-effect diagram to identify root causes of the problems. Finally, improvements are proposed based on the identified problems. Results show that waiting time is critical to quality for health services in the ED.

  16. Real-time threat assessment for critical infrastructure protection: data incest and conflict in evidential reasoning

    NASA Astrophysics Data System (ADS)

    Brandon, R.; Page, S.; Varndell, J.

    2012-06-01

    This paper presents a novel application of Evidential Reasoning to Threat Assessment for critical infrastructure protection. A fusion algorithm based on the PCR5 Dezert-Smarandache fusion rule is proposed which fuses alerts generated by a vision-based behaviour analysis algorithm and a-priori watch-list intelligence data. The fusion algorithm produces a prioritised event list according to a user-defined set of event-type severity or priority weightings. Results generated from application of the algorithm to real data and Behaviour Analysis alerts captured at London's Heathrow Airport under the EU FP7 SAMURAI programme are presented. A web-based demonstrator system is also described which implements the fusion process in real-time. It is shown that this system significantly reduces the data deluge problem, and directs the user's attention to the most pertinent alerts, enhancing their Situational Awareness (SA). The end-user is also able to alter the perceived importance of different event types in real-time, allowing the system to adapt rapidly to changes in priorities as the situation evolves. One of the key challenges associated with fusing information deriving from intelligence data is the issue of Data Incest. Techniques for handling Data Incest within Evidential Reasoning frameworks are proposed, and comparisons are drawn with respect to Data Incest management techniques that are commonly employed within Bayesian fusion frameworks (e.g. Covariance Intersection). The challenges associated with simultaneously dealing with conflicting information and Data Incest in Evidential Reasoning frameworks are also discussed.

  17. [Organ transplantation in Germany: Critical examination in times of scarce resources].

    PubMed

    Haverich, A; Haller, H

    2016-01-01

    Organ transplantation over the last 40 years has developed into a standardized successful procedure for the replacement of heart, kidney liver, lung, and pancreas. During this time, treatment strategies have greatly improved and novel procedures such as living related organ donation have been introduced. Despite these improvements, the number of organ transplants has stalled in recent years. In the face of increasing numbers of patients on the waiting list for organ transplantation, this situation is unacceptable and ways to improve the situation of organ transplantation have to be found.The reasons for the stagnant situation in organ transplantation are manifold and include lack of awareness in the general population, insufficient organ procurement in hospitals as well as problems in organ allocation. The criteria for organ allocation have been unfairly reported to EUROTRANSPLANT by some of the presently 44 centers in order of more rapidly receive an organ for their patients on the waiting list. The evolving discussions around this so-called transplantation scandal has further eroded support for organ transplantation in Germany. A critical assessment and a well-defined plan are necessary to improve the situation, increase the number of transplanted organs, and reduce the unacceptably long waiting time for patients in Germany.

  18. A mobile application to support collection and analytics of real-time critical care data.

    PubMed

    Vankipuram, Akshay; Vankipuram, Mithra; Ghaemmaghami, Vafa; Patel, Vimla L

    2017-11-01

    Data collection, in high intensity environments, poses several challenges including the ability to observe multiple streams of information. These problems are especially evident in critical care, where monitoring of the Advanced Trauma Life Support (ATLS) protocol provides an excellent opportunity to study the efficacy of applications that allow for the rapid capture of event information, providing theoretically-driven feedback using the data. Our goal was, (a) to design and implement a way to capture data on deviation from the standard practice based on the theoretical foundation of error classification from our past research, (b) to provide a means to meaningfully visualize the collected data, and (c) to provide a proof-of-concept for this implementation, using some understanding of user experience in clinical practice. We present the design and development of a web application designed to be used primarily on mobile devices and a summary data viewer to allow clinicians to, (a) track their activities, (b) provide real-time feedback of deviations from guidelines and protocols, and (c) provide summary feedback highlighting decisions made. We used a framework previously developed to classify activities in trauma as the theoretical foundation of the rules designed to do the same algorithmically, in our application. Attending physicians at a Level 1 trauma center used the application in the clinical setting and provided feedback for iterative development. Informal interviews and surveys were used to gain some deeper understanding of the user experience using this application in-situ. Activity visualizations were created highlighting decisions made during a trauma code as well as classification of tasks per the theoretical framework. The attendings reviewed the efficacy of the data visualizations as part of their interviews. We also conducted a proof-of-concept evaluation by way of usability questionnaire. Two attendings rated 4 out of the usability 6 categories highly

  19. Soil water storage, mixing dynamics and resulting travel times through the critical zone in northern latitudes

    NASA Astrophysics Data System (ADS)

    Sprenger, Matthias; Tetzlaff, Doerthe; Weiler, Markus; Soulsby, Chris

    2017-04-01

    Water partitioning in the unsaturated zone into groundwater recharge, plant transpiration, and evaporation is fundamental for estimating storages and travel times. How water is mixed and routed through the soil is of broad interest to understand plant available water, contamination transport and weathering rates in the critical zone. Earlier work has shown how seasonal changes in hydroclimate influence the time variant character of travel times. A strong seasonality characterizes the northern latitudes which are particularly sensitive to climate and land use changes. It is crucial to understand how variation and change in hydroclimate and vegetation phenology impact time variant storage dynamics and flow path partitioning in the unsaturated zone. To better understand the influence of these ecohydrological processes on travel times of evaporative, transpiration and recharge fluxes in northern latitudes, we characterized soil physical properties, hydrometric conditions and soil water isotopic composition in the upper soil profile in two different land scape units in the long term experimental catchment, Bruntland Burn in the Scottish Highlands. Our two sampling locations are characterized by podzol soils with high organic matter content but they differ with regard to their vegetation cover with either Scots Pine (Pinus sylvestris) or heather (Calluna sp. and Erica Sp). To assess storage and mixing dynamics in the vadose zone, we parameterized a numerical 1-D flow model using the soil textural information along with soil moisture and soil water stable isotopes (δ2H and δ18O). The water flow and transport were simulated based on the Richards and the advection dispersion equation. Differences between water flows of mobile and tightly bound soil waters and the mixing between the two pore spaces were considered. Isotopic fractionation due to evaporation from soil and interception storage was taken into account, while plant water uptake did not alter the isotopic

  20. Critical care in the surgical global period.

    PubMed

    Painter, Julie R

    2013-03-01

    This article explores the rules and regulations from Current Procedural Terminology (CPT) code set and US Medicare and Medicaid Services (Medicare) regarding multiple physicians reporting critical care services during the global period. The article takes into account the critical care definitions, regulations, documentation requirements, and services each provider can report to Medicare. A clinical scenario based on literature supporting the types of complications and care that might typically be included in the post-operative period for a patient who is surgically treated for a type A aortic dissection was analyzed. It was determined that multiple physicians may provide critical care services to a single patient during the global period. The physician who performed the primary procedure cannot report critical care separately unless documentation supporting use of modifier 25 (significant, separately identifiable services) or 24 (unrelated services) supports that critical care is unrelated to the global period. Other physicians may report critical care services separately if specific criteria are met. To report critical care services to Medicare, the patient's condition must meet the Medicare definition of critical care and the physicians should generally represent different specialties providing different aspects of care to the critically ill or injured patient as defined by Medicare. There should be no overlap in time of services provided by each physician. Each physician's documentation should clearly support medical necessity with the diagnosis demonstrating the critical nature of the patients' illness, the total time spent providing critical care, the critical care service provided, and other contributing factors.

  1. Locked-in syndrome: a critical and time-dependent diagnosis.

    PubMed

    Barbic, David; Levine, Zachary; Tampieri, Donatella; Teitelbau, Jeanne

    2012-09-01

    Locked-in syndrome (LIS) is the combination of quadriplegia and anarthria (inability to speak), with the preservation of consciousness. The majority of cases are caused by basilar artery occlusion leading to brainstem infarction in the ventral pons, yet numerous other etiologies have been described. The diagnosis of LIS is completely dependent on the physician's ability to know that these manifestations originate in the brainstem and the posterior circulation that supplies it. This knowledge hinges on the ability of the examining physician to conduct a rapid, yet appropriately thorough neurologic examination. With recent advances in interventional neuroradiology leading to improved patient outcomes, LIS has evolved into a critical, time-dependent diagnosis. Herein, we present the case of a male patient who initially presented to the emergency department of a community hospital with coma of unknown cause. By presenting this case and focusing on the importance of the occulomotor exam, we hope to help in the rapid identification and treatment of patients with LIS in the emergency room and avoid outcomes similar to that of our patient.

  2. Critical space-time networks and geometric phase transitions from frustrated edge antiferromagnetism.

    PubMed

    Trugenberger, Carlo A

    2015-12-01

    Recently I proposed a simple dynamical network model for discrete space-time that self-organizes as a graph with Hausdorff dimension d(H)=4. The model has a geometric quantum phase transition with disorder parameter (d(H)-d(s)), where d(s) is the spectral dimension of the dynamical graph. Self-organization in this network model is based on a competition between a ferromagnetic Ising model for vertices and an antiferromagnetic Ising model for edges. In this paper I solve a toy version of this model defined on a bipartite graph in the mean-field approximation. I show that the geometric phase transition corresponds exactly to the antiferromagnetic transition for edges, the dimensional disorder parameter of the former being mapped to the staggered magnetization order parameter of the latter. The model has a critical point with long-range correlations between edges, where a continuum random geometry can be defined, exactly as in Kazakov's famed 2D random lattice Ising model but now in any number of dimensions.

  3. Climatic and landscape controls on water transit times and silicate mineral weathering in the critical zone

    NASA Astrophysics Data System (ADS)

    Zapata-Rios, Xavier; McIntosh, Jennifer; Rademacher, Laura; Troch, Peter A.; Brooks, Paul D.; Rasmussen, Craig; Chorover, Jon

    2015-08-01

    The critical zone (CZ) can be conceptualized as an open system reactor that is continually transforming energy and water fluxes into an internal structural organization and dissipative products. In this study, we test a controlling factor on water transit times (WTT) and mineral weathering called Effective Energy and Mass Transfer (EEMT). We hypothesize that EEMT, quantified based on local climatic variables, can effectively predict WTT within—and mineral weathering products from—the CZ. This study tests whether EEMT or static landscape characteristics are good predictors of WTT, aqueous phase solutes, and silicate weathering products. Our study site is located around Redondo Peak, a rhyolitic volcanic resurgent dome, in northern New Mexico. At Redondo Peak, springs drain slopes along an energy gradient created by differences in terrain aspect. This investigation uses major solute concentrations, the calculated mineral mass undergoing dissolution, and the age tracer tritium and relates them quantitatively to EEMT and landscape characteristics. We found significant correlations between EEMT, WTT, and mineral weathering products. Significant correlations were observed between dissolved weathering products (Na+ and DIC), 3H concentrations, and maximum EEMT. In contrast, landscape characteristics such as contributing area of spring, slope gradient, elevation, and flow path length were not as effective predictive variables of WTT, solute concentrations, and mineral weathering products. These results highlight the interrelationship between landscape, hydrological, and biogeochemical processes and suggest that basic climatic data embodied in EEMT can be used to scale hydrological and hydrochemical responses in other sites.

  4. Broadcast-quality-stereoscopic video in a time-critical entertainment and corporate environment

    NASA Astrophysics Data System (ADS)

    Gay, Jean-Philippe

    1995-03-01

    `reality present: Peter Gabrial and Cirque du Soleil' is a 12 minute original work directed and produced by Doug Brown, Jean-Philippe Gay & A. Coogan, which showcases creative content applications of commercial stereoscopic video equipment. For production, a complete equipment package including a Steadicam mount was used in support of the Ikegami LK-33 camera. Remote production units were fielded in the time critical, on-stage and off-stage environments of 2 major live concerts: Peter Gabriel's Secret World performance at the San Diego Sports Arena, and Cirque du Soleil's Saltimbanco performance in Chicago. Twin 60 Hz video channels were captured on Beta SP for maximum post production flexibility. Digital post production and field sequential mastering were effected in D-2 format at studio facilities in Los Angeles. The program was world premiered to a large public at the World of Music, Arts and Dance festivals in Los Angeles and San Francisco, in late 1993. It was presented to the artists in Los Angeles, Montreal and Washington D.C. Additional presentations have been made using a broad range of commercial and experimental stereoscopic video equipment, including projection systems, LCD and passive eyewear, and digital signal processors. Technical packages for live presentation have been fielded on site and off, through to the present.

  5. Critical space-time networks and geometric phase transitions from frustrated edge antiferromagnetism

    NASA Astrophysics Data System (ADS)

    Trugenberger, Carlo A.

    2015-12-01

    Recently I proposed a simple dynamical network model for discrete space-time that self-organizes as a graph with Hausdorff dimension dH=4 . The model has a geometric quantum phase transition with disorder parameter (dH-ds) , where ds is the spectral dimension of the dynamical graph. Self-organization in this network model is based on a competition between a ferromagnetic Ising model for vertices and an antiferromagnetic Ising model for edges. In this paper I solve a toy version of this model defined on a bipartite graph in the mean-field approximation. I show that the geometric phase transition corresponds exactly to the antiferromagnetic transition for edges, the dimensional disorder parameter of the former being mapped to the staggered magnetization order parameter of the latter. The model has a critical point with long-range correlations between edges, where a continuum random geometry can be defined, exactly as in Kazakov's famed 2D random lattice Ising model but now in any number of dimensions.

  6. A critical time window for organismal interactions in a pelagic ecosystem.

    PubMed

    Benoit-Bird, Kelly J; McManus, Margaret A

    2014-01-01

    To measure organismal coherence in a pelagic ecosystem, we used moored sensors to describe the vertical dynamics of each step in the food chain in shelf waters off the west shore of Oahu, Hawaii. Horizontally extensive, intense aggregations of phytoplankton, zooplankton, and micronekton exhibited strong diel patterns in abundance and vertical distribution, resulting in a highly variable potential for interaction amongst trophic levels. Only around dusk did zooplankton layers overlap with phytoplankton layers. Shortly after sunset, micronekton ascended from the deep, aggregating on the island's shelf. Short-lived departures in migration patterns were detected in depth, vertical distribution, density, and total abundance of micronekton when zooplankton layers were present with typical patterns resuming within one hour. Layers of zooplankton began to disappear within 20 minutes of the arrival of micronekton with no layers present after 50 minutes. The effects of zooplankton layers cascaded even further up the food chain, affecting many behaviors of dolphins observed at dusk including their depth, group size, and inter-individual spacing. As a result of these changes in behavior, during a 30-minute window just after dusk, the number of feeding events observed for each dolphin and consequently the feeding time for each individual more than doubled when zooplankton layers were present. Dusk is a critical period for interactions amongst species in this system from phytoplankton to top predators. Our observations that short time windows can drive the structure and function of a complex suite of organisms highlight the importance of explicitly adding a temporal dimension at a scale relevant to individual organisms to our descriptions of heterogeneity in ocean ecosystems.

  7. Audits in real time for safety in critical care: definition and pilot study.

    PubMed

    Sirgo Rodríguez, G; Olona Cabases, M; Martin Delgado, M C; Esteban Reboll, F; Pobo Peris, A; Bodí Saera, M

    2014-11-01

    Adverse events significantly impact upon mortality rates and healthcare costs. To design a checklist of safety measures based on relevant scientific literature, apply random checklist measures to critically ill patients in real time (safety audits), and determine its utility and feasibility. A list of safety measures based on scientific literature was drawn up by investigators. Subsequently, a group of selected experts evaluated these measures using the Delphi methodology. Audits were carried out on 14 days over a period of one month. Each day, 50% of the measures were randomly selected and measured in 50% of the randomized patients. Utility was assessed by measuring the changes in clinical performance after audits, using the variable improvement proportion related to audits. Feasibility was determined by the successful completion of auditing on each of the days on which audits were attempted. The final verified checklist comprised 37 measures distributed into 10 blocks. The improvement proportion related to audits was reported in 83.78% of the measures. This proportion was over 25% in the following measures: assessment of the alveolar pressure limit, checking of mechanical ventilation alarms, checking of monitor alarms, correct prescription of the daily treatment orders, daily evaluation of the need for catheters, enteral nutrition monitoring, assessment of semi-recumbent position, and checking that patient clinical information is properly organized in the clinical history. Feasibility: rounds were completed on the 14 proposed days. Audits in real time are a useful and feasible tool for modifying clinical actions and minimizing errors. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  8. A Critical Time Window for Organismal Interactions in a Pelagic Ecosystem

    PubMed Central

    Benoit-Bird, Kelly J.; McManus, Margaret A.

    2014-01-01

    To measure organismal coherence in a pelagic ecosystem, we used moored sensors to describe the vertical dynamics of each step in the food chain in shelf waters off the west shore of Oahu, Hawaii. Horizontally extensive, intense aggregations of phytoplankton, zooplankton, and micronekton exhibited strong diel patterns in abundance and vertical distribution, resulting in a highly variable potential for interaction amongst trophic levels. Only around dusk did zooplankton layers overlap with phytoplankton layers. Shortly after sunset, micronekton ascended from the deep, aggregating on the island's shelf. Short-lived departures in migration patterns were detected in depth, vertical distribution, density, and total abundance of micronekton when zooplankton layers were present with typical patterns resuming within one hour. Layers of zooplankton began to disappear within 20 minutes of the arrival of micronekton with no layers present after 50 minutes. The effects of zooplankton layers cascaded even further up the food chain, affecting many behaviors of dolphins observed at dusk including their depth, group size, and inter-individual spacing. As a result of these changes in behavior, during a 30-minute window just after dusk, the number of feeding events observed for each dolphin and consequently the feeding time for each individual more than doubled when zooplankton layers were present. Dusk is a critical period for interactions amongst species in this system from phytoplankton to top predators. Our observations that short time windows can drive the structure and function of a complex suite of organisms highlight the importance of explicitly adding a temporal dimension at a scale relevant to individual organisms to our descriptions of heterogeneity in ocean ecosystems. PMID:24844981

  9. Time-dependent Monte Carlo simulations of critical and Lifshitz points of the axial-next-nearest-neighbor Ising model.

    PubMed

    da Silva, Roberto; Alves, Nelson; Drugowich de Felício, Jose Roberto

    2013-01-01

    In this work, we study the critical behavior of second-order points, specifically the Lifshitz point (LP) of a three-dimensional Ising model with axial competing interactions [the axial-next-nearest-neighbor Ising (ANNNI) model], using time-dependent Monte Carlo simulations. We use a recently developed technique that helps us localize the critical temperature corresponding to the best power law for magnetization decay over time: (m(0)=1)~t(-β/νz), which is expected of simulations starting from initially ordered states. We obtain original results for the dynamic critical exponent z, evaluated from the behavior of the ratio F(2)(t)=(m(0)=0)/(2)(m(0)=1)~t(3/z), along the critical line up to the LP. We explore all the critical exponents of the LP in detail, including the dynamic critical exponent θ that characterizes the initial slip of magnetization and the global persistence exponent θ(g) associated with the probability P(t) that magnetization keeps its signal up to time t. Our estimates for the dynamic critical exponents at the Lifshitz point are z=2.34(2) and θ(g)=0.336(4), values that are very different from those of the three-dimensional Ising model (the ANNNI model without the next-nearest-neighbor interactions at the z axis, i.e., J(2)=0), i.e., z≈2.07 and θ(g)≈0.38. We also present estimates for the static critical exponents β and ν, obtained from extended time-dependent scaling relations. Our results for static exponents are in good agreement with previous works.

  10. Time-Critical Studies: Rapid response to Transient Dynamic Mid-Ocean Ridge Events

    NASA Astrophysics Data System (ADS)

    Dziak, R. P.; Cowen, J. P.; Baker, E. T.; Bohnenstiehl, D. R.

    2005-12-01

    The Time-Critical Studies (TCS) Theme of Ridge 2000 focuses on observations of the immediate geochemical and geobiological consequences of magmatic and tectonic events along the global mid-ocean ridge system. NOAA's T-Phase Monitoring Program has accessed the U.S. Navy's NE SOSUS data in real-time since 1993, providing the TCS community with detection of seismicity associated with eruptive or tectonic activity along the Juan de Fuca (JFR) and Gorda Ridges. This remote detection of earthquake swarms, coupled to NSF and NOAA funding for pre-event staging of equipment and supplies, allows directed and increasingly well-organized field responses to event sites. On 27 February 2005, one of the largest submarine earthquake sequences recorded with SOSUS occurred at the Endeavour segment of the JFR. The swarm met all criteria for magmatic earthquake sequences (see Dziak et al. poster and upcoming EOS article). This swarm differed from other plume-producing swarms in that it migrated more slowly (< 0.1 m/s) and over less distance (< 30 km) and occurred entirely within an overlap zone rather than within the bathymetric minimum of a segment. Despite the ambiguous character of the earthquake swarm, the Event Response Community responded since: (1) Although the swarm appeared to be magmatic, there is no way to confirm seafloor or water-column effects without in situ observations; and (2) absent a seafloor eruption, the physical process of injecting magma into the crust should cause significant faulting and fissuring that could result in the release of hydrothermal fluids. The high intensity of the earthquake swarm greatly increased this possibility. This response effort marked the sixth time since 1993 that a research cruise was organized for rapid response to the site of earthquake activity. The response team was on station just 6 days after notification of the seismic swarm, the fastest response yet mounted. Although the team detected no evidence of a new lava flow, or event

  11. The Ideal Time Interval for Critical Care Severity-of-Illness Assessment

    PubMed Central

    Pollack, Murray M.; Dean, J. Michael; Butler, Jerry; Holubkov, Richard; Doctor, Allan; Meert, Kathleen L.; Newth, Christopher J. L.; Berg, Robert A.; Moler, Frank; Dalton, Heidi; Wessel, David L.; Berger, John; Harrison, Rick E.; Carcillo, Joseph A.; Shanley, Thomas P.; Nicholson, Carol E.

    2013-01-01

    Objective Determine if the shortest sampling interval for laboratory variables used to estimate baseline severity of illness in pediatric critical care is equivalently sensitive across multiple sites without site-specific bias, while accounting for the vast majority of dysfunction compared to the standard 0 hour to 12 hour Pediatric Risk of Mortality (PRISM) III score. Design Prospective, random patient selection. Setting General/Medical and Cardiac/Cardiovascular pediatric intensive care units (PICUs) in 8 hospitals. Patients Patients < 18 years admitted to the PICU. Interventions None. Measurements and Main Results A total of 376 patients were included. Measurements for PRISM III laboratory variables (pH, PCO2, total CO2, PaO2, glucose, potassium, blood urea nitrogen (BUN), creatinine, total (WBC) count, platelet count, PT/PTT) were recorded from 2 hours prior to the PICU admission through 12 hours of the PICU care except for data in the operating room. Decreasing the observation period from the 0 hour to 12 hours post-PICU admission resulted in progressive decreases in the PRISM III laboratory variables measured. However, allowing the observation period to start 2 hours prior to PICU admission to 4 hours reduced this loss to only 3.4%. Similar trends existed for each of the individual laboratory PRISM III variables. There was a nearly identical distribution of laboratory PRISM III points within the −2 hour to 4 hour period compared to the standard period. We did not detect any institutional bias using the −2 hour to 4 hour time period compared to the baseline. Conclusions Prognostically important laboratory physiologic data collected within the interval from two hours prior to PICU to admission through four hours after admission account for the vast majority of dysfunction that these variables would contribute to PRISM III scores. There was no institutional bias associated with this sampling period. PMID:23628831

  12. The Association of Fever with Total Mechanical Ventilation Time in Critically Ill Patients

    PubMed Central

    Yokoyama, Takeshi

    2016-01-01

    This research aims to investigate the impact of fever on total mechanical ventilation time (TVT) in critically ill patients. Subgroup analysis was conducted using a previous prospective, multicenter observational study. We included mechanically ventilated patients for more than 24 hours from 10 Korean and 15 Japanese intensive care units (ICU), and recorded maximal body temperature under the support of mechanical ventilation (MAXMV). To assess the independent association of MAXMV with TVT, we used propensity-matched analysis in a total of 769 survived patients with medical or surgical admission, separately. Together with multiple linear regression analysis to evaluate the association between the severity of fever and TVT, the effect of MAXMV on ventilator-free days was also observed by quantile regression analysis in all subjects including non-survivors. After propensity score matching, a MAXMV ≥ 37.5°C was significantly associated with longer mean TVT by 5.4 days in medical admission, and by 1.2 days in surgical admission, compared to those with MAXMV of 36.5°C to 37.4°C. In multivariate linear regression analysis, patients with three categories of fever (MAXMV of 37.5°C to 38.4°C, 38.5°C to 39.4°C, and ≥ 39.5°C) sustained a significantly longer duration of TVT than those with normal range of MAXMV in both categories of ICU admission. A significant association between MAXMV and mechanical ventilator-free days was also observed in all enrolled subjects. Fever may be a detrimental factor to prolong TVT in mechanically ventilated patients. These findings suggest that fever in mechanically ventilated patients might be associated with worse mechanical ventilation outcome. PMID:27822946

  13. Timing of PD-1 Blockade Is Critical to Effective Combination Immunotherapy with Anti-OX40.

    PubMed

    Messenheimer, David J; Jensen, Shawn M; Afentoulis, Michael E; Wegmann, Keith W; Feng, Zipei; Friedman, David J; Gough, Michael J; Urba, Walter J; Fox, Bernard A

    2017-08-28

    Purpose: Antibodies specific for inhibitory checkpoints PD-1 and CTLA-4 have shown impressive results against solid tumors. This has fueled interest in novel immunotherapy combinations to affect patients who remain refractory to checkpoint blockade monotherapy. However, how to optimally combine checkpoint blockade with agents targeting T-cell costimulatory receptors, such as OX40, remains a critical question.Experimental Design: We utilized an anti-PD-1-refractory, orthotopically transplanted MMTV-PyMT mammary cancer model to investigate the antitumor effect of an agonist anti-OX40 antibody combined with anti-PD-1. As PD-1 naturally aids in immune contraction after T-cell activation, we treated mice with concurrent combination treatment versus sequentially administering anti-OX40 followed by anti-PD-1.Results: The concurrent addition of anti-PD-1 significantly attenuated the therapeutic effect of anti-OX40 alone. Combination-treated mice had considerable increases in type I and type II serum cytokines and significantly augmented expression of inhibitory receptors or exhaustion markers CTLA-4 and TIM-3 on T cells. Combination treatment increased intratumoral CD4(+) T-cell proliferation at day 13, but at day 19, both CD4(+) and CD8(+) T-cell proliferation was significantly reduced compared with untreated mice. In two tumor models, sequential combination of anti-OX40 followed by anti-PD-1 (but not the reverse order) resulted in significant increases in therapeutic efficacy. Against MMTV-PyMT tumors, sequential combination was dependent on both CD4(+) and CD8(+) T cells and completely regressed tumors in approximately 30% of treated animals.Conclusions: These results highlight the importance of timing for optimized therapeutic effect with combination immunotherapies and suggest the testing of sequencing in combination immunotherapy clinical trials. Clin Cancer Res; 1-13. ©2017 AACR. ©2017 American Association for Cancer Research.

  14. Hospitalizations, Costs, and Mortality among Infants with Critical Congenital Heart Disease: How Important Is Timely Detection?

    PubMed Central

    Peterson, Cora; Dawson, April; Grosse, Scott D.; Riehle-Colarusso, Tiffany; Olney, Richard S.; Tanner, Jean Paul; Kirby, Russell S.; Correia, Jane A.; Watkins, Sharon M.; Cassell, Cynthia H.

    2015-01-01

    BACKGROUND Critical congenital heart disease (CCHD) was recently added to the U.S. Recommended Uniform Screening Panel for newborns. States considering screening requirements may want more information about the potential impact of screening. This study examined potentially avoidable mortality among infants with late detected CCHD and assessed whether late detection was associated with increased hospital resource use during infancy. METHODS This was a state-wide, population-based, observational study of infants with CCHD (n =3603) born 1998 to 2007 identified by the Florida Birth Defects Registry. We examined 12 CCHD conditions that are targets of newborn screening. Late detection was defined as CCHD diagnosis after the birth hospitalization. Deaths potentially avoidable through screening were defined as those that occurred outside a hospital following birth hospitalization discharge and those that occurred within 3 days of an emergency readmission. RESULTS For 23% (n =825) of infants, CCHD was not detected during the birth hospitalization. Death occurred among 20% (n =568/2,778) of infants with timely detected CCHD and 8% (n =66/825) of infants with late detected CCHD, unadjusted for clinical characteristics. Potentially preventable deaths occurred in 1.8% (n =15/825) of infants with late detected CCHD (0.4% of all infants with CCHD). In multivariable models adjusted for selected characteristics, late CCHD detection was significantly associated with 52% more admissions, 18% more hospitalized days, and 35% higher inpatient costs during infancy. CONCLUSION Increased CCHD detection at birth hospitals through screening may lead to decreased hospital costs and avoid some deaths during infancy. Additional studies conducted after screening implementation are needed to confirm these findings. PMID:24000201

  15. Moderate Exercise Allows for shorter Recovery Time in Critical Limb Ischemia.

    PubMed

    Lejay, Anne; Laverny, Gilles; Paradis, Stéphanie; Schlagowski, Anna-Isabel; Charles, Anne-Laure; Singh, François; Zoll, Joffrey; Thaveau, Fabien; Lonsdorfer, Evelyne; Dufour, Stéphane; Favret, Fabrice; Wolff, Valérie; Metzger, Daniel; Chakfe, Nabil; Geny, Bernard

    2017-01-01

    Whether and how moderate exercise might allow for accelerated limb recovery in chronic critical limb ischemia (CLI) remains to be determined. Chronic CLI was surgically induced in mice, and the effect of moderate exercise (training five times per week over a 3-week period) was investigated. Tissue damages and functional scores were assessed on the 4th, 6th, 10th, 20th, and 30th day after surgery. Mice were sacrificed 48 h after the last exercise session in order to assess muscle structure, mitochondrial respiration, calcium retention capacity, oxidative stress and transcript levels of genes encoding proteins controlling mitochondrial functions (PGC1α, PGC1β, NRF1) and anti-oxidant defenses markers (SOD1, SOD2, catalase). CLI resulted in tissue damages and impaired functional scores. Mitochondrial respiration and calcium retention capacity were decreased in the ischemic limb of the non-exercised group (Vmax = 7.11 ± 1.14 vs. 9.86 ± 0.86 mmol 02/min/g dw, p < 0.001; CRC = 7.01 ± 0.97 vs. 11.96 ± 0.92 microM/mg dw, p < 0.001, respectively). Moderate exercise reduced tissue damages, improved functional scores, and restored mitochondrial respiration and calcium retention capacity in the ischemic limb (Vmax = 9.75 ± 1.00 vs. 9.82 ± 0.68 mmol 02/min/g dw; CRC = 11.36 ± 1.33 vs. 12.01 ± 1.24 microM/mg dw, respectively). Exercise also enhanced the transcript levels of PGC1α, PGC1β, NRF1, as well as SOD1, SOD2, and catalase. Moderate exercise restores mitochondrial respiration and calcium retention capacity, and it has beneficial functional effects in chronic CLI, likely by stimulating reactive oxygen species-induced biogenesis and anti-oxidant defenses. These data support further development of exercise therapy even in advanced peripheral arterial disease.

  16. Real time evolution of non-Gaussian cumulants in the QCD critical regime

    DOE PAGES

    Mukherjee, Swagato; Venugopalan, Raju; Yin, Yi

    2015-09-23

    In this study, we derive a coupled set of equations that describe the nonequilibrium evolution of cumulants of critical fluctuations for spacetime trajectories on the crossover side of the QCD phase diagram. In particular, novel expressions are obtained for the nonequilibrium evolution of non-Gaussian skewness and kurtosis cumulants. UBy utilizing a simple model of the spacetime evolution of a heavy-ion collision, we demonstrate that, depending on the relaxation rate of critical fluctuations, skewness and kurtosis can differ significantly in magnitude as well as in sign from equilibrium expectations. Memory effects are important and shown to persist even for trajectories thatmore » skirt the edge of the critical regime. We use phenomenologically motivated parametrizations of freeze-out curves and of the beam-energy dependence of the net baryon chemical potential to explore the implications of our model study for the critical-point search in heavy-ion collisions.« less

  17. Real time evolution of non-Gaussian cumulants in the QCD critical regime

    SciTech Connect

    Mukherjee, Swagato; Venugopalan, Raju; Yin, Yi

    2015-09-23

    In this study, we derive a coupled set of equations that describe the nonequilibrium evolution of cumulants of critical fluctuations for spacetime trajectories on the crossover side of the QCD phase diagram. In particular, novel expressions are obtained for the nonequilibrium evolution of non-Gaussian skewness and kurtosis cumulants. UBy utilizing a simple model of the spacetime evolution of a heavy-ion collision, we demonstrate that, depending on the relaxation rate of critical fluctuations, skewness and kurtosis can differ significantly in magnitude as well as in sign from equilibrium expectations. Memory effects are important and shown to persist even for trajectories that skirt the edge of the critical regime. We use phenomenologically motivated parametrizations of freeze-out curves and of the beam-energy dependence of the net baryon chemical potential to explore the implications of our model study for the critical-point search in heavy-ion collisions.

  18. Development of a rugged handheld device for real-time analysis of heart rate: entropy in critically ill patients.

    PubMed

    Mejaddam, Ali Y; van der Wilden, Gwendolyn M; Chang, Yuchiao; Cropano, Catrina M; Sideris, Antonis C; Hwabejire, John O; Velmahos, George C; Alam, Hasan B; de Moya, Marc A; King, David R

    2013-01-01

    The usefulness of heart rate variability (HRV) and heart rate complexity (HRC) analysis as a potential triage tool has been limited by the inability to perform real-time analysis on a portable, handheld monitoring platform. Through a multidisciplinary effort of academia and industry, we report on the development of a rugged, handheld and noninvasive device that provides HRV and HRC analysis in real-time in critically ill patients. After extensive re-engineering, real-time HRV and HRC analyses were incorporated into an existing, rugged, handheld monitoring platform. Following IRB approval, the prototype device was used to monitor 20 critically ill patients and 20 healthy controls to demonstrate real-world discriminatory potential. Patients were compared to healthy controls using a Student?s t test as well as repeated measures analysis. Receiver operator characteristic (ROC) curves were generated for HRV and HRC. Critically ill patients had a mean APACHE-2 score of 15, and over 50% were mechanically ventilated and requiring vasopressor support. HRV and HRC were both lower in the critically ill patients compared to healthy controls (p < 0.0001) and remained so after repeated measures analysis. The area under the ROC for HRV and HRC was 0.95 and 0.93, respectively. This is the first demonstration of real-time, handheld HRV and HRC analysis. This prototype device successfully discriminates critically ill patients from healthy controls. This may open up possibilities for real-world use as a trauma triage tool, particularly on the battlefield. 2013.

  19. Moderate Exercise Allows for shorter Recovery Time in Critical Limb Ischemia

    PubMed Central

    Lejay, Anne; Laverny, Gilles; Paradis, Stéphanie; Schlagowski, Anna-Isabel; Charles, Anne-Laure; Singh, François; Zoll, Joffrey; Thaveau, Fabien; Lonsdorfer, Evelyne; Dufour, Stéphane; Favret, Fabrice; Wolff, Valérie; Metzger, Daniel; Chakfe, Nabil; Geny, Bernard

    2017-01-01

    Whether and how moderate exercise might allow for accelerated limb recovery in chronic critical limb ischemia (CLI) remains to be determined. Chronic CLI was surgically induced in mice, and the effect of moderate exercise (training five times per week over a 3-week period) was investigated. Tissue damages and functional scores were assessed on the 4th, 6th, 10th, 20th, and 30th day after surgery. Mice were sacrificed 48 h after the last exercise session in order to assess muscle structure, mitochondrial respiration, calcium retention capacity, oxidative stress and transcript levels of genes encoding proteins controlling mitochondrial functions (PGC1α, PGC1β, NRF1) and anti-oxidant defenses markers (SOD1, SOD2, catalase). CLI resulted in tissue damages and impaired functional scores. Mitochondrial respiration and calcium retention capacity were decreased in the ischemic limb of the non-exercised group (Vmax = 7.11 ± 1.14 vs. 9.86 ± 0.86 mmol 02/min/g dw, p < 0.001; CRC = 7.01 ± 0.97 vs. 11.96 ± 0.92 microM/mg dw, p < 0.001, respectively). Moderate exercise reduced tissue damages, improved functional scores, and restored mitochondrial respiration and calcium retention capacity in the ischemic limb (Vmax = 9.75 ± 1.00 vs. 9.82 ± 0.68 mmol 02/min/g dw; CRC = 11.36 ± 1.33 vs. 12.01 ± 1.24 microM/mg dw, respectively). Exercise also enhanced the transcript levels of PGC1α, PGC1β, NRF1, as well as SOD1, SOD2, and catalase. Moderate exercise restores mitochondrial respiration and calcium retention capacity, and it has beneficial functional effects in chronic CLI, likely by stimulating reactive oxygen species-induced biogenesis and anti-oxidant defenses. These data support further development of exercise therapy even in advanced peripheral arterial disease. PMID:28790926

  20. Critical Pedagogy in Uncertain Times: Hope and Possibilities. Education, Politics and Public Life

    ERIC Educational Resources Information Center

    Macrine, Sheila L., Ed.

    2012-01-01

    This book provides comprehensive analyses of issues related to the struggle against the forces of imperial-induced privatization, not just in education, but in all of social life. It situates Critical Pedagogy in the twenty-first century and offers not only critiques but also practical applications, suggestions, and strategies on how attacks can…

  1. Time to Look Anew: Critical Pedagogy and Disciplines within Higher Education

    ERIC Educational Resources Information Center

    McArthur, Jan

    2010-01-01

    This article explores the attitudes of writers within the tradition of critical pedagogy towards disciplines in higher education. With particular focus on Henry Giroux's work, it contrasts his portrayal of disciplines as closed, limiting and elitist with an alternative one of disciplines as complex, permeable and contested spaces. Critical…

  2. Tumultuous Times of Education Reform: A Critical Reflection on Caring in Policy and Practice

    ERIC Educational Resources Information Center

    Green, Mary G.; Tucker, Janice L.

    2011-01-01

    This article examines "caring" in the context of radical education reform in one Canadian province and school district. Historical provincial policy documents set the context for the district analysis. Drawing on our experiences both as participants and researchers, we use theories of care, critical policy, and the tools of critical…

  3. Critical Pedagogy in Uncertain Times: Hope and Possibilities. Education, Politics and Public Life

    ERIC Educational Resources Information Center

    Macrine, Sheila L., Ed.

    2012-01-01

    This book provides comprehensive analyses of issues related to the struggle against the forces of imperial-induced privatization, not just in education, but in all of social life. It situates Critical Pedagogy in the twenty-first century and offers not only critiques but also practical applications, suggestions, and strategies on how attacks can…

  4. Tumultuous Times of Education Reform: A Critical Reflection on Caring in Policy and Practice

    ERIC Educational Resources Information Center

    Green, Mary G.; Tucker, Janice L.

    2011-01-01

    This article examines "caring" in the context of radical education reform in one Canadian province and school district. Historical provincial policy documents set the context for the district analysis. Drawing on our experiences both as participants and researchers, we use theories of care, critical policy, and the tools of critical…

  5. Immortal time bias in critical care research: application of time-varying Cox regression for observational cohort studies.

    PubMed

    Shintani, Ayumi K; Girard, Timothy D; Eden, Svetlana K; Arbogast, Patrick G; Moons, Karel G M; Ely, E Wesley

    2009-11-01

    To examine the bias introduced by using time-fixed methodology to analyze the effects of a time-varying exposure incurred in the intensive care unit. Prospective cohort and Monte Carlo simulation studies. Medical and coronary intensive care units in a university hospital. A total of 224 mechanically ventilated patients. Part I was a case study analyzing the association between delirium in the intensive care unit (exposure variable) and outcomes (intensive care unit length of stay and 6-mo mortality) in a prospective cohort study. Part II was a Monte Carlo simulation generating 16,000 data sets wherein the true associations between delirium and outcomes were known before analysis. In both parts, we assessed associations between delirium in the intensive care unit and outcomes (intensive care unit length of stay and mortality), using time-fixed vs. time-varying Cox regression methodology. In the case study, delirium analyzed as a time-fixed variable was associated with a delayed intensive care unit discharge (adjusted hazard ratio = 1.9, 95% confidence interval, 1.3-2.7, p < .001), but no association was noted using a time-varying method (adjusted hazard ratio = 1.1, 95% confidence interval = 0.7-1.6, p = .70). Alternatively, delirium analyzed as a time-fixed variable was not associated with 6-mo mortality (adjusted hazard ratio = 2.9, 95% confidence interval, 0.9-5.0, p = .09), whereas delirium analyzed as a time-varying variable was associated with increased mortality (adjusted hazard ratio = 3.2, 95% confidence interval, 1.4-7.7, p = .008). In the simulation study, time-fixed methods produced erroneous results in 97.1% of the data sets with no true association; time-varying methods produced erroneous results in only 3.7%. Similarly, time-fixed methods produced biased results when a true association was present, whereas time-varying methods produced accurate results. Studies using a time-fixed analytic approach to understand relationships between exposures and

  6. Optimal Time-decay Estimates for the Compressible Navier-Stokes Equations in the Critical L p Framework

    NASA Astrophysics Data System (ADS)

    Danchin, Raphaël; Xu, Jiang

    2017-04-01

    The global existence issue for the isentropic compressible Navier-Stokes equations in the critical regularity framework was addressed in Danchin (Invent Math 141(3):579-614, 2000) more than 15 years ago. However, whether (optimal) time-decay rates could be shown in critical spaces has remained an open question. Here we give a positive answer to that issue not only in the L 2 critical framework of Danchin (Invent Math 141(3):579-614, 2000) but also in the general L p critical framework of Charve and Danchin (Arch Ration Mech Anal 198(1):233-271, 2010), Chen et al. (Commun Pure Appl Math 63(9):1173-1224, 2010), Haspot (Arch Ration Mech Anal 202(2):427-460, 2011): we show that under a mild additional decay assumption that is satisfied if, for example, the low frequencies of the initial data are in {L^{p/2}(Rd)}, the L p norm (the slightly stronger dot B^0_{p,1} norm in fact) of the critical global solutions decays like t^{-d(1/p - 1/4} for {tto+∞,} exactly as firstly observed by Matsumura and Nishida in (Proc Jpn Acad Ser A 55:337-342, 1979) in the case p = 2 and d = 3, for solutions with high Sobolev regularity. Our method relies on refined time weighted inequalities in the Fourier space, and is likely to be effective for other hyperbolic/parabolic systems that are encountered in fluid mechanics or mathematical physics.

  7. The Infeasibility of Quantifying the Reliability of Life-Critical Real-Time Software

    NASA Technical Reports Server (NTRS)

    Butler, Ricky W.; Finelli, George B.

    1991-01-01

    This paper affirms that the quantification of life-critical software reliability is infeasible using statistical methods whether applied to standard software or fault-tolerant software. The classical methods of estimating reliability are shown to lead to exhorbitant amounts of testing when applied to life-critical software. Reliability growth models are examined and also shown to be incapable of overcoming the need for excessive amounts of testing. The key assumption of software fault tolerance separately programmed versions fail independently is shown to be problematic. This assumption cannot be justified by experimentation in the ultrareliability region and subjective arguments in its favor are not sufficiently strong to justify it as an axiom. Also, the implications of the recent multiversion software experiments support this affirmation.

  8. Designing for Temporal Awareness: The Role of Temporality in Time-Critical Medical Teamwork

    PubMed Central

    Kusunoki, Diana S.; Sarcevic, Aleksandra

    2016-01-01

    This paper describes the role of temporal information in emergency medical teamwork and how time-based features can be designed to support the temporal awareness of clinicians in this fast-paced and dynamic environment. Engagement in iterative design activities with clinicians over the course of two years revealed a strong need for time-based features and mechanisms, including timestamps for tasks based on absolute time and automatic stopclocks measuring time by counting up since task performance. We describe in detail the aspects of temporal awareness central to clinicians’ awareness needs and then provide examples of how we addressed these needs through the design of a shared information display. As an outcome of this process, we define four types of time representation techniques to facilitate the design of time-based features: (1) timestamps based on absolute time, (2) timestamps relative to the process start time, (3) time since task performance, and (4) time until the next required task. PMID:27478880

  9. Stability of non-monotone critical traveling waves for reaction-diffusion equations with time-delay

    NASA Astrophysics Data System (ADS)

    Chern, I.-Liang; Mei, Ming; Yang, Xiongfeng; Zhang, Qifeng

    2015-08-01

    This paper is concerned with the stability of critical traveling waves for a kind of non-monotone time-delayed reaction-diffusion equations including Nicholson's blowflies equation which models the population dynamics of a single species with maturation delay. Such delayed reaction-diffusion equations possess monotone or oscillatory traveling waves. The latter occurs when the birth rate function is non-monotone and the time-delay is big. It has been shown that such traveling waves ϕ (x + ct) exist for all c ≥c* and are exponentially stable for all wave speed c >c*[13], where c* is called the critical wave speed. In this paper, we prove that the critical traveling waves ϕ (x +c* t) (monotone or oscillatory) are also time-asymptotically stable, when the initial perturbations are small in a certain weighted Sobolev norm. The adopted method is the technical weighted-energy method with some new flavors to handle the critical oscillatory waves. Finally, numerical simulations for various cases are carried out to support our theoretical results.

  10. CoR-MAC: Contention over Reservation MAC Protocol for Time-Critical Services in Wireless Body Area Sensor Networks.

    PubMed

    Yu, Jeongseok; Park, Laihyuk; Park, Junho; Cho, Sungrae; Keum, Changsup

    2016-05-09

    Reserving time slots for urgent data, such as life-critical information, seems to be very attractive to guarantee their deadline requirements in wireless body area sensor networks (WBASNs). On the other hand, this reservation imposes a negative impact on performance for the utilization of a channel. This paper proposes a new channel access scheme referred to as the contention over reservation MAC (CoR-MAC) protocol for time-critical services in wireless body area sensor networks. CoR-MAC uses the dual reservation; if the reserved time slots are known to be vacant, other nodes can access the time slots by contention-based reservation to maximize the utilization of a channel and decrease the delay of the data. To measure the effectiveness of the proposed scheme against IEEE 802.15.4 and IEEE 802.15.6, we evaluated their performances with various performance indexes. The CoR-MAC showed 50% to 850% performance improvement in terms of the delay of urgent and time-critical data according to the number of nodes.

  11. CoR-MAC: Contention over Reservation MAC Protocol for Time-Critical Services in Wireless Body Area Sensor Networks

    PubMed Central

    Yu, Jeongseok; Park, Laihyuk; Park, Junho; Cho, Sungrae; Keum, Changsup

    2016-01-01

    Reserving time slots for urgent data, such as life-critical information, seems to be very attractive to guarantee their deadline requirements in wireless body area sensor networks (WBASNs). On the other hand, this reservation imposes a negative impact on performance for the utilization of a channel. This paper proposes a new channel access scheme referred to as the contention over reservation MAC (CoR-MAC) protocol for time-critical services in wireless body area sensor networks. CoR-MAC uses the dual reservation; if the reserved time slots are known to be vacant, other nodes can access the time slots by contention-based reservation to maximize the utilization of a channel and decrease the delay of the data. To measure the effectiveness of the proposed scheme against IEEE 802.15.4 and IEEE 802.15.6, we evaluated their performances with various performance indexes. The CoR-MAC showed 50% to 850% performance improvement in terms of the delay of urgent and time-critical data according to the number of nodes. PMID:27171085

  12. Neuregulin-Dependent Regulation of Fast-Spiking Interneuron Excitability Controls the Timing of the Critical Period.

    PubMed

    Gu, Yu; Tran, Trinh; Murase, Sachiko; Borrell, Andrew; Kirkwood, Alfredo; Quinlan, Elizabeth M

    2016-10-05

    Maturation of excitatory drive onto fast-spiking interneurons (FS INs) in the visual cortex has been implicated in the control of the timing of the critical period for ocular dominance plasticity. However, the mechanisms that regulate the strength of these synapses over cortical development are not understood. Here we use a mouse model to show that neuregulin (NRG) and the receptor tyrosine kinase erbB4 regulate the timing of the critical period. NRG1 enhanced the strength of excitatory synapses onto FS INs, which inhibited ocular dominance plasticity during the critical period but rescued plasticity in transgenics with hypoexcitable FS INs. Blocking the effects of endogenous neuregulin via inhibition of erbBs rescued ocular dominance plasticity in postcritical period adults, allowing recovery from amblyopia induced by chronic monocular deprivation. Thus, the strength of excitation onto FS INs is a key determinant of critical period plasticity and is maintained at high levels by NRG-erbB4 signaling to constrain plasticity in adulthood.

  13. Early depth assessment of local burns by videomicroscopy: 24 h after injury is a critical time point.

    PubMed

    Mihara, Kyomi; Shindo, Hajime; Ohtani, Minako; Nagasaki, Kotaro; Nakashima, Reiko; Katoh, Norito; Kishimoto, Saburo

    2011-09-01

    Videomicroscopy has simple and prompt operability, and useful in the burn depth assessment in its early phase. A burn wound is, however, a dynamic environment in the first few days and the critical time to assess a burn wound by videomicroscopy has not been investigated. The aim of this study is to investigate the critical time point to assess the burn depth by videomicroscopy. Forty one patients with 44 intermediate depth burns admitted within 7 days after injury were included. Accuracies were assessed by comparison with clinical outcome: healing within 21 days after injury or not with conservative treatment. We prospectively evaluated and compared the accuracy of the videomicroscopy measurements with the clinical assessments. All findings were serialized in order of time after injury and divided into three groups, and we compared the appreciation of burn depth by videomicroscopy findings among groups. The videomicroscopy measurements is significantly accurate compared with clinical assessments (p=0.001). The accuracy of videomicroscopy measurements was significantly lower in the post-injury <24 h group compared with post-injury ≥24 h group (p=0.004). Videomicroscopy is effective tool in assessment of early burn depth and the critical time point to assess the burn depth by videomicroscopy is 24 h after injury. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  14. Barriers and Facilitators to Initiating and Completing Time-Limited Trials in Critical Care.

    PubMed

    Bruce, Courtenay R; Liang, Cecilia; Blumenthal-Barby, Jennifer S; Zimmerman, Janice; Downey, Andrea; Pham, Linda; Theriot, Lisette; Delgado, Estevan D; White, Douglas

    2015-12-01

    A time-limited trial is an agreement between clinicians and patients or surrogate decision makers to use medical therapies over a defined period of time to see if the patient improves or deteriorates according to agreed-upon clinical milestones. Although time-limited trials are broadly advocated, there is little empirical evidence of the benefits and risks of time-limited trials, when they are initiated, when and why they succeed or fail, and what facilitates completion of them. Our study objectives were to 1) identify the purposes for which clinicians use time-limited trials and 2) identify barriers and facilitators to initiating and completing time-limited trials. Semistructured interviews: We analyzed interviews using qualitative description with constant comparative techniques. Nine hundred-bed, academic, tertiary hospital in Houston, Texas. Interviewees were from open medical, surgical, neurosurgical, and cardiovascular ICUs. Thirty healthcare professionals were interviewed (nine surgeons, 16 intensivists, three nurse practitioners, and two "other" clinicians). None. Interviewees reported initiating time-limited trials for three different purposes: to prepare surrogates and clinicians for discussion and possible shifts toward comfort-care only therapies, build consensus, and refine prognostic information. The main barriers to initiating time-limited trials involve clinicians' or surrogate decision makers' disagreement on setting a time limit. Barriers to completing time-limited trials include 1) requesting more time; 2) communication breakdowns because of rotating call schedules; and 3) changes in clinical course. Finally, facilitators to completing time-limited trials include 1) having defined goals about what could be achieved during an ICU stay, either framed in narrow, numeric terms or broad goals focusing on achievable activities of daily living; 2) applying time-limited trials in certain types of cases; and 3) taking ownership to ensure completion of the

  15. Real-Time Monitoring of Critical Care Analytes in the Bloodstream with Chemical Sensors: Progress and Challenges

    NASA Astrophysics Data System (ADS)

    Frost, Megan C.; Meyerhoff, Mark E.

    2015-07-01

    We review approaches and challenges in developing chemical sensor-based methods to accurately and continuously monitor levels of key analytes in blood related directly to the status of critically ill hospitalized patients. Electrochemical and optical sensor-based technologies have been pursued to measure important critical care species in blood [i.e., oxygen, carbon dioxide, pH, electrolytes (K+, Na+, Cl-, etc.), glucose, and lactate] in real-time or near real-time. The two main configurations examined to date for achieving this goal have been intravascular catheter sensors and patient attached ex vivo sensors with intermittent blood sampling via an attached indwelling catheter. We discuss the status of these configurations and the main issues affecting the accuracy of the measurements, including cell adhesion and thrombus formation on the surface of the sensors, sensor drift, sensor selectivity, etc. Recent approaches to mitigate these nagging performance issues that have prevented these technologies from clinical use are also discussed.

  16. 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).

  17. 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)

  18. Timing of Newborn Pulse Oximetry Screenings for Critical Congenital Heart Defects Before Discharge.

    PubMed

    Crouch, Lynn; Speroni, Karen Gabel; Jones, Ruth Ann; MacDougall, Eileen P; Daniel, Marlon G

    2016-01-01

    To determine if there would be positive results from a second pulse oximetry screening (POS) completed for newborns at discharge at 28 to 48 hours of age in addition to the newborn POS completed at 24 to 25 hours of age. Prospective descriptive research study. Rural, mid-Atlantic, 13-bed, level I hospital. Newborns (N = 1,002) at 35 weeks' gestation or older discharged from the newborn nursery. Registered nurses (RNs) performed POS at 24 to 25 hours of age (POS 1) and at discharge but less than 48 hours of age (POS 2). Data related to critical congenital heart defects were collected. There were no positive POS results (O2 saturation ≤ 90%) at POS 1 or POS 2, and no additional diagnostic tests were ordered as a result of POS. Although one full-term newborn had negative results at POS 1 and POS 2, the RN identified a murmur, and a subsequent echocardiogram was used to detect tetralogy of Fallot and pulmonary atresia. The RNs detected concerning conditions in 14 newborns that resulted in 28 additional tests, including echocardiograms (9), chest x-ray imaging (8), laboratory testing (7), electrocardiograms (3), and ultrasound imaging (1). The POS-positive result rate was 0 for newborns at POS 1 and POS 2. Therefore, our study findings supported Maryland's mandate of one POS completed within 24 to 48 hours of birth. Nurses must continue to be vigilant about assessing newborns, including screening for critical congenital heart defects and congenital heart defects. Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  19. Optimal Time-decay Estimates for the Compressible Navier-Stokes Equations in the Critical L p Framework

    NASA Astrophysics Data System (ADS)

    Danchin, Raphaël; Xu, Jiang

    2016-11-01

    The global existence issue for the isentropic compressible Navier-Stokes equations in the critical regularity framework was addressed in Danchin (Invent Math 141(3):579-614, 2000) more than 15 years ago. However, whether (optimal) time-decay rates could be shown in critical spaces has remained an open question. Here we give a positive answer to that issue not only in the L 2 critical framework of Danchin (Invent Math 141(3):579-614, 2000) but also in the general L p critical framework of Charve and Danchin (Arch Ration Mech Anal 198(1):233-271, 2010), Chen et al. (Commun Pure Appl Math 63(9):1173-1224, 2010), Haspot (Arch Ration Mech Anal 202(2):427-460, 2011): we show that under a mild additional decay assumption that is satisfied if, for example, the low frequencies of the initial data are in {L^{p/2}({R}d)} , the L p norm (the slightly stronger {dot B^0_{p,1}} norm in fact) of the critical global solutions decays like {t^{-d(1/p-1/4)}} for {tto+∞,} exactly as firstly observed by Matsumura and Nishida in (Proc Jpn Acad Ser A 55:337-342, 1979) in the case p = 2 and d = 3, for solutions with high Sobolev regularity. Our method relies on refined time weighted inequalities in the Fourier space, and is likely to be effective for other hyperbolic/parabolic systems that are encountered in fluid mechanics or mathematical physics.

  20. Reliable real-time calculation of heart-rate complexity in critically ill patients using multiple noisy waveform sources.

    PubMed

    Liu, Nehemiah T; Cancio, Leopoldo C; Salinas, Jose; Batchinsky, Andriy I

    2014-04-01

    Heart-rate complexity (HRC) has been proposed as a new vital sign for critical care medicine. The purpose of this research was to develop a reliable method for determining HRC continuously in real time in critically ill patients using multiple waveform channels that also compensates for noisy and unreliable data. Using simultaneously acquired electrocardiogram (Leads I, II, V) and arterial blood pressure waveforms sampled at 360 Hz from 250 patients (over 375 h of patient data), we evaluated a new data fusion framework for computing HRC in real time. The framework employs two algorithms as well as signal quality indices. HRC was calculated (via the method of sample entropy), and equivalence tests were then performed. Bland-Altman plots and box plots of differences between mean HRC values were also obtained. Finally, HRC differences were analyzed by paired t tests. The gold standard for obtaining true means was manual verification of R waves and subsequent entropy calculations. Equivalence tests between mean HRC values derived from manually verified sequences and those derived from automatically detected peaks showed that the "Fusion" values were the least statistically different from the gold standard. Furthermore, the fusion of waveform sources produced better error density distributions than those derived from individual waveforms. The data fusion framework was shown to provide in real-time a reliable continuously streamed HRC value, derived from multiple waveforms in the presence of noise and artifacts. This approach will be validated and tested for assessment of HRC in critically ill patients.

  1. The Evolution of Television Criticism in the New York "Times": 1949-1977.

    ERIC Educational Resources Information Center

    Vincent, Richard C.

    1980-01-01

    Shows that "The New York Times" devoted a significant portion of its television-related articles to personality features from 1949 to 1977 and that only recently has this trend showed signs of changing. (FL)

  2. Heart rate time series characteristics for early detection of infections in critically ill patients.

    PubMed

    Tambuyzer, T; Guiza, F; Boonen, E; Meersseman, P; Vervenne, H; Hansen, T K; Bjerre, M; Van den Berghe, G; Berckmans, D; Aerts, J M; Meyfroidt, G

    2017-04-01

    It is difficult to make a distinction between inflammation and infection. Therefore, new strategies are required to allow accurate detection of infection. Here, we hypothesize that we can distinguish infected from non-infected ICU patients based on dynamic features of serum cytokine concentrations and heart rate time series. Serum cytokine profiles and heart rate time series of 39 patients were available for this study. The serum concentration of ten cytokines were measured using blood sampled every 10 min between 2100 and 0600 hours. Heart rate was recorded every minute. Ten metrics were used to extract features from these time series to obtain an accurate classification of infected patients. The predictive power of the metrics derived from the heart rate time series was investigated using decision tree analysis. Finally, logistic regression methods were used to examine whether classification performance improved with inclusion of features derived from the cytokine time series. The AUC of a decision tree based on two heart rate features was 0.88. The model had good calibration with 0.09 Hosmer-Lemeshow p value. There was no significant additional value of adding static cytokine levels or cytokine time series information to the generated decision tree model. The results suggest that heart rate is a better marker for infection than information captured by cytokine time series when the exact stage of infection is not known. The predictive value of (expensive) biomarkers should always be weighed against the routinely monitored data, and such biomarkers have to demonstrate added value.

  3. Critical Care Admissions following Total Laryngectomy: Is It Time to Change Our Practice?

    PubMed Central

    Morgan, Alexandria; Gibson, Bethan; Berry, Sandeep; Jaffery, Ali

    2016-01-01

    Critical Care Unit (CCU) beds are a limited resource and in increasing demand. Studies have shown that complex head and neck patients can be safely managed on a ward setting given the appropriate staffing and support. This retrospective case series aims to quantify the CCU care received by patients following total laryngectomy (TL) at a District General Hospital (DGH) and compare patient outcomes in an attempt to inform current practice. Data relating to TL were collected over a 5-year period from 1st January 2010 to 31st December 2015. A total of 22 patients were included. All patients were admitted to CCU postoperatively for an average length of stay of 25.5 hours. 95% of these patients were admitted to CCU for the purpose of close monitoring only, not requiring any active treatment prior to discharge to the ward. 73% of total complications were encountered after the first 24 hours postoperatively at which point patients had been stepped down to ward care. Avoiding the use of CCU beds and instead providing the appropriate level of care on the ward would result in a potential cost saving of approximately £8,000 with no influence on patient morbidity and mortality. PMID:27752264

  4. Moments of action provide insight into critical times for advection-diffusion-reaction processes.

    PubMed

    Ellery, Adam J; Simpson, Matthew J; McCue, Scott W; Baker, Ruth E

    2012-09-01

    Berezhkovskii and co-workers introduced the concept of local accumulation time as a finite measure of the time required for the transient solution of a reaction-diffusion equation to effectively reach steady state [Biophys J. 99, L59 (2010); Phys. Rev. E 83, 051906 (2011)]. Berezhkovskii's approach is a particular application of the concept of mean action time (MAT) that was introduced previously by McNabb [IMA J. Appl. Math. 47, 193 (1991)]. Here, we generalize these previous results by presenting a framework to calculate the MAT, as well as the higher moments, which we call the moments of action. The second moment is the variance of action time, the third moment is related to the skew of action time, and so on. We consider a general transition from some initial condition to an associated steady state for a one-dimensional linear advection-diffusion-reaction partial differential equation (PDE). Our results indicate that it is possible to solve for the moments of action exactly without requiring the transient solution of the PDE. We present specific examples that highlight potential weaknesses of previous studies that have considered the MAT alone without considering higher moments. Finally, we also provide a meaningful interpretation of the moments of action by presenting simulation results from a discrete random-walk model together with some analysis of the particle lifetime distribution. This work shows that the moments of action are identical to the moments of the particle lifetime distribution for certain transitions.

  5. Effect of timing of critical incident stress debriefing (CISD) on posttraumatic symptoms.

    PubMed

    Campfield, K M; Hills, A M

    2001-04-01

    Seventy-seven civilian employees who were victims of robbery were randomly assigned to either an immediate (< 10 hr) or delayed (> 48 hr) debriefing group, using the J. Mitchell (1983) CISD protocol. Scores on the Posttraumatic Stress Diagnostic Scale were obtained at 4 time intervals: debrief, 2 and 4 days post-debrief, and 2 weeks postrobbery. The number and severity of symptoms did not differ at debrief, but were lower for the immediate than for the delayed group at each subsequent time interval. The number and severity of symptoms declined across time intervals; however, although this reduction was pronounced for the immediate group it was minimal for the delayed group. The results supported use of immediate debriefing with this type of incident and victim.

  6. Adaptive critic designs for discrete-time zero-sum games with application to H(infinity) control.

    PubMed

    Al-Tamimi, Asma; Abu-Khalaf, Murad; Lewis, Frank L

    2007-02-01

    In this correspondence, adaptive critic approximate dynamic programming designs are derived to solve the discrete-time zero-sum game in which the state and action spaces are continuous. This results in a forward-in-time reinforcement learning algorithm that converges to the Nash equilibrium of the corresponding zero-sum game. The results in this correspondence can be thought of as a way to solve the Riccati equation of the well-known discrete-time H(infinity) optimal control problem forward in time. Two schemes are presented, namely: 1) a heuristic dynamic programming and 2) a dual-heuristic dynamic programming, to solve for the value function and the costate of the game, respectively. An H(infinity) autopilot design for an F-16 aircraft is presented to illustrate the results.

  7. A conceptual model for evolving run time support of mission and safety critical components in large, complex, distributed systems

    NASA Technical Reports Server (NTRS)

    Mckay, Charles W.

    1988-01-01

    Large, complex, distributed systems should be evolved to maximize life cycle support for non-stop operation of mission and safety critical components. This paper outlines the key issues and a recommended approach for tailoring a conceptual model of Ada run time support environments to meet the specific needs of such an application. Prerequisite concepts for this model have been described previously by this author and are summarized. This model proposes upward-compatible extensions to a previously published model of Ada run time environments from the ARTEWG (Ada Run Time Environment Working Group). The first model was used to identify Ada run time requirements, dependencies, issues, features, and options for single processor applications; however, the particular needs for distributed processing were not explicitly described. The purpose of this extended model is to address the needed systems software support for Ada application programs in distributed computing environments.

  8. A Paradox within the Time Value of Money: A Critical Thinking Exercise for Finance Students

    ERIC Educational Resources Information Center

    Delaney, Charles J.; Rich, Steven P.; Rose, John T.

    2016-01-01

    This study presents a paradox within the time value of money (TVM), namely, that the interest-principal sequence embedded in the payment stream of an amortized loan is exactly the opposite of the interest-principal sequence implicit in the present value of a matching annuity. We examine this inverse sequence, both mathematically and intuitively,…

  9. Eye Colour and Reaction Time: An Opportunity for Critical Statistical Reasoning

    ERIC Educational Resources Information Center

    Watson, Jane

    2008-01-01

    This author was surprised to read a short article in "The Mercury" newspaper in Hobart about blue-eyed people being more intelligent and brown-eyed people having faster reaction times. Such an article invites immediate scepticism from the statistically literate. The lack of data in the article should lead the interested reader to a…

  10. The efficacy of a restart break for recycling with optimal performance depends critically on circadian timing.

    PubMed

    Van Dongen, Hans P A; Belenky, Gregory; Vila, Bryan J

    2011-07-01

    Under simulated shift-work conditions, we investigated the efficacy of a restart break for maintaining neurobehavioral functioning across consecutive duty cycles, as a function of the circadian timing of the duty periods. As part of a 14-day experiment, subjects underwent two cycles of five simulated daytime or nighttime duty days, separated by a 34-hour restart break. Cognitive functioning and high-fidelity driving simulator performance were tested 4 times per day during the two duty cycles. Lapses on a psychomotor vigilance test (PVT) served as the primary outcome variable. Selected sleep periods were recorded polysomnographically. The experiment was conducted under standardized, controlled laboratory conditions with continuous monitoring. Twenty-seven healthy adults (13 men, 14 women; aged 22-39 years) participated in the study. Subjects were randomly assigned to a nighttime duty (experimental) condition or a daytime duty (control) condition. The efficacy of the 34-hour restart break for maintaining neurobehavioral functioning from the pre-restart duty cycle to the post-restart duty cycle was compared between these two conditions. Relative to the daytime duty condition, the nighttime duty condition was associated with reduced amounts of sleep, whereas sleep latencies were shortened and slow-wave sleep appeared to be conserved. Neurobehavioral performance measures ranging from lapses of attention on the PVT to calculated fuel consumption on the driving simulators remained optimal across time of day in the daytime duty schedule, but degraded across time of night in the nighttime duty schedule. The 34-hour restart break was efficacious for maintaining PVT performance and other objective neurobehavioral functioning profiles from one duty cycle to the next in the daytime duty condition, but not in the nighttime duty condition. Subjective sleepiness did not reliably track objective neurobehavioral deficits. The 34-hour restart break was adequate for maintaining

  11. Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review

    PubMed Central

    Greenhalgh, Trisha; Wieringa, Sietse

    2011-01-01

    The literature on ‘knowledge translation’ presents challenges for the reviewer because different terms have been used to describe the generation, sharing and application of knowledge and different research approaches embrace different philosophical positions on what knowledge is. We present a narrative review of this literature which deliberately sought to highlight rather than resolve tensions between these different framings. Our findings suggest that while ‘translation’ is a widely used metaphor in medicine, it constrains how we conceptualise and study the link between knowledge and practice. The ‘translation’ metaphor has, arguably, led to particular difficulties in the fields of ‘evidence-based management’ and ‘evidence-based policymaking’ – where it seems that knowledge obstinately refuses to be driven unproblematically into practice. Many non-medical disciplines such as philosophy, sociology and organization science conceptualise knowledge very differently, as being (for example) ‘created’, ‘constructed’, ‘embodied’, ‘performed’ and ‘collectively negotiated’ – and also as being value-laden and tending to serve the vested interests of dominant élites. We propose that applying this wider range of metaphors and models would allow us to research the link between knowledge and practice in more creative and critical ways. We conclude that research should move beyond a narrow focus on the ‘know–do gap’ to cover a richer agenda, including: (a) the situation-specific practical wisdom (phronesis) that underpins clinical judgement; (b) the tacit knowledge that is built and shared among practitioners (‘mindlines’); (c) the complex links between power and knowledge; and (d) approaches to facilitating macro-level knowledge partnerships between researchers, practitioners, policymakers and commercial interests. PMID:22179293

  12. Health Monitor for Multitasking, Safety-Critical, Real-Time Software

    NASA Technical Reports Server (NTRS)

    Zoerner, Roger

    2011-01-01

    Health Manager can detect Bad Health prior to a failure occurring by periodically monitoring the application software by looking for code corruption errors, and sanity-checking each critical data value prior to use. A processor s memory can fail and corrupt the software, or the software can accidentally write to the wrong address and overwrite the executing software. This innovation will continuously calculate a checksum of the software load to detect corrupted code. This will allow a system to detect a failure before it happens. This innovation monitors each software task (thread) so that if any task reports "bad health," or does not report to the Health Manager, the system is declared bad. The Health Manager reports overall system health to the outside world by outputting a square wave signal. If the square wave stops, this indicates that system health is bad or hung and cannot report. Either way, "bad health" can be detected, whether caused by an error, corrupted data, or a hung processor. A separate Health Monitor Task is started and run periodically in a loop that starts and stops pending on a semaphore. Each monitored task registers with the Health Manager, which maintains a count for the task. The registering task must indicate if it will run more or less often than the Health Manager. If the task runs more often than the Health Manager, the monitored task calls a health function that increments the count and verifies it did not go over max-count. When the periodic Health Manager runs, it verifies that the count did not go over the max-count and zeroes it. If the task runs less often than the Health Manager, the periodic Health Manager will increment the count. The monitored task zeroes the count, and both the Health Manager and monitored task verify that the count did not go over the max-count.

  13. Is it time to drop the 'knowledge translation' metaphor? A critical literature review.

    PubMed

    Greenhalgh, Trisha; Wieringa, Sietse

    2011-12-01

    The literature on 'knowledge translation' presents challenges for the reviewer because different terms have been used to describe the generation, sharing and application of knowledge and different research approaches embrace different philosophical positions on what knowledge is. We present a narrative review of this literature which deliberately sought to highlight rather than resolve tensions between these different framings. Our findings suggest that while 'translation' is a widely used metaphor in medicine, it constrains how we conceptualise and study the link between knowledge and practice. The 'translation' metaphor has, arguably, led to particular difficulties in the fields of 'evidence-based management' and 'evidence-based policymaking' - where it seems that knowledge obstinately refuses to be driven unproblematically into practice. Many non-medical disciplines such as philosophy, sociology and organization science conceptualise knowledge very differently, as being (for example) 'created', 'constructed', 'embodied', 'performed' and 'collectively negotiated' - and also as being value-laden and tending to serve the vested interests of dominant élites. We propose that applying this wider range of metaphors and models would allow us to research the link between knowledge and practice in more creative and critical ways. We conclude that research should move beyond a narrow focus on the 'know-do gap' to cover a richer agenda, including: (a) the situation-specific practical wisdom (phronesis) that underpins clinical judgement; (b) the tacit knowledge that is built and shared among practitioners ('mindlines'); (c) the complex links between power and knowledge; and (d) approaches to facilitating macro-level knowledge partnerships between researchers, practitioners, policymakers and commercial interests.

  14. CA1 neurons in the human hippocampus are critical for autobiographical memory, mental time travel, and autonoetic consciousness

    PubMed Central

    Bartsch, Thorsten; Döhring, Juliane; Rohr, Axel; Jansen, Olav; Deuschl, Günther

    2011-01-01

    Autobiographical memories in our lives are critically dependent on temporal lobe structures. However, the contribution of CA1 neurons in the human hippocampus to the retrieval of episodic autobiographical memory remains elusive. In patients with a rare acute transient global amnesia, highly focal lesions confined to the CA1 field of the hippocampus can be detected on MRI. We studied the effect of these lesions on autobiographical memory using a detailed autobiographical interview including the remember/know procedure. In 14 of 16 patients, focal lesions in the CA1 sector of the hippocampal cornu ammonis were detected. Autobiographical memory was significantly affected over all time periods, including memory for remote periods. Impairment of episodic memory and autonoetic consciousness exhibited a strong temporal gradient extending 30 to 40 y into the past. These results highlight the distinct and critical role of human hippocampal CA1 neurons in autobiographical memory retrieval and for re-experiencing detailed episodic memories. PMID:21987814

  15. Multicentre study to develop a medication safety package for decreasing inpatient harm from omission of time-critical medications.

    PubMed

    Graudins, Linda V; Ingram, Catherine; Smith, Brodie T; Ewing, Wendy J; Vandevreede, Melita

    2015-02-01

    Omitting time-critical medications leads to delays in treatment and may result in patient harm. Published studies show that omission of prescribed medication doses is common. Although most are inconsequential, up to 86% of omitted medications place patients at some risk of harm. Funding was obtained to develop a medication safety package to facilitate decreasing omitted dose incidents by audit, education and feedback. A panel of nursing and pharmacy hospital staff in Victoria, Australia, reviewed existing audit tools and published studies to develop a critical medication list and audit tool. The tool, definitions and instructions were tested in 11 rural, urban and teaching hospitals. Qualitative feedback was sought to refine the tool using a Plan-Do-Study-Act model. An educational presentation was developed using reported incidents. Staff in 11 hospitals tested the audit tool in 321 patients receiving 17 361 doses of medication. Feedback indicated audit data were useful for informing improvements in practice and for accreditation. The educational material consists of the User Guide, plus a presentation for nursing staff illustrated by six cases with questions, with instructions on how to decrease harm from omitted doses by ensuring correct documentation and prioritising time-critical medications. A medication safety package using standard definitions and a critical medication list was successfully tested. It is now used by nursing and pharmacy staff across the state. Several interstate hospitals are using the tools as part of their hospital medication safety programmes. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  16. Fractal, entropic and chaotic approaches to complex physiological time series analysis: a critical appraisal.

    PubMed

    Li, Cheng; Ding, Guang-Hong; Wu, Guo-Qiang; Poon, Chi-Sang

    2009-01-01

    A wide variety of methods based on fractal, entropic or chaotic approaches have been applied to the analysis of complex physiological time series. In this paper, we show that fractal and entropy measures are poor indicators of nonlinearity for gait data and heart rate variability data. In contrast, the noise titration method based on Volterra autoregressive modeling represents the most reliable currently available method for testing nonlinear determinism and chaotic dynamics in the presence of measurement noise and dynamic noise.

  17. Search is a time-critical event: when search and rescue missions may become futile.

    PubMed

    Adams, Annette L; Schmidt, Terri A; Newgard, Craig D; Federiuk, Carol S; Christie, Michael; Scorvo, Sean; DeFreest, Melissa

    2007-01-01

    The purpose of this study was to derive and validate a rule for duration of search (ie, search time) that maximizes survivors and after which a search and rescue (SAR) mission may be considered for termination. This was a retrospective cohort study of all SAR missions initiated in Oregon over a 7-year period, which were documented in a population-based administrative database. The following types of search missions were excluded from analysis: redundant reports of a single search; lost helicopters and airplanes; support of organized events; law-enforcement searches; searches for persons actively avoiding rescue; body recovery missions; and cases without outcome information. The cohort was divided into a derivation cohort (searches from 1997-2000) and a validation cohort (2001-2003). The primary outcome was survival. Variables considered in the model included age, gender, minimum and maximum daily temperatures, precipitation, search time, and whether the search involved an air or water incident. Missing data were handled using multiple imputation. Classification and regression tree (CART) methods were used to derive the model. The derivation cohort included 1040 searches involving 1509 victims, 70 (4.6%) of whom died. The validation cohort included 1262 searches involving 1778 victims; 115 (6.5%) died. Search time was the only variable retained in the final model, with a cut-point of 51 hours. The derivation model was 98.9% sensitive; the same model run using the validation cohort was 99.3% sensitive. This time-based model may aid search managers in the decision about starting a search or changing search tactics for missing persons.

  18. miRNAs are required for generating a time-delay critical for the circadian oscillator

    PubMed Central

    Chen, Rongmin; D’Alessandro, Matthew; Lee, Choogon

    2013-01-01

    Background Circadian clocks coordinate an organism’s activities and regulate metabolic homeostasis in relation to daily environmental changes, most notably light/dark cycles. As in other organisms, the timekeeping mechanism in mammals depends on a self-sustaining transcriptional negative feedback loop with a built-in time delay in feedback inhibition. Although the time delay is essential for generating a slow, self-sustaining negative feedback loop with a period close to 24 hours, the exact mechanisms underlying the time delay are not known. Results We show here that RNA interference mediated by microRNAs (miRNAs) is an essential mechanism in generating the time delay. In Dicer-deficient (and thus miRNA-deficient) cells and mice, circadian rhythms were dramatically shortened (by ~2 hours), although the rhythms remained robust. The period shortening was caused by faster PER1 and PER2 translation in the Dicer-deficient cells. We also identified three specific miRNAs that regulate Per expression, and showed that knockdown of these miRNAs in wild-type cells also shortened the circadian period. Conclusions Consistent with the canonical function of miRNAs as translational modulators of target genes and their widespread roles in cell physiology, circadian rhythms are also modulated by miRNA-mediated RNA interference acting on posttranscriptional regulation of key clock genes. Our present study definitively shows that RNA interference is an important modulator of circadian rhythms by controlling the pace of PER synthesis, and presents a novel layer of regulation for the clock. PMID:24094851

  19. Effect of meal timing not critical for the pharmacokinetics of tegaserod (HTF 919).

    PubMed

    Zhou, H; Khalilieh, S; Lau, H; Guerret, M; Osborne, S; Alladina, L; Laurent, A L; McLeod, J F

    1999-09-01

    This study assessed the pharmacokinetic profiles of administering tegaserod (HTF 919) at different time intervals with respect to a meal. It was a randomized, open-label, two-phase, five-period crossover study. In the first phase, 18 healthy subjects received a single 12 mg oral dose of tegaserod administered either 30 or 15 minutes prior to the start of the 600-calorie, fat-rich breakfast. In the second phase, subjects received a single 12 mg oral dose of tegaserod 1 minute before, 2.5 hours after the start of meal, or with a continued 4-hour postdose fast. Safety assessment and plasma samples for the determination of drug concentration were obtained for 24 hours postdose. Noncompartmental analysis results indicated that the AUC of tegaserod was reduced by almost half under fed conditions compared to the fasted condition. Exploratory analyses were implemented to further investigate the absorption characteristics of tegaserod under different fed conditions. A numerical deconvolution approach was used to obtain the tegaserod oral absorption versus time profiles under both fasted and fed conditions. The tegaserod oral absorption versus time profiles were then fitted by NONMEM to a model containing two absorption phases. Based on the absorption analyses, we found that the reduction in the bioavailability of tegaserod under fed conditions was primarily due to a decrease in the extent of absorption and less so to a decrease in the absorption rate(s). Therefore, although the timing of administration of food does not appear to significantly alter the pharmacokinetics of tegaserod, the administration of food reduces the AUC by approximately 50%.

  20. Time Critical Targeting: Predictive Vs Reactionary Methods An Analysis For The Future

    DTIC Science & Technology

    2002-06-01

    for example, aircraft were usually required to stay above 15,000 feet above ground level ( AGL ), making target identification difficult by day and...controllers (FACs) misidentified and bombed a Kosovar refugee column, the altitude was lowered to 5,000 feet ( AGL ) to help improve the chances of accurate...for an aircraft at 20,000 feet AGL is four to five miles, resulting in a time of flight of almost a minute.82

  1. Effectiveness of PRP Injection in Reducing Recovery Time of Acute Hamstring Injury: A Critically Appraised Topic.

    PubMed

    Manduca, Mary Lynn; Straub, Stephen J

    2017-07-17

    Clinical Scenario Hamstring strains are common athletic injuries, with a high recurrence rate (34%).(2) Recently, platelet-rich-plasma (PRP) injections have gained popularity as a potential treatment option to accelerate healing of hamstring injury.(3) Focused Clinical Question Does the combination of PRP injection and rehabilitation decrease recovery time of acute hamstring injury as compared to rehabilitation alone in collegiate athletes? Summary of Key Findings A literature search resulted in three randomized controlled trials (RCT). One study showed benefits in various outcome measures with PRP, compared to rehabilitation alone, while two showed no benefits. One study reported improved pain, ultrasonography regenerative indications, and recovery time with PRP injection following acute hamstring injury(1), however, larger studies have shown no benefits.(7-9) The literature demonstrates conflicting evidence regarding benefits of PRP injections in hamstring injuries. Clinical Bottom Line At this time, PRP injections cannot be recommended as having value for hamstring injuries, compared to rehabilitation alone. Strength of Recommendation Due to inconsistent or limited quality patient-oriented evidence in existing literature, the strength of this recommendation is grade B, based on the Strength of Recommendation Taxonomy (SORT).(7).

  2. Task-oriented quality assessment and adaptation in real-time mission critical video streaming applications

    NASA Astrophysics Data System (ADS)

    Nightingale, James; Wang, Qi; Grecos, Christos

    2015-02-01

    In recent years video traffic has become the dominant application on the Internet with global year-on-year increases in video-oriented consumer services. Driven by improved bandwidth in both mobile and fixed networks, steadily reducing hardware costs and the development of new technologies, many existing and new classes of commercial and industrial video applications are now being upgraded or emerging. Some of the use cases for these applications include areas such as public and private security monitoring for loss prevention or intruder detection, industrial process monitoring and critical infrastructure monitoring. The use of video is becoming commonplace in defence, security, commercial, industrial, educational and health contexts. Towards optimal performances, the design or optimisation in each of these applications should be context aware and task oriented with the characteristics of the video stream (frame rate, spatial resolution, bandwidth etc.) chosen to match the use case requirements. For example, in the security domain, a task-oriented consideration may be that higher resolution video would be required to identify an intruder than to simply detect his presence. Whilst in the same case, contextual factors such as the requirement to transmit over a resource-limited wireless link, may impose constraints on the selection of optimum task-oriented parameters. This paper presents a novel, conceptually simple and easily implemented method of assessing video quality relative to its suitability for a particular task and dynamically adapting videos streams during transmission to ensure that the task can be successfully completed. Firstly we defined two principle classes of tasks: recognition tasks and event detection tasks. These task classes are further subdivided into a set of task-related profiles, each of which is associated with a set of taskoriented attributes (minimum spatial resolution, minimum frame rate etc.). For example, in the detection class

  3. Platelets are not critical effector cells for the time course of murine passive crescentic glomerulonephritis.

    PubMed

    Hohenstein, Bernd; Daniel, Christoph; Johnson, Richard J; Amann, Kerstin U; Hugo, Christian P M

    2013-01-01

    Although platelets are well-known effector cells of inflammatory renal disease, clinical studies were not able to establish platelet inhibition as an effective therapy. Our previous studies using Vasodilator stimulated Phosphoprotein- and P2Y1-deficient mice suggested some early, but no long-term effects of platelets in passive crescentic glomerulonephritis. To define the role of platelets for this disease model, passive crescentic glomerulonephritis was induced in 72 C57Bl/6 mice by intraperitoneal injection of sheep anti-rabbit glomerular basement membrane antibody on 2 consecutive days. Platelets were depleted using anti-glycoprotein Ibα antibodies (p0p3/p0p4) every 4th day. Mice treated with equal amounts of sterile Phosphate buffered solution or rat-IgG served as controls. Blood, urine, and tissues were harvested on days 3 and 28. Renal tissue sections were evaluated after immunostaining using (semi)quantitative and computer-assisted image analysis. Compared to controls, efficient depletion was achieved as indicated by a markedly prolonged bleeding time and a more than 90% reduction in platelet counts (800/nl vs. 42/nl; P < 0.001). Functional (creatinine-clearance and proteinuria) parameters demonstrated no significant differences between the groups. Neither parameters of renal injury (glomerulosclerosis and fibrosis) nor glomerular/tubulointerstitial matrix expansion (by collagen IV staining), glomerular capillary rarefaction (lectin staining), and the glomerular/tubulointerstitial proliferative response (proliferating cell nuclear antigen) demonstrated any differences between platelet-depleted mice and PBS- or rat-IgG-treated nephritic mice at any time point. Despite effective platelet inhibition/depletion, neither the short- nor long-term course of passive crescentic nephrotoxic nephritis was affected. These data indicate that platelets play a minor role during the time course of this disease model in the mouse.

  4. Use of risk assessment analysis by failure mode, effects, and criticality to reduce door-to-balloon time.

    PubMed

    Khare, Rahul K; Nannicelli, Anna P; Powell, Emilie S; Seivert, Nicholas P; Adams, James G; Holl, Jane L

    2013-10-01

    The Centers for Medicare & Medicaid Services currently endorses a door-to-balloon time of 90 minutes or less for patients presenting to the emergency department (ED) with ST-segment elevation myocardial infarction. Recent evidence shows that a door-to-balloon time of 60 minutes significantly decreases inhospital mortality. We seek to use a proactive risk assessment method of failure mode, effects, and criticality analysis (FMECA) to evaluate door-to-balloon time process, to investigate how each component failure may affect the performance of a system, and to evaluate the frequency and the potential severity of harm of each failure. We conducted a 2-part study: FMECA of the door-to-balloon time system and process of care, and evaluation of a single institution's door-to-balloon time operational data using a retrospective observational cohort design. A multidisciplinary group of FMECA participants described the door-to-balloon time process to then create a comprehensive map and table listing all process steps and identified process failures, including their frequency, consequence, and causes. Door-to-balloon time operational data were assessed by "on" versus "off" hours. Fifty-one failure points were identified across 4 door-to-balloon time phases. Of the 12 high-risk failures, 58% occurred between ECG and catheterization laboratory activation. Total door-to-balloon time during on hours had a median time of 55 minutes (95% confidence interval 46 to 60 minutes) compared with 77 minutes (95% confidence interval 68 to 83 minutes) during off hours. The FMECA revealed clear areas of potential delay and vulnerability that can be addressed to decrease door-to-balloon time from 90 to 60 minutes. FMECAs can provide a robust assessment of potential risks and can serve as the platform for significant process improvement and system redesign for door-to-balloon time. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  5. On the time to reach a critical number of infections in epidemic models with infective and susceptible immigrants.

    PubMed

    Almaraz, E; Gómez-Corral, A; Rodríguez-Bernal, M T

    2016-06-01

    In this paper we examine the time T to reach a critical number K0 of infections during an outbreak in an epidemic model with infective and susceptible immigrants. The underlying process X, which was first introduced by Ridler-Rowe (1967), is related to recurrent diseases and it appears to be analytically intractable. We present an approximating model inspired from the use of extreme values, and we derive formulae for the Laplace-Stieltjes transform of T and its moments, which are evaluated by using an iterative procedure. Numerical examples are presented to illustrate the effects of the contact and removal rates on the expected values of T and the threshold K0, when the initial time instant corresponds to an invasion time. We also study the exact reproduction number Rexact,0 and the population transmission number Rp, which are random versions of the basic reproduction number R0.

  6. Mechanical diagnosis of human erythrocytes by ultra-high speed manipulation unraveled critical time window for global cytoskeletal remodeling

    NASA Astrophysics Data System (ADS)

    Ito, Hiroaki; Murakami, Ryo; Sakuma, Shinya; Tsai, Chia-Hung Dylan; Gutsmann, Thomas; Brandenburg, Klaus; Pöschl, Johannes M. B.; Arai, Fumihito; Kaneko, Makoto; Tanaka, Motomu

    2017-02-01

    Large deformability of erythrocytes in microvasculature is a prerequisite to realize smooth circulation. We develop a novel tool for the three-step “Catch-Load-Launch” manipulation of a human erythrocyte based on an ultra-high speed position control by a microfluidic “robotic pump”. Quantification of the erythrocyte shape recovery as a function of loading time uncovered the critical time window for the transition between fast and slow recoveries. The comparison with erythrocytes under depletion of adenosine triphosphate revealed that the cytoskeletal remodeling over a whole cell occurs in 3 orders of magnitude longer timescale than the local dissociation-reassociation of a single spectrin node. Finally, we modeled septic conditions by incubating erythrocytes with endotoxin, and found that the exposure to endotoxin results in a significant delay in the characteristic transition time for cytoskeletal remodeling. The high speed manipulation of erythrocytes with a robotic pump technique allows for high throughput mechanical diagnosis of blood-related diseases.

  7. Mechanical diagnosis of human erythrocytes by ultra-high speed manipulation unraveled critical time window for global cytoskeletal remodeling.

    PubMed

    Ito, Hiroaki; Murakami, Ryo; Sakuma, Shinya; Tsai, Chia-Hung Dylan; Gutsmann, Thomas; Brandenburg, Klaus; Pöschl, Johannes M B; Arai, Fumihito; Kaneko, Makoto; Tanaka, Motomu

    2017-02-24

    Large deformability of erythrocytes in microvasculature is a prerequisite to realize smooth circulation. We develop a novel tool for the three-step "Catch-Load-Launch" manipulation of a human erythrocyte based on an ultra-high speed position control by a microfluidic "robotic pump". Quantification of the erythrocyte shape recovery as a function of loading time uncovered the critical time window for the transition between fast and slow recoveries. The comparison with erythrocytes under depletion of adenosine triphosphate revealed that the cytoskeletal remodeling over a whole cell occurs in 3 orders of magnitude longer timescale than the local dissociation-reassociation of a single spectrin node. Finally, we modeled septic conditions by incubating erythrocytes with endotoxin, and found that the exposure to endotoxin results in a significant delay in the characteristic transition time for cytoskeletal remodeling. The high speed manipulation of erythrocytes with a robotic pump technique allows for high throughput mechanical diagnosis of blood-related diseases.

  8. Critical role of sorafenib exposure over time for its antitumor activity in thyroid cancer.

    PubMed

    Bellesoeur, Audrey; Carton, Edith; Mir, Olivier; Groussin, Lionel; Blanchet, Benoit; Billemont, Bertrand; Clerc, Jérôme; Goldwasser, François

    2014-06-01

    Sorafenib, a multi-kinase inhibitor that targets the VEGF, PDGF and BRAF pathways, has demonstrated significant clinical activity in metastatic differentiated thyroid cancer. However, all patients eventually experience disease progression with a median progression-free survival close to 10 months. Since sorafenib exposure is known to decrease over time, we hypothesized that dose adjustments aiming to restore adequate exposure could lead to further clinical activity. We report, as a proof of concept on a patient with radio-iodine resistant metastatic thyroid cancer, who experienced disease progression after an initial response to sorafenib (400 mg twice daily). Whereas the thyroglobulin-progression-free survival at standard doses was 6 months, iterative dose optimization led to a prolonged progression-free survival up to 41 months. Sorafenib doses were increased up to 1600 mg bid, in order to maintain clinical activity, and to restore active plasma concentration, since sorafenib exposure had decreased over the time. Toxicity was mild and manageable for more than 2 years. However, the patient eventually experienced grade 3 proteinuria leading to treatment discontinuation. This observation opens up new horizons for daily management of radioactive iodine-refractory differentiated thyroid cancer patients progressing under standard doses of sorafenib, and stress the need to monitor its plasma concentration.

  9. Critical analysis of rhinovirus RNA load quantification by real-time reverse transcription-PCR.

    PubMed

    Schibler, Manuel; Yerly, Sabine; Vieille, Gaël; Docquier, Mylène; Turin, Lara; Kaiser, Laurent; Tapparel, Caroline

    2012-09-01

    Rhinoviruses are the most frequent cause of human respiratory infections, and quantitative rhinovirus diagnostic tools are needed for clinical investigations. Although results obtained by real-time reverse-transcription PCR (RT-PCR) assays are frequently converted to viral RNA loads, this presents several limitations regarding accurate virus RNA quantification, particularly given the need to reliably quantify all known rhinovirus genotypes with a single assay. Using an internal extraction control and serial dilutions of an in vitro-transcribed rhinovirus RNA reference standard, we validated a quantitative one-step real-time PCR assay. We then used chimeric rhinovirus genomes with 5'-untranslated regions (5'UTRs) originating from the three rhinovirus species and from one enterovirus to estimate the impact of the 5'UTR diversity. Respiratory specimens from infected patients were then also analyzed. The assay quantification ability ranged from 4.10 to 9.10 log RNA copies/ml, with an estimated error margin of ±10%. This variation was mainly linked to target variability and interassay variability. Taken together, our results indicate that our assay can reliably estimate rhinovirus RNA load, provided that the appropriate error margin is used. In contrast, due to the lack of a universal rhinovirus RNA standard and the variability related to sample collection procedures, accurate absolute rhinovirus RNA quantification in respiratory specimens is currently hardly feasible.

  10. Frequency and Time Domain Analysis of Foetal Heart Rate Variability with Traditional Indexes: A Critical Survey

    PubMed Central

    Romano, Maria; Iuppariello, Luigi; Ponsiglione, Alfonso Maria; Improta, Giovanni; Bifulco, Paolo; Cesarelli, Mario

    2016-01-01

    Monitoring of foetal heart rate and its variability (FHRV) covers an important role in assessing health of foetus. Many analysis methods have been used to get quantitative measures of FHRV. FHRV has been studied in time and in frequency domain and interesting clinical results have been obtained. Nevertheless, a standardized definition of FHRV and a precise methodology to be used for its evaluation are lacking. We carried out a literature overview about both frequency domain analysis (FDA) and time domain analysis (TDA). Then, by using simulated FHR signals, we defined the methodology for FDA. Further, employing more than 400 real FHR signals, we analysed some of the most common indexes, Short Term Variability for TDA and power content of the spectrum bands and sympathovagal balance for FDA, and evaluated their ranges of values, which in many cases are a novelty. Finally, we verified the relationship between these indexes and two important parameters: week of gestation, indicator of foetal growth, and foetal state, classified as active or at rest. Our results indicate that, according to literature, it is necessary to standardize the procedure for FHRV evaluation and to consider week of gestation and foetal state before FHR analysis. PMID:27195018

  11. Critical review on Bhaishajya Kaala (time of drug administration) in Ayurveda

    PubMed Central

    Junjarwad, Ashwini V.; Savalgi, Pavan B.; Vyas, Mahesh Kumar

    2013-01-01

    Bhaishajya Kaala (time of drug administration) is an important principle to be considered while treating a disease. Still hardly a handful of physicians are seen, who account for this. To highlight its imperial role in Chikitsa, there is an immense necessity to analyze this concept, which is the need of the hour. Bhaishajya Kaala is mainly explained in relation with Bala of Roga, Rogi, particular Dosha, Dooshya, and various other factors. The comprehensive understanding of this concept involves so many questions as, why there is a difference in the number of Aushdha Kaala? What is the logic behind their indications as well as contraindications? The present paper focuses on the above points to find out the convincing answers. PMID:24049398

  12. Decreased Cancer Survival in Individuals Separated at Time of Diagnosis: Critical Period for Cancer Pathophysiology?

    PubMed Central

    Sprehn, Gwen C.; Chambers, Joanna E.; Saykin, Andrew J.; Konski, Andre; Johnstone, Peter A. S.

    2009-01-01

    Background It long has been recognized that married patients have improved cancer survival when compared to unmarried patients. This has been postulated as being due to increased support, potentially leading to better compliance with therapy. Conversely, some data exist pointing to a relationship between marital discord and decreased immunity. We examined whether unmarried patients have a different prognosis by whether they are (a) never married; (b) divorced; (c) widowed; or (d) separated at time of diagnosis. Methods The public access data of the Surveillance, Epidemiology and End Results (SEER) registry were queried for cancer survival across all 17 registries between 1973 and 2004. Data were last updated by SEER in April, 2007. Records of 3.79 million patients were included in the analysis. We specifically analyzed 5- and 10-year relative survival (5yRS, 10yRS), defined as observed survival divided by observed survival of an age-, race- and gender-matched population without disease, for all cancer patients by marital status, with specific subset analyses as indicated. Results Among unmarried patients, those separated at time of diagnosis had the lowest survival, followed by widowed, divorced, and never married patients. 5- and 10-year relative survival of separated patients was 72% and 64% that of married patients, respectively. This relationship persists when data are analyzed by gender. Conclusions Separated marital status is associated with a significant decrement in cancer survival, even in comparison with other unmarried groups. While other socioeconomic variables could contribute to this phenomenon, further research into the immunologic correlates of the acutely stressful condition of marital separation should be conducted. PMID:19705348

  13. Timing of Environmental Exposures as a Critical Element in Breast Cancer Risk

    PubMed Central

    Birnbaum, Linda S.

    2015-01-01

    Objective: The role of the chemical environment in disease initiation or progression is becoming more evident. Endocrine disruption via environmental chemicals is now well documented in humans, rodent research models, and wildlife. Breast cancer is an endocrine-based disease whose risk may be modified by environmental exposures. Our purpose is to encourage more investigation into early life environmental exposures as they relate to breast cancer risk factors and disease over a lifetime. Evidence: The 2009 President's Cancer Panel, 2012 Institute of Medicine, 2013 Interagency Breast Cancer and the Environment Research Coordinating Committee reports, and research publications dated ≥2012 in PubMed were used to inform our perspective. Consensus Process: Literature was reviewed and evidence gathered on the effects of the environment on risk of breast cancer or mammary tumor development in animal research models as it pertained to the influence of timing of exposure on later-life outcomes. Conclusions: Evidence has accumulated for several chemicals that environmental factors have a stronger effect on breast cancer risk when exposure occurred early in life. The insecticide, dichlorodiphenyltrichloroethane, is an excellent example and is just one of several chemicals for which there seems to be both animal and human evidence for the developmental basis of adult disease. The developing breast undergoes many changes in early life, leaving it vulnerable to the effects of epigenetic marks, endocrine disruption, and carcinogens. More research is needed in the area of early beginnings of breast cancer, with prevention of the disease as the ultimate goal. PMID:26214118

  14. Postexercise nutrient intake timing in humans is critical to recovery of leg glucose and protein homeostasis.

    PubMed

    Levenhagen, D K; Gresham, J D; Carlson, M G; Maron, D J; Borel, M J; Flakoll, P J

    2001-06-01

    Although the importance of postexercise nutrient ingestion timing has been investigated for glycogen metabolism, little is known about similar effects for protein dynamics. Each subject (n = 10) was studied twice, with the same oral supplement (10 g protein, 8 g carbohydrate, 3 g fat) being administered either immediately (EARLY) or 3 h (LATE) after 60 min of moderate-intensity exercise. Leg blood flow and circulating concentrations of glucose, amino acids, and insulin were similar for EARLY and LATE. Leg glucose uptake and whole body glucose utilization (D-[6,6-2H(2)]glucose) were stimulated threefold and 44%, respectively, for EARLY vs. LATE. Although essential and nonessential amino acids were taken up by the leg in EARLY, they were released in LATE. Although proteolysis was unaffected, leg (L-[ring-2H(5)]phenylalanine) and whole body (L-[1-13C]leucine) protein synthesis were elevated threefold and 12%, respectively, for EARLY vs. LATE, resulting in a net gain of leg and whole body protein. Therefore, similar to carbohydrate homeostasis, EARLY postexercise ingestion of a nutrient supplement enhances accretion of whole body and leg protein, suggesting a common mechanism of exercise-induced insulin action.

  15. Statistical Analysis of fMRI Time-Series: A Critical Review of the GLM Approach.

    PubMed

    Monti, Martin M

    2011-01-01

    Functional magnetic resonance imaging (fMRI) is one of the most widely used tools to study the neural underpinnings of human cognition. Standard analysis of fMRI data relies on a general linear model (GLM) approach to separate stimulus induced signals from noise. Crucially, this approach relies on a number of assumptions about the data which, for inferences to be valid, must be met. The current paper reviews the GLM approach to analysis of fMRI time-series, focusing in particular on the degree to which such data abides by the assumptions of the GLM framework, and on the methods that have been developed to correct for any violation of those assumptions. Rather than biasing estimates of effect size, the major consequence of non-conformity to the assumptions is to introduce bias into estimates of the variance, thus affecting test statistics, power, and false positive rates. Furthermore, this bias can have pervasive effects on both individual subject and group-level statistics, potentially yielding qualitatively different results across replications, especially after the thresholding procedures commonly used for inference-making.

  16. Closed-loop glucose control in critically ill patients using continuous glucose monitoring system (CGMS) in real time.

    PubMed

    Chee, Frederick; Fernando, Tyrone; van Heerden, P Vernon

    2003-03-01

    A study was conducted to determine if continuous subcutaneous glucose monitoring (from MiniMed CGMS) could be used in real-time to control blood sugar level (BSL) in patients with critical illness. A closed-loop control system was constructed to use CGMS in a real-time manner, coupled with a proportional integral (PI) control algorithm based on a sliding scale approach, for automatic intravenous infusion of insulin to patients. A total of five subjects with high BSL (> 10 mmol/L) participated in formal studies of the closed-loop control system. Subjects were recruited from critically ill patients in the intensive care unit (ICU) after informed consent was obtained. Error grid analysis showed that 64.6% of the BSL readings as determined in real time using CGMS sensor, when compared to conventional BSL measurements on blood drawn from an arterial line, was clinically accurate (i.e., < 20% deviation from glucometer value). In the five patients who underwent closed-loop control, the controller managed to control only one patient's glycaemia without any manual intervention. Manual intervention was required due to the real-time sensor reading deviating more than 20% from the glucometer value, and also as a safety mechanism. Test on equality of mean and variance for BSL attained prior to, during, and post trial showed that the controller's performance was comparable to manual control. We conclude that the automatic sliding scale approach of closed-loop BSL control is feasible in patients in intensive care. More work is needed in the refinement of the algorithm and the improvement of real-time sensor accuracy.

  17. Estimation of ground water residence times in the Critical zone: insight from U activity ratios

    NASA Astrophysics Data System (ADS)

    Chabaux, Francois; Ackerer, Julien; Lucas, Yann; viville, Daniel

    2016-04-01

    The use of radioactive disequilibria as tracers and chronometers of weathering processes and related mass transfers has been recognized since the 60'. The development, over the last two decades, of analytical methods for measuring very precisely U-series nuclides (especially, 234U, 230Th and 226Ra) in environmental samples has opened up new scientific applications in Earth Surface Sciences. Here, we propose to present the potential of U activity ratios in surface waters as chronometer of water transfers at a watershed scale. This will be illustrated from studies performed at different scales, with the analysis of U activity ratios in surface waters from small watersheds (Strengbach and Ringelbach watersheds in the Vosges Mountain, France) but also from watersheds of much more regional extension (e.g., the Upper Rhine basin or the Ganges basin). These various studies show that variations of U activity ratios in surface waters are mainly associated with 234U-238U fractionations occurring during the water transfer within the bedrock, which intensity depends on two main parameters: the petro-physical characteristics of the aquifer, principally the geometry of water-rock interfaces and the duration of the water-rock interactions. This readily explains why different U activity ratios (UAR) can be observed in the different aquifers of a continental hydrosystem and hence why UAR can be used to trace the source of river waters. For a hydrological system developed on a substratum marked by fairly homogeneous petro-physical characteristics, the main parameter controlling the UAR in waters draining such a system would be the duration of the water-rock interactions. Variations of UAR in stream or spring waters of such a system can therefore be modeled using simple reactive transport model, which allows the estimation of both the dissolution rate of the bedrock and the residence time of the waters within the aquifer.

  18. Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study.

    PubMed

    Azabou, Eric; Rohaut, Benjamin; Heming, Nicholas; Magalhaes, Eric; Morizot-Koutlidis, Régine; Kandelman, Stanislas; Allary, Jeremy; Moneger, Guy; Polito, Andrea; Maxime, Virginie; Annane, Djillali; Lofaso, Frederic; Chrétien, Fabrice; Mantz, Jean; Porcher, Raphael; Sharshar, Tarek

    2017-12-01

    Somatosensory (SSEP) and brainstem auditory (BAEP) evoked potentials are neurophysiological tools which, respectively, explore the intracranial conduction time (ICCT) and the intrapontine conduction time (IPCT). The prognostic values of prolonged cerebral conduction times in deeply sedated patients have never been assessed. Sedated patients are at risk of developing new neurological complications, undetected. In this prospective observational bi-center pilot study, we investigated whether early impairment of SSEP's ICCT and/or BAEP's IPCT could predict in-ICU mortality or altered mental status (AMS), in deeply sedated critically ill patients. SSEP by stimulation of the median nerve and BAEP were assessed in critically ill patients receiving deep sedation on day 3 following ICU admission. Deep sedation was defined by a Richmond Assessment sedation Scale (RASS) <-3. Mean left- and right-side ICCT and IPCT were measured for each patient. Primary and secondary outcomes were, respectively, in-ICU mortality and AMS defined as the occurrence of delirium and/or delayed awakening after discontinuation of sedation. Eighty-six patients were studied of which 49 (57%) were non-brain-injured and 37 (43%) were brain-injured. Impaired ICCT was a predictor of in-ICU mortality after adjustment on the global Sequential Organ Failure Assessment score (SOFA) [OR (95% CI) = 2.69 (1.05-6.85); p = 0.039] and on the non-neurological SOFA components [2.67 (1.05-6.81); p = 0.040]. IPCT was more frequently delayed in the subgroup of patients who developed post-sedation AMS (24%) compared those without AMS (0%). However, this difference did not reach statistical significance (p = 0.053). Impairment rates of ICCT and IPCT were not found to be significantly different between non-brain- and brain-injured subgroups of patients. In critically ill patients receiving deep sedation, early ICCT impairment was associated with mortality. Somatosensory and brainstem auditory evoked potentials may

  19. Determining the critical effective temperature and heat dispersal pattern in monopolar radiofrequency ablation using temperature-time integration

    PubMed Central

    TSENG, HOW; LIN, SEY-EN; CHANG, YEN-LIANG; CHEN, MING-HSU; HUNG, SHIH-HAN

    2016-01-01

    The radiofrequency ablation (RFA) lesion size is posited to be disproportionate to the total delivered energy, and temperature-time integration (TTI) may have a more critical effect on lesion size. The present study aimed to evaluate this hypothesis by determining the temperature threshold and temperature distribution over tissues during the RFA lesioning process. Using an ex vivo chicken tissue model and an in vivo rabbit model with RFA applied for 2 min under various target temperature settings, the resultant lesions were evaluated histologically using Masson's trichrome stain. The temperature distribution over the tissue during the RFA lesioning process was also determined using a VT02 Visual IR Thermometer. It was revealed that the thermal injury threshold for RFA in the chicken tissues was ~65°C, but that it ranged from 55–65°C in mammals. Using infra-red thermal imaging, the temperature gradient (from the center to the periphery) during the RFA lesioning process demonstrated a uniform heat diffusion pattern. This data supports the proposed hypothesis that TTI is a critical parameter in determining RFA lesion size and can be applied clinically using the following equation: [Target temperature − 55 (°C)] × time (sec) is proportional to RFA lesion size. PMID:26997990

  20. A decision-theoretic approach to the display of information for time-critical decisions: The Vista project

    NASA Technical Reports Server (NTRS)

    Horvitz, Eric; Ruokangas, Corinne; Srinivas, Sampath; Barry, Matthew

    1993-01-01

    We describe a collaborative research and development effort between the Palo Alto Laboratory of the Rockwell Science Center, Rockwell Space Operations Company, and the Propulsion Systems Section of NASA JSC to design computational tools that can manage the complexity of information displayed to human operators in high-stakes, time-critical decision contexts. We shall review an application from NASA Mission Control and describe how we integrated a probabilistic diagnostic model and a time-dependent utility model, with techniques for managing the complexity of computer displays. Then, we shall describe the behavior of VPROP, a system constructed to demonstrate promising display-management techniques. Finally, we shall describe our current research directions on the Vista 2 follow-on project.

  1. The predictive ability of critical thinking, nursing GPA, and SAT scores on first-time NCLEX-RN performance.

    PubMed

    Romeo, Elizabeth M

    2013-01-01

    This study was conducted to investigate the predictability of several variables in achieving first-time success on the NCLEX-RN. Several researchers have attempted to investigate the differences between students who passed the NCLEX-RN the first time and those who failed. No studies used a large enough failure group to have statistical significance. The three specific variables in this study were nursing GPA, SAT combined math and verbal scores, and critical thinking measured on a standardized assessment examination. An ex post facto study design was used to examine data from the records of associate degree nursing graduates during a three-year period. The most significant predictors of NCLEX-RN success were the students' nursing GPA and the overall standardized assessment examination score. The findings of this study could potentially influence the identification of students at risk for NCLEX-RN failure.

  2. Is timing of prescribed fire critical for limiting post-fire erosion? Lessons from Portugal

    NASA Astrophysics Data System (ADS)

    Shakesby, Richard A.; Ferreira, Carla S. S.; Walsh, Rory P. D.; Ferreira, António J. D.; Urbanek, Emilia; Stoof, Cathelijne R.

    2010-05-01

    before summer 2009 indicated soil losses generally lower than those collected from similar terrain affected by wildfire. However, rainfall events during the 2009-10 autumn - winter period have been large and have included some intense storms sufficiently erosive to increase erosion rates relative to those recorded in the early post-fire months of spring and early summer 2009. Despite a relatively moist post-fire spring and the rapid appearance of new shoots from resprouting vegetation in particular, the thin degraded nature of the soil has been in large part responsible for the slow establishment of a vegetation cover sufficiently dense to be very effective at protecting the soil. Pre-fire and post-fire erosion and indicative nutrient content of soil collected from the sediment fences are considered and compared with results from the wildfire site and from the literature to assess whether timing of prescribed fire within the window of opportunity matters to any great extent.

  3. Decision Modeling in Sleep Apnea: The Critical Roles of Pretest Probability, Cost of Untreated Obstructive Sleep Apnea, and Time Horizon

    PubMed Central

    Moro, Marilyn; Westover, M. Brandon; Kelly, Jessica; Bianchi, Matt T.

    2016-01-01

    Study Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality, and treatment with positive airway pressure (PAP) is cost-effective. However, the optimal diagnostic strategy remains a subject of debate. Prior modeling studies have not consistently supported the widely held assumption that home sleep testing (HST) is cost-effective. Methods: We modeled four strategies: (1) treat no one; (2) treat everyone empirically; (3) treat those testing positive during in-laboratory polysomnography (PSG) via in-laboratory titration; and (4) treat those testing positive during HST with auto-PAP. The population was assumed to lack independent reasons for in-laboratory PSG (such as insomnia, periodic limb movements in sleep, complex apnea). We considered the third-party payer perspective, via both standard (quality-adjusted) and pure cost methods. Results: The preferred strategy depended on three key factors: pretest probability of OSA, cost of untreated OSA, and time horizon. At low prevalence and low cost of untreated OSA, the treat no one strategy was favored, whereas empiric treatment was favored for high prevalence and high cost of untreated OSA. In-laboratory backup for failures in the at-home strategy increased the preference for the at-home strategy. Without laboratory backup in the at-home arm, the in-laboratory strategy was increasingly preferred at longer time horizons. Conclusion: Using a model framework that captures a broad range of clinical possibilities, the optimal diagnostic approach to uncomplicated OSA depends on pretest probability, cost of untreated OSA, and time horizon. Estimating each of these critical factors remains a challenge warranting further investigation. Citation: Moro M, Westover MB, Kelly J, Bianchi MT. Decision modeling in sleep apnea: the critical roles of pretest probability, cost of untreated obstructive sleep apnea, and time horizon. J Clin Sleep Med 2016;12(3):409–418. PMID:26518699

  4. Relationship between rate of fentanyl infusion and time to achieve sedation in nonobese and obese critically ill children.

    PubMed

    Johnson, Peter N; Skrepnek, Grant H; Golding, Charles L; Owora, Arthur H; Thomas, Amber N; Miller, Jamie L

    2017-08-01

    The relationship between initial fentanyl infusion dosage and time to goal sedation in nonobese and obese critically ill children was examined. A retrospective cohort study of 75 fentanyl infusions initiated in mechanically ventilated children age 2-17 years with an inpatient admission between January 1, 2012, and May 31, 2014, who subsequently received a fentanyl infusion was conducted. The primary outcomes of the study included the time to goal sedation and fentanyl dosage characteristics (i.e., underdosage, optimal dosage, or overdosage). Sedation scores were assessed by the State Behavioral Scale, a validated instrument to assess sedation in children. Key independent (predictor) variables were collected, including baseline demographics and admission diagnoses. Multivariable regression models were used to examine the association between initial fentanyl infusion dosage and time to goal sedation or dosing characteristics while controlling for obesity status and other modifying or confounding factors. A total of 75 infusions met the study's inclusion criteria, representing 74 patients. The majority of patients (52%) were boys, and the median age was 8.1 years. Eighteen children (24%) were obese. The median time to goal sedation was 10.9 hours. Among nonobese children, every 10-μg/hr increase in initial fentanyl dosage was associated with a 19% lower probability of achieving goal sedation at any point in time. Initial fentanyl dosage was not associated with time to goal sedation in obese children. Fentanyl infusion rates in obese and nonobese children varied widely in the time needed to achieve goal sedation. At any given time, initial fentanyl infusion rates were less likely to result in goal sedation in nonobese than in obese children. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  5. Riding the Lexical Speedway: A Critical Review on the Time Course of Lexical Selection in Speech Production

    PubMed Central

    Strijkers, Kristof; Costa, Albert

    2011-01-01

    Speech requires time. How much time often depends on the amount of labor the brain has to perform in order to retrieve the linguistic information related to the ideas we want to express. Although most psycholinguistic research in the field of language production has focused on the net result of time required to utter words in various experimental conditions, over the last years more and more researchers pursued the objective to flesh out the time course of particular stages implicated in language production. Here we critically review these studies, with particular interest for the time course of lexical selection. First, we evaluate the data underlying the estimates of an influential temporal meta-analysis on language production (Indefrey and Levelt, 2004). We conclude that those data alone are not sufficient to provide a reliable time frame of lexical selection. Next, we discuss recent neurophysiological evidence which we argue to offer more explicit insights into the time course of lexical selection. Based on this evidence we suggest that, despite the absence of a clear time frame of how long lexical selection takes, there is sufficient direct evidence to conclude that the brain initiates lexical access within 200 ms after stimulus presentation, hereby confirming Indefrey and Levelt’s estimate. In a final section, we briefly review the proposed mechanisms which could lead to this rapid onset of lexical access, namely automatic spreading activation versus specific concept selection, and discuss novel data which support the notion of spreading activation, but indicate that the speed with which this principle takes effect is driven by a top-down signal in function of the intention to engage in a speech act. PMID:22144973

  6. Providing critical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a Six Sigma level of performance.

    PubMed

    Blick, Kenneth E

    2013-08-01

    To develop a fully automated core laboratory, handling samples on a "first in, first out" real-time basis with Lean/Six Sigma management tools. Our primary goal was to provide services to critical care areas, eliminating turnaround time outlier percentage (TAT-OP) as a factor in patient length of stay (LOS). A secondary goal was to achieve a better laboratory return on investment. In 2011, we reached our primary goal when we calculated the TAT-OP distribution and found we had achieved a Six Sigma level of performance, ensuring that our laboratory service can be essentially eliminated as a factor in emergency department patient LOS. We also measured return on investment, showing a productivity improvement of 35%, keeping pace with our increased testing volume. As a result of our Lean process improvements and Six Sigma initiatives, in part through (1) strategic deployment of point-of-care testing and (2) core laboratory total automation with robotics, middleware, and expert system technology, physicians and nurses at the Oklahoma University Medical Center can more effectively deliver lifesaving health care using evidence-based protocols that depend heavily on "on time, every time" laboratory services.

  7. Association between timing of intubation and outcome in critically ill patients: A secondary analysis of the ICON audit.

    PubMed

    Bauer, Philippe R; Gajic, Ognjen; Nanchal, Rahul; Kashyap, Rahul; Martin-Loeches, Ignacio; Sakr, Yasser; Jakob, Stephan M; François, Bruno; Wittebole, Xavier; Wunderink, Richard G; Vincent, Jean-Louis

    2017-06-16

    The optimal timing of endotracheal intubation in critically ill patients requiring invasive mechanical ventilation remains undefined. In a secondary analysis of the large, prospective ICON database, we used a piecewise proportional hazards model to compare outcomes in patients who underwent intubation early (within two days after intensive care unit [ICU] admission) or later. After excluding 5340 patients already intubated on admission or with therapeutic limitation, 4729 patients were analyzed, of whom 4074 never underwent intubation. Of the remaining 655 patients, 449 underwent intubation early and 206 later. Despite similar severity scores on ICU admission, unadjusted ICU (27.6 vs. 18.2%) and hospital (33.3 vs. 23.4%) mortality rates were higher in patients intubated later than in those intubated earlier, as were ICU (9 [5-16] vs. 4 [2-9] days) and hospital (24 [9-35] vs. 13 [7-24] days) lengths-of-stay (all p<0.001). After adjustment, the hazard for ICU and hospital death was significantly greater >10days after ICU admission for patients intubated late. In this large cohort of critically ill patients requiring intubation, intubation >2days after admission was associated with increased mortality later in the hospital course. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Variability of Residence Time tracer Concentrations at the Southern Sierra Critical Zone Observatory during the California Drought

    NASA Astrophysics Data System (ADS)

    Visser, A.; Thaw, M.; Stacy, E.; Hunsaker, C. T.; Bibby, R. K.; Deinhart, A.; Schorzman, K.; Egnatuk, C. M.; Conklin, M. H.; Esser, B.

    2015-12-01

    California water supply from high elevation snow melt is vulnerable to climate change and prolonged drought conditions. Reduced snow pack and earlier snow melt will result in a greater reliance on man-made reservoirs and subsurface catchment storage. To gain insight into the subsurface storage volume of high elevation catchments, we studied the residence time distribution of surface water leaving the Southern Sierra Critical Zone Observatory. Since October 2014, we have collected monthly samples of two residence time tracers with contrasting half-lives: sulfur-35 (87.5 days) and tritium (12.32 years). Upstream catchment area at the three nested sampling locations is 1 km2 (P301 sub-catchment), 4 km2 (Providence Creek) and ~50 km2 (Big Creek). Samples were analyzed at LLNL by low level liquid scintillation counting and noble gas mass spectrometry after helium accumulation. Variations in tracer concentrations in precipitation, both for tritium (11-24 pCi/L) and sulfur-35 (24-100 mBq/L), complicate straightforward interpretation of residence times. Sulfur-35 concentrations show that last year precipitation contributes 1% - 10% of total stream flow, even during peak snowmelt. Tritium concentrations in stream flow vary between 40% and 60% of the initial concentration in precipitation (15.5 pCi/L), indicating that water leaving the catchment has a residence time on the order of years to decades. Additional analyses of sodium-22 (2.6 year half-life) will aid in deconvoluting the residence time distribution. These low tracer concentrations can be attributed to current severe drought conditions, resulting in low discharge rates and longer residence times. This work performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344. LLNL-ABS-675107

  9. A comparison of simple reaction time, visual discrimination and critical flicker fusion frequency in professional divers at elevated pressure.

    PubMed

    Tikkinen, Janne; Wuorimaa, Tomi; Siimes, Martti A

    2016-06-01

    Inert gas narcosis (IGN) impairs cognitive performance and some divers are more susceptible to IGN than others. We compared the sensitivity of two reaction time tests to detect changes in performance at pressure and compared these results with critical flicker fusion frequency (CFF) changes at the same ambient pressures. The study assessed simple reaction time (RT), mean time correct of the discrimination reaction time (MTC) and CFF in 30 professional divers breathing air at 101 kPa and 608 kPa in a hyperbaric chamber. RT and MTC increased at 608 kPa by 5.1 ± 9.4% (P = 0.04) and 7.3 ± 12.3% (P = 0.01) respectively. RT decreased to pre-compression level after decompression and MTC decreased to a level lower than pre-compression (P < 0.001) values. CFF increased by 2.5 ± 2.8% (P < 0.001) at 608 kPa. CFF decreased to pre-compression level after decompression. An increase in CFF was inversely correlated with a decrease in RT (r = 0.38, P = 0.04) and in MTC (r = 0.43, P = 0.02) at 608 kPa. Response speeds of the same subjects were impaired in both reaction time tasks at 608 kPa, whereas CFF increased at depth. An association between changes in response times and changes in CFF suggests that divers susceptible to IGN may also be susceptible to the effects of elevated oxygen partial pressure. If this holds true, the future selection of professional divers could be improved by the use of simple cognitive tests.

  10. Swimming performance in juvenile shortnose sturgeon (Acipenser brevirostrum): the influence of time interval and velocity increments on critical swimming tests.

    PubMed

    Downie, Adam T; Kieffer, James D

    2017-01-01

    The most utilized method to measure swimming performance of fishes has been the critical swimming speed (UCrit) test. In this test, the fish is forced to swim against an incrementally increasing flow of water until fatigue. Before the water velocity is increased, the fish swims at the water velocity for a specific, pre-arranged time interval. The magnitude of the velocity increments and the time interval for each swimming period can vary across studies making the comparison between and within species difficult. This issue has been acknowledged in the literature, however, little empirical evidence exists that tests the importance of velocity and time increments on swimming performance in fish. A practical application for fish performance is through the design of fishways that enable fish to bypass anthropogenic structures (e.g. dams) that block migration routes, which is one of the causes of world-wide decline in sturgeon populations. While fishways will improve sturgeon conservation, they need to be specifically designed to accommodate the swimming capabilities specific for sturgeons, and it is possible that current swimming methodologies have under-estimated the swimming performance of sturgeons. The present study assessed the UCrit of shortnose sturgeon using modified UCrit to determine the importance of velocity increment (5 and 10 cm s(-1)) and time (5, 15 and 30 min) intervals on swimming performance. UCrit was found to be influenced by both time interval and water velocity. UCrit was generally lower in sturgeon when they were swum using 5cm s(-1) compared with 10 cm s(-1) increments. Velocity increment influences the UCrit more than time interval. Overall, researchers must consider the impacts of using particular swimming criteria when designing their experiments.

  11. Swimming performance in juvenile shortnose sturgeon (Acipenser brevirostrum): the influence of time interval and velocity increments on critical swimming tests

    PubMed Central

    Kieffer, James D.

    2017-01-01

    Abstract The most utilized method to measure swimming performance of fishes has been the critical swimming speed (UCrit) test. In this test, the fish is forced to swim against an incrementally increasing flow of water until fatigue. Before the water velocity is increased, the fish swims at the water velocity for a specific, pre-arranged time interval. The magnitude of the velocity increments and the time interval for each swimming period can vary across studies making the comparison between and within species difficult. This issue has been acknowledged in the literature, however, little empirical evidence exists that tests the importance of velocity and time increments on swimming performance in fish. A practical application for fish performance is through the design of fishways that enable fish to bypass anthropogenic structures (e.g. dams) that block migration routes, which is one of the causes of world-wide decline in sturgeon populations. While fishways will improve sturgeon conservation, they need to be specifically designed to accommodate the swimming capabilities specific for sturgeons, and it is possible that current swimming methodologies have under-estimated the swimming performance of sturgeons. The present study assessed the UCrit of shortnose sturgeon using modified UCrit to determine the importance of velocity increment (5 and 10 cm s−1) and time (5, 15 and 30 min) intervals on swimming performance. UCrit was found to be influenced by both time interval and water velocity. UCrit was generally lower in sturgeon when they were swum using 5cm s−1 compared with 10 cm s−1 increments. Velocity increment influences the UCrit more than time interval. Overall, researchers must consider the impacts of using particular swimming criteria when designing their experiments. PMID:28835841

  12. Critical Time Intervention for People Leaving Shelters in the Netherlands: Assessing Fidelity and Exploring Facilitators and Barriers.

    PubMed

    de Vet, Renée; Lako, Danielle A M; Beijersbergen, Mariëlle D; van den Dries, Linda; Conover, Sarah; van Hemert, Albert M; Herman, Daniel B; Wolf, Judith R L M

    2017-01-01

    International dissemination of evidence-based interventions calls for rigorous evaluation. As part of an evaluation of critical time intervention (CTI) for homeless people and abused women leaving Dutch shelters, this study assessed fidelity in two service delivery systems and explored factors influencing model adherence. Data collection entailed chart review (n = 70) and two focus groups with CTI workers (n = 11). The intervention obtained an overall score of three out of five (fairly implemented) for compliance fidelity and chart quality combined. Fidelity did not differ significantly between service systems, supporting its suitability for a range of populations. The eight themes that emerged from the focus groups as affecting model adherence provide guidance for future implementation efforts.

  13. The prognostic role of non-critical lactate levels for in-hospital survival time among ED patients with sepsis.

    PubMed

    Aluisio, Adam R; Jain, Ashika; Baron, Bonny J; Sarraf, Saman; Sinert, Richard; Legome, Eric; Zehtabchi, Shahriar

    2016-02-01

    This study describes emergency department (ED) sepsis patients with non-critical serum venous lactate (LAC) levels (LAC <4.0 mmol/L) who suffered in-hospital mortality and examines LAC in relation to survival times. An ED based retrospective cohort study accrued September 2010 to August 2014. Inclusion criteria were ED admission, LAC sampling, >2 systemic inflammatory response syndrome criteria with an infectious source (sepsis), and in-hospital mortality. Kaplan-Meier curves were used for survival estimates. An a priori sub-group analysis for patients with repeat LAC within 6 hours of initial sampling was undertaken. The primary outcome was time to in-hospital death evaluated using rank-sum tests and regression models. One hundred ninety-seven patients met inclusion criteria. Pulmonary infections were the most common (44%) and median LAC was 1.9 mmol/L (1.5, 2.5). Thirteen patients (7%) died within 24 hours and 79% by ≤28 days. Median survival was 11 days (95% CI, 8.0-13). Sixty-two patients had repeat LAC sampling with 14 (23%) and 48 (77%) having decreasing increasing levels, respectively. No significant differences were observed in treatment requirements between the LAC subgroups. Among patients with decreasing LAC, median survival was 24 days (95% CI, 5-32). For patients with increasing LAC median survival was significantly shorter (7 days; 95% CI, 4-11, P = .04). Patients with increasing LAC had a non-significant trend toward reduced survival (HR = 1.6 95% CI, 0.90-3.0, P = .10). In septic ED patients experiencing in-hospital death, non-critical serum venous lactate may be utilized as a risk-stratifying tool for early mortality, while increasing LAC levels may identify those in danger of more rapid deterioration. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. The impact of the introduction of critical care outreach services in England: a multicentre interrupted time-series analysis.

    PubMed

    Gao, Haiyan; Harrison, David A; Parry, Gareth J; Daly, Kathleen; Subbe, Christian P; Rowan, Kathy

    2007-01-01

    Critical care outreach services (CCOS) have been widely introduced in England with little rigorous evaluation. We undertook a multicentre interrupted time-series analysis of the impact of CCOS, as characterised by the case mix, outcome and activity of admissions to adult, general critical care units in England. Data from the Case Mix Programme Database (CMPD) were linked with the results of a survey on the evolution of CCOS in England. Over 350,000 admissions to 172 units between 1996 and 2004 were extracted from the CMPD. The start date of CCOS, activities performed, coverage and staffing were identified from survey data and other sources. Individual patient-level data in the CMPD were collapsed into a monthly time series for each unit (panel data). Population-averaged panel-data models were fitted using a generalised estimating equation approach. Various potential outcomes reflecting possible objectives of the CCOS were investigated in three subgroups of admissions: all admissions to the unit, admissions from the ward, and unit survivors discharged to the ward. The primary comparison was between periods when a formal CCOS was and was not present. Secondary analyses considered specific CCOS activities, coverage and staffing. In all, 108 units were included in the analysis, of which 79 had formal CCOS starting between 1996 and 2004. For admissions from the ward, CCOS were associated with significant decreases in the proportion of admissions receiving cardiopulmonary resuscitation before admission (odds ratio 0.84, 95% confidence interval 0.73 to 0.96), admission out of hours (odds ratio 0.91, 0.84 to 0.97) and mean Intensive Care National Audit & Research Centre physiology score (decrease in mean 1.22, 0.31 to 2.12). There was no significant change in unit mortality (odds ratio 0.97, 0.87 to 1.08) and no significant, sustained effects on outcomes for unit survivors discharged alive to the ward. The observational nature of the study limits its ability to infer

  15. Mechanical diagnosis of human erythrocytes by ultra-high speed manipulation unraveled critical time window for global cytoskeletal remodeling

    PubMed Central

    Ito, Hiroaki; Murakami, Ryo; Sakuma, Shinya; Tsai, Chia-Hung Dylan; Gutsmann, Thomas; Brandenburg, Klaus; Pöschl, Johannes M. B.; Arai, Fumihito; Kaneko, Makoto; Tanaka, Motomu

    2017-01-01

    Large deformability of erythrocytes in microvasculature is a prerequisite to realize smooth circulation. We develop a novel tool for the three-step “Catch-Load-Launch” manipulation of a human erythrocyte based on an ultra-high speed position control by a microfluidic “robotic pump”. Quantification of the erythrocyte shape recovery as a function of loading time uncovered the critical time window for the transition between fast and slow recoveries. The comparison with erythrocytes under depletion of adenosine triphosphate revealed that the cytoskeletal remodeling over a whole cell occurs in 3 orders of magnitude longer timescale than the local dissociation-reassociation of a single spectrin node. Finally, we modeled septic conditions by incubating erythrocytes with endotoxin, and found that the exposure to endotoxin results in a significant delay in the characteristic transition time for cytoskeletal remodeling. The high speed manipulation of erythrocytes with a robotic pump technique allows for high throughput mechanical diagnosis of blood-related diseases. PMID:28233788

  16. Neurokinin B Is Critical for Normal Timing of Sexual Maturation but Dispensable for Adult Reproductive Function in Female Mice

    PubMed Central

    True, Cadence; Nasrin Alam, Sayeda; Cox, Kimberly; Chan, Yee-Ming

    2015-01-01

    Humans carrying mutations in neurokinin B (NKB) or the NKB receptor fail to undergo puberty due to decreased secretion of GnRH. Despite this pubertal delay, many of these patients go on to achieve activation of their hypothalamic-pituitary-gonadal axis in adulthood, a phenomenon termed reversal, indicating that NKB signaling may play a more critical role for the timing of pubertal development than adult reproductive function. NKB receptor-deficient mice are hypogonadotropic but have no defects in the timing of sexual maturation. The current study has performed the first phenotypic evaluation of mice bearing mutations in Tac2, the gene encoding the NKB ligand, to determine whether they have impaired sexual development similar to their human counterparts. Male Tac2−/− mice showed no difference in the timing of sexual maturation or fertility compared with wild-type littermates and were fertile. In contrast, Tac2−/− females had profound delays in sexual maturation, with time to vaginal opening and first estrus occurring significantly later than controls, and initial abnormalities in estrous cycles. However, cycling recovered in adulthood and Tac2−/− females were fertile, although they produced fewer pups per litter. Thus, female Tac2−/− mice parallel humans harboring NKB pathway mutations, with delayed sexual maturation and activation of the reproductive cascade later in life. Moreover, direct comparison of NKB ligand and receptor-deficient females confirmed that only NKB ligand-deficient animals have delayed sexual maturation, suggesting that in the absence of the NKB receptor, NKB may regulate the timing of sexual maturation through other tachykinin receptors. PMID:25574869

  17. Scaling in Omori law Waiting Time Distributions and Implications for Earthquakes as a Self-Organized Critical Phenomena

    NASA Astrophysics Data System (ADS)

    Jonsdottir, K.; Lindman, M.; Roberts, R.; Lund, B.

    2006-12-01

    Observed power law distributions of earthquake magnitudes, locations and aftershock waiting time distributions are often taken as a support for earthquakes being a phenomena of self-organized criticality (SOC), implying that earthquakes cannot be predicted. Here we study the scaling behaviour of waiting time distributions for aftershock sequences obeying the Omori law (dn/dt=K/(c+t)^p) in order to investigate the implications for the SOC hypothesis. We show that the Omori waiting time distribution is constant in the range [0, (2c)^p/K], exhibit power law decay with exponent 2-1/p in the range [(2c)^p/K, (c+T)^p/K] and falls off rapidly for waiting times larger than (c+T)^p/K, where K, c and p are the Omori law parameters and T the length of the aftershock sequence. The bounded range of the power law regime implies that we cannot immediately regard empirical Omori waiting time distributions as evidence of SOC. For a given value of K and p the scaling of the upper bound is essentially an effect of a finite time series and does not contradict SOC. The scaling of the lower bound controlled by c, however, implies that a non-zero c cannot support SOC as the power law regime is bounded at short waiting times. It is therefore important to deduce whether c, reflecting a roughly constant rate in the beginning of aftershock sequences, only represents incomplete detection of earthquakes, or, is a true description of the physics of the aftershock process. For a given aftershock sequence, we can estimate the number of missed events if the true value of c is zero. Removing the number of missed events from a simulation of the sequence with c=0 results in a sequence deviating significantly from that described by a non-zero c. We illustrate this using simulations and investigations of real aftershock sequences. We can show, for the aftershock sequences we have studied, that it is highly probable that the roughly constant rate during the initial c seconds do not represent incomplete

  18. Comparison of inter-trial recovery times for the determination of critical power and W' in cycling.

    PubMed

    Karsten, Bettina; Hopker, James; Jobson, Simon A; Baker, Jonathan; Petrigna, Luca; Klose, Andreas; Beedie, Christopher

    2017-07-01

    Critical Power (CP) and W' are often determined using multi-day testing protocols. To investigate this cumbersome testing method, the purpose of this study was to compare the differences between the conventional use of a 24-h inter-trial recovery time with those of 3 h and 30 min for the determination of CP and W'. 9 moderately trained cyclists performed an incremental test to exhaustion to establish the power output associated with the maximum oxygen uptake (p[Formula: see text]max), and 3 protocols requiring time-to-exhaustion trials at a constant work-rate performed at 80%, 100% and 105% of p[Formula: see text]max. Design: Protocol A utilised 24-h inter-trial recovery (CP24/W'24), protocol B utilised 3-h inter-trial recovery (CP3/W'3), and protocol C used 30-min inter-trial recovery period (CP0.5/W'0.5). CP and W' were calculated using the inverse time (1/t) versus power (P) relation (P = W'(1/t) + CP). 95% Limits of Agreement between protocol A and B were -9 to 15 W; -7.4 to 7.8 kJ (CP/W') and between protocol A and protocol C they were -27 to 22 W; -7.2 to 15.1 kJ (CP/W'). Compared to criterion protocol A, the average prediction error of protocol B was 2.5% (CP) and 25.6% (W'), whilst for protocol C it was 3.7% (CP) and 32.9% (W'). 3-h and 30-min inter-trial recovery time protocols provide valid methods of determining CP but not W' in cycling.

  19. Resolving critical dimension drift over time in plasma etching through virtual metrology based wafer-to-wafer control

    NASA Astrophysics Data System (ADS)

    Lee, Ho Ki; Baek, Kye Hyun; Shin, Kyoungsub

    2017-06-01

    As semiconductor devices are scaled down to sub-20 nm, process window of plasma etching gets extremely small so that process drift or shift becomes more significant. This study addresses one of typical process drift issues caused by consumable parts erosion over time and provides feasible solution by using virtual metrology (VM) based wafer-to-wafer control. Since erosion of a shower head has center-to-edge area dependency, critical dimensions (CDs) at the wafer center and edge area get reversed over time. That CD trend is successfully estimated on a wafer-to-wafer basis by a partial least square (PLS) model which combines variables from optical emission spectroscopy (OES), VI-probe and equipment state gauges. R 2 of the PLS model reaches 0.89 and its prediction performance is confirmed in a mass production line. As a result, the model can be exploited as a VM for wafer-to-wafer control. With the VM, advanced process control (APC) strategy is implemented to solve the CD drift. Three σ of CD across wafer is improved from the range (1.3-2.9 nm) to the range (0.79-1.7 nm). Hopefully, results introduced in this paper will contribute to accelerating implementation of VM based APC strategy in semiconductor industry.

  20. Timing and extent of response in colorectal cancer: critical review of current data and implication for future trials

    PubMed Central

    Aprile, Giuseppe; Fontanella, Caterina; Bonotto, Marta; Rihawi, Karim; Lutrino, Stefania Eufemia; Ferrari, Laura; Casagrande, Mariaelena; Ongaro, Elena; Berretta, Massimiliano; Avallone, Antonio; Rosati, Gerardo; Giuliani, Francesco; Fasola, Gianpiero

    2015-01-01

    The identification of new surrogate endpoints for advanced colorectal cancer is becoming crucial and, along with drug development, it represents a research field increasingly studied. Although overall survival (OS) remains the strongest trial endpoint available, it requires larger sample size and longer periods of time for an event to happen. Surrogate endpoints such as progression free survival (PFS) or response rate (RR) may overcome these issues but, as such, they need to be prospectively validated before replacing the real endpoints; moreover, they often bear many other limitations. In this narrative review we initially discuss the role of time-to-event endpoints, objective response and response rate as surrogates of OS in the advanced colorectal cancer setting, discussing also how such measures are influenced by the tumor assessment criteria currently employed. We then report recent data published about early tumor shrinkage and deepness of response, which have recently emerged as novel potential endpoint surrogates, discussing their strengths and weaknesses and providing a critical comment. Despite being very compelling, the role of such novel response measures is yet to be confirmed and their surrogacy with OS still needs to be further investigated within larger and well-designed trials. PMID:26308250

  1. Critical review of real-time methods for solid waste characterisation: Informing material recovery and fuel production.

    PubMed

    Vrancken, C; Longhurst, P J; Wagland, S T

    2017-03-01

    Waste management processes generally represent a significant loss of material, energy and economic resources, so legislation and financial incentives are being implemented to improve the recovery of these valuable resources whilst reducing contamination levels. Material recovery and waste derived fuels are potentially valuable options being pursued by industry, using mechanical and biological processes incorporating sensor and sorting technologies developed and optimised for recycling plants. In its current state, waste management presents similarities to other industries that could improve their efficiencies using process analytical technology tools. Existing sensor technologies could be used to measure critical waste characteristics, providing data required by existing legislation, potentially aiding waste treatment processes and assisting stakeholders in decision making. Optical technologies offer the most flexible solution to gather real-time information applicable to each of the waste mechanical and biological treatment processes used by industry. In particular, combinations of optical sensors in the visible and the near-infrared range from 800nm to 2500nm of the spectrum, and different mathematical techniques, are able to provide material information and fuel properties with typical performance levels between 80% and 90%. These sensors not only could be used to aid waste processes, but to provide most waste quality indicators required by existing legislation, whilst offering better tools to the stakeholders. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Methionine splanchnic uptake is increased in critically ill children

    USDA-ARS?s Scientific Manuscript database

    During critical illness the splanchnic area is profoundly affected. There is no information on splanchnic uptake of amino acids in vivo, in critically ill children. Methionine splanchnic uptake in critically ill children will differ from estimates in healthy adults. We studied 24 critically ill chil...

  3. The Relationship between Critical Thinking Abilities, Dispositional Traits, and the Career States of Part-Time Adult Learners.

    ERIC Educational Resources Information Center

    Duffy, Jean Ann

    2000-01-01

    Continuing education students (n=73) identified their career state and completed the Watson-Glaser Critical Thinking Appraisal and California Critical Thinking Disposition Inventory. Most were at career plateau or indecision stages. The ability to recognize assumptions, appraise situations, and make judgments was related to career state. (SK)

  4. Effects of time and day of admission on the outcome of critically ill patients admitted to ICU

    PubMed Central

    Orsini, Jose; Rajayer, Salil; Ahmad, Noeen; Din, Nanda; Morante, Joaquin; Malik, Ryan; Shim, Ahmed

    2016-01-01

    Background Studies have shown that patients admitted to hospitals on weekends and after-hours experience worse outcome than those admitted on weekdays and daytime hours. Although admissions of patients to intensive care units (ICUs) occur 24 hours a day, not all critical care units maintain the same level of staffing during nighttime, weekends, and holidays. This raises concerns in view of evidence showing that the organizational structure of an ICU influences the outcome of critically ill patients. The objective of this study is to evaluate the effects of day and time of admission to ICU on patients’ outcome. Methods A single-center, prospective, observational study was conducted among all consecutive admissions to ICU in a community teaching hospital during a 4-month period. Results A total of 282 patients were admitted during the study period. Their mean age was 59.5 years (median 59, range 17–96), and the majority were male (157, 55.7%). Mean Acute Physiology and Chronic Health Evaluation (APACHE)-II score was 18.9 (median 33, range 1–45), and mean ICU length of stay was 3.1 days (median 2, range 1–19). Of the patients, 104 patients (36.9%) were admitted during weekends and 178 (63.1%) during weekdays. A total of 122 patients (43.3%) were admitted after-hours, constituting 68.5% of all admissions during weekdays. Fifty-six patients (19.9%) were admitted during daytime hours, representing 31.5% of all weekday admissions. Forty-five patients (15.9%) died in ICU. Compared to patients admitted on weekends, those admitted on weekdays had increased ICU mortality (operating room (OR)=0.437; 95% confidence interval=0.2054–0.9196; p=0.0293). Conclusion Admissions to ICU during weekends were not independently associated with increased mortality. A linear relationship between weekdays and after-hours admissions to ICU with mortality was observed at our institution. PMID:27987290

  5. Addressing critical environmental data gaps via low-cost, real-time, cellular-based environmental monitoring

    NASA Astrophysics Data System (ADS)

    Caylor, K. K.; Wolf, A.; Siegfried, B.

    2014-12-01

    Models in the environmental sciences are repositories in a sense of the current state of understanding of critical processes. However, as our understanding of these processes (and their accompanying models) become more granular, the data requirements to parameterize them become more limiting. In addition, as these models become more useful, they are often pressed into service for decision support, meaning that they cannot accept the data latency typical of most environmental observations. Finally, the vast majority of environmental data is generated at highly-instrumented, infrastructure-rich "mega sites" in the US/Europe, while many of the most pressing environmental issues are in rural locales and in the developing world. Cellular-based environmental sensing is a promising means to provide granular data in real time from remote locales to improve model-based forecasting using data assimilation. Applications we are working on include drought forecasting and food security; forest and crop responses to weather and climate change; and rural water usage. Over the past two years, we have developed a suite of integrated hardware, firmware, and backend APIs that accommodates an unlimited variety of sensors, and propagates these data onto the internet over mobile networks. Scientific data holds a unique role for demanding well-characterized information on sensor error and our design attempts to balance error reduction with low costs. The result is a deployment system that undercuts competing commercial products by as much as 90%, allowing more ubiquitous deployment with lower risks associated with sensor loss. Enclosure design and power management are critical ingredients for remote deployments under variable environmental conditions. Sensors push data onto cloud storage and make this data available via public API's via a backend server that accommodates additional metadata essential for interpreting observations, particularly their measurement errors. The data these pods

  6. No Critical Peripheral Fatigue Threshold during Intermittent Isometric Time to Task Failure Test with the Knee Extensors

    PubMed Central

    Froyd, Christian; Beltrami, Fernando G.; Millet, Guillaume Y.; Noakes, Timothy D.

    2016-01-01

    It has been proposed that group III and IV muscle afferents provide inhibitory feedback from locomotor muscles to the central nervous system, setting an absolute threshold for the development of peripheral fatigue during exercise. The aim of this study was to test the validity of this theory. Thus, we asked whether the level of developed peripheral fatigue would differ when two consecutive exercise trials were completed to task failure. Ten trained sport students performed two exercise trials to task failure on an isometric dynamometer, allowing peripheral fatigue to be assessed 2 s after maximal voluntary contraction (MVC) post task failure. The trials, separated by 8 min, consisted of repeated sets of 10 × 5-s isometric knee extension followed by 5-s rest between contractions. In each set, the first nine contractions were performed at a target force at 60% of the pre-exercise MVC, while the 10th contraction was a MVC. MVC and evoked force responses to supramaximal electrical femoral nerve stimulation on relaxed muscles were assessed during the trials and at task failure. Stimulations at task failure consisted of single stimulus (SS), paired stimuli at 10 Hz (PS10), paired stimuli at 100 Hz (PS100), and 50 stimuli at 100 Hz (tetanus). Time to task failure for the first trial (12.84 ± 5.60 min) was longer (P < 0.001) than for the second (5.74 ± 1.77 min). MVC force was significantly lower at task failure for both trials compared with the pre-exercise values (both P < 0.001), but there were no differences in MVC at task failure in the first and second trials (P = 1.00). However, evoked peak force for SS, PS100, and tetanus were all reduced more at task failure in the second compared to the first trial (P = 0.014 for SS, P < 0.001 for PS100 and tetanus). These results demonstrate that subjects do not terminate exercise at task failure because they have reached a critical threshold in peripheral fatigue. The present data therefore question the existence of a

  7. A national study of plasma use in critical care: clinical indications, dose and effect on prothrombin time

    PubMed Central

    2011-01-01

    Introduction Fresh frozen plasma (FFP) is widely used, but few studies have described patterns of plasma use in critical care. We carried out a multicentre study of coagulopathy in intensive care units (ICUs) and here describe overall FFP utilisation in adult critical care, the indications for transfusions, factors indicating the doses used and the effects of FFP use on coagulation. Methods We conducted a prospective, multicentre, observational study of all patients sequentially admitted to 29 adult UK general ICUs over 8 weeks. Daily data throughout ICU admission were collected concerning coagulation, relevant clinical outcomes (including bleeding), coagulopathy (defined as international normalised ratio (INR) >1.5, or equivalent prothrombin time (PT)), FFP and cryoprecipitate use and indications for transfusion. Results Of 1,923 admissions, 12.7% received FFP in the ICU during 404 FFP treatment episodes (1,212 FFP units). Overall, 0.63 FFP units/ICU admission were transfused (0.11 units/ICU day). Reasons for FFP transfusion were bleeding (48%), preprocedural prophylaxis (15%) and prophylaxis without planned procedure (36%). Overall, the median FFP dose was 10.8 ml kg-1, but doses varied widely (first to third quartile, 7.2 to 14.4 ml kg-1). Thirty-one percent of FFP treatments were to patients without PT prolongation, and 41% were to patients without recorded bleeding and only mildly deranged INR (<2.5). Higher volumes of FFP were administered when the indication was bleeding (median doses: bleeding 11.1 ml kg-1, preprocedural prophylaxis 9.8 ml kg-1, prophylaxis without procedure 8.9 ml kg-1; P = 0.009 across groups) and when the pretransfusion INR was higher (ranging from median dose 8.9 ml kg-1 at INR ≤1.5 to 15.7 ml kg-1 at INR >3; P < 0.001 across ranges). Regression analyses suggested bleeding was the strongest predictor of higher FFP dose. Pretransfusion INR was more frequently normal when the transfusion indication was bleeding. Overall, posttransfusion

  8. Communication latencies of Apple push notification messages relevant for delivery of time-critical information to anesthesia providers.

    PubMed

    Rothman, Brian S; Dexter, Franklin; Epstein, Richard H

    2013-08-01

    Tablet computers and smart phones have gained popularity in anesthesia departments for educational and patient care purposes. VigiVU(™) is an iOS application developed at Vanderbilt University for remote viewing of perioperative information, including text message notifications delivered via the Apple Push Notification (APN) service. In this study, we assessed the reliability of the APN service. Custom software was written to send a message every minute to iOS devices (iPad(®), iPod Touch(®), and iPhone(®)) via wireless local area network (WLAN) and cellular pathways 24 hours a day over a 4-month period. Transmission and receipt times were recorded and batched by days, with latencies calculated as their differences. The mean, SEM, and the exact 95% upper confidence limits for the percent of days with ≥1 prolonged (>100 seconds) latency were calculated. Acceptable performance was defined as mean latency <30 seconds and ≤0.5% of latencies >100 seconds. Testing conditions included fixed locations of devices in high signal strength locations. Mean latencies were <1 second for iPad and iPod devices (WLAN), and <4 seconds for iPhone (cellular). Among >173,000 iPad and iPod latencies, none were >100 seconds. For iPhone latencies, 0.03% ± 0.01% were >100 seconds. The 95% upper confidence limits of days with ≥1 prolonged latency were 42% (iPhone) and 5% to 8% (iPad, iPod). The APN service was reliable for all studied devices over WLAN and cellular pathways, and performance was better than third party paging systems using Internet connections previously investigated using the same criteria. However, since our study was a best-case assessment, testing is required at individual sites considering use of this technology for critical messaging. Furthermore, since the APN service may fail due to Internet or service provider disruptions, a backup paging system is recommended if the APN service were to be used for critical messaging.

  9. Geochemical evolution of the Critical Zone across variable time scales informs concentration-discharge relationships: Jemez River Basin Critical Zone Observatory

    NASA Astrophysics Data System (ADS)

    McIntosh, Jennifer C.; Schaumberg, Courtney; Perdrial, Julia; Harpold, Adrian; Vázquez-Ortega, Angélica; Rasmussen, Craig; Vinson, David; Zapata-Rios, Xavier; Brooks, Paul D.; Meixner, Thomas; Pelletier, Jon; Derry, Louis; Chorover, Jon

    2017-05-01

    This study investigates the influence of water, carbon, and energy fluxes on solute production and transport through the Jemez Critical Zone (CZ) and impacts on C-Q relationships over variable spatial and temporal scales. Chemical depletion-enrichment profiles of soils, combined with regolith thickness and groundwater data indicate the importance to stream hydrochemistry of incongruent dissolution of silicate minerals during deep bedrock weathering, which is primarily limited by water fluxes, in this highly fractured, young volcanic terrain. Under high flow conditions (e.g., spring snowmelt), wetting of soil and regolith surfaces and presence of organic acids promote mineral dissolution and provide a constant supply of base cations, Si, and DIC to soil water and groundwater. Mixing of waters from different hydrochemical reservoirs in the near stream environment during "wet" periods leads to the chemostatic behavior of DIC, base cations, and Si in stream flow. Metals transported by organic matter complexation (i.e., Ge, Al) and/or colloids (i.e., Al) during periods of soil saturation and lateral connectivity to the stream display a positive relationship with Q. Variable Si-Q relationships, under all but the highest flow conditions, can be explained by nonconservative transport and precipitation of clay minerals, which influences long versus short-term Si weathering fluxes. By combining measurements of the CZ obtained across different spatial and temporal scales, we were able to constrain weathering processes in different hydrological reservoirs that may be flushed to the stream during hydrologic events, thereby informing C-Q relationships.

  10. Prolonged prothrombin time after recombinant activated factor VII therapy in critically bleeding trauma patients is associated with adverse outcomes.

    PubMed

    McMullin, Neil R; Wade, Charles E; Holcomb, John B; Nielsen, Tina G; Rossaint, Rolf; Riou, Bruno; Rizoli, Sandro B; Kluger, Yoram; Choong, Philip I T; Warren, Brian; Tortella, Bartholomew J; Boffard, Kenneth D

    2010-07-01

    In trauma patients with significant hemorrhage, it is hypothesized that failure to normalize prothrombin time (PT) after recombinant activated factor VII (rFVIIa) treatment predicts poor clinical outcomes and potentially indicates a need for additional therapeutic interventions. To assess the value of PT to predict outcomes after rFVIIa or placebo therapy, we performed a post hoc analysis of data from 169 severely injured, critically bleeding trauma patients who had 1-hour postdose PT measurements from two randomized clinical trials. Baseline characteristics and outcome parameters were compared between subjects with 1-hour postdose PT >or=18 seconds and PT <18 seconds. In rFVIIa-treated subjects, prolonged postdose PT values >or=18 seconds were associated with significantly higher 24-hour mortality (60% vs. 3%; p < 0.001) and 30-day mortality, increased incidence of massive transfusion, and fewer intensive care unit-free days compared with postdose PT values <18 seconds. Recombinant rFVIIa-treated subjects with postdose PT >or=18 seconds had significantly lower baseline hemoglobin levels, fibrinogen levels, and platelet counts than subjects with postdose PT values <18 seconds even though they received similar amounts of blood products before rFVIIa dosing. Placebo-treated subjects with postdose PT >or=18 seconds had significantly increased incidence of massive transfusion, significantly decreased intensive care unit-free days, and significantly lower levels of fibrinogen and platelets at baseline compared with subjects with postdose PT values <18 seconds. The presence of prolonged PT after rFVIIa or placebo therapy was associated with poor clinical outcomes. Because subjects with postdosing PT >or=18 seconds had low levels of hemoglobin, fibrinogen, and platelets, this group may benefit from additional blood component therapy.

  11. Real-time determination of critical quality attributes using near-infrared spectroscopy: a contribution for Process Analytical Technology (PAT).

    PubMed

    Rosas, Juan G; Blanco, Marcel; González, Josep M; Alcalà, Manel

    2012-08-15

    Process Analytical Technology (PAT) is playing a central role in current regulations on pharmaceutical production processes. Proper understanding of all operations and variables connecting the raw materials to end products is one of the keys to ensuring quality of the products and continuous improvement in their production. Near infrared spectroscopy (NIRS) has been successfully used to develop faster and non-invasive quantitative methods for real-time predicting critical quality attributes (CQA) of pharmaceutical granulates (API content, pH, moisture, flowability, angle of repose and particle size). NIR spectra have been acquired from the bin blender after granulation process in a non-classified area without the need of sample withdrawal. The methodology used for data acquisition, calibration modelling and method application in this context is relatively inexpensive and can be easily implemented by most pharmaceutical laboratories. For this purpose, Partial Least-Squares (PLS) algorithm was used to calculate multivariate calibration models, that provided acceptable Root Mean Square Error of Predictions (RMSEP) values (RMSEP(API)=1.0 mg/g; RMSEP(pH)=0.1; RMSEP(Moisture)=0.1%; RMSEP(Flowability)=0.6 g/s; RMSEP(Angle of repose)=1.7° and RMSEP(Particle size)=2.5%) that allowed the application for routine analyses of production batches. The proposed method affords quality assessment of end products and the determination of important parameters with a view to understanding production processes used by the pharmaceutical industry. As shown here, the NIRS technique is a highly suitable tool for Process Analytical Technologies.

  12. Strength training increases endurance time to exhaustion during high-intensity exercise despite no change in critical power.

    PubMed

    Sawyer, Brandon J; Stokes, David G; Womack, Christopher J; Morton, R Hugh; Weltman, Arthur; Gaesser, Glenn A

    2014-03-01

    The purpose of this study was to determine whether improvements in endurance exercise performance elicited by strength training were accurately reflected by changes in parameters of the power-duration hyperbola for high-intensity exercise. Before and after 8 weeks of strength training (N = 14) or no exercise, control (N = 5), 19 males (age: 20.6 ± 2.0 years; weight: 78.2 ± 15.9 kg) performed a maximal incremental exercise test on a cycle ergometer and also cycled to exhaustion during 4 constant-power exercise bouts. Critical power (CP) and anaerobic work capacity (W') were estimated using nonlinear and linear models. Subjects in the strength training group improved significantly more than controls (p < 0.05) for strength (~30%), power at V[Combining Dot Above]O2peak (7.9%), and time to exhaustion (TTE) for all 4 constant-power tests (~39%). Contrary to our hypothesis, CP did not change significantly after strength training (p > 0.05 for all models). Strength training improved W' (mean range of improvement = +5.8 to +10.0 kJ; p < 0.05) for both linear models. Increases in W' were consistently positively correlated with improvements in TTE, whereas changes in CP were not. Our findings indicate that strength training alters the power-duration hyperbola such that W' is enhanced without any improvement in CP. Consequently, CP may not be robust enough to track changes in endurance capacity elicited by strength training, and we do not recommend it to be used for this purpose. Conversely, W' may be the better indicator of improvement in endurance performance elicited by strength training.

  13. Influence of hang time and location on bacterial contamination of intravenous bags in a veterinary emergency and critical care setting.

    PubMed

    Guillaumin, Julien; Olp, Nichole M; Magnusson, Karissa D; Butler, Amy L; Daniels, Joshua B

    2017-09-01

    To assess the rate of bacterial contamination of fluid and ports in intravenous bags in a veterinary emergency room (ER) and intensive care unit (ICU). Experimental model. Ninety intravenous fluid bags of lactated balanced-electrolytes solution (1 L) hung in a university hospital. Bags were hung in 2 different locations in the ER (sink and bins) and one location in the ICU (sink) for 11 days. Bags were punctured 3 times daily with a sterile needle to simulate clinical use. Injection ports were swabbed and 50 mL of fluid were collected in duplicates on days 0, 2, 4, 7, and 10. Aerobic bacterial cultures were performed on the fluid and injection port. Contamination was defined as bacterial growth of a similar phenotype across 2 consecutive times. Increase in the fluid contamination rate from day 0 was tested using an exact binomial test. Port contamination rate between locations was tested using Fisher's exact test. Combined bacterial growth on injection ports reached a mean (95% confidence interval) of 8.1 (0.005-16.2) cfu/port on day 10. The combined port contamination was 3.3%, 11.1%, 17.8%, and 31.1% on days 0, 2, 4, and 7, respectively. Port contamination was similar between ER and ICU. However, port contamination was higher in the sink versus the bins area (38.3% vs 16.7%, P = 0.032). No fluid bag was contaminated at days 0 and 2. The contamination rate of fluid bag was 1.1% and 4.4% on days 4 and 7, respectively. All bags with contaminated fluid were in the ER (6.7%, 95% exact binomial confidence interval 1.9-16.2%). Injection port contamination reached 31.1% on day 7. Contamination was more likely when the bags were hung next to a sink. In our model of bag puncture, fluid contamination occurred between days 2 and 4. © Veterinary Emergency and Critical Care Society 2017.

  14. Time to decannulation and associated risk factors in the postacute rehabilitation of critically ill patients with intensive care unit-acquired weakness: a cohort study.

    PubMed

    Thomas, Simone; Sauter, Wolfgang; Starrost, Ulrike; Pohl, Marcus; Mehrholz, Jan

    2017-08-01

    Treatment of critical illness on intensive-care-units (ICU) results often in persistent invasive endotracheal intubation which might delay rehabilitation and increases the risk of mortality. Recent longitudinal studies have described the recovery of critically ill people, but the detailed time course of decannulation in patients with chronic critical illness with ICU-acquired muscle weakness (ICUAW) is not well known. The aim of our study was to describe the decannulation times and associated risk factors in patients who are chronic critically ill with ICU acquired weakness. This is a cohort study. Postacute and rehabilitation units. Chronic critically ill patients with ICUAW and tracheostomy tube. We calculated the time until decannulation and used possible predictor variables to explain this time course. We included 122 patients with ICUAW. Successful decannulation of the tracheostomy tube was achieved after a median of 40.5 days (interquartile range= 44) after study onset and after a median of 89 days (interquartile range= 58) after onset of primary illness. Our final multivariate Cox-Proportional Hazard model included two main risk factors for decannulation: the amount of medical tubes such as catheters at admission to the rehabilitation center (adjusted hazard ratio [HR]=1.572 (95% CI: 1.021 to 2.415) and the duration of weaning from respirator in days (adjusted HR= 1.02 per day (95% CI: 1.006 to 1.03). No adverse events occurred. We described the detailed time course of decannulation in the rehabilitation of chronic critically ill patients and no adverse events were observed. Taken many single factors into account the quantity of medical tubes and the duration of weaning from respirator were associated risk factors for decannulation in this population. Knowing an exact time course of decannulation supports medical decisions in clinical rehabilitation and might help to give a prognosis for decannulation. The amount of medical tubes and the duration of weaning

  15. Critical Length Criterion and the Arc Chain Model for Calculating the Arcing Time of the Secondary Arc Related to AC Transmission Lines

    NASA Astrophysics Data System (ADS)

    Cong, Haoxi; Li, Qingmin; Xing, Jinyuan; Li, Jinsong; Chen, Qiang

    2015-06-01

    The prompt extinction of the secondary arc is critical to the single-phase reclosing of AC transmission lines, including half-wavelength power transmission lines. In this paper, a low-voltage physical experimental platform was established and the motion process of the secondary arc was recorded by a high-speed camera. It was found that the arcing time of the secondary arc rendered a close relationship with its arc length. Through the input and output power energy analysis of the secondary arc, a new critical length criterion for the arcing time was proposed. The arc chain model was then adopted to calculate the arcing time with both the traditional and the proposed critical length criteria, and the simulation results were compared with the experimental data. The study showed that the arcing time calculated from the new critical length criterion gave more accurate results, which can provide a reliable criterion in term of arcing time for modeling and simulation of the secondary arc related with power transmission lines. supported by National Natural Science Foundation of China (Nos. 51277061 and 51420105011)

  16. Part-Time Learners in Open and Distance Learning: Revisiting the Critical Importance of Choice, Flexibility and Employability

    ERIC Educational Resources Information Center

    Butcher, John; Rose-Adams, John

    2015-01-01

    In this article, we argue that, if open learning seeks to (re)assert a social justice mission, issues of openness and flexibility are more critical than ever. Drawing on qualitative data from a National Union of Students Wales/Open University study, which explored, in the voices of Welsh students, the identity, motivation and barriers faced by…

  17. Part-Time Learners in Open and Distance Learning: Revisiting the Critical Importance of Choice, Flexibility and Employability

    ERIC Educational Resources Information Center

    Butcher, John; Rose-Adams, John

    2015-01-01

    In this article, we argue that, if open learning seeks to (re)assert a social justice mission, issues of openness and flexibility are more critical than ever. Drawing on qualitative data from a National Union of Students Wales/Open University study, which explored, in the voices of Welsh students, the identity, motivation and barriers faced by…

  18. Clarification to 1998 Agreement Regarding the National Remedy Review Board Review Criteria for Department of Energy Non-Time Critical Removal Actions

    EPA Pesticide Factsheets

    The purpose of this memorandum is to provide additional clarification on the applicability of the October 5, 1998, joint Environmental Protection Agency (EPA) and the Department of Energy (DOE) agreement on DOE decommissioning projects titled Review of Department of Energy Non-Time Critical Removal Actions by the National Remedy Review Board.

  19. A Critical Challenge: The Engagement and Assessment of Contingent, Part-Time Adjunct Faculty Professors in United States Community Colleges

    ERIC Educational Resources Information Center

    Jolley, Michael R.; Cross, Emily; Bryant, Miles

    2014-01-01

    In 2011, according to a National Center for Education Statistics report, part-time instructional staff in all higher education institutions exceeded full-time faculty members for the first time, accounting for 50% of all instructional staff (National Center for Education Statistics [NCES], 2012). The same report indicates part-time faculty in…

  20. A Critical Challenge: The Engagement and Assessment of Contingent, Part-Time Adjunct Faculty Professors in United States Community Colleges

    ERIC Educational Resources Information Center

    Jolley, Michael R.; Cross, Emily; Bryant, Miles

    2014-01-01

    In 2011, according to a National Center for Education Statistics report, part-time instructional staff in all higher education institutions exceeded full-time faculty members for the first time, accounting for 50% of all instructional staff (National Center for Education Statistics [NCES], 2012). The same report indicates part-time faculty in…

  1. Field-induced quantum critical point in planar Heisenberg ferromagnets with long-range interactions: Two-time Green's function framework

    NASA Astrophysics Data System (ADS)

    Campana, L. S.; de Cesare, L.; Esposito, U.; Mercaldo, M. T.; Rabuffo, I.

    2010-07-01

    The two-time Green’s function method is used to study the critical properties and crossover phenomena near the field-induced quantum critical point (QCP) of a d -dimensional spin- S planar Heisenberg ferromagnet with long-range interactions decaying as r-α (with α>d ) with the distance r between spins. We adopt the Callen scheme for spin S and the Tyablikov decoupling procedure which is expected to provide suitable results at low temperatures. Different quantum critical regimes are found in the (α,d) plane and the global structure of the phase diagram is determined showing the typical V-shaped region close to the QCP. Depending on the values of α , we find that also for dimensionalities d⩽2 a finite-temperature critical line, ending in the QCP, exists with asymptotic behaviors and crossovers which can be employed as a useful guide for experimental studies. Moreover, these crossovers are shown to be suitably described in terms of (α,d) -dependent scaling functions and effective critical exponents.

  2. P- v criticality in the extended phase space of a noncommutative geometry inspired Reissner-Nordström black hole in AdS space-time

    NASA Astrophysics Data System (ADS)

    Liang, Jun; Guan, Zhi-Hua; Liu, Yan-Chun; Liu, Bo

    2017-02-01

    The P- v criticality and phase transition in the extended phase space of a noncommutative geometry inspired Reissner-Nordström (RN) black hole in Anti-de Sitter (AdS) space-time are studied, where the cosmological constant appears as a dynamical pressure and its conjugate quantity is thermodynamic volume of the black hole. It is found that the P- v criticality and the small black hole/large black hole phase transition appear for the noncommutative RN-AdS black hole. Numerical calculations indicate that the noncommutative parameter affects the phase transition as well as the critical temperature, horizon radius, pressure and ratio. The critical ratio is no longer universal, which is different from the result in the van de Waals liquid-gas system. The nature of phase transition at the critical point is also discussed. Especially, for the noncommutative geometry inspired RN-AdS black hole, a new thermodynamic quantity Ψ conjugate to the noncommutative parameter θ has to be defined further, which is required for consistency of both the first law of thermodynamics and the corresponding Smarr relation.

  3. SCREEN: A simple layperson administered screening algorithm in low resource international settings significantly reduces waiting time for critically ill children in primary healthcare clinics.

    PubMed

    Hansoti, Bhakti; Jenson, Alexander; Kironji, Antony G; Katz, Joanne; Levin, Scott; Rothman, Richard; Kelen, Gabor D; Wallis, Lee A

    2017-01-01

    In low resource settings, an inadequate number of trained healthcare workers and high volumes of children presenting to Primary Healthcare Centers (PHC) result in prolonged waiting times and significant delays in identifying and evaluating critically ill children. The Sick Children Require Emergency Evaluation Now (SCREEN) program, a simple six-question screening algorithm administered by lay healthcare workers, was developed in 2014 to rapidly identify critically ill children and to expedite their care at the point of entry into a clinic. We sought to determine the impact of SCREEN on waiting times for critically ill children post real world implementation in Cape Town, South Africa. This is a prospective, observational implementation-effectiveness hybrid study that sought to determine: (1) the impact of SCREEN implementation on waiting times as a primary outcome measure, and (2) the effectiveness of the SCREEN tool in accurately identifying critically ill children when utilised by the QM and adherence by the QM to the SCREEN algorithm as secondary outcome measures. The study was conducted in two phases, Phase I control (pre-SCREEN implementation- three months in 2014) and Phase II (post-SCREEN implementation-two distinct three month periods in 2016). In Phase I, 1600 (92.38%) of 1732 children presenting to 4 clinics, had sufficient data for analysis and comprised the control sample. In Phase II, all 3383 of the children presenting to the 26 clinics during the sampling time frame had sufficient data for analysis. The proportion of critically ill children who saw a professional nurse within 10 minutes increased tenfold from 6.4% to 64% (Phase I to Phase II) with the median time to seeing a professional nurse reduced from 100.3 minutes to 4.9 minutes, (p < .001, respectively). Overall layperson screening compared to Integrated Management of Childhood Illnesses (IMCI) designation by a nurse had a sensitivity of 94.2% and a specificity of 88.1%, despite large variance

  4. SCREEN: A simple layperson administered screening algorithm in low resource international settings significantly reduces waiting time for critically ill children in primary healthcare clinics

    PubMed Central

    Jenson, Alexander; Kironji, Antony G.; Katz, Joanne; Levin, Scott; Rothman, Richard; Kelen, Gabor D.; Wallis, Lee A.

    2017-01-01

    Background In low resource settings, an inadequate number of trained healthcare workers and high volumes of children presenting to Primary Healthcare Centers (PHC) result in prolonged waiting times and significant delays in identifying and evaluating critically ill children. The Sick Children Require Emergency Evaluation Now (SCREEN) program, a simple six-question screening algorithm administered by lay healthcare workers, was developed in 2014 to rapidly identify critically ill children and to expedite their care at the point of entry into a clinic. We sought to determine the impact of SCREEN on waiting times for critically ill children post real world implementation in Cape Town, South Africa. Methods and findings This is a prospective, observational implementation-effectiveness hybrid study that sought to determine: (1) the impact of SCREEN implementation on waiting times as a primary outcome measure, and (2) the effectiveness of the SCREEN tool in accurately identifying critically ill children when utilised by the QM and adherence by the QM to the SCREEN algorithm as secondary outcome measures. The study was conducted in two phases, Phase I control (pre-SCREEN implementation- three months in 2014) and Phase II (post-SCREEN implementation—two distinct three month periods in 2016). In Phase I, 1600 (92.38%) of 1732 children presenting to 4 clinics, had sufficient data for analysis and comprised the control sample. In Phase II, all 3383 of the children presenting to the 26 clinics during the sampling time frame had sufficient data for analysis. The proportion of critically ill children who saw a professional nurse within 10 minutes increased tenfold from 6.4% to 64% (Phase I to Phase II) with the median time to seeing a professional nurse reduced from 100.3 minutes to 4.9 minutes, (p < .001, respectively). Overall layperson screening compared to Integrated Management of Childhood Illnesses (IMCI) designation by a nurse had a sensitivity of 94.2% and a

  5. A proposed procedure for expressing the behavior of a full engine cycle by identifying its critical load timings

    NASA Astrophysics Data System (ADS)

    Marius Andrei, Mihalache; Gheorghe, Nagit; Gavril, Musca; Vasile, Merticaru, Jr.; Marius Ionut, Ripanu

    2016-11-01

    In the present study the authors propose a new algorithm for identifying the right loads that act upon a functional connecting rod during a full engine cycle. The loads are then divided into three categories depending on the results they produce, as static, semi-dynamic and dynamic ones Because an engine cycle extends up to 720°, the authors aim to identify a method of substitution of values that produce the same effect as a previous value of a considered angle did. In other words, the proposed method aims to pin point the critical values that produce an effect different as the one seen before during a full engine cycle. Only those values will then be considered as valid loads that act upon the connecting rod inside FEA analyses. This technique has been applied to each of the three categories mentioned above and did produced different critical values for each one of them. The whole study relies on a theoretical mechanical project which was developed in order to identify the right values that correspond to each degree of the entire engine cycle of a Daewoo Tico automobile.

  6. Prolonged Prothrombin Time After Recombinant Activated Factor VII Therapy in Critically Bleeding Trauma Patients Is Associated With Adverse Outcomes

    DTIC Science & Technology

    2010-07-01

    mortality.25–28 Currently, no definitive laboratory test is available to gauge the efficacy of rFVIIa. The PT assay is an in vitro measurement of time to clot ...formation by the tissue factor (TF) dependent pathway, and it is used to screen for hemo- static disorders. PT is measured as the time from the...addition of calcium chloride and thromboplastin (a phospholipid source) and tissue factor, to the time of clot formation, as measured by a mechanical or

  7. Buy now, saved later? The critical impact of time-to-pandemic uncertainty on pandemic cost-effectiveness analyses.

    PubMed

    Drake, Tom; Chalabi, Zaid; Coker, Richard

    2015-02-01

    Investment in pandemic preparedness is a long-term gamble, with the return on investment coming at an unknown point in the future. Many countries have chosen to stockpile key resources, and the number of pandemic economic evaluations has risen sharply since 2009. We assess the importance of uncertainty in time-to-pandemic (and associated discounting) in pandemic economic evaluation, a factor frequently neglected in the literature to-date. We use a probability tree model and Monte Carlo parameter sampling to consider the cost effectiveness of antiviral stockpiling in Cambodia under parameter uncertainty. Mean elasticity and mutual information (MI) are used to assess the importance of time-to-pandemic compared with other parameters. We also consider the sensitivity to choice of sampling distribution used to model time-to-pandemic uncertainty. Time-to-pandemic and discount rate are the primary drivers of sensitivity and uncertainty in pandemic cost effectiveness models. Base case cost effectiveness of antiviral stockpiling ranged between is US$112 and US$3599 per DALY averted using historical pandemic intervals for time-to-pandemic. The mean elasticities for time-to-pandemic and discount rate were greater than all other parameters. Similarly, the MI scores for time to pandemic and discount rate were greater than other parameters. Time-to-pandemic and discount rate were key drivers of uncertainty in cost-effectiveness results regardless of time-to-pandemic sampling distribution choice. Time-to-pandemic assumptions can "substantially" affect cost-effectiveness results and, in our model, is a greater contributor to uncertainty in cost-effectiveness results than any other parameter. We strongly recommend that cost-effectiveness models include probabilistic analysis of time-to-pandemic uncertainty. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

  8. Long-Time Behavior and Critical Limit of Subcritical SQG Equations in Scale-Invariant Sobolev Spaces

    NASA Astrophysics Data System (ADS)

    Coti Zelati, Michele

    2017-09-01

    We consider the subcritical SQG equation in its natural scale-invariant Sobolev space and prove the existence of a global attractor of optimal regularity. The proof is based on a new energy estimate in Sobolev spaces to bootstrap the regularity to the optimal level, derived by means of nonlinear lower bounds on the fractional Laplacian. This estimate appears to be new in the literature and allows a sharp use of the subcritical nature of the L^∞ bounds for this problem. As a by-product, we obtain attractors for weak solutions as well. Moreover, we study the critical limit of the attractors and prove their stability and upper semicontinuity with respect to the strength of the diffusion.

  9. Examination of silicate limitation of primary production in Jiaozhou Bay, China. II. Critical value and time of silicate limitation and satisfaction of the phytoplankton growth

    NASA Astrophysics Data System (ADS)

    Dongfang, Yang; Jing, Zhang; Zhenhui, Gao; Yu, Chen; Peiyan, Sun

    2003-03-01

    Analysis and comparison of Jiaozhou Bay data collected from May 1991 to February 1994 revealed the spatiotemporal variations of the ambient Si(OH)4:NO3 (Si:N) concentration rations and the seasonal variations of (Si:N) ratios in Jiaozhou Bay and showed that the Si:N ratios were <1 throughout Jiaozhou Bay in spring, autumn, and winter. These results provide further evidence that silicate limits the growth of phytoplankton (i.e. diatoms) in spring, autumn and winter. Moreover, comparison of the spatiotemporal variations of the Si:N ratio and primary production in Jiaozhou Bay suggested their close relationship. The spatiotemporal pattern of dissolved silicate matched well that of primary production in Jiaozhou Bay. Along with the environmental change of Jiaozhou Bay in the last thirty years, the N and P concentrations tended to rise, whereas Si concentration showed cyclic seasonal variations. With the variation of nutrient Si limiting the primary production in mind, the authors found that the range of values of primary production is divided into three parts: the basic value of Si limited primary production, the extent of Si limited primary production and the critical value of Si limited primary production, which can be calculated for Jiaozhou Bay by Equations (1), (2) and (3), showing that the time of the critical value of Si limitation of phytoplankton growth in Jiaozhou Bay is around November 3 to November 13 in autumn; and that the time of the critical value of Si satisfaction of phytoplankton growth in Jiaozhou Bay is around May 22 to June 7 in spring. Moreover, the calculated critical value of Si satisfactory for phytoplankton growth is 2.15-0.76 μmol/L and the critical value of Si limitation of phytoplankton growth is 1.42-0.36 μmol/L; so that the time period of Si limitation of phytoplankton growth is around November 13 to May 22 in the next year; the time period of Si satisfactory for phytoplankton growth is around June 7 to November 3. This result also

  10. Examination of silicate limitation of primary production in Jiaozhou Bay, China. II. Critical value and time of silicate limitation and satisfaction of the phytoplankton growth

    NASA Astrophysics Data System (ADS)

    Yang, Dongfang; Zhang, Jing; Gao, Zhenhui; Chen, Yu; Sun, Peiyan

    2003-03-01

    Analysis and comparison of Jiaozhou Bay data collected from May 1991 to February 1994 revealed the spatiotemporal variations of the ambient Si(OH)4:NO3 (Si:N) concentration rations and the seasonal variations of (Si:N) ratios in Jiaozhou Bay and showed that the Si:N ratios were <1 throughout Jiaozhou Bay in spring, autumn, and winter. These results provide further evidence that silicate limits the growth of phytoplankton (i.e. diatoms) in spring, autumn and winter. Moreover, comparison of the spatiotemporal variations of the Si:N ratio and primary production in Jiaozhou Bay suggested their close relationship. The spatiotemporal pattern of dissolved silicate matched well that of primary production in Jiaozhou Bay. Along with the environmental change of Jiaozhou Bay in the last thirty years, the N and P concentrations tended to rise, whereas Si concentration showed cyclic seasonal variations. With the variation of nutrient Si limiting the primary production in mind, the authors found that the range of values of primary production is divided into three parts: the basic value of Si limited primary production, the extent of Si limited primary production and the critical value of Si limited primary production, which can be calculated for Jiaozhou Bay by Equations (1), (2) and (3), showing that the time of the critical value of Si limitation of phytoplankton growth in Jiaozhou Bay is around November 3 to November 13 in autumn; and that the time of the critical value of Si satisfaction of phytoplankton growth in Jiaozhou Bay is around May 22 to June 7 in spring. Moreover, the calculated critical value of Si satisfactory for phytoplankton growth is 2.15 0.76 μmol/L and the critical value of Si limitation of phytoplankton growth is 1.42 0.36 μmol/L; so that the time period of Si limitation of phytoplankton growth is around November 13 to May 22 in the next year; the time period of Si satisfactory for phytoplankton growth is around June 7 to November 3. This result also

  11. Investigating critical effects of variegated lubricants, glidants and hydrophilic additives on lag time of press coated ethylcellulose tablets.

    PubMed

    Patadia, Riddhish; Vora, Chintan; Mittal, Karan; Mashru, Rajashree

    2016-01-01

    The research envisaged focuses on vital impacts of variegated lubricants, glidants and hydrophilic additives on lag time of press coated ethylcellulose (EC) tablets using prednisone as a model drug. Several lubricants and glidants such as magnesium stearate, colloidal SiO2, sodium stearyl fumarate, talc, stearic acid, polyethylene glycol (6000) and glyceryl behenate were investigated to understand their effects on lag time by changing their concentrations in outer coat. Further, the effects of hydrophilic additives on lag time were examined for hydroxypropylmethylcellulose (E5), hydroxypropylcellulose (EF and SSL), povidone (K30), copovidone, polyethylene glycol (4000), lactose and mannitol. In vitro drug release testing revealed that each selected lubricant/glidant, if present even at concentration of 0.25% w/w, significantly reduced the lag time of press coated tablets. Specifically, colloidal SiO2 and/or magnesium stearate were detrimental while other lubricants/glidants were relatively less injurious. Among hydrophilic additives, freely water soluble fillers had utmost influence in lag time, whereas, comparatively less impact was observed with polymeric binders. Concisely, glidant and lubricant should be chosen to have minimal impact on lag time and further judicious selection of hydrophilic additives should be exercised for modulating lag time of pulsatile release formulations.

  12. Experiencing Art with the Ill, the Elderly, and Their Caregivers

    ERIC Educational Resources Information Center

    Barrett, Terry

    2011-01-01

    This article is a personal narrative of a teaching artist reaching out to persons ill, elderly, and their caregivers because of his own experiences with cancer. As a teaching artist, the author serves schools and communities as an art critic, that is, one who facilitates discussions about works of art made by the learners or by established…

  13. Experiencing Art with the Ill, the Elderly, and Their Caregivers

    ERIC Educational Resources Information Center

    Barrett, Terry

    2011-01-01

    This article is a personal narrative of a teaching artist reaching out to persons ill, elderly, and their caregivers because of his own experiences with cancer. As a teaching artist, the author serves schools and communities as an art critic, that is, one who facilitates discussions about works of art made by the learners or by established…

  14. Prognostic categories and timing of negative prognostic communication from critical care physicians to family members at end-of-life in an intensive care unit.

    PubMed

    Gutierrez, Karen M

    2013-09-01

    Negative prognostic communication is often delayed in intensive care units, which limits time for families to prepare for end-of-life. This descriptive study, informed by ethnographic methods, was focused on exploring critical care physician communication of negative prognoses to families and identifying timing influences. Prognostic communication of critical care physicians to nurses and family members was observed and physicians and family members were interviewed. Physician perception of prognostic certainty, based on an accumulation of empirical data, and the perceived need for decision-making, drove the timing of prognostic communication, rather than family needs. Although prognoses were initially identified using intuitive knowledge for patients in one of the six identified prognostic categories, utilizing decision-making to drive prognostic communication resulted in delayed prognostic communication to families until end-of-life (EOL) decisions could be justified with empirical data. Providers will better meet the needs of families who desire earlier prognostic information by separating prognostic communication from decision-making and communicating the possibility of a poor prognosis based on intuitive knowledge, while acknowledging the uncertainty inherent in prognostication. This sets the stage for later prognostic discussions focused on EOL decisions, including limiting or withdrawing treatment, which can be timed when empirical data substantiate intuitive prognoses. This allows additional time for families to anticipate and prepare for end-of-life decision-making.

  15. Ebola Virus Disease: Rapid Diagnosis and Timely Case Reporting are Critical to the Early Response for Outbreak Control.

    PubMed

    Stamm, Lola V

    2015-09-01

    Ebola virus disease (EVD) is a life-threatening zoonosis caused by infection with the Ebola virus. Since the first reported EVD outbreak in the Democratic Republic of the Congo, several small outbreaks have been reported in central Africa with about 2,400 cases occurring between 1976 and 2013. The 2013-2015 EVD outbreak in west Africa is the first documented outbreak in this region and the largest ever with over 27,000 cases and more than 11,000 deaths. Although EVD transmission rates have recently decreased in west Africa, this crisis continues to threaten global health and security, particularly since infected travelers could spread EVD to other resource-limited areas of the world. Because vaccines and drugs are not yet licensed for EVD, outbreak control is dependent on the use of non-pharmaceutical interventions (e.g., infection control practices, isolation of EVD cases, contact tracing with follow-up and quarantine, sanitary burial, health education). However, delays in diagnosing and reporting EVD cases in less accessible rural areas continue to hamper control efforts. New advances in rapid diagnostics for identifying presumptive EVD cases and in mobile-based technologies for communicating critical health-related information should facilitate deployment of an early response to prevent the amplification of sporadic EVD cases into large-scale outbreaks.

  16. Ebola Virus Disease: Rapid Diagnosis and Timely Case Reporting are Critical to the Early Response for Outbreak Control

    PubMed Central

    Stamm, Lola V.

    2015-01-01

    Ebola virus disease (EVD) is a life-threatening zoonosis caused by infection with the Ebola virus. Since the first reported EVD outbreak in the Democratic Republic of the Congo, several small outbreaks have been reported in central Africa with about 2,400 cases occurring between 1976 and 2013. The 2013–2015 EVD outbreak in west Africa is the first documented outbreak in this region and the largest ever with over 27,000 cases and more than 11,000 deaths. Although EVD transmission rates have recently decreased in west Africa, this crisis continues to threaten global health and security, particularly since infected travelers could spread EVD to other resource-limited areas of the world. Because vaccines and drugs are not yet licensed for EVD, outbreak control is dependent on the use of non-pharmaceutical interventions (e.g., infection control practices, isolation of EVD cases, contact tracing with follow-up and quarantine, sanitary burial, health education). However, delays in diagnosing and reporting EVD cases in less accessible rural areas continue to hamper control efforts. New advances in rapid diagnostics for identifying presumptive EVD cases and in mobile-based technologies for communicating critical health-related information should facilitate deployment of an early response to prevent the amplification of sporadic EVD cases into large-scale outbreaks. PMID:26175026

  17. "I Just Didn't Have Enough Time..." Assisting the Busy Adult Learner Develop Critical Reading and Thinking Skills.

    ERIC Educational Resources Information Center

    Diaz-Lefebvre, Rene

    Several factors are related to adult students' completion or noncompletion of reading assignments before class--lack of study time, their motivation for taking college classes, their need to feel involved in the learning process, and their expectations for success in the classroom. One of the biggest fears of adults returning to a school…

  18. "I Just Didn't Have Enough Time..." Assisting the Busy Adult Learner Develop Critical Reading and Thinking Skills.

    ERIC Educational Resources Information Center

    Diaz-Lefebvre, Rene

    Several factors are related to adult students' completion or noncompletion of reading assignments before class--lack of study time, their motivation for taking college classes, their need to feel involved in the learning process, and their expectations for success in the classroom. One of the biggest fears of adults returning to a school…

  19. Bedside Teaching on Time to Disposition Improves Length of Stay for Critically-ill Emergency Departments Patients.

    PubMed

    Pourmand, Ali; Lucas, Raymond; Pines, Jesse M; Shokoohi, Hamid; Yadav, Kabir

    2013-03-01

    We tested the effect of a brief disposition process intervention on residents' time to disposition and emergency department (ED) length of stay (LOS) in high acuity ED patients. This was a quasi-experimental study design in a single teaching hospital where ED residents are responsible for administrative bed requests for patients. Enrollment was performed for intervention and control groups on an even-odd day schedule. Inclusion criteria were ED patients triaged as Emergency Severity Index (ESI) 1 and 2. In the intervention group, the attending physician prompted the resident to make the disposition immediately after the evaluation of resuscitation patients. In the control group, the attending physicians did not intervene in the disposition process unless more than 2 hours passed without a disposition. Main outcomes were time to disposition and total ED LOS. A total of 104 patients were enrolled; 53 (51%) in the intervention group and 51 (49%) in the control group. After controlling for ESI and resident training year, mean disposition time was significantly shorter in the intervention group by 41.4 minutes (95% CI: 32.6-50.1). LOS was also shorter in the intervention group by 93.3 minutes (95% CI: 41.9-144.6). Prompting residents to enter administrative disposition orders in high acuity patients is associated with significant reduction in both time to disposition and ED LOS.

  20. Utilizing Social Networks in Times of Crisis: Understanding, Exploring and Analyzing Critical Incident Management at Institutions of Higher Education

    ERIC Educational Resources Information Center

    Asselin, Martha Jo

    2012-01-01

    With the rising number of major crises on college campuses today (Security on Campus Inc., 2009), institutions of higher education can benefit from understanding of how social networks may be used in times of emergency. What is currently known about the usage of social networks is not integral to the current practices of crisis management that are…

  1. Utilizing Social Networks in Times of Crisis: Understanding, Exploring and Analyzing Critical Incident Management at Institutions of Higher Education

    ERIC Educational Resources Information Center

    Asselin, Martha Jo

    2012-01-01

    With the rising number of major crises on college campuses today (Security on Campus Inc., 2009), institutions of higher education can benefit from understanding of how social networks may be used in times of emergency. What is currently known about the usage of social networks is not integral to the current practices of crisis management that are…

  2. Design, Development and Evaluation of Collaborative Team Training Method in Virtual Worlds for Time-Critical Medical Procedures

    ERIC Educational Resources Information Center

    Khanal, Prabal

    2014-01-01

    Medical students acquire and enhance their clinical skills using various available techniques and resources. As the health care profession has move towards team-based practice, students and trainees need to practice team-based procedures that involve timely management of clinical tasks and adequate communication with other members of the team.…

  3. Design, Development and Evaluation of Collaborative Team Training Method in Virtual Worlds for Time-Critical Medical Procedures

    ERIC Educational Resources Information Center

    Khanal, Prabal

    2014-01-01

    Medical students acquire and enhance their clinical skills using various available techniques and resources. As the health care profession has move towards team-based practice, students and trainees need to practice team-based procedures that involve timely management of clinical tasks and adequate communication with other members of the team.…

  4. Act Fast as Time Is Less: High Faecal Carriage of Carbapenem-Resistant Enterobacteriaceae in Critical Care Patients

    PubMed Central

    Sahu, Manisa; Pathrose, Edwin Joseph; Shivdas, Sarita

    2016-01-01

    Introduction Carbapenem-resistant Enterobacteriaceae (CRE) are drug-resistant Gram-negative bacteria that are present in the community as well as in hospitals. Their infection and colonisation puts critically ill patients at high risk due to the drug-resistant nature of the strains and possible spreading of these organisms, even in a hospital environment. Aim To examine the presence and types of Enterobacteriaceae species in patients admitted directly from the community. Materials and Methods The present study was a one-month pilot conducted in the ICU of a tertiary care hospital in Mumbai, India in 2015. Faecal samples of patients admitted from the community directly to the ICU were analysed using tests like MHT (Modified Hodge) and EDTA for the presence of IMP (action on Imipenem) and KPC (Klebsiella Test Pneumoniae Carbapenemase) producing strains of Enterobacteriaceae. Polymerase Chain Reaction (PCR) was performed to look for VIM, IMP, NDM1, OXA, and KPC genes. Antibiotic Sensitivity Test was carried out as per CLSI guidelines. Results The results showed an alarming level of faecal carriage rates in adult ICU patients. Klebsiella pneumonia was the most common carbapenem-resistant isolate, closely followed by Escherichia coli. PCR results revealed nine strains were positive for bla(KPC) gene, from which 7 were Klebsiella pneumoniae and one each of Escherichia coli and Klebsiella oxytoca was observed. Antibiotic Sensitivity Test results showed that the isolates had maximum sensitivity to Colistin (100%) and Tigecycline (95%). Conclusion These levels indicate that in the absence of CRE screenings, proper isolation of carrier patients is not possible, leading to possible spreading of these resistant bacteria strains in ICUs. A longer period of study is required to obtain more substantial data to validate the results of this pilot. PMID:27790429

  5. Making time and space: the impact of mindfulness training on nursing and midwifery practice. A critical interpretative synthesis.

    PubMed

    Hunter, Louise

    2016-04-01

    To explore qualitative literature to ascertain whether and how nurses and midwives perceive that mindfulness impacts on their practice, particularly their interactions with patients. Stress and burnout, which negatively impact patient care, are widely reported among nurses and midwives, who face unique stressors as professionals who often hold little organisational power, but are expected to shoulder the burden of resource cuts and an increasingly complex workload. Mindfulness is recommended as a tool to decrease stress and burnout in health professionals, and may also increase practitioner compassion and improve patient interactions. A critical interpretative synthesis. A systematic search was undertaken to identify qualitative studies where the majority of participants were qualified nurses and/or midwives who had attended mindfulness training. Retrieved literature was read and reread to identify relevant material, which was then coded into themes. Related themes were grouped into synthetic constructs, and a synthetic argument was produced to illustrate the relationships between these. Five relevant papers were identified. Findings indicate that mindfulness training enables nurses and midwives to gain some control over their thoughts and stress levels. This then creates a quiet mental space giving them agency and perspective and leading to improved caring, including a more patient-centred focus and increased presence and listening. Mindfulness appears to alter the way nurses and midwives operate within a stressful work environment, thereby changing the way the environment is experienced by themselves and, potentially, the people in their care. Further research is needed, but current qualitative research suggests mindfulness may enable nurses and midwives to work with compassion in stressful and demanding work environments. Mindfulness may offer an enabling way of coping with stress, in contrast to long-standing strategies such as task-orientation and

  6. Critical elements in implementations of just-in-time management: empirical study of cement industry in Pakistan.

    PubMed

    Qureshi, Muhammad Imran; Iftikhar, Mehwish; Bhatti, Mansoor Nazir; Shams, Tauqeer; Zaman, Khalid

    2013-01-01

    In recent years, inventory management is continuous challenge for all organizations not only due to heavy cost associated with inventory holding, but also it has a great deal to do with the organizations production process. Cement industry is a growing sector of Pakistan's economy which is now facing problems in capacity utilization of their plants. This study attempts to identify the key strategies for successful implementation of just-in-time (JIT) management philosophy on the cement industry of Pakistan. The study uses survey responses from four hundred operations' managers of cement industry in order to know about the advantages and benefits that cement industry have experienced by Just in time (JIT) adoption. The results show that implementing the quality, product design, inventory management, supply chain and production plans embodied through the JIT philosophy which infect enhances cement industry competitiveness in Pakistan. JIT implementation increases performance by lower level of inventory, reduced operations & inventory costs was reduced eliminates wastage from the processes and reduced unnecessary production which is a big challenge for the manufacturer who are trying to maintain the continuous flow processes. JIT implementation is a vital manufacturing strategy that reaches capacity utilization and minimizes the rate of defect in continuous flow processes. The study emphasize the need for top management commitment in order to incorporate the necessary changes that need to take place in cement industry so that JIT implementation can take place in an effective manner.

  7. Time and Demand are Two Critical Dimensions of Immunometabolism: The Process of Macrophage Activation and the Pentose Phosphate Pathway

    PubMed Central

    Nagy, Csörsz; Haschemi, Arvand

    2015-01-01

    A process is a function of time; in immunometabolism, this is reflected by the stepwise adaptation of metabolism to sustain the bio-energetic demand of an immune-response in its various states and shades. This perspective article starts by presenting an early attempt to investigate the physiology of inflammation, in order to illustrate one of the basic concepts of immunometabolism, wherein an adapted metabolism of infiltrating immune cells affects tissue function and inflammation. We then focus on the process of macrophage activation and aim to delineate the factor time within the current molecular context of metabolic-rewiring important for adapting primary carbohydrate metabolism. In the last section, we will provide information on how the pentose phosphate pathway may be of importance to provide both nucleotide precursors and redox-equivalents, and speculate how carbon-scrambling events in the non-oxidative pentose phosphate pathway might be regulated within cells by demand. We conclude that the adapted metabolism of inflammation is specific in respect to the effector-function and appears as a well-orchestrated event, dynamic by nature, and based on a functional interplay of signaling- and metabolic-pathways. PMID:25904920

  8. Role of real-time reverse transcription polymerase chain reaction for detection of respiratory viruses in critically ill children with respiratory disease: Is it time for a change in algorithm?

    PubMed

    Aramburo, Angela; van Schaik, Sandrijn; Louie, Janice; Boston, Erica; Messenger, Sharon; Wright, Carolyn; Lawrence Drew, W

    2011-07-01

    To identify the respiratory viral pathogens associated with acute lower respiratory tract infection in critically ill pediatric patients by using real-time reverse transcription-polymerase chain reaction, and compare results with those of direct fluorescence antibody assay testing. Observational cohort study. Pediatric intensive care unit at a tertiary care academic hospital. Pediatric patients admitted to the pediatric intensive care unit with severe respiratory symptoms consistent with viral lower respiratory tract infection. None. Respiratory samples of pediatric patients admitted to the pediatric intensive care unit with severe respiratory symptoms between January 2008 and July 2009 were tested with direct fluorescence antibody assay and real-time reverse transcription-polymerase chain reaction. At least one viral agent was detected in 70.5% of specimens by real-time reverse transcription-polymerase chain reaction and in 16.5% by direct fluorescence antibody assay (p < .001). Real-time reverse transcription-polymerase chain reaction increased the total viral yield five-fold compared to direct fluorescence antibody assay. Rhinovirus was the most commonly identified virus (41.6%). For viruses included in the direct fluorescence antibody assay panel, direct fluorescence antibody assay had a sensitivity of 0.42 (95% confidence interval 0.25-0.61) and a specificity of 1 (95% confidence interval 0.86-1.00) compared with real-time reverse transcription-polymerase chain reaction. Coinfections were not uncommon, in particular with rhinovirus, and these patients tended to have higher mortality. Direct fluorescence antibody assay testing is a suboptimal method for the detection of respiratory viruses in critically ill children with lower respiratory tract infection. Given the importance of a prompt and accurate viral diagnosis for this group of patients, we suggest that real-time reverse transcription-polymerase chain reaction becomes part of the routine diagnostic

  9. A novel time series analysis approach for prediction of dialysis in critically ill patients using echo-state networks.

    PubMed

    Verplancke, T; Van Looy, S; Steurbaut, K; Benoit, D; De Turck, F; De Moor, G; Decruyenaere, J

    2010-01-21

    Echo-state networks (ESN) are part of a group of reservoir computing methods and are basically a form of recurrent artificial neural networks (ANN). These methods can perform classification tasks on time series data. The recurrent ANN of an echo-state network has an 'echo-state' characteristic. This 'echo-state' functions as a fading memory: samples that have been introduced into the network in a further past, are faded away. The echo-state approach for the training of recurrent neural networks was first described by Jaeger H. et al. In clinical medicine, until this moment, no original research articles have been published to examine the use of echo-state networks. This study examines the possibility of using an echo-state network for prediction of dialysis in the ICU. Therefore, diuresis values and creatinine levels of the first three days after ICU admission were collected from 830 patients admitted to the intensive care unit (ICU) between May 31 th 2003 and November 17th 2007. The outcome parameter was the performance by the echo-state network in predicting the need for dialysis between day 5 and day 10 of ICU admission. Patients with an ICU length of stay <10 days or patients that received dialysis in the first five days of ICU admission were excluded. Performance by the echo-state network was then compared by means of the area under the receiver operating characteristic curve (AUC) with results obtained by two other time series analysis methods by means of a support vector machine (SVM) and a naive Bayes algorithm (NB). The AUC's in the three developed echo-state networks were 0.822, 0.818, and 0.817. These results were comparable to the results obtained by the SVM and the NB algorithm. This proof of concept study is the first to evaluate the performance of echo-state networks in an ICU environment. This echo-state network predicted the need for dialysis in ICU patients. The AUC's of the echo-state networks were good and comparable to the performance of other

  10. Neural-Network-Based Robust Optimal Tracking Control for MIMO Discrete-Time Systems With Unknown Uncertainty Using Adaptive Critic Design.

    PubMed

    Liu, Lei; Wang, Zhanshan; Zhang, Huaguang

    2017-03-02

    This paper is concerned with the robust optimal tracking control strategy for a class of nonlinear multi-input multi-output discrete-time systems with unknown uncertainty via adaptive critic design (ACD) scheme. The main purpose is to establish an adaptive actor-critic control method, so that the cost function in the procedure of dealing with uncertainty is minimum and the closed-loop system is stable. Based on the neural network approximator, an action network is applied to generate the optimal control signal and a critic network is used to approximate the cost function, respectively. In contrast to the previous methods, the main features of this paper are: 1) the ACD scheme is integrated into the controllers to cope with the uncertainty and 2) a novel cost function, which is not in quadric form, is proposed so that the total cost in the design procedure is reduced. It is proved that the optimal control signals and the tracking errors are uniformly ultimately bounded even when the uncertainty exists. Finally, a numerical simulation is developed to show the effectiveness of the present approach.

  11. Time Series miRNA-mRNA integrated analysis reveals critical miRNAs and targets in macrophage polarization

    PubMed Central

    Lu, Liangqun; McCurdy, Sara; Huang, Sijia; Zhu, Xun; Peplowska, Karolina; Tiirikainen, Maarit; Boisvert, William A.; Garmire, Lana X.

    2016-01-01

    Polarization of macrophages is regulated through complex signaling networks. Correlating miRNA and mRNA expression over time after macrophage polarization has not yet been investigated. We used paired RNA-Seq and miRNA-Seq experiments to measure the mRNA and miRNA expression in bone marrow-derived macrophages over a time-series of 8 hours. Bioinformatics analysis identified 31 differentially expressed miRNAs between M1 and M2 polarized macrophages. The top 4 M1 miRNAs (miR-155-3p, miR-155-5p, miR-147-3p and miR-9-5p) and top 4 M2 miRNAs (miR-27a-5p, let-7c-1-3p, miR-23a-5p and miR-23b-5p) were validated by qPCR. Interestingly, M1 specific miRNAs could be categorized to early- and late-response groups, in which three new miRNAs miR-1931, miR-3473e and miR-5128 were validated as early-response miRNAs. M1 polarization led to the enrichment of genes involved in immune responses and signal transduction, whereas M2 polarization enriched genes involved in cell cycle and metabolic processes. C2H2 zinc-finger family members are key targets of DE miRNAs. The integrative analysis between miRNAs and mRNAs demonstrates the regulations of miRNAs on nearly four thousand differentially expressed genes and most of the biological pathways enriched in macrophage polarization. In summary, this study elucidates the expression profiles of miRNAs and their potential targetomes during macrophage polarization. PMID:27981970

  12. First-time whole blood donation: A critical step for donor safety and retention on first three donations.

    PubMed

    Gillet, P; Rapaille, A; Benoît, A; Ceinos, M; Bertrand, O; de Bouyalsky, I; Govaerts, B; Lambermont, M

    2015-01-01

    Whole blood donation is generally safe although vasovagal reactions can occur (approximately 1%). Risk factors are well known and prevention measures are shown as efficient. This study evaluates the impact of the donor's retention in relation to the occurrence of vasovagal reaction for the first three blood donations. Our study of data collected over three years evaluated the impact of classical risk factors and provided a model including the best combination of covariates predicting VVR. The impact of a reaction at first donation on return rate and complication until the third donation was evaluated. Our data (523,471 donations) confirmed the classical risk factors (gender, age, donor status and relative blood volume). After stepwise variable selection, donor status, relative blood volume and their interaction were the only remaining covariates in the model. Of 33,279 first-time donors monitored over a period of at least 15 months, the first three donations were followed. Data emphasised the impact of complication at first donation. The return rate for a second donation was reduced and the risk of vasovagal reaction was increased at least until the third donation. First-time donation is a crucial step in the donors' career. Donors who experienced a reaction at their first donation have a lower return rate for a second donation and a higher risk of vasovagal reaction at least until the third donation. Prevention measures have to be processed to improve donor retention and provide blood banks with adequate blood supply. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. Critical assessment of day time traffic noise level at curbside open-air microenvironment of Kolkata City, India.

    PubMed

    Kundu Chowdhury, Anirban; Debsarkar, Anupam; Chakrabarty, Shibnath

    2015-01-01

    The objective of the research work is to assess day time traffic noise level at curbside open-air microenvironment of Kolkata city, India under heterogeneous environmental conditions. Prevailing traffic noise level in terms of A-weighted equivalent noise level (Leq) at the microenvironment was in excess of 12.6 ± 2.1 dB(A) from the day time standard of 65 dB(A) for commercial area recommended by the Central Pollution Control Board (CPCB) of India. Noise Climate and Traffic Noise Index of the microenvironment were accounted for 13 ± 1.8 dB(A) and 88.8 ± 6.1 dB(A) respectively. A correlation analysis explored that prevailing traffic noise level of the microenvironment had weak negative (-0.21; p < 0.01) and very weak positive (0.19; p < 0.01) correlation with air temperature and relative humidity. A Varimax rotated principal component analysis explored that motorized traffic volume had moderate positive loading with background noise component (L90, L95, L99) and prevailing traffic noise level had very strong positive loading with peak noise component (L1, L5, L10). Background and peak noise component cumulatively explained 80.98 % of variance in the data set. Traffic noise level at curbside open-air microenvironment of Kolkata City was higher than the standard recommended by CPCB of India. It was highly annoying also. Air temperature and relative humidity had little influence and the peak noise component had the most significant influence on the prevailing traffic noise level at curbside open-air microenvironment. Therefore, traffic noise level at the microenvironment of the city can be reduced with careful honking and driving.

  14. Verification and Validation of Neutronic/Thermalhydraulic 3D-Time Dependent Model for Treatment of Super-critical States of Light water Research Reactors Accidents

    SciTech Connect

    Khaled, S.M.

    2015-07-01

    This work presents the Verification and testing both the neutronic and thermal-hydraulics response of the positive reactivity-initiated power excursion accidents in small light water research reactors. Some research reactors have to build its own severe accidents code system. In this sense, a 3D space-time-dependent neutron diffusion models with thermal hydraulic feedback have been introduced, compared and tested both experimentally at criticality 14-cent and theoretically up to 1.5 $ with a number of similar codes. The results shows that no expected core failure or moderator boiling. (author)

  15. Comparing Methodologies for Evaluating Emergency Medical Services Ground Transport Access to Time-critical Emergency Services: A Case Study Using Trauma Center Care.

    PubMed

    Doumouras, Aristithes G; Gomez, David; Haas, Barbara; Boyes, Donald M; Nathens, Avery B

    2012-09-01

    The regionalization of medical services has resulted in improved outcomes and greater compliance with existing guidelines. For certain "time-critical" conditions intimately associated with emergency medicine, early intervention has demonstrated mortality benefits. For these conditions, then, appropriate triage within a regionalized system at first diagnosis is paramount, ideally occurring in the field by emergency medical services (EMS) personnel. Therefore, EMS ground transport access is an important metric in the ongoing evaluation of a regionalized care system for time-critical emergency services. To our knowledge, no studies have demonstrated how methodologies for calculating EMS ground transport access differ in their estimates of access over the same study area for the same resource. This study uses two methodologies to calculate EMS ground transport access to trauma center care in a single study area to explore their manifestations and critically evaluate the differences between the methodologies. Two methodologies were compared in their estimations of EMS ground transport access to trauma center care: a routing methodology (RM) and an as-the-crow-flies methodology (ACFM). These methodologies were adaptations of the only two methodologies that had been previously used in the literature to calculate EMS ground transport access to time-critical emergency services across the United States. The RM and ACFM were applied to the nine Level I and Level II trauma centers within the province of Ontario by creating trauma center catchment areas at 30, 45, 60, and 120 minutes and calculating the population and area encompassed by the catchments. Because the methodologies were identical for measuring air access, this study looks specifically at EMS ground transport access. Catchments for the province were created for each methodology at each time interval, and their populations and areas were significantly different at all time periods. Specifically, the RM calculated

  16. Decision solution, data manipulation and trust: The (un-)willingness to donate organs in Germany in critical times.

    PubMed

    Schwettmann, Lars

    2015-07-01

    In 2011 and 2012 a change of rules and a data-manipulation scandal focused German public attention on organ donation. This increased citizens' background knowledge as well as their willingness to respond to surveys. The present study is an effort to seize this research opportunity and to create evidence on which policy recommendations can be conceivably based. It uses data from two major representative surveys from 2011 to 2012 to address four central questions: Which characteristics, experiences and attitudes correlate with the written or unwritten willingness of individuals to donate (WTD) their own organs post-mortem? How has the WTD changed over time? To what extent does the WTD depend on normative trust? Which factors correlate with trust? The data is analyzed through summary statistics and regression models. Several hypotheses regarding factors connected with the WTD are confirmed in the survey results. Altruistic motives, relevant knowledge and trust are decisive. The special role of trust is corroborated by the data. As current German politics prevents the introduction of post-mortem donation incentives, potential policy making proposals are restricted to institutional changes to regain trust including the implementation of an organ donor registry and the advancement of counselling talks with general practitioners.

  17. Progesterone prevents development of neuropathic pain in a rat model: Timing and duration of treatment are critical

    PubMed Central

    Dableh, Liliane J; Henry, James L

    2011-01-01

    Background: Progesterone is emerging as an important protective agent against various injuries to the nervous system. Neuroprotective and remyelinating effects have been documented for this neurosteroid, which is synthesized by, and acts on, the central and peripheral nervous systems. Neuropathic pain is a severe, persistent condition that is generally resistant to treatment, and poses major personal, social, and economic burdens. The purpose of this study was to determine if single-dose or repeated progesterone administration would alleviate tactile hypersensitivity in a rat model of neuropathic pain, and to determine if early versus late initiation of treatment has an effect on the outcome. Methods: Rats were unilaterally implanted with a polyethylene cuff around the sciatic nerve, and sensitivity to von Frey filament stimulation was measured over approximately 12 weeks. Results: Rats given progesterone starting one hour after cuff implantation, and daily until day 4, exhibited tactile hypersensitivity similar to that of vehicle-treated rats for the duration of the study. When progesterone was started one hour after cuff implantation and given daily until day 10, rats exhibited no tactile hypersensitivity in the later part of the study, after treatment had stopped. When progesterone treatment was initiated at 20 days, once the model had been fully established, and given daily for 4 or even 11 days, no differences in withdrawal thresholds were observed compared with controls. Progesterone did not have any effect on withdrawal thresholds when given as a single dose, as measured at 30, 60 and 90 minutes after administration. Conclusion: These results indicate that progesterone, when administered immediately after nerve injury, and for a sufficient period of time, can prevent the development of neuropathic pain, and may offer new strategies for the treatment of this highly debilitating condition. PMID:21559355

  18. Optimization of door-to-electrocardiogram time within a critical pathway for the management of acute coronary syndromes at a teaching hospital in Colombia.

    PubMed

    Sprockel, John Jaime; Tovar Diaz, Lina Paola; Omaña Orduz, Olga Paola; Saavedra, Miguel Angel; Chaves Santiago, Walter Gabriel; Diaztagle Fernández, Juan José

    2015-03-01

    Door-to-electrocardiogram (D2E) time is recognized as one of the quality parameters in the attention of acute coronary syndromes. Electrocardiogram realization within periods below 10 minutes increases the possibility to achieve quick and effective reperfusion, which has an impact on outcomes. To describe the results of a strategy whose goal is to improve the fulfillment of the D2E deadline below 10 minutes in adults who attend the emergency service due to chest pain with clinical suspicion of acute coronary syndromes. Before-and-after study that assesses D2E time upon the implementation of actions for the reorganization of the process of attention of the patients with chest pain within the context of the implementation of a critical pathway. A total of 373 patients were assessed, 204 in the before stage and 169 in the after stage. The median D2E time was 16 minutes in the before stage, in 41% of the cases it was below 10 minutes; upon the implementation of the change in the process of attention of chest pain the median was 5 minutes, with 63% of the cases below 10 minutes, exhibiting a statistically significant difference. The actions taken led to a lower median of D2E time and a higher percentage of patients with times below 10 minutes. However, further interventions are required to assure a higher number of patients with D2E times below 10 minutes.

  19. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients

    PubMed Central

    Karakitsos, Dimitrios; Labropoulos, Nicolaos; De Groot, Eric; Patrianakos, Alexandros P; Kouraklis, Gregorios; Poularas, John; Samonis, George; Tsoutsos, Dimosthenis A; Konstadoulakis, Manousos M; Karabinis, Andreas

    2006-01-01

    Introduction Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method. Methods In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index. Results There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001). Conclusion The present data suggest that ultrasound

  20. A complexity basis for phenomenology: How information states at criticality offer a new approach to understanding experience of self, being and time.

    PubMed

    Hankey, Alex

    2015-12-01

    In the late 19th century Husserl studied our internal sense of time passing, maintaining that its deep connections into experience represent prima facie evidence for it as the basis for all investigations in the sciences: Phenomenology was born. Merleau-Ponty focused on perception pointing out that any theory of experience must accord with established aspects of biology i.e. be embodied. Recent analyses suggest that theories of experience require non-reductive, integrative information, together with a specific property connecting them to experience. Here we elucidate a new class of information states with just such properties found at the loci of control of complex biological systems, including nervous systems. Complexity biology concerns states satisfying self-organized criticality. Such states are located at critical instabilities, commonly observed in biological systems, and thought to maximize information diversity and processing, and hence to optimize regulation. Major results for biology follow: why organisms have unusually low entropies; and why they are not merely mechanical. Criticality states form singular self-observing systems, which reduce wave packets by processes of perfect self-observation associated with feedback gain g = 1. Analysis of their information properties leads to identification of a new kind of information state with high levels of internal coherence, and feedback loops integrated into their structure. The major idea presented here is that the integrated feedback loops are responsible for our 'sense of self', and also the feeling of continuity in our sense of time passing. Long-range internal correlations guarantee a unique kind of non-reductive, integrative information structure enabling such states to naturally support phenomenal experience. Being founded in complexity biology, they are 'embodied'; they also fulfill the statement that 'The self is a process', a singular process. High internal correlations and René Thom

  1. Time

    ERIC Educational Resources Information Center

    Circle, David

    2005-01-01

    When a teacher gives their time to a student, it is more significant to that student than anything else one could do for him or her. Music teachers deal with time all the time. Someone once said that "time is like money: we never have enough." This may seem true; however, time is not like money. One can make more money, but one cannot "make time."…

  2. Molecular and morphological phylogenetics of chelonine parasitoid wasps (Hymenoptera: Braconidae), with a critical assessment of divergence time estimations.

    PubMed

    Kittel, Rebecca N; Austin, Andrew D; Klopfstein, Seraina

    2016-08-01

    Parasitoid wasps of the subfamily Cheloninae are both species rich and poorly known. Although the taxonomy of Cheloninae appears to be relatively stable, there is no clear understanding of relationships among higher-level taxa. We here applied molecular phylogenetic analyses using three markers (COI, EF1α, 28S) and 37 morphological characters to elucidate the evolution and systematics of these wasps. Analyses were based on 83 specimens representing 13 genera. All genera except Ascogaster, Phanerotoma, and Pseudophanerotoma formed monophyletic groups; Furcidentia (stat. rev.) is raised to generic rank. Neither Chelonus (Chelonus) nor Chelonus (Microchelonus) were recovered as monophyletic, but together formed a monophyletic lineage. The tribes Chelonini and Odontosphaeropygini formed monophyletic groups, but the Phanerotomini sensu Zettel and Pseudophanerotomini were retrieved as either para- or polyphyletic. The genera comprising the former subfamily Adeliinae were confirmed as being nested within the Cheloninae. To estimate the age of the subfamily, we used 16 fossil taxa. Three approaches were compared: fixed-rate dating, node dating, and total-evidence dating, with age estimates differing greatly between the three methods. Shortcomings of each approach in relation to our dataset are discussed, and none of the age estimates is deemed sufficiently reliable. Given that most dating studies use a single method only, in most cases without presenting analyses on the sensitivity to priors, it is likely that numerous age estimates in the literature suffer from a similar lack of robustness. We argue for a more rigorous approach to dating analyses and for a faithful presentation of uncertainties in divergence time estimates. Given the results of the phylogenetic analysis the following taxonomic changes are proposed: Furcidentia Zettel (stat. rev.), previously treated as a subgenus of Pseudophanerotoma Zettel is raised to generic rank; Microchelonus Szépligeti (syn. nov

  3. Development of Electronic Nose and Near Infrared Spectroscopy Analysis Techniques to Monitor the Critical Time in SSF Process of Feed Protein

    PubMed Central

    Jiang, Hui; Chen, Quansheng

    2014-01-01

    In order to assure the consistency of the final product quality, a fast and effective process monitoring is a growing need in solid state fermentation (SSF) industry. This work investigated the potential of non-invasive techniques combined with the chemometrics method, to monitor time-related changes that occur during SSF process of feed protein. Four fermentation trials conducted were monitored by an electronic nose device and a near infrared spectroscopy (NIRS) spectrometer. Firstly, principal component analysis (PCA) and independent component analysis (ICA) were respectively applied to the feature extraction and information fusion. Then, the BP_AdaBoost algorithm was used to develop the fused model for monitoring of the critical time in SSF process of feed protein. Experimental results showed that the identified results of the fusion model are much better than those of the single technique model both in the training and validation sets, and the complexity of the fusion model was also less than that of the single technique model. The overall results demonstrate that it has a high potential in online monitoring of the critical moment in SSF process by use of integrating electronic nose and NIRS techniques, and data fusion from multi-technique could significantly improve the monitoring performance of SSF process. PMID:25330048

  4. Development of electronic nose and near infrared spectroscopy analysis techniques to monitor the critical time in SSF process of feed protein.

    PubMed

    Jiang, Hui; Chen, Quansheng

    2014-10-17

    In order to assure the consistency of the final product quality, a fast and effective process monitoring is a growing need in solid state fermentation (SSF) industry. This work investigated the potential of non-invasive techniques combined with the chemometrics method, to monitor time-related changes that occur during SSF process of feed protein. Four fermentation trials conducted were monitored by an electronic nose device and a near infrared spectroscopy (NIRS) spectrometer. Firstly, principal component analysis (PCA) and independent component analysis (ICA) were respectively applied to the feature extraction and information fusion. Then, the BP_AdaBoost algorithm was used to develop the fused model for monitoring of the critical time in SSF process of feed protein. Experimental results showed that the identified results of the fusion model are much better than those of the single technique model both in the training and validation sets, and the complexity of the fusion model was also less than that of the single technique model. The overall results demonstrate that it has a high potential in online monitoring of the critical moment in SSF process by use of integrating electronic nose and NIRS techniques, and data fusion from multi-technique could significantly improve the monitoring performance of SSF process.

  5. Phase transitions and critical phenomena in the two-dimensional Ising model with dipole interactions: A short-time dynamics study.

    PubMed

    Horowitz, C M; Bab, M A; Mazzini, M; Rubio Puzzo, M L; Saracco, G P

    2015-10-01

    The ferromagnetic Ising model with antiferromagnetic dipole interactions is investigated by means of Monte Carlo simulations, focusing on the characterization of the phase transitions between the tetragonal liquid and stripe of width h phases. The dynamic evolution of the physical observables is analyzed within the short-time regime for 0.5≤δ≤1.3, where δ is the ratio between the short-range exchange and the long-range dipole interaction constants. The obtained results for the interval 0.5≤δ≤1.2 indicate that the phase transition line between the h=1 stripe and tetragonal liquid phases is continuous. This finding contributes to clarifying the controversy about the order of this transition. This controversy arises from the difficulties introduced in the simulations due to the presence of long-range dipole interactions, such as an important increase in the simulation times that limits the system size used, strong finite size effects, as well as to the existence of multiple metastable states at low temperatures. The study of the short-time dynamics of the model allows us to avoid these hindrances. Moreover, due to the fact that the finite-size effects do not significantly affect the power-law behavior exhibited in the observables within the short-time regime, the results could be attributed to those corresponding to the thermodynamic limit. As a consequence of this, a careful characterization of the critical behavior for the whole transition line is performed by giving the complete set of critical exponents.

  6. The impact of a Critical Care Information System (CCIS) on time spent charting and in direct patient care by staff in the ICU: a review of the literature.

    PubMed

    Mador, Rebecca L; Shaw, Nicola T

    2009-07-01

    The introduction of a Critical Care Information System (CCIS) into an intensive care unit (ICU) is purported to reduce the time health care providers (HCP) spend on documentation and increase the time available for direct patient care. However, there is a paucity of rigorous empirical research that has investigated these assertions. Moreover, those studies that have sought to elucidate the relationship between the introduction of a CCIS and the time spent by staff on in/direct patient care activities have published contradictory findings. The objective of this literature review is to establish the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU. Five electronic databases were searched including PubMed Central, EMBASE, CINAHL, IEEE Xplore, and the Cochrane Database of Systematic Reviews. Reference lists of all published papers were hand searched, and citations reviewed to identify extra papers. We included studies that were empirical articles, published in English, and provided original data on the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU. In total, 12 articles met the inclusion criteria. Workflow analysis (66%) and time-and-motion analysis (25%) were the most common forms of data collection. Three (25%) studies found an increase in time spent charting, five (42%) found no difference, and four (33%) studies reported a decrease. Results on the impact of a CCIS on direct patient care were similarly inconclusive. Due to the discrepant findings and several key methodological issues, the impact of a CCIS on time spent charting and in direct patient care remains unclear. This review highlights the need for an increase in rigorous empirical research in this area and provides recommendations for the design and implementation of future studies.

  7. Late-onset bipolar illness: the geriatric bipolar type VI.

    PubMed

    Azorin, Jean-Michel; Kaladjian, Arthur; Adida, Marc; Fakra, Eric

    2012-03-01

    In parallel to considerable progress in understanding and treatment of bipolarity and despite growing interest in old age psychiatry, late-onset bipolar illness (LOBI) has remained relatively understudied so far, probably in reason of its complexity. To update available data, a systematic review was conducted, focusing on the main issues addressed in literature in regard to this topic. In addition to data on epidemiology, clinical features and treatment, five main issues could be identified: LOBI as secondary disorder, LOBI as expression of a lower vulnerability to the disease, LOBI as subform of pseudodementia, LOBI as risk factor for developing dementia, and LOBI as bipolar type VI (bipolarity in the context of dementia like processes). Levels of available evidence were found to vary according to the addressed issue. Although the concept of bipolar type VI could be criticized for subsuming under one single heading all the four other issues, this concept may be of pragmatic value in helping clinicians to orientate both diagnosis process and treatment decisions. Among others, the question as to whether some forms of bipolar type VI could constitute a special risk factor for developing dementia deserves further investigation. More studies are also needed to better disentangle the effects of age at onset from those of age itself.

  8. Admission time to hospital: a varying standard for a critical definition for admissions to an intensive care unit from the emergency department.

    PubMed

    Nanayakkara, Shane; Weiss, Heike; Bailey, Michael; van Lint, Allison; Cameron, Peter; Pilcher, David

    2014-11-01

    Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of 'time of admission' for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU). Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67,787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED. Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83-5.35) to 5.1 h (2.82-8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay. Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED. WHAT IS KNOWN ABOUT THE TOPIC?: There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely on quality data to improve decision

  9. Critical evaluation of a simple retention time predictor based on LogKow as a complementary tool in the identification of emerging contaminants in water.

    PubMed

    Bade, Richard; Bijlsma, Lubertus; Sancho, Juan V; Hernández, Felix

    2015-07-01

    There has been great interest in environmental analytical chemistry in developing screening methods based on liquid chromatography-high resolution mass spectrometry (LC-HRMS) for emerging contaminants. Using HRMS, compound identification relies on the high mass resolving power and mass accuracy attainable by these analyzers. When dealing with wide-scope screening, retention time prediction can be a complementary tool for the identification of compounds, and can also reduce tedious data processing when several peaks appear in the extracted ion chromatograms. There are many in silico, Quantitative Structure-Retention Relationship methods available for the prediction of retention time for LC. However, most of these methods use commercial software to predict retention time based on various molecular descriptors. This paper explores the applicability and makes a critical discussion on a far simpler and cheaper approach to predict retention times by using LogKow. The predictor was based on a database of 595 compounds, their respective LogKow values and a chromatographic run time of 18min. Approximately 95% of the compounds were found within 4.0min of their actual retention times, and 70% within 2.0min. A predictor based purely on pesticides was also made, enabling 80% of these compounds to be found within 2.0min of their actual retention times. To demonstrate the utility of the predictors, they were successfully used as an additional tool in the identification of 30 commonly found emerging contaminants in water. Furthermore, a comparison was made by using different mass extraction windows to minimize the number of false positives obtained.

  10. Time-critical social mobilization.

    PubMed

    Pickard, Galen; Pan, Wei; Rahwan, Iyad; Cebrian, Manuel; Crane, Riley; Madan, Anmol; Pentland, Alex

    2011-10-28

    The World Wide Web is commonly seen as a platform that can harness the collective abilities of large numbers of people to accomplish tasks with unprecedented speed, accuracy, and scale. To explore the Web's ability for social mobilization, the Defense Advanced Research Projects Agency (DARPA) held the DARPA Network Challenge, in which competing teams were asked to locate 10 red weather balloons placed at locations around the continental United States. Using a recursive incentive mechanism that both spread information about the task and incentivized individuals to act, our team was able to find all 10 balloons in less than 9 hours, thus winning the Challenge. We analyzed the theoretical and practical properties of this mechanism and compared it with other approaches.

  11. Testing the Critical Window Hypothesis of Timing and Duration of Estradiol Treatment on Hypothalamic Gene Networks in Reproductively Mature and Aging Female Rats

    PubMed Central

    Yin, Weiling; Maguire, Sean M.; Pham, Brian; Garcia, Alexandra N.; Dang, Nguyen-Vy; Liang, Jingya; Wolfe, Andrew; Hofmann, Hans A.

    2015-01-01

    At menopause, the dramatic loss of ovarian estradiol (E2) necessitates the adaptation of estrogen-sensitive neurons in the hypothalamus to an estrogen-depleted environment. We developed a rat model to test the “critical window” hypothesis of the effects of timing and duration of E2 treatment after deprivation on the hypothalamic neuronal gene network in the arcuate nucleus and the medial preoptic area. Rats at 2 ages (reproductively mature or aging) were ovariectomized and given E2 or vehicle replacement regimes of differing timing and duration. Using a 48-gene quantitative low-density PCR array and weighted gene coexpression network analysis, we identified gene modules differentially regulated by age, timing, and duration of E2 treatment. Of particular interest, E2 status differentially affected suites of genes in the hypothalamus involved in energy balance, circadian rhythms, and reproduction. In fact, E2 status was the dominant factor in determining gene modules and hormone levels; age, timing, and duration had more subtle effects. Our results highlight the plasticity of hypothalamic neuroendocrine systems during reproductive aging and its surprising ability to adapt to diverse E2 replacement regimes. PMID:26018250

  12. Dynamics of pulsed laser ablation plasmas in high-density CO2 near the critical point investigated by time-resolved shadowgraph imaging

    NASA Astrophysics Data System (ADS)

    Urabe, Keiichiro; Kato, Toru; Himeno, Shohei; Kato, Satoshi; Stauss, Sven; Baba, Motoyoshi; Suemoto, Tohru; Terashima, Kazuo

    2013-09-01

    Pulsed laser ablation (PLA) plasmas generated in high-density gases and liquids are promising for the synthesis of nanomaterials. However, the characteristics of such plasmas are still not well understood. In order to improve the understandings of PLA plasmas in high-density fluids including gases, liquids, and supercritical fluids (SCFs), we have investigated the dynamics of PLA plasmas in high-density carbon dioxide (CO2) . We report on experimental results of time-resolved shadowgraph imaging, from the generation of plasma plume to the extinction of cavitation bubbles. Shadowgraph images revealed that the PLA plasma dynamics showed two distinct behaviors. These are divided by gas-liquid coexistence curve and the so-called Widom line, which separates gas-like and liquid-like SCF domains. Furthermore, cavitation bubble observed in liquid CO2 near the critical point showed peculiar characteristics, the formation of an inner bubble and an outer shell structure, which so far has never been reported. The experiments indicate that thermophysical properties of PLA plasmas can be tuned by controlling solvent temperature and pressure around the critical point, which may be useful for materials processing. This work was supported financially in part by a Grant-in-Aid for Scientific Research on Innovative Areas (No. 21110002) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

  13. Critical Ischemia Times and the Effect of Novel Preservation Solutions HTK-N and TiProtec on Tissues of a Vascularized Tissue Isograft.

    PubMed

    Messner, Franka; Hautz, Theresa; Blumer, Michael J F; Bitsche, Mario; Pechriggl, Elisabeth J; Hermann, Martin; Zelger, Bettina; Zelger, Bernhard; Öfner, Dietmar; Schneeberger, Stefan

    2017-09-01

    We herein investigate critical ischemia times and the effect of novel preservation solutions such as new histidine-tryptophan-ketoglutarate (HTK-N) and TiProtec on the individual tissues of a rat limb isograft. Orthotopic hind-limb transplantations were performed in male Lewis rats after 2 hours, 6 hours, or 10 hours of cold ischemia (CI). Limbs were flushed and stored in HTK-N, TiProtec, HTK, or saline solution. Muscle, nerve, vessel, skin, and bone samples were procured on day 10 for histology, immunohistochemistry, confocal and electron microscopy, and quantitative real-time polymerase chain reaction analysis. Histomorphology of the muscle showed a mainly perivascular inflammatory infiltrate, fibrotic degeneration, and neovascularization after 6 hours and 10 hours of CI. However, centrally aligned nuclei observed in muscle fibers suggest for muscle regeneration in these samples. In addition to Wallerian degeneration, nerve injury was significantly aggravated (P = 0.032) after prolonged CI. Proinflammatory and regulatory cytokines were most significantly upregulated after 2-hour CI. Our data suggest no superiority of novel perfusates HTK-N and TiProtec in terms of tissue preservation, compared with HTK and saline. Limiting CI time for less than 6 hours is the most significant factor to reduce tissue damage in vascularized tissue transplantation. Signs of muscle regeneration give rise that ischemic muscle damage in limb transplantation might be reversible to a certain extent.

  14. Minimizing door-to-balloon time is not the most critical factor in improving clinical outcome of ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

    PubMed

    Ho, Yuan-Chih; Tsai, Tzu-Hsien; Sung, Pei-Hsun; Chen, Yung-Lung; Chung, Sheng-Ying; Yang, Cheng-Hsu; Chen, Shyh-Ming; Chen, Chien-Jen; Fang, Hsiu-Yu; Wu, Chiung-Jen; Yip, Hon-Kan

    2014-08-01

    We tested the hypothesis that, as compared with conventional door-to-balloon, shortened door-to-balloon time would further improve 30-day outcome in ST-elevation myocardial infarction patients undergoing primary stenting. Retrospective cohort study Academic tertiary care hospital with approximately 2600 beds Between January 2008 and December 2009, 266 ST-elevation myocardial infarction patients underwent primary stenting with conventional Door-to-baloon were consecutively enrolled as group 1, while 293 ST-elevation myocardial infarction patients underwent primary stenting with shortened door-to-balloon between January 2010 and December 2011 were consecutively enrolled as group 2. Shorten door-to-balloon time. The results showed that time from chest pain onset to door did not differ between two groups (p > 0.1), whereas door-to-balloon time was significantly reduced in group 2 compared with that in group 1 (p < 0.0001). The prevalences of successful reperfusion, acute and subacute stent thrombosis, 30-day death or combined endpoint (defined as congestive heart failure ≥ New York Heart Association functional class 3 or 30-d death), and left ventricular function did not differ between two groups (all p > 0.05), whereas the peak creatine phosphokinase level was significantly reduced in group 2 (< 0.05). Further analysis showed that shortening the chest pain-to-reperfusion time to less than 240 minutes was the most important factor in improving left ventricular function (p < 0.001) and 30-day combined endpoint. Multivariate analysis showed that congestive heart failure greater than or equal to New York Heart Association functional class 3, poor left ventricular function, and age (all p < 0.001) along with unsuccessful reperfusion (p = 0.25) were independently predictive of 30-day mortality. Shortening the duration between chest pain onset and reperfusion to less than 4.0 hours was critical in reducing myocardial necrosis and improving heart function and 30-day

  15. It's time to put the C.A.R.T. before the H.O.R.S.E. or putting critical, analytical, and reflective thinking before

    Treesearch

    David L. Jewell

    2002-01-01

    Higher education is the target of criticism for, among other things, the failure to teach students how to think - critically, analytically, and reflectively - and for placing too much emphasis on career preparation or professional education. While a number of external factors have, perhaps, led to such criticism being warranted, faculty - including those in Recreation...

  16. Thinking Critically about Critical Thinking

    ERIC Educational Resources Information Center

    Mulnix, Jennifer Wilson

    2012-01-01

    As a philosophy professor, one of my central goals is to teach students to think critically. However, one difficulty with determining whether critical thinking can be taught, or even measured, is that there is widespread disagreement over what critical thinking actually is. Here, I reflect on several conceptions of critical thinking, subjecting…

  17. Thinking Critically about Critical Thinking

    ERIC Educational Resources Information Center

    Mulnix, Jennifer Wilson

    2012-01-01

    As a philosophy professor, one of my central goals is to teach students to think critically. However, one difficulty with determining whether critical thinking can be taught, or even measured, is that there is widespread disagreement over what critical thinking actually is. Here, I reflect on several conceptions of critical thinking, subjecting…

  18. Does direct admission from an emergency department with on-site neurosurgical services facilitate time critical surgical intervention following a traumatic brain injury in children?

    PubMed

    Fayeye, O; Ushewokunze, S; Stickley, J; Reynolds, F; Solanki, G; Rodrigues, D; Walsh, A R; Kay, A

    2013-06-01

    -site neurosurgical services significantly facilitates time critical surgery in children following a traumatic brain injury.

  19. A review of the first 10 years of critical care aeromedical transport during operation iraqi freedom and operation enduring freedom: the importance of evacuation timing.

    PubMed

    Ingalls, Nichole; Zonies, David; Bailey, Jeffrey A; Martin, Kathleen D; Iddins, Bart O; Carlton, Paul K; Hanseman, Dennis; Branson, Richard; Dorlac, Warren; Johannigman, Jay

    2014-08-01

    Advances in the care of the injured patient are perhaps the only benefit of military conflict. One of the unique aspects of the military medical care system that emerged during Operation Iraqi Freedom and Operation Enduring Freedom has been the opportunity to apply existing civilian trauma system standards to the provision of combat casualty care across an evolving theater of operations. To identify differences in mortality for soldiers undergoing early and rapid evacuation from the combat theater and to evaluate the capabilities of the Critical Care Air Transport Team (CCATT) and Joint Theater Trauma Registry databases to provide adequate data to support future initiatives for improvement of performance. Retrospective review of CCATT records and the Joint Theater Trauma Registry from September 11, 2001, to December 31, 2010, for the in-theater military medicine health system, including centers in Iraq, Afghanistan, and Germany. Of 2899 CCATT transport records, those for 975 individuals had all the required data elements. Rapid evacuation by the CCATT. Survival as a function of time from injury to arrival at the role IV facility at Landstuhl Regional Medical Center. The patient cohort demonstrated a mean Injury Severity Score of 23.7 and an overall 30-day mortality of 2.1%. Mortality en route was less than 0.02%. Statistically significant differences between survivors and decedents with respect to the Injury Severity Score (mean [SD], 23.4 [12.4] vs 37.7 [16.5]; P < .001), cumulative volume of blood transfused among the patients in each group who received a transfusion (P < .001), worst base deficit (mean [SD], -3.4 [5.0] vs -7.8 [6.9]; P = .02), and worst international normalized ratio (median [interquartile range], 1.2 [1.0-1.4] vs 1.4 [1.1-2.2]; P = .03) were observed. We found no statistically significant difference between survivors and decedents with respect to time from injury to arrival at definitive care. Rapid movement of critically

  20. Assessment of critical exposure and outcome windows in time-to-event analysis with application to air pollution and preterm birth study.

    PubMed

    Chang, Howard H; Warren, Joshua L; Darrow, Lnydsey A; Reich, Brian J; Waller, Lance A

    2015-07-01

    In reproductive epidemiology, there is a growing interest to examine associations between air pollution exposure during pregnancy and the risk of preterm birth (PTB). One important research objective is to identify critical periods of exposure and estimate the associated effects at different stages of pregnancy. However, population studies have reported inconsistent findings. This may be due to limitations from the standard analytic approach of treating PTB as a binary outcome without considering time-varying exposures together over the course of pregnancy. To address this research gap, we present a Bayesian hierarchical model for conducting a comprehensive examination of gestational air pollution exposure by estimating the joint effects of weekly exposures during different vulnerable periods. Our model also treats PTB as a time-to-event outcome to address the challenge of different exposure lengths among ongoing pregnancies. The proposed model is applied to a dataset of geocoded birth records in the Atlanta metropolitan area between 1999-2005 to examine the risk of PTB associated with gestational exposure to ambient fine particulate matter [Formula: see text]m in aerodynamic diameter (PM[Formula: see text]). We find positive associations between PM[Formula: see text] exposure during early and mid-pregnancy, and evidence that associations are stronger for PTBs occurring around week 30.

  1. Mediation analysis of critical time intervention for persons living with serious mental illnesses: assessing the role of family relations in reducing psychiatric rehospitalization.

    PubMed

    Tomita, Andrew; Lukens, Ellen P; Herman, Daniel B

    2014-03-01

    Critical Time Intervention (CTI) is a time-limited care coordination intervention designed to reduce homelessness and other adverse outcomes for persons living with serious mental illness during the transition period between institutions and community living. This study assesses whether CTI improves the quality of family relationships between family members and individuals living with serious mental illness, and examines whether changes in quality of family relationship mediated the association between the intervention and psychiatric rehospitalization outcomes. This study utilizes data from a randomized controlled trial that assessed the effect of CTI in preventing homelessness. Following discharge from inpatient psychiatric treatment in New York City, 150 previously homeless persons living with serious mental illness were randomly assigned to receive usual services only or 9 months of CTI in addition to usual services. Findings from mixed-effects regression models indicated that those assigned to the CTI group reported greater frequency of family contact and greater improvement in satisfaction with family relations than the comparison group during the 18-month follow-up period. Mediation analysis revealed that greater improvement in satisfaction with family relations mediated the effect of CTI on psychiatric rehospitalization outcome, but only at a modest level. These findings suggest that a relatively brief but targeted intervention delivered at the point of hospital discharge may contribute to strengthening family relations and that improvement in perceived family relationship quality can contribute to a reduction in psychiatric rehospitalization.

  2. L-Kuramoto-Sivashinsky SPDEs vs. time-fractional SPIDEs: Exact continuity and gradient moduli, 1/2-derivative criticality, and laws

    NASA Astrophysics Data System (ADS)

    Allouba, Hassan; Xiao, Yimin

    2017-07-01

    We establish exact, dimension-dependent, spatio-temporal, uniform and local moduli of continuity for (1) the fourth order L-Kuramoto-Sivashinsky (L-KS) SPDEs and for (2) the time-fractional stochastic partial integro-differential equations (SPIDEs), driven by the space-time white noise in one-to-three dimensional spaces. Both classes were introduced-with Brownian-time-type kernel formulations-by Allouba in a series of articles starting in 2006, where he presented class (2) in its rigorous stochastic integral equations form. He proved existence, uniqueness, and sharp spatio-temporal Hölder regularity for the above two classes of equations in d = 1 , 2 , 3. We show that both classes are (1 / 2)- Hölder continuously differentiable in space when d = 1, and we give the exact uniform and local moduli of continuity for the gradient in both cases. This is unprecedented for SPDEs driven by the space-time white noise. Our results on exact moduli show that the half-derivative SPIDE is a critical case. It signals the onset of rougher modulus regularity in space than both time-fractional SPIDEs with time-derivatives of order < 1 / 2 and L-KS SPDEs. This is despite the fact that they all have identical spatial Hölder regularity, as shown earlier by Allouba. Moreover, we show that the temporal laws governing (1) and (2) are fundamentally different. We relate L-KS SPDEs to the Houdré-Villa bifractional Brownian motion, yielding a Chung-type law of the iterated logarithm for these SPDEs. We use the underlying explicit kernels and spectral/harmonic analysis to prove our results. On one hand, this work builds on the recent works on delicate sample path properties of Gaussian random fields. On the other hand, it builds on and complements Allouba's earlier works on (1) and (2). Similar regularity results hold for the Allen-Cahn nonlinear members of (1) and (2) on compacts via change of measure.

  3. Criticality in epidemiology

    NASA Astrophysics Data System (ADS)

    Stollenwerk, Nico; Jansen, Vincent A. A.

    For a long time criticality has been considered in epidemiological models. We review the body of theory developed over the last twenty five years for the simplest models. It is at first glance difficult to imagine that an epidemiological system operates at a very fine tuned critical state as opposed to any other parameter region. However, the advent of self-organized criticality has given hints in how to interpret large fluctuations observed in many natural systems including epidemiological systems. We show some scenarios where criticality has been observed (e.g., measles under vaccination) and where evolution towards a critical state can explain fluctuations (e.g., meningococcal disease.)

  4. The effectiveness of critical time intervention for abused women and homeless people leaving Dutch shelters: study protocol of two randomised controlled trials

    PubMed Central

    2013-01-01

    Background One of the main priorities of Dutch organisations providing shelter services is to develop evidence-based interventions in the care for abused women and homeless people. To date, most of these organisations have not used specific intervention models and the interventions which have been implemented rarely have an empirical and theoretical foundation. The present studies aim to examine the effectiveness of critical time intervention (CTI) for abused women and homeless people. Methods In two multi-centre randomised controlled trials we investigate whether CTI, a time-limited (nine month) outreach intervention, is more effective than care-as-usual for abused women and homeless people making the transition from shelter facilities to supported or independent housing. Participants were recruited in 19 women’s shelter facilities and 22 homeless shelter facilities across The Netherlands and randomly allocated to the intervention group (CTI) or the control group (care-as-usual). They were interviewed four times in nine months: once before leaving the shelter, and then at three, six and nine months after leaving the shelter. Quality of life (primary outcome for abused women) and recurrent loss of housing (primary outcome for homeless people) as well as secondary outcomes (e.g. care needs, self-esteem, loneliness, social support, substance use, psychological distress and service use) were assessed during the interviews. In addition, the model integrity of CTI was investigated during the data collection period. Discussion Based on international research CTI is expected to be an appropriate intervention for clients making the transition from institutional to community living. If CTI proves to be effective for abused women and homeless people, shelter services could include this case management model in their professional standards and improve the (quality of) services for clients. Trial registration NTR3463 and NTR3425 PMID:25927562

  5. Critical Care

    MedlinePlus

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  6. Archetypal Criticism.

    ERIC Educational Resources Information Center

    Chesebro, James W.; And Others

    1990-01-01

    Argues that archetypal criticism is a useful way of examining universal, historical, and cross-cultural symbols in classrooms. Identifies essential features of an archetype; outlines operational and critical procedures; illustrates archetypal criticism as applied to the cross as a symbol; and provides a synoptic placement for archetypal criticism…

  7. Critical values in hematology.

    PubMed

    McFarlane, A; Aslan, B; Raby, A; Bourner, G; Padmore, R

    2015-02-01

    Critical values are life-threatening results that require immediate notification to the patient's healthcare provider. Accreditation bodies require laboratories to establish critical values. A survey of Ontario laboratories was conducted to determine current practice for critical values in hematology. The survey was sent to 182 participants questioning sources for establishing critical values, levels, review frequency, delta checks, and reporting. The survey was completed by laboratory managers, supervisors, technical specialists, senior technologists, and bench technologists working in hematology. The majority of participating laboratories have established critical values limits for hemoglobin, leukocyte counts, and platelet counts. Most laboratories also include the presence of malaria parasites and blast cells. Some laboratories reported the presence of plasma cells, sickle cells, schistocytes, and spherocytes as critical values. Multiple sources are used for establishing a critical value policy. There was variability for the frequency of critical values review. Rules may differ for a first-time patient sample vs. a repeat patient sample. Delta checks are seldom used to determine whether a result should be called a critical value. Most participants require the individual taking the critical result(s) to read back and confirm that they are directly involved with the patient's care. There is a lack of consensus for critical values reporting in hematology. As critical value reporting is crucial for patient safety, standardization of this practice would be beneficial. © 2014 John Wiley & Sons Ltd.

  8. [Determination of the critical time point for efficacy of L-arginine infusion therapy in a case of MELAS with frequent stroke-like episodes].

    PubMed

    Sudo, Akira; Sano, Hitomi; Kawamura, Nobuaki

    2014-01-01

    MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) is the most representative subtype of mitochondrial diseases. Administration of L-arginine (L-Arg) or a precursor of nitric oxide (NO) has been proposed as a promising medication for MELAS because one of the pathophysiological mechanisms is supposedly a decreased capacity for NO-dependent vasodilation. We experienced a girl with MELAS and frequent stroke-like episodes who was treated with L-Arg infusion. We evaluated the efficacy of L-Arg infusion therapy based on whether her headache and nausea were disappeared and neurological symptoms were improved within 24 hours of L-Arg administration. L-Arg infusions were effective in all four episodes when the treatment was started within 4 hours of the onset of stroke-like episodes. On the other hand, the infusion was effective in only one out of five episodes when the medication was delayed by more than 4 hours after the onset. Furthermore, the early administration of L-Arg resulted in better outcomes regarding new lesions determined by brain MRI. Our data suggest that L-Arg infusion may be most effective when it is started within 4 hours of the onset of neurological symptoms in the acute phase of MELAS. The study of a large number of episodes in many patients will be needed to determine the critical time point of L-Arg administration after the onset of the acute phase of MELAS.

  9. Time course and amplitude of DNA methylation in the shoot apical meristem are critical points for bolting induction in sugar beet and bolting tolerance between genotypes.

    PubMed

    Trap-Gentil, Marie-Véronique; Hébrard, Claire; Lafon-Placette, Clément; Delaunay, Alain; Hagège, Daniel; Joseph, Claude; Brignolas, Franck; Lefebvre, Marc; Barnes, Steve; Maury, Stéphane

    2011-05-01

    An epigenetic control of vernalization has been demonstrated in annual plants such as Arabidopsis and cereals, but the situation remains unclear in biennial plants such as sugar beet that has an absolute requirement for vernalization. The role of DNA methylation in flowering induction and the identification of corresponding target loci also need to be clarified. In this context, sugar beet (Beta vulgaris altissima) genotypes differing in bolting tolerance were submitted to various bolting conditions such as different temperatures and/or methylating drugs. DNA hypomethylating treatment was not sufficient to induce bolting while DNA hypermethylation treatment inhibits and delays bolting. Vernalizing and devernalizing temperatures were shown to affect bolting as well as DNA methylation levels in the shoot apical meristem. In addition, a negative correlation was established between bolting and DNA methylation. Genotypes considered as resistant or sensitive to bolting could also be distinguished by their DNA methylation levels. Finally, sugar beet homologues of the Arabidopsis vernalization genes FLC and VIN3 exhibited distinct DNA methylation marks during vernalization independently to the variations of global DNA methylation. These vernalization genes also displayed differences in mRNA accumulation and methylation profiles between genotypes resistant or sensitive to bolting. Taken together, the data suggest that the time course and amplitude of DNA methylation variations are critical points for the induction of sugar beet bolting and represent an epigenetic component of the genotypic bolting tolerance, opening up new perspectives for sugar beet breeding.

  10. Order of photocatalytic degradation as ranked by critical photonic times (CPTs) indicates the composition of organic dye mixtures: selectivity of hydroxyl radicals.

    PubMed

    Shigwedha, Nditange; Hua, Zhaozhe; Chen, Jian

    2006-01-01

    A simple critical photonic time (CPT) ranking method for the simultaneous determination of known organic dyes in the industrial wastewater of different concentrations was developed. A kinetic-measure, CPT theory, was developed to discriminate between the dyes in the textile effluent solution. The CPTs were calculated and ranked 1-4 from the smallest to the largest. The ranks indicate the order in which the individual dyes in the effluents were photocatalytically degraded. The described procedure allowed us to monitor the decolorization kinetics of the dyes in mixtures of different concentrations, when subjected to immobilized TiO2 photocatalysis in the presence of H2O2 from the start (H2O2FS). The outcome of hydroxyl radical (HO*) attack was consistently specific and regioselective for the individual dyes in the textile effluent. To explain the effect of HO*, the order of degradation of Acid Orange 52 < Acid Yellow 36 < Acid Red 17 < Acid Blue 45 < polyvinyl alcohol (PVA) was inferred.

  11. Being Critical of Criticality in the Brain

    PubMed Central

    Beggs, John M.; Timme, Nicholas

    2012-01-01

    Relatively recent work has reported that networks of neurons can produce avalanches of activity whose sizes follow a power law distribution. This suggests that these networks may be operating near a critical point, poised between a phase where activity rapidly dies out and a phase where activity is amplified over time. The hypothesis that the electrical activity of neural networks in the brain is critical is potentially important, as many simulations suggest that information processing functions would be optimized at the critical point. This hypothesis, however, is still controversial. Here we will explain the concept of criticality and review the substantial objections to the criticality hypothesis raised by skeptics. Points and counter points are presented in dialog form. PMID:22701101

  12. Exploration for unknown substances in rapeseed oil that shorten survival time of stroke-prone spontaneously hypertensive rats. Effects of super critical gas extraction fractions.

    PubMed

    Ohara, Naoki; Naito, Yukiko; Nagata, Tomoko; Tatematsu, Kenjiro; Fuma, Shin-Ya; Tachibana, Shigehiro; Okuyama, Harumi

    2006-07-01

    To identify the causative substances for the shortening of survival time by rapeseed (Canola) oil in stroke-prone spontaneously hypertensive rats (SHRSP), SHRSP were fed on a standard chow supplemented with 10 w/w% soybean oil (control), rapeseed oil, one of the fractions of rapeseed oil obtained by super critical gas extraction (SCE) under a pressure of 180-bar or 350-bar, at 40 degrees C, or the residue from the extraction (with 0.5% NaCl in drinking water). In another series of experiment, SHRSP were fed for 8 weeks on the above-mentioned diets without salt loading and autopsied. Fatty acid compositions in these diets were similar, except in the soybean oil diet, and phytosterol contents were: (diet containing) 180-bar fraction>residue>rapeseed oil>350-bar fraction>soybean oil. Survival times in the rapeseed oil, 350-bar fraction and residue groups were shorter than, whereas that in the 180-bar fraction was similar to in the soybean oil group. In the 8-week feeding experiment, chronic nephropathy was found frequently in the groups other than the soybean oil group. The heart weights were higher in the rapeseed oil and residue groups. Cerebral necrosis was found in the residue group. Taken together, the followings are concluded, (1) Neither the fatty acid composition, nor the amount of phytosterols in the diets appeared to be decisive in the shortening of life. (2) SCE appeared to produce a safe (180-bar) fraction, though it failed to separate clearly the causative substances into specific fractions. (3) The factors that facilitate the genetic disease of SHRSP appear to exist in rapeseed oil. However, they might not be identical to those responsible for the life-shortening, since there were no findings common across the rapeseed oil, 350-bar and residue groups, which showed similar life-shortening.

  13. Early gestation as the critical time-window for changes in the prenatal environment to affect the adult human blood methylome.

    PubMed

    Tobi, Elmar W; Slieker, Roderick C; Stein, Aryeh D; Suchiman, H Eka D; Slagboom, P Eline; van Zwet, Erik W; Heijmans, Bastiaan T; Lumey, L H

    2015-08-01

    The manipulation of pregnancy diets in animals can lead to changes in DNA methylation with phenotypic consequences in the offspring. Human studies have concentrated on the effects of nutrition during early gestation. Lacking in humans is an epigenome-wide association study of DNA methylation in relation to perturbations in nutrition across all gestation periods. We used the quasi-experimental setting of the Dutch famine of 1944-45 to evaluate the impact of famine exposure during specific 10-week gestation periods, or during any time in gestation, on genome-wide DNA methylation levels at age ∼ 59 years. In addition, we evaluated the impact of exposure during a shorter pre- and post-conception period. DNA methylation was assessed using the Illumina 450k array in whole blood among 422 individuals with prenatal famine exposure and 463 time- or sibling-controls without prenatal famine exposure. Famine exposure during gestation weeks 1-10, but not weeks 11-20, 21-30 or 31-delivery, was associated with an increase in DNA methylation of CpG dinucleotides cg20823026 (FAM150B), cg10354880 (SLC38A2) and cg27370573 (PPAP2C) and a decrease of cg11496778 (OSBPL5/MRGPRG) (P < 5.9 × 10(-7), PFDR < 0.031). There was an increase in methylation of TACC1 and ZNF385A after exposure during any time in gestation (P < 2.0 × 10(-7), PFDR = 0.034) and a decrease of cg23989336 (TMEM105) after exposure around conception. These changes represent a shift of 0.3-0.6 standard deviations and are linked to genes involved in growth, development and metabolism. Early gestation, and not mid or late gestation, is identified as a critical time-period for adult DNA methylation changes in whole blood after prenatal exposure to famine. © The Author 2015. Published by Oxford University Press on behalf of the International Epidemiological Association.

  14. Intermittent criticality revealed in the ENIGMA magnetometer array time series prior to the strongest magnetic storms of the present solar cycle

    NASA Astrophysics Data System (ADS)

    Balasis, Georgios; Daglis, Ioannis A.; Contoyiannis, Yiannis; Potirakis, Stelios M.; Papadimitriou, Constantinos; Melis, Nikolaos S.; Giannakis, Omiros; Anastasiadis, Anastasios; Kontoes, Charalampos

    2017-04-01

    The geomagnetic field observations of the ENIGMA magnetometer array associated with the most intense magnetic storms of solar cycle 24 are studied in terms of the theory of critical phenomena and phase transitions. The application of the critical fluctuations analysis method on the unprocessed Earth's magnetic field variations provides evidence of the existence of criticality from 8 up to 45 hours before the occurrence of these intense magnetic storms. The identified dynamics are analogous to those of thermal systems undergoing phase transition of the second-order. Detrended fluctuation analysis results are consistent to the findings of the method of critical fluctuations implying that the underlying nonlinear processes are anti-persistent, as expected for criticality caused by intermittent dynamics.

  15. How Critical Is Critical Thinking?

    ERIC Educational Resources Information Center

    Shaw, Ryan D.

    2014-01-01

    Recent educational discourse is full of references to the value of critical thinking as a 21st-century skill. In music education, critical thinking has been discussed in relation to problem solving and music listening, and some researchers suggest that training in critical thinking can improve students' responses to music. But what exactly is…

  16. Critical Thinking vs. Critical Consciousness

    ERIC Educational Resources Information Center

    Doughty, Howard A.

    2006-01-01

    This article explores four kinds of critical thinking. The first is found in Socratic dialogues, which employ critical thinking mainly to reveal logical fallacies in common opinions, thus cleansing superior minds of error and leaving philosophers free to contemplate universal verities. The second is critical interpretation (hermeneutics) which…

  17. Critically Thinking about Critical Thinking

    ERIC Educational Resources Information Center

    Weissberg, Robert

    2013-01-01

    In this article, the author states that "critical thinking" has mesmerized academics across the political spectrum and that even high school students are now being called upon to "think critically." He furthers adds that it is no exaggeration to say that "critical thinking" has quickly evolved into a scholarly…

  18. How Critical Is Critical Thinking?

    ERIC Educational Resources Information Center

    Shaw, Ryan D.

    2014-01-01

    Recent educational discourse is full of references to the value of critical thinking as a 21st-century skill. In music education, critical thinking has been discussed in relation to problem solving and music listening, and some researchers suggest that training in critical thinking can improve students' responses to music. But what exactly is…

  19. Flow Through Cement Fracture Under Geological Carbon Sequestration Conditions: Critical Residence Time as a Unifying Parameter for Fracture Opening or Self-Sealing Behavior

    NASA Astrophysics Data System (ADS)

    Li, L.; Brunet, J. P. L.; Karpyn, Z.; Huerta, N. J.

    2016-12-01

    During geological carbon sequestration (GCS) large quantities of CO2 are injected in underground formations. Cement fractures represent preferential leakage pathways in abandoned wells upon exposure to CO2-rich fluid. Contrasting self- healing and fracture opening behavior have been observed while a unifying framework is still missing. The modelling of this process is challenging as it involves complex chemical, mechanical and transport interactions. We developed a process-based reactive transport model that explicitly simulates flow and multi-component reactive transport in fractured cement by reproducing experimental observations of sharp flow rate reduction during exposure to carbonated water. Mechanical interactions have not been included. The simulation shows a similar reaction network as in diffusion-controlled systems without flow. That is, CO2-rich water induced portlandite dissolution, releasing calcium that further reacted with carbonate to form calcite. This created localized changes in porosity and permeability inducing large differences in the long term response of the system through a complex positive feedback loop (e.g., a decrease in local permeability induces a decrease in flow that in turn amplifies the precipitation of calcite through a reduced acidic brine flow). The calibrated model was used to generate 250 numerical experiments of CO2-flooding in cement fractures with varying initial hydraulic apertures (b) and residence times (τ) defined as the ratio of fracture volume over flow rate. A long τ leads to slow replenishment of carbonated water, calcite precipitation, and self-sealing. The opposite occurs when τ is small with short fractures and fast flow rates. Simulation results indicate that a critical residence time τc - the minimum τ required for self-sealing -divides the conditions that trigger the diverging opening and self-sealing behavior. The τc value depends on the initial aperture size (see figure). Among the 250 simulated

  20. Criticality Model

    SciTech Connect

    A. Alsaed

    2004-09-14

    The ''Disposal Criticality Analysis Methodology Topical Report'' (YMP 2003) presents the methodology for evaluating potential criticality situations in the monitored geologic repository. As stated in the referenced Topical Report, the detailed methodology for performing the disposal criticality analyses will be documented in model reports. Many of the models developed in support of the Topical Report differ from the definition of models as given in the Office of Civilian Radioactive Waste Management procedure AP-SIII.10Q, ''Models'', in that they are procedural, rather than mathematical. These model reports document the detailed methodology necessary to implement the approach presented in the Disposal Criticality Analysis Methodology Topical Report and provide calculations utilizing the methodology. Thus, the governing procedure for this type of report is AP-3.12Q, ''Design Calculations and Analyses''. The ''Criticality Model'' is of this latter type, providing a process evaluating the criticality potential of in-package and external configurations. The purpose of this analysis is to layout the process for calculating the criticality potential for various in-package and external configurations and to calculate lower-bound tolerance limit (LBTL) values and determine range of applicability (ROA) parameters. The LBTL calculations and the ROA determinations are performed using selected benchmark experiments that are applicable to various waste forms and various in-package and external configurations. The waste forms considered in this calculation are pressurized water reactor (PWR), boiling water reactor (BWR), Fast Flux Test Facility (FFTF), Training Research Isotope General Atomic (TRIGA), Enrico Fermi, Shippingport pressurized water reactor, Shippingport light water breeder reactor (LWBR), N-Reactor, Melt and Dilute, and Fort Saint Vrain Reactor spent nuclear fuel (SNF). The scope of this analysis is to document the criticality computational method. The criticality

  1. An investigation of dynamic surface tension, critical micelle concentration, and aggregation number of three nonionic surfactants using NMR, time-resolved fluorescence quenching, and maximum bubble pressure tensiometry.

    PubMed

    Kjellin, U R Mikael; Reimer, Johan; Hansson, Per

    2003-06-15

    Several physicochemical properties have been determined for N-dodecyllactobionamide (LABA), maltose 6'-O-dodecanoate (C12-maltose ester), and tetra(ethylene oxide) dodecyl amide (TEDAd). The increase in the flexibility of the sugar headgroup, enabling more possible molecular conformations, reduces the minimum area/molecule at the liquid-vapor interface obtained at the critical micelle concentration (cmc). The obtained cmc's were 0.35 mM (LABA), 0.3 mM (C12-maltose ester), and 0.5 mM (TEDAd). The monomer diffusion coefficient decreased with the molecular weight and increasing headgroup flexibility of the sugar headgroup, and values were in the range from 3.1 x 10(-10) to 3.6 x 10(-10) m2/s. The micelle diffusion coefficients (0.46 x 10(-10) to 0.68 x 10(-10) m2/s) indicated that the TEDAd micelles deviated most from spherical shape. The micelle aggregation numbers determined by time-resolved fluorescence quenching (TRFQ) were estimated to be 120+/-10 (LABA), 90+/-10 (C12-maltose ester), and 130+/-10 (TEDAd). The dynamic surface tension measurements show that the adsorption of TEDAd onto the liquid-vapor interface at short surface lifetimes is diffusion-limited, whereas an adsorption barrier is present for the sugar surfactants. The analysis of the dynamic surface tension data above the cmc shows that the rate of demicellization is faster for TEDAd than for the two sugar-based surfactants.

  2. Real-time application of critical dimension measurement of TFT-LCD pattern using a newly proposed 2D image-processing algorithm

    NASA Astrophysics Data System (ADS)

    Lee, Jeong-Ho; Kim, You-Sik; Kim, Sung-Ryoung; Lee, Il-Hwan; Pahk, Heui-Jae

    2008-07-01

    A critical dimension measurement system for TFT-LCD patterns has been implemented in this study. To improve the measurement accuracy, an imaging auto-focus algorithm, fast pattern-matching algorithm, and precise edge detection algorithm with subpixel accuracy have been developed and implemented in the system. The optimum focusing position can be calculated using the image focus estimator. The two-step auto-focusing technique has been newly proposed for various LCD patterns, and various focus estimators have been compared to select a stable and accurate one. Fast pattern matching and subpixel edge detection have been developed for measurement. The new approach, called NEMC, is based on edge detection for the selection of influential points; in this approach, points having a strong edge magnitude are only used in the matching procedure. To accelerate pattern matching, point correlation and an image pyramid structure are combined. Edge detection is the most important technique in a vision inspection system. A two-stage edge detection algorithm has been introduced. In the first stage, a first order derivative operator such as the Sobel operator is used to place the edge points and to find the edge directions using a least-square estimation method with pixel accuracy. In the second stage, an eight-connected neighborhood of the estimated edge points is convolved with the LoG (Laplacian of Gaussian) operator, and the LoG-filtered image can be modeled as a continuous function using the facet model. The measurement results of the various patterns are finally presented. The developed system has been successfully used in the TFT-LCD manufacturing industry, and repeatability of less than 30 nm (3 σ) can be obtained with a very fast inspection time.

  3. Critical Chain Exercises

    ERIC Educational Resources Information Center

    Doyle, John Kevin

    2010-01-01

    Critical Chains project management focuses on holding buffers at the project level vs. task level, and managing buffers as a project resource. A number of studies have shown that Critical Chain project management can significantly improve organizational schedule fidelity (i.e., improve the proportion of projects delivered on time) and reduce…

  4. 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

  5. Critical thinking.

    PubMed

    Price, A; Price, B

    1996-05-01

    Critical thinking is a process applied to midwifery theory, research and experience. It is a positive activity, responsive to context, drawing on negative and positive triggers and emotions to suggest ways of acting in future. Practice-based and reflective midwifery assignments should reflect the midwifery goals of critical thinking. This may require adjustments in assessment criteria and a questioning of standard academic conventions.

  6. Critical Muralism

    ERIC Educational Resources Information Center

    Rosette, Arturo

    2009-01-01

    This study focuses on the development and practices of Critical Muralists--community-educator-artist-leader-activists--and situates these specifically in relation to the Mexican mural tradition of los Tres Grandes and in relation to the history of public art more generally. The study examines how Critical Muralists address artistic and…

  7. CISN Display - Reliable Delivery of Real-time Earthquake Information, Including Rapid Notification and ShakeMap to Critical End Users

    NASA Astrophysics Data System (ADS)

    Rico, H.; Hauksson, E.; Thomas, E.; Friberg, P.; Given, D.

    2002-12-01

    The California Integrated Seismic Network (CISN) Display is part of a Web-enabled earthquake notification system alerting users in near real-time of seismicity, and also valuable geophysical information following a large earthquake. It will replace the Caltech/USGS Broadcast of Earthquakes (CUBE) and Rapid Earthquake Data Integration (REDI) Display as the principal means of delivering graphical earthquake information to users at emergency operations centers, and other organizations. Features distinguishing the CISN Display from other GUI tools are a state-full client/server relationship, a scalable message format supporting automated hyperlink creation, and a configurable platform-independent client with a GIS mapping tool; supporting the decision-making activities of critical users. The CISN Display is the front-end of a client/server architecture known as the QuakeWatch system. It is comprised of the CISN Display (and other potential clients), message queues, server, server "feeder" modules, and messaging middleware, schema and generators. It is written in Java, making it platform-independent, and offering the latest in Internet technologies. QuakeWatch's object-oriented design allows components to be easily upgraded through a well-defined set of application programming interfaces (APIs). Central to the CISN Display's role as a gateway to other earthquake products is its comprehensive XML-schema. The message model starts with the CUBE message format, but extends it by provisioning additional attributes for currently available products, and those yet to be considered. The supporting metadata in the XML-message provides the data necessary for the client to create a hyperlink and associate it with a unique event ID. Earthquake products deliverable to the CISN Display are ShakeMap, Ground Displacement, Focal Mechanisms, Rapid Notifications, OES Reports, and Earthquake Commentaries. Leveraging the power of the XML-format, the CISN Display provides prompt access to

  8. 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.

  9. Rapid detection of health-care-associated bloodstream infection in critical care using multipathogen real-time polymerase chain reaction technology: a diagnostic accuracy study and systematic review.

    PubMed

    Warhurst, Geoffrey; Dunn, Graham; Chadwick, Paul; Blackwood, Bronagh; McAuley, Daniel; Perkins, Gavin D; McMullan, Ronan; Gates, Simon; Bentley, Andrew; Young, Duncan; Carlson, Gordon L; Dark, Paul

    2015-05-01

    There is growing interest in the potential utility of real-time polymerase chain reaction (PCR) in diagnosing bloodstream infection by detecting pathogen deoxyribonucleic acid (DNA) in blood samples within a few hours. SeptiFast (Roche Diagnostics GmBH, Mannheim, Germany) is a multipathogen probe-based system targeting ribosomal DNA sequences of bacteria and fungi. It detects and identifies the commonest pathogens causing bloodstream infection. As background to this study, we report a systematic review of Phase III diagnostic accuracy studies of SeptiFast, which reveals uncertainty about its likely clinical utility based on widespread evidence of deficiencies in study design and reporting with a high risk of bias. Determine the accuracy of SeptiFast real-time PCR for the detection of health-care-associated bloodstream infection, against standard microbiological culture. Prospective multicentre Phase III clinical diagnostic accuracy study using the standards for the reporting of diagnostic accuracy studies criteria. Critical care departments within NHS hospitals in the north-west of England. Adult patients requiring blood culture (BC) when developing new signs of systemic inflammation. SeptiFast real-time PCR results at species/genus level compared with microbiological culture in association with independent adjudication of infection. Metrics of diagnostic accuracy were derived including sensitivity, specificity, likelihood ratios and predictive values, with their 95% confidence intervals (CIs). Latent class analysis was used to explore the diagnostic performance of culture as a reference standard. Of 1006 new patient episodes of systemic inflammation in 853 patients, 922 (92%) met the inclusion criteria and provided sufficient information for analysis. Index test assay failure occurred on 69 (7%) occasions. Adult patients had been exposed to a median of 8 days (interquartile range 4-16 days) of hospital care, had high levels of organ support activities and recent

  10. Techniques and standards in intraoperative graft verification by transit time flow measurement after coronary artery bypass graft surgery: a critical review.

    PubMed

    Niclauss, Lars

    2017-01-01

    Transit time flow measurement (TTFM) is a quality control tool for intraoperative graft evaluation in coronary artery bypass graft (CABG) surgery. A critical review of the literature available using TTFM in CABG surgery is the focus of this article. The main objectives will be to detail precise parameters for flow evaluation, to show limitations of TTFM and to prove its predictive impact on postoperative graft failure rate. Publications listed in the PubMed database were reviewed, searching for intraoperative graft verification in coronary surgery by TTFM, with postoperative imaging follow-up (FU) modality and with a special focus on publications released after European guidelines from 2010. Nine included publications revealed an overall graft failure rate of ∼12%. Mean graft flow had a positive predictive value in the largest study, and cut-offs, of at least 20 ml/min for internal mammary artery (IMA) grafts, therein partially confirming guidelines, and 30-40 ml/min for saphenous venous grafts (SVGs) were proposed. An explicit correlation between graft flow, patency rate and severity of coronary stenosis, by indicating the fractional flow reserve, was found for IMA grafts. Increased pulsatility index and increased systolic reverse flow probably predict worse outcome and may help identifying competitive flow. Diastolic filling, rarely indicated, could not be confirmed as the predictive marker. No significant correlation of TTFM and graft failure rate for radial and other arterial grafts could be found, partially due to the small number of these types of grafts analysed. Larger target vessels and lower postoperative CK-MB levels may predict better graft patency rates. Low sensitivity for TTFM to reliably detect graft failure is certainly a major issue, as found in randomized analyses. However, methodical limitations and varying threshold values for TTFM render a general consensus difficult. Influence of quantity (vessel territory distribution) and quality

  11. Critical power derived from a 3-min all-out test predicts 16.1-km road time-trial performance.

    PubMed

    Black, Matthew I; Durant, Jacob; Jones, Andrew M; Vanhatalo, Anni

    2014-01-01

    It has been shown that the critical power (CP) in cycling estimated using a novel 3-min all-out protocol is reliable and closely matches the CP derived from conventional procedures. The purpose of this study was to assess the predictive validity of the all-out test CP estimate. We hypothesised that the all-out test CP would be significantly correlated with 16.1-km road time-trial (TT) performance and more strongly correlated with performance than the gas exchange threshold (GET), respiratory compensation point (RCP) and VO2 max. Ten club-level male cyclists (mean±SD: age 33.8±8.2 y, body mass 73.8±4.3 kg, VO2 max 60±4 ml·kg(-1)·min(-1)) performed a 10-mile road TT, a ramp incremental test to exhaustion, and two 3-min all-out tests, the first of which served as familiarisation. The 16.1-km TT performance (27.1±1.2 min) was significantly correlated with the CP (309±34 W; r = -0.83, P<0.01) and total work done during the all-out test (70.9±6.5 kJ; r = -0.86, P<0.01), the ramp incremental test peak power (433±30 W; r = -0.75, P<0.05) and the RCP (315±29 W; r = -0.68, P<0.05), but not with GET (151±32 W; r = -0.21) or the VO2 max (4.41±0.25 L·min(-1); r = -0.60). These data provide evidence for the predictive validity and practical performance relevance of the 3-min all-out test. The 3-min all-out test CP may represent a useful addition to the battery of tests employed by applied sport physiologists or coaches to track fitness and predict performance in atheletes.

  12. Critics and Criticism of Education

    ERIC Educational Resources Information Center

    Ornstein, Allan C.

    1977-01-01

    Radical educational critics, such as Edgar Friedenberg, Paul Goodman, A. S. Neill, John Holt, Jonathan Kozol, Herbert Kohl, James Herndon, and Ivan Illich, have few constructive goals, no strategy for broad change, and a disdain for modernization and compromise. Additionally, these critics, says the author, fail to consider social factors related…

  13. Taking criticism.

    PubMed

    Dowd, Steven B; Davidhizar, Ruth

    2006-01-01

    The manner in which criticism is dealt with is one of the important behaviors to master in a healthcare work environment: 1.) respond calmly, 2) use a problem solving approach, 3) avoid blaming others, 4) increase the complainers feelings of power, 4) increase feelings of power, 5) communicate respect, 6) do not respond to criticism with an e-mail, 7) forgive the complainer and not hold a grudge; and 8) let the buck stop as soon as possible, and 9) take criticism seriously. Dealing with criticism will never be easy. It just isn't! But using a reasoned approach will help, and get us back to why we entered healthcare - to take care of patients.

  14. Critical Careers.

    ERIC Educational Resources Information Center

    Bowles, Roger A.

    2001-01-01

    Reports the critical shortage of qualified equipment technicians, especially in biomedical equipment. Cites the importance of encouraging careers in this field and describes a source of occupational information. (SK)

  15. Effectiveness of a sediment time critical removal action-PCB reduction in fish tissue, surface water, and sediment via wet excavation.

    PubMed

    Santini, Andrew D; King, Todd; Krawczyk, Keith; Kern, John W

    2015-01-01

    Documenting successful remediation of polychlorinated biphenyl (PCB)-contaminated sediments is limited; potentially due to inadequate monitoring methods, complexities associated with the environment, and selected remedial techniques. At some sites, absence of appropriate baseline and postremoval monitoring limits proper evaluation of remedial efficacy. Accurate interpretation of interactions between media, space, time, species, lipid content, and remedial technique requires robust study design and data. This article presents baseline and postremoval data documenting reduced PCB concentrations in fish tissue, surface water, and sediment in response to the US Environmental Protection Agency (USEPA) time-critical removal action (TCRA) that was conducted at the former Bryant Mill Pond (BMP) on Portage Creek in Kalamazoo, Michigan. The BMP is part of an operable unit (OU) within the Allied Paper, Inc./Portage Creek/Kalamazoo River Superfund Site. PCBs discharged to the creek as a byproduct of carbonless copy paper recycling are the primary contaminant of concern. Paper waste residuals commonly appear as gray to light gray clays in river sediments and floodplain soils. The cleanup criterion was 10 mg/kg, with a residual PCB concentration goal of 1 mg/kg. Because the PCB-containing waste is (generally) associated with readily visible light gray clay, excavation of all visibly contaminated current or formerly impounded sediment served as a surrogate for the cleanup criteria and goal. Sediment was wet excavated and backfilled after diversion of the creek. After confirmation that PCB concentrations met cleanup criteria, the stream was diverted to the excavated side, and excavation and backfilling were completed. Overall, 146000 cubic yards of material including PCB-contaminated sediments were removed from the BMP. The long-term monitoring (LTM) program implemented by the Michigan Department of Environmental Quality (MDEQ), and historic data from a variety of sources

  16. In-Network Processing for Mission-Critical Wireless Networked Sensing and Control: A Real-Time, Efficiency, and Resiliency Perspective

    ERIC Educational Resources Information Center

    Xiang, Qiao

    2014-01-01

    As wireless cyber-physical systems (WCPS) are increasingly being deployed in mission-critical applications, it becomes imperative that we consider application QoS requirements in in-network processing (INP). In this dissertation, we explore the potentials of two INP methods, packet packing and network coding, on improving network performance while…

  17. In-Network Processing for Mission-Critical Wireless Networked Sensing and Control: A Real-Time, Efficiency, and Resiliency Perspective

    ERIC Educational Resources Information Center

    Xiang, Qiao

    2014-01-01

    As wireless cyber-physical systems (WCPS) are increasingly being deployed in mission-critical applications, it becomes imperative that we consider application QoS requirements in in-network processing (INP). In this dissertation, we explore the potentials of two INP methods, packet packing and network coding, on improving network performance while…

  18. Rethinking Creative Teaching and Teaching as Research: Mapping the Critical Phases that Mark Times of Change and Choosing as Learners and Teachers of Music

    ERIC Educational Resources Information Center

    Burnard, Pamela

    2012-01-01

    This article describes the use of a visual-based construct elicitation tool developed from the use of critical incident charting for the purpose of reflecting on our creative learning journeys either at significant points as music learners in childhood, in adult life, or as preservice or experienced teachers. In this article, I introduce diverse…

  19. Rethinking Creative Teaching and Teaching as Research: Mapping the Critical Phases that Mark Times of Change and Choosing as Learners and Teachers of Music

    ERIC Educational Resources Information Center

    Burnard, Pamela

    2012-01-01

    This article describes the use of a visual-based construct elicitation tool developed from the use of critical incident charting for the purpose of reflecting on our creative learning journeys either at significant points as music learners in childhood, in adult life, or as preservice or experienced teachers. In this article, I introduce diverse…

  20. Diarrhoea in the critically ill.

    PubMed

    Reintam Blaser, Annika; Deane, Adam M; Fruhwald, Sonja

    2015-04-01

    To summarize existing evidence on definition, epidemiology, mechanisms, risk factors, consequences, outcome and management of diarrhoea in the critically ill. In health, diarrhoea is defined as the passage of three or more loose or liquid stools per day. In the critically ill, the diagnosis is yet to be formalized and reported prevalence of diarrhoea varies according to the definition used. Recent studies estimate the prevalence between 14 and 21% and describe risk factors for diarrhoea in critically ill patients. The precipitant of diarrhoea always needs to be identified, as targeted therapies are important for several causes. Although the majority of patients with diarrhoea require only supportive care, it is always essential to exclude, or confirm and treat infectious diarrhoea. There is little evidence to support delaying or withdrawing provision of enteral nutrition in patients with diarrhoea, and we recommend continuing enteral nutrition whenever possible. However, the consequences of diarrhoea - hypovolaemia, electrolyte disturbances, malnutrition, skin lesions and contamination of wounds - should be avoided or at least recognized promptly. A definition of diarrhoea and a practical approach to identify the precipitant and to manage diarrhoea in critically ill patients are proposed.

  1. Quantum criticality of a spin-1 XY model with easy-plane single-ion anisotropy via a two-time Green function approach avoiding the Anderson-Callen decoupling

    NASA Astrophysics Data System (ADS)

    Mercaldo, M. T.; Rabuffo, I.; De Cesare, L.; Caramico D'Auria, A.

    2016-04-01

    In this work we study the quantum phase transition, the phase diagram and the quantum criticality induced by the easy-plane single-ion anisotropy in a d-dimensional quantum spin-1 XY model in absence of an external longitudinal magnetic field. We employ the two-time Green function method by avoiding the Anderson-Callen decoupling of spin operators at the same sites which is of doubtful accuracy. Following the original Devlin procedure we treat exactly the higher order single-site anisotropy Green functions and use Tyablikov-like decouplings for the exchange higher order ones. The related self-consistent equations appear suitable for an analysis of the thermodynamic properties at and around second order phase transition points. Remarkably, the equivalence between the microscopic spin model and the continuous O(2) -vector model with transverse-Ising model (TIM)-like dynamics, characterized by a dynamic critical exponent z=1, emerges at low temperatures close to the quantum critical point with the single-ion anisotropy parameter D as the non-thermal control parameter. The zero-temperature critic anisotropy parameter Dc is obtained for dimensionalities d > 1 as a function of the microscopic exchange coupling parameter and the related numerical data for different lattices are found to be in reasonable agreement with those obtained by means of alternative analytical and numerical methods. For d > 2, and in particular for d=3, we determine the finite-temperature critical line ending in the quantum critical point and the related TIM-like shift exponent, consistently with recent renormalization group predictions. The main crossover lines between different asymptotic regimes around the quantum critical point are also estimated providing a global phase diagram and a quantum criticality very similar to the conventional ones.

  2. How Critical Is Critical Infrastructure?

    DTIC Science & Technology

    2015-09-01

    be misdirected even though it is the cornerstone mission of the department to prevent terrorism and enhance security. It is likely that the...facilities DHS works to protect from terrorism are not the most likely targets for attacks. The manner in which facilities are designated as critical...security, critical infrastructure, world trade center, military theory, terrorism 15. NUMBER OF PAGES 155 16. PRICE CODE 17. SECURITY CLASSIFICATION

  3. Effectiveness of Automated Notification and Customer Service Call Centers for Timely and Accurate Reporting of Critical Values: A Laboratory Medicine Best Practices Systematic Review and Meta-Analysis

    PubMed Central

    Liebow, Edward B.; Derzon, James H.; Fontanesi, John; Favoretto, Alessandra M.; Baetz, Rich Ann; Shaw, Colleen; Thompson, Pamela; Mass, Diana; Christenson, Robert; Epner, Paul; Snyder, Susan R.

    2015-01-01

    Objective To conduct a systematic review of automatic notification methods and consider evidence-based recommendations for best practices in improving the timeliness and accuracy of critical value reporting. Results 196 bibliographic records were identified, with nine meeting review inclusion criteria. Four studies examined automated notification systems and five assessed call center performance. Average improvement from implementing automated notification systems is d = 0.42 (95% CI = 0.2 – 0.62) while the average odds ratio for call centers is OR = 22.1 (95% CI = 17.1 – 28.6). Conclusions The evidence, though suggestive, is not sufficient to make a recommendation for or against using automated notification systems as a best practice to improve the timeliness and accuracy of critical value reporting in an in-patient care setting. Call centers, however, are effective in improving the timeliness and accuracy of critical value reporting in an in-patient care setting, and are recommended as an “evidence-based best practice.” PMID:22750773

  4. Critical chemotactic collapse

    NASA Astrophysics Data System (ADS)

    Lushnikov, Pavel M.

    2010-04-01

    A Keller-Segel model describes macroscopic dynamics of bacterial colonies and biological cells as well as dynamics of a gas of self-gravitating Brownian particles. Bacteria secret chemical which attracts other bacteria so that they move towards chemical gradient creating nonlocal attraction between bacteria. If bacterial (or Brownian particle) density exceeds a critical value then the density collapses (blows up) in a finite time which corresponds to bacterial aggregation or gravitational collapse. Collapse in the Keller-Segel model has striking qualitative similarities with a nonlinear Schrödinger equation including critical collapse in two dimensions and supercritical collapse in three dimensions. A self-similar solution near blow up point is studied in the critical two-dimensional case and it has a form of a rescaled steady state solution which contains a critical number of bacteria. Time dependence of scaling of that solution has square root scaling law with logarithmic modification.

  5. Greening critical care.

    PubMed

    Chapman, Martin; Chapman, Alison

    2011-01-01

    Climate change and environmental stewardship are phrases that have been defining the past few decades and promoting change in our societies. The sensitivities of intensive care as a specialty make the process of greening an intensive care unit a challenge, but not one that is insurmountable. This paper discusses opportunities for critical care to reduce its environmental impact and provide a framework change. The article includes suggestions of what can be done as an individual, as a unit and as a hospital. Generally, practices in critical care are accepted without questioning the environmental consequences. We believe it is time for change, and critical care should give environmental stewardship a higher priority.

  6. Mission Critical Networking

    SciTech Connect

    Eltoweissy, Mohamed Y.; Du, David H.C.; Gerla, Mario; Giordano, Silvia; Gouda, Mohamed; Schulzrinne, Henning; Youssef, Moustafa

    2010-06-01

    Mission-Critical Networking (MCN) refers to networking for application domains where life or livelihood may be at risk. Typical application domains for MCN include critical infrastructure protection and operation, emergency and crisis intervention, healthcare services, and military operations. Such networking is essential for safety, security and economic vitality in our complex world characterized by uncertainty, heterogeneity, emergent behaviors, and the need for reliable and timely response. MCN comprise networking technology, infrastructures and services that may alleviate the risk and directly enable and enhance connectivity for mission-critical information exchange among diverse, widely dispersed, mobile users.

  7. Greening critical care

    PubMed Central

    2011-01-01

    Climate change and environmental stewardship are phrases that have been defining the past few decades and promoting change in our societies. The sensitivities of intensive care as a specialty make the process of greening an intensive care unit a challenge, but not one that is insurmountable. This paper discusses opportunities for critical care to reduce its environmental impact and provide a framework change. The article includes suggestions of what can be done as an individual, as a unit and as a hospital. Generally, practices in critical care are accepted without questioning the environmental consequences. We believe it is time for change, and critical care should give environmental stewardship a higher priority. PMID:21635700

  8. Staying Critical

    ERIC Educational Resources Information Center

    Carr, Wilfred; Kemmis, Stephen

    2005-01-01

    In this article, the two authors of "Becoming Critical: education, knowledge and action research" look back at the book's history since its publication 20 years ago. We describe how the book was originally written, and the diverse responses and reactions that it has produced. We identify some of the book's inadequacies and limitations,…

  9. Critical Information at Critical Moments

    ERIC Educational Resources Information Center

    Fierman, Ben; Thrower, Raymond H., Jr.

    2011-01-01

    On a daily basis, administrators are reminded of the potential, perhaps the likelihood, of violence or natural crises on their campuses. Comprehensive studies have been conducted and point to recommendations and best practices for planning, preparing, responding to, and recovering from critical incidents. The International Association of Campus…

  10. Heavy fermion quantum criticality.

    PubMed

    Nazario, Zaira; Santiago, David I

    2008-09-26

    During the last few years, investigations of rare-earth materials have made clear that heavy fermion quantum criticality exhibits novel physics not fully understood. In this work, we write for the first time the effective action describing the low energy physics of the system. The f fermions are replaced by a dynamical scalar field whose nonzero expected value corresponds to the heavy fermion phase. The effective theory is amenable to numerical studies as it is bosonic, circumventing the fermion sign problem. Via effective action techniques, renormalization group studies, and Callan-Symanzik resummations, we describe the heavy fermion criticality and predict the heavy fermion critical dynamical susceptibility and critical specific heat. The specific heat coefficient exponent we obtain (0.39) is in excellent agreement with the experimental result at low temperatures (0.4).

  11. Altered gonadal steroidogenesis in critical illness: is treatment with anabolic steroids indicated?

    PubMed

    Spratt, D I

    2001-12-01

    The physiology of the reproductive system changes dramatically with the onset of major illness. The serum testosterone concentrations fall to pre-pubertal levels secondary to a decreased secretion of gonadotropins and a decreased Leydig cell response to luteinizing hormone. At the same time, the serum oestrogen concentration rises as the result of an increased rate of peripheral aromatization. The clinical consequences of these marked changes are not yet well understood. One line of evidence argues for the administration of anabolic steroids (derivatives of testosterone) to critically ill patients to improve their catabolic state. Another line of evidence in animal models suggests that testosterone may suppress the immune system and myocardial function in critical illness. No clinical trials of oestrogen administration to critically ill patients have been reported, although two animal studies suggest that oestrogen may have a positive effect on survival. This chapter reviews changes in the physiology of the reproductive system in major illness as well as current evidence regarding the clinical effects of androgens and oestrogens in critical illness and their potential therapeutic roles.

  12. Contingent valuation scenarios for chronic illnesses: the case of childhood asthma.

    PubMed

    Brandt, Sylvia; Vásquez Lavín, Felipe; Hanemann, Michael

    2012-12-01

    We use a contingent valuation (CV) study of childhood asthma to discuss a central issue in designing CV studies of chronic illness-the need for a detailed, realistic scenario that minimizes confounding factors-and show how to address this issue. We apply our methodology to estimate households' willingness to pay (WTP) for reductions in asthma morbidity. By using a combination of focus groups, revealed preference surveys, and epidemiological surveys, we gathered information on health status, attitudes, and beliefs regarding asthma, risk-averting behaviors, perceptions of these behaviors, and household socioeconomic characteristics. We used this information to design a CV survey that we extensively tested for validity. In the survey, we elicited participants' WTP for a hypothetical device that would reduce symptom-days by improving asthma management; these data enabled us to estimate household WTP by using a variety of econometric models. Our analysis of households with children with asthma yielded the following conclusions: the scenario should address both physical asthma symptoms and the psychosocial stress of managing a chronic illness; the survey should measure household perceptions of the burden of asthma in addition to objective measures such as symptom-days; and the scenario should not involve substantial behavioral changes or a new medication, to avoid confounding household preferences with unrelated attributes of the scenario. Our primary models estimated mean household WTP for a 50% reduction in symptom-days (and accompanying reductions in psychosocial stress) at $56.48 to $64.84 per month. Our methodology can be used to inform CV studies of chronic illness. Our WTP estimates can help regulatory agencies assess a wide range of policies that affect the incidence or severity of asthma. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  13. The effect of the time dependent angular distribution of the intergrain magnetic field on the transport critical current in Ag-(Bi,Pb)2Sr2Ca2Cu3Ox tapes

    NASA Astrophysics Data System (ADS)

    Glowacki, B. A.; Noji, H.; Oota, A.

    1996-08-01

    Changes in the energy dissipation of the tape form Ag-(Bi,Pb)2Sr2Ca2Cu3Ox conductor have been interpreted in terms of magnetic flux movement from, or into, the intergrain regions of the highly textured plate like grain structure. The time dependent increase or decrease of the transport critical current (Ic), originates from time dependent angular superposition of the current induced self field (HSF), and external magnetic field [field cooling (HFC), and zero-field cooling (HZFC)] at the intergrain regions. The existence of time dependent changes of Ic can be explained in terms of the time dependent flux redistribution in grains and grain boundaries caused by thermal relaxation processes.

  14. Applying critical thinking to nursing.

    PubMed

    Price, Bob

    2015-08-19

    Critical thinking and writing are skills that are not easy to acquire. The term 'critical' is used differently in social and clinical contexts. Nursing students need time to master the inquisitive and ruminative aspects of critical thinking that are required in academic environments. This article outlines what is meant by critical thinking in academic settings, in relation to both theory and reflective practice. It explains how the focus of a question affects the sort of critical thinking required and offers two taxonomies of learning, to which students can refer when analysing essay requirements. The article concludes with examples of analytical writing in reference to theory and reflective practice.

  15. Reviews/Essays: School Start Times and the Sleep-Wake Cycle of Adolescents--A Review and Critical Evaluation of Available Evidence

    ERIC Educational Resources Information Center

    Kirby, Matthew; Maggi, Stefania; D'Angiulli, Amedeo

    2011-01-01

    The authors have integrated the major findings on the sleep-wake cycle and its performance correlates in adolescents. Basic research shows that lack of synchronicity between early school start times and the circadian rhythm of adolescents (and the sleep debt accumulated as a result) involves several cognitive correlates that may harm the academic…

  16. Reviews/Essays: School Start Times and the Sleep-Wake Cycle of Adolescents--A Review and Critical Evaluation of Available Evidence

    ERIC Educational Resources Information Center

    Kirby, Matthew; Maggi, Stefania; D'Angiulli, Amedeo

    2011-01-01

    The authors have integrated the major findings on the sleep-wake cycle and its performance correlates in adolescents. Basic research shows that lack of synchronicity between early school start times and the circadian rhythm of adolescents (and the sleep debt accumulated as a result) involves several cognitive correlates that may harm the academic…

  17. A Critical Analysis of the Role of Wait Time in Classroom Interactions and the Effects on Student and Teacher Interactional Behaviours

    ERIC Educational Resources Information Center

    Ingram, Jenni; Elliott, Victoria

    2016-01-01

    Extending the pauses between teachers' and students' turns (wait time) has been recommended as a way of improving classroom learning. Drawing on the Conversation Analysis literature on classroom interactions alongside extracts of classroom interactions, the relationship between these pauses and the interactional behaviour of teachers and students…

  18. A Critical Analysis of the Role of Wait Time in Classroom Interactions and the Effects on Student and Teacher Interactional Behaviours

    ERIC Educational Resources Information Center

    Ingram, Jenni; Elliott, Victoria

    2016-01-01

    Extending the pauses between teachers' and students' turns (wait time) has been recommended as a way of improving classroom learning. Drawing on the Conversation Analysis literature on classroom interactions alongside extracts of classroom interactions, the relationship between these pauses and the interactional behaviour of teachers and students…

  19. Uncommon Teaching in Commonsense Times: A Case Study of a Critical Multicultural Educator and the Academic Success of Diverse Student Populations

    ERIC Educational Resources Information Center

    Camp, Emilie M.; Oesterreich, Heather A.

    2010-01-01

    In an effort to explore the complexity of how teachers develop and sustain the ability to teach uncommonly in commonsense times, the authors conducted a life history case study of Rae, a fifth grade teacher at a local elementary school in the Southwest United States who has practiced and sustained uncommon teaching for four years. Combining…

  20. PRACTICAL: Planning and Resource Allocation in C2-Domains With Time Critical Algorithms (PRACTICAL: Planning en Allocatie in C2-Domeinen Met Tijdkritische Algoritmen)

    DTIC Science & Technology

    1993-02-01

    entities 18 3.1.2 Time map 18 3.2 Tcmporal query interface language ( Tequila ) 18 3.3 Calculating path distances 19 3.4 Implementation approache, 22 3.4.1...a possibility to query the temporal database. 3.2 Temporal query interface language ( Tequila ) There are two interesting query types: * Determination

  1. Using Time-Lapse 3D Electrical Resistivity Tomography to Image the Seasonal Heterogeneous Change in Near-Surface Resistivity in the Reynolds Creek Critical Zone Observatory

    NASA Astrophysics Data System (ADS)

    Nielson, T.; Bradford, J. H.; Seyfried, M. S.

    2016-12-01

    At the Reynolds Creek Critical Zone Observatory (RCCZO), located in southwest Idaho, long term monitoring of soil moisture using in situ moisture probes has shown that during the dry summer only the shallow soils(<30 cm) respond to rainfall events, as shown in Figure 1, while the deeper soils are recharged only during the wet winter. This is not an uncommon observation in semi-arid environments but how this response to rainfall varies spatially at the plot scale has yet to be measured. To investigate this process, we installed 7x8 m2 electrical resistivity tomography (ERT) arrays at two field sites, Low Elevation Sage (LES) at 1406 m in elevation and Mid Elevation Sage (MES) at 1653 m in elevation. We monitored the two sites weekly during the spring and fall of 2015 and 2016 to capture the dry down and wet up of the soils. Controls for the geophysical data were obtained from soil moisture probes adjacent to the ERT arrays at 5, 15, 30, 60 and 90 cm of depth. The inverted resistivity grids show that the region that readily responds to rainfall varies both within a plot and between sites. MES's rainfall responsive zone is shallow partially continuous layer (see Figure 2), while LES's is deeper and bowl shaped (see Figure 3). Further the inverted grids at MES, Figure 2, show rainfall responsive, vertical tube structures which are likely hydraulically conductive pathways to the deeper vadose zone. This spatial heterogeneity cannot be captured by the existing moisture probe data. Our results imply that spatially limited hydraulically conductive pathways may link the shallow soils to the deeper vadose zone even during the seasonal dry periods where these regions are thought to be disconnected.

  2. District health planning at a time of transition: a critical review and lessons learnt from the implementation of regional planning in Uganda.

    PubMed

    Curtale, Filippo; Musila, Timothy; Opigo, Jimmy; Nantamu, Dyogo; Ezati, Isaac Alidria

    2016-05-01

    A quarter of a century after the Harare Declaration on Strengthening District Health Systems Based on Primary Health Care (1987) was conceived, district health teams (DHTs) are facing a markedly changed situation. Rapid population growth, urbanization, a rapidly developing private sector, and the increasing role of vertical programs and global initiatives have marginalized the planning process and weakened the entire district health system (DHS). The Ugandan Ministry of Health (MoH) responded to these challenges by beginning a review of district planning: a key action point of the Harare Declaration. The first step was a critical review of relevant literature, then central and district health staff were engaged with to provide their input in developing the new strategy. Through a field experiment started in 2012-13, and still underway, the MoH is developing an innovative regional approach to health planning, which aims to encompass the complexity of the new context of health care provision and coordinate all new actors (private health providers, projects and local government staff from other sectors) operating in the health sector. A strategic revision of the planning process represents an opportunity to develop an appropriate 'Theory of Change', intended as a broader approach of thinking about the entire DHS and the relative role and functions of the DHT. Leadership and stewardship capacities of MoH staff, at central and peripheral level, must be strengthened and supported to achieve the expected changes and results. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Unmanned Aerial Vehicle (UAV) Dynamic-Tracking Directional Wireless Antennas for Low Powered Applications that Require Reliable Extended Range Operations in Time Critical Scenarios

    SciTech Connect

    Scott G. Bauer; Matthew O. Anderson; James R. Hanneman

    2005-10-01

    The proven value of DOD Unmanned Aerial Vehicles (UAVs) will ultimately transition to National and Homeland Security missions that require real-time aerial surveillance, situation awareness, force protection, and sensor placement. Public services first responders who routinely risk personal safety to assess and report a situation for emergency actions will likely be the first to benefit from these new unmanned technologies. ‘Packable’ or ‘Portable’ small class UAVs will be particularly useful to the first responder. They require the least amount of training, no fixed infrastructure, and are capable of being launched and recovered from the point of emergency. All UAVs require wireless communication technologies for real- time applications. Typically on a small UAV, a low bandwidth telemetry link is required for command and control (C2), and systems health monitoring. If the UAV is equipped with a real-time Electro-Optical or Infrared (EO/Ir) video camera payload, a dedicated high bandwidth analog/digital link is usually required for reliable high-resolution imagery. In most cases, both the wireless telemetry and real-time video links will be integrated into the UAV with unity gain omni-directional antennas. With limited on-board power and payload capacity, a small UAV will be limited with the amount of radio-frequency (RF) energy it transmits to the users. Therefore, ‘packable’ and ‘portable’ UAVs will have limited useful operational ranges for first responders. This paper will discuss the limitations of small UAV wireless communications. The discussion will present an approach of utilizing a dynamic ground based real-time tracking high gain directional antenna to provide extend range stand-off operation, potential RF channel reuse, and assured telemetry and data communications from low-powered UAV deployed wireless assets.

  4. Science education in Africa; A critical time for critical thinking.

    NASA Astrophysics Data System (ADS)

    Murabona, S.; Daka, O.; Chileshi, M.; Darrow, J.; Tung, A.; Wanless, E.; Hand, K.

    2005-12-01

    The change toward industrialization and a technologically advanced society is occurring at an ever increasing rate in developing regions of the world. Such change brings with it both the benefits of access to medicine, water, and food, and the negative effects of pollution, the destruction of natural resources, and the loss of both cultural and biological diversity. In many developing regions the human population is uneducated and incapable of playing an active role in the changes occurring around them. Here we discuss the work of our small non-profit, Cosmos Education, and our efforts to improve basic science education in sub-Saharan Africa. The mission of Cosmos Education is to foster global sustainable development through improved science and technology education in developing regions of the world. Our guiding vision is quite simple: Youth are the future. Education is the key. Cosmos Education aims to make a sustained and effective difference by working from the ground up - reaching individual students and teachers and making a difference in the classroom. We focus on science and technology education and the role of science and technology in health, the environment, and sustainable development. Our model is grassroots development from within; we want the youth in developing regions of the world to decide how their nations develop. In order to be able to do this, the youth must have the knowledge and skills needed to understand the rapidly changing world around them. They must be inspired, empowered, and engaged in their education. By working directly in classrooms, making learning fun with hands-on experiments, and providing the students with talented role-models from their own geographic region, we hope to excite students about their potential drive development from within and to catalyze development that will have a positive effect on the biosphere.

  5. Nuclear criticality information system

    SciTech Connect

    Koponen, B.L.; Hampel, V.E.

    1981-11-30

    The nuclear criticality safety program at LLNL began in the 1950's with a critical measurements program which produced benchmark data until the late 1960's. This same time period saw the rapid development of computer technology useful for both computer modeling of fissile systems and for computer-aided management and display of the computational benchmark data. Database management grew in importance as the amount of information increased and as experimental programs were terminated. Within the criticality safety program at LLNL we began at that time to develop a computer library of benchmark data for validation of computer codes and cross sections. As part of this effort, we prepared a computer-based bibliography of criticality measurements on relatively simple systems. However, it is only now that some of these computer-based resources can be made available to the nuclear criticality safety community at large. This technology transfer is being accomplished by the DOE Technology Information System (TIS), a dedicated, advanced information system. The NCIS database is described.

  6. A critical review of peripheral arterial tone and pulse transit time as indirect diagnostic methods for detecting sleep disordered breathing and characterizing sleep structure.

    PubMed

    Pépin, Jean-Louis; Tamisier, Renaud; Borel, Jean-Christian; Baguet, Jean-Phillipe; Lévy, Patrick

    2009-11-01

    Sympathetic activity varies continuously across sleep stages. During rapid eye movement sleep, sympathetic tone increases substantially but is highly variable. Microarousals are associated with momentary bursts of sympathetic activity. Abnormal respiratory events progressively elevate sympathetic activity in proportion to the severity of oxyhemoglobin desaturation. These phenomena imply that cardiovascular markers of sympathetic activity such as peripheral arterial tone (PAT) and pulse transit time could be indirect tools for diagnosing sleep disordered breathing and characterizing sleep structure and fragmentation. Measurement of variations in PAT coupled with pulse rate accelerations and desaturations in oximetry can be used to diagnose sleep apnea. Good agreement between both manually and automatically analyzed PAT recordings and polysomnography has been demonstrated during in-laboratory or at-home studies. Numerous validation studies against esophageal pressure have demonstrated that pulse transit time is the best noninvasive method for measurement of respiratory effort. Pulse transit time and PAT are sensitive techniques for arousal recognition, particularly in children and infants. There are specific sleep stage-dependent PAT patterns that allow for the recognition of rapid eye movement sleep and, in the case of nonrapid eye movement sleep, the separation of lighter stages from deeper, slow wave sleep. Elevated nocturnal sympathetic activity as documented by PAT attenuations is linked with chronically elevated blood pressure in humans. Cardiovascular markers of autonomic control during sleep permit not only the diagnosis of obstructive sleep apnea and estimation of sleep structure but are also linked with the prevalence of daytime hypertension.

  7. Real-Time 3D Fluoroscopy-Guided Large Core Needle Biopsy of Renal Masses: A Critical Early Evaluation According to the IDEAL Recommendations

    SciTech Connect

    Kroeze, Stephanie G. C.; Huisman, Merel; Verkooijen, Helena M.; Diest, Paul J. van; Ruud Bosch, J. L. H.; Bosch, Maurice A. A. J. van den

    2012-06-15

    Introduction: Three-dimensional (3D) real-time fluoroscopy cone beam CT is a promising new technique for image-guided biopsy of solid tumors. We evaluated the technical feasibility, diagnostic accuracy, and complications of this technique for guidance of large-core needle biopsy in patients with suspicious renal masses. Methods: Thirteen patients with 13 suspicious renal masses underwent large-core needle biopsy under 3D real-time fluoroscopy cone beam CT guidance. Imaging acquisition and subsequent 3D reconstruction was done by a mobile flat-panel detector (FD) C-arm system to plan the needle path. Large-core needle biopsies were taken by the interventional radiologist. Technical success, accuracy, and safety were evaluated according to the Innovation, Development, Exploration, Assessment, Long-term study (IDEAL) recommendations. Results: Median tumor size was 2.6 (range, 1.0-14.0) cm. In ten (77%) patients, the histological diagnosis corresponded to the imaging findings: five were malignancies, five benign lesions. Technical feasibility was 77% (10/13); in three patients biopsy results were inconclusive. The lesion size of these three patients was <2.5 cm. One patient developed a minor complication. Median follow-up was 16.0 (range, 6.4-19.8) months. Conclusions: 3D real-time fluoroscopy cone beam CT-guided biopsy of renal masses is feasible and safe. However, these first results suggest that diagnostic accuracy may be limited in patients with renal masses <2.5 cm.

  8. Characterization of attenuated food motivation in high-fat diet-induced obesity: Critical roles for time on diet and reinforcer familiarity.

    PubMed

    Tracy, Andrea L; Wee, Colin J M; Hazeltine, Grace E; Carter, Rebecca A

    2015-03-15

    Prior work using animal models to study the effects of obesogenic diets on food motivation have generated inconsistent results, with some reporting increases and others reporting decreases in responding on food-reinforced tasks. Here, we identified two specific variables that may account for these discrepant outcomes - the length of time on the obesigenic diet and the familiarity of the food reinforcer - and examined the independent roles of these factors. Time on diet was found to be inversely related to food motivation, as rats consuming a 40% high-fat diet (HFD) for only 3weeks did not differ from chow-fed rats when responding for a sucrose reinforcer on a progressive ratio (PR) schedule, but responding was suppressed after 6weeks of ad lib HFD consumption. Explicitly manipulating experience with the sucrose reinforcer by pre-exposing half the rats prior to 10weeks of HFD consumption attenuated the motivational deficit seen in the absence of this familiarity, resulting in obese rats performing at the same level as lean rats. Finally, after 8weeks on a HFD, rats did not express a conditioned place preference for sucrose, indicating a decrement in reward value independent of motivation. These findings are consistent with prior literature showing an increase in food motivation for rats with a shorter time consuming the obesigenic diet, and for those with more prior experience with the reinforcer. This account also helps reconcile these findings with increased food motivation in obese humans due to extensive experience with palatable food and suggests that researchers engaging in non-human animal studies of obesity would better model the conditions under which human obesity develops by using a varied, cafeteria-style diet to increase the breadth of food experiences.

  9. Use of the C-27J Fixed-Wing Aircraft for Conducting Army Mission Critical, Time Sensitive Missions in Counterinsurgency Operations

    DTIC Science & Technology

    2010-01-01

    personnel. For routine and nonemergency requests, it is up to the crew to determine what cargo gets moved. The entire process can be trumped , however...or above can bump a lower-priority item from a flight and insert a MCTS shipment. Figure 4 is a flow graph of the Army and Air Force air tasking...day or launched on the next scheduled non-alert mission within crew rest time limits. A second procedure is the dynamic tasking of mission diverts

  10. The cryoprotectant used, its concentration, and the equilibration time are critical for the successful cryopreservation of rabbit sperm: DIMETHylacetamide versus dimethylsulfoxide.

    PubMed

    Iaffaldano, N; Di Iorio, M; Rosato, M Pina

    2012-10-01

    This study was designed to identify a suitable freezing protocol for rabbit semen by comparing the effects of different concentrations and equilibration times of dimethylacetamide (DMA) and dimethylsulfoxide (DMSO) on the postthaw quality of the semen. After establishing the best protocols for each cryoprotectant, their efficacy was compared by examining the in vivo fertilizing capacity of the semen samples. Pooled semen samples diluted in freezing medium containing 4%, 6%, or 8% DMA or DMSO (all combined with 1% sucrose as a nonpermeating cryoprotectant) were loaded in straws and equilibrated for 5, 15, or 45 min before freezing in liquid nitrogen vapor. The variables assessed after thawing were sperm motility, viability, osmotic resistance, and acrosome and DNA integrity. Marked effects on these variables were shown by the cryoprotectant concentration and equilibration time, with best results obtained using DMA 6% or DMSO 8% and equilibration times of 45 min. These freezing protocols were selected to compare the two cryoprotectants in an insemination trial. Three groups of 114 rabbit does (28 nulliparous and 86 multiparous in each group) were inseminated with fresh semen or with semen frozen using the optimized DMA or DMSO protocols. Fertility rates and numbers of kids born were similar, respectively for the DMSO-frozen (79.8% and 7.7 ± 0.3 young per kindling) and fresh semen (81.6% and 8.6 ± 0.3) yet higher (P ≤ 0.05) than the rates returned using the DMA-frozen semen (47.4% and 6.7 ± 0.4). Moreover, the numbers of rabbits born alive when DMSO was used in the freezing protocol, despite being lower than those recorded using fresh semen, were higher than when DMA was used as the cryoprotectant (P < 0.05). The physiological status of the does (nulliparous or multiparous) had no influence on the fertility and prolificacy results. Our findings indicate that the cryosurvival of rabbit sperm frozen using DMSO or DMA as the cryoprotectant is highly influenced by

  11. CISN Display Progress to Date - Reliable Delivery of Real-Time Earthquake Information, and ShakeMap to Critical End Users

    NASA Astrophysics Data System (ADS)

    Rico, H.; Hauksson, E.; Thomas, E.; Friberg, P.; Frechette, K.; Given, D.

    2003-12-01

    The California Integrated Seismic Network (CISN) has collaborated to develop a next-generation earthquake notification system that is nearing its first operations-ready release. The CISN Display actively alerts users of seismic data, and vital earthquake hazards information following a significant event. It will primarily replace the Caltech/USGS Broadcast of Earthquakes (CUBE) and Rapid Earthquake Data Integration (REDI) Display as the principal means of delivering geographical seismic data to emergency operations centers, utility companies and media outlets. A subsequent goal is to provide automated access to the many Web products produced by regional seismic networks after an earthquake. Another aim is to create a highly configurable client, allowing user organizations to overlay infrastructure data critical to their roles as first-responders, or lifeline operators. And the final goal is to integrate these requirements, into a package offering several layers of reliability to ensure delivery of services. Central to the CISN Display's role as a gateway to Web-based earthquake products is its comprehensive XML-messaging schema. The message model uses many of the same attributes in the CUBE format, but extends the old standard by provisioning additional elements for products currently available, and others yet to be considered. The client consumes these XML-messages, sorts them through a resident Quake Data Merge filter, and posts updates that also include hyperlinks associated to specific event IDs on the display map. Earthquake products available for delivery to the CISN Display are ShakeMap, focal mechanisms, waveform data, felt reports, aftershock forecasts and earthquake commentaries. By design the XML-message schema can evolve as products and information needs change, without breaking existing applications that rely on it. The latest version of the CISN Display can also automatically download ShakeMaps and display shaking intensity within the GIS system. This

  12. Critical points of DNA quantification by real-time PCR--effects of DNA extraction method and sample matrix on quantification of genetically modified organisms.

    PubMed

    Cankar, Katarina; Stebih, Dejan; Dreo, Tanja; Zel, Jana; Gruden, Kristina

    2006-08-14

    Real-time PCR is the technique of choice for nucleic acid quantification. In the field of detection of genetically modified organisms (GMOs) quantification of biotech products may be required to fulfil legislative requirements. However, successful quantification depends crucially on the quality of the sample DNA analyzed. Methods for GMO detection are generally validated on certified reference materials that are in the form of powdered grain material, while detection in routine laboratories must be performed on a wide variety of sample matrixes. Due to food processing, the DNA in sample matrixes can be present in low amounts and also degraded. In addition, molecules of plant origin or from other sources that affect PCR amplification of samples will influence the reliability of the quantification. Further, the wide variety of sample matrixes presents a challenge for detection laboratories. The extraction method must ensure high yield and quality of the DNA obtained and must be carefully selected, since even components of DNA extraction solutions can influence PCR reactions. GMO quantification is based on a standard curve, therefore similarity of PCR efficiency for the sample and standard reference material is a prerequisite for exact quantification. Little information on the performance of real-time PCR on samples of different matrixes is available. Five commonly used DNA extraction techniques were compared and their suitability for quantitative analysis was assessed. The effect of sample matrix on nucleic acid quantification was assessed by comparing 4 maize and 4 soybean matrixes. In addition 205 maize and soybean samples from routine analysis were analyzed for PCR efficiency to assess variability of PCR performance within each sample matrix. Together with the amount of DNA needed for reliable quantification, PCR efficiency is the crucial parameter determining the reliability of quantitative results, therefore it was chosen as the primary criterion by which to

  13. Critical points of DNA quantification by real-time PCR – effects of DNA extraction method and sample matrix on quantification of genetically modified organisms

    PubMed Central

    Cankar, Katarina; Štebih, Dejan; Dreo, Tanja; Žel, Jana; Gruden, Kristina

    2006-01-01

    Background Real-time PCR is the technique of choice for nucleic acid quantification. In the field of detection of genetically modified organisms (GMOs) quantification of biotech products may be required to fulfil legislative requirements. However, successful quantification depends crucially on the quality of the sample DNA analyzed. Methods for GMO detection are generally validated on certified reference materials that are in the form of powdered grain material, while detection in routine laboratories must be performed on a wide variety of sample matrixes. Due to food processing, the DNA in sample matrixes can be present in low amounts and also degraded. In addition, molecules of plant origin or from other sources that affect PCR amplification of samples will influence the reliability of the quantification. Further, the wide variety of sample matrixes presents a challenge for detection laboratories. The extraction method must ensure high yield and quality of the DNA obtained and must be carefully selected, since even components of DNA extraction solutions can influence PCR reactions. GMO quantification is based on a standard curve, therefore similarity of PCR efficiency for the sample and standard reference material is a prerequisite for exact quantification. Little information on the performance of real-time PCR on samples of different matrixes is available. Results Five commonly used DNA extraction techniques were compared and their suitability for quantitative analysis was assessed. The effect of sample matrix on nucleic acid quantification was assessed by comparing 4 maize and 4 soybean matrixes. In addition 205 maize and soybean samples from routine analysis were analyzed for PCR efficiency to assess variability of PCR performance within each sample matrix. Together with the amount of DNA needed for reliable quantification, PCR efficiency is the crucial parameter determining the reliability of quantitative results, therefore it was chosen as the primary

  14. Lung ultrasound in the critically ill

    PubMed Central

    2014-01-01

    Lung ultrasound is a basic application of critical ultrasound, defined as a loop associating urgent diagnoses with immediate therapeutic decisions. It requires the mastery of ten signs: the bat sign (pleural line), lung sliding (yielding seashore sign), the A-line (horizontal artifact), the quad sign, and sinusoid sign indicating pleural effusion, the fractal, and tissue-like sign indicating lung consolidation, the B-line, and lung rockets indicating interstitial syndrome, abolished lung sliding with the stratosphere sign suggesting pneumothorax, and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. All of these disorders were assessed using CT as the “gold standard” with sensitivity and specificity ranging from 90% to 100%, allowing ultrasound to be considered as a reasonable bedside “gold standard” in the critically ill. The BLUE-protocol is a fast protocol (<3 minutes), which allows diagnosis of acute respiratory failure. It includes a venous analysis done in appropriate cases. Pulmonary edema, pulmonary embolism, pneumonia, chronic obstructive pulmonary disease, asthma, and pneumothorax yield specific profiles. Pulmonary edema, e.g., yields anterior lung rockets associated with lung sliding, making the “B-profile.” The FALLS-protocol adapts the BLUE-protocol to acute circulatory failure. It makes sequential search for obstructive, cardiogenic, hypovolemic, and distributive shock using simple real-time echocardiography (right ventricle dilatation, pericardial effusion), then lung ultrasound for assessing a direct parameter of clinical volemia: the apparition of B-lines, schematically, is considered as the endpoint for fluid therapy. Other aims of lung ultrasound are decreasing medical irradiation: the LUCIFLR program (most CTs in ARDS or trauma can be postponed), a use in traumatology, intensive care unit, neonates (the signs are the same than

  15. Lung ultrasound in the critically ill.

    PubMed

    Lichtenstein, Daniel A

    2014-01-09

    Lung ultrasound is a basic application of critical ultrasound, defined as a loop associating urgent diagnoses with immediate therapeutic decisions. It requires the mastery of ten signs: the bat sign (pleural line), lung sliding (yielding seashore sign), the A-line (horizontal artifact), the quad sign, and sinusoid sign indicating pleural effusion, the fractal, and tissue-like sign indicating lung consolidation, the B-line, and lung rockets indicating interstitial syndrome, abolished lung sliding with the stratosphere sign suggesting pneumothorax, and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. All of these disorders were assessed using CT as the "gold standard" with sensitivity and specificity ranging from 90% to 100%, allowing ultrasound to be considered as a reasonable bedside "gold standard" in the critically ill. The BLUE-protocol is a fast protocol (<3 minutes), which allows diagnosis of acute respiratory failure. It includes a venous analysis done in appropriate cases. Pulmonary edema, pulmonary embolism, pneumonia, chronic obstructive pulmonary disease, asthma, and pneumothorax yield specific profiles. Pulmonary edema, e.g., yields anterior lung rockets associated with lung sliding, making the "B-profile." The FALLS-protocol adapts the BLUE-protocol to acute circulatory failure. It makes sequential search for obstructive, cardiogenic, hypovolemic, and distributive shock using simple real-time echocardiography (right ventricle dilatation, pericardial effusion), then lung ultrasound for assessing a direct parameter of clinical volemia: the apparition of B-lines, schematically, is considered as the endpoint for fluid therapy. Other aims of lung ultrasound are decreasing medical irradiation: the LUCIFLR program (most CTs in ARDS or trauma can be postponed), a use in traumatology, intensive care unit, neonates (the signs are the same than in adults

  16. H. R. 5244: a bill providing for the orderly and timely development of critical energy resources on the United States Outer Continental Shelf. Introduced in the House of Representatives, Ninety-Ninth Congress, Second Session, July 24, 1986

    SciTech Connect

    Not Available

    1986-01-01

    The Offshore Energy Security Act of 1986 provides for the orderly and timely development of critical energy resources on the Outer Continental Shelf, where estimates place 60% of US undiscovered energy resources. Current US leasing includes only 2.5% of Continental Shelf in comparison with a world figure of 30%. The legislation recognizes the impact of low oil prices on the domestic oil industry in terms of lost employment opportunities and technical expertise. The Act would stimulate exploration, development, and production to meet the economic and energy needs of the country. The Act also sets up an advisory committee to make safety recommendations.

  17. Critical illness--a lived reality for patients and their families.

    PubMed

    Foster, Jan

    2004-10-01

    This case study tells of one family's experience surrounding the diagnosis of rare cancer, where both the medical system and family struggle with a critical, largely unknown illness. The experience was complicated by communication issues between the medical profession and family, support from counselling services, and lack of information--compounded by a health system concentrated in metropolitan areas.

  18. Critical Assessment of Time-Dependent Density Functional Theory for Excited States of Open-Shell Systems: II. Doublet-Quartet Transitions.

    PubMed

    Li, Zhendong; Liu, Wenjian

    2016-06-14

    Compared with closed-shell systems, open-shell systems place three additional challenges to time-dependent density functional theory (TD-DFT) for electronically excited states: (a) the spin-contamination problem is a serious issue; (b) the exchange-correlation (XC) kernel may be numerically instable; and (c) the single-determinant description of open-shell ground states readily becomes energetically instable. Confined to flip-up single excitations, the spin-contamination problem can largely be avoided by using the spin-flip TD-DFT (SF-TD-DFT) formalism, provided that a noncollinear XC kernel is employed. As for the numerical instabilities associated with such a kernel, only an ad hoc scheme has been proposed so far, viz., the ALDA0 kernel, which amounts to setting the divergent components (arising from density gradients and kinetic energy density) simply to zero. The ground-state instability problem can effectively be avoided by introducing the Tamm-Dancoff approximation (TDA) to TD-DFT. Therefore, on a general basis, the SF-TDA/ALDA0 Ansatz is so far the only promising means within the TD-DFT framework for flip-up single excitations of open-shell systems. To assess systematically the performance of SF-TDA/ALDA0, in total 61 low-lying quartet excited states of the benchmark set of 11 small radicals [J. Chem. Theory Comput. 2016, 12, 238] are investigated with various XC functionals. Taking the MRCISD+Q (multireference configuration interaction with singles and doubles plus the Davidson correction) results as benchmark, it is found that the mean absolute errors of SF-TDA/ALDA0 with the SAOP (statistical averaging of model orbital potentials), global hybrid, and range-separated hybrid functionals are in the range of 0.2-0.4 eV. This is in line not only with the typical accuracy of TD-DFT for singlet and triplet excited states of closed-shell systems but also with the gross accuracy of spin-adapted TD-DFT for spin-conserving excited states of open-shell systems.

  19. Frequency of Pathogenic Paediatric Bacterial Meningitis in Mozambique: The Critical Role of Multiplex Real-Time Polymerase Chain Reaction to Estimate the Burden of Disease

    PubMed Central

    Nhantumbo, Aquino Albino; Cantarelli, Vlademir Vicente; Caireão, Juliana; Munguambe, Alcides Moniz; Comé, Charlotte Elizabeth; Pinto, Gabriela do Carmo; Zimba, Tomás Francisco; Mandomando, Inácio; Semá, Cynthia Baltazar; Dias, Cícero; Moraes, Milton Ozório; Gudo, Eduardo Samo

    2015-01-01

    Background In Sub-Saharan Africa, including Mozambique, acute bacterial meningitis (ABM) represents a main cause of childhood mortality. The burden of ABM is seriously underestimated because of the poor performance of culture sampling, the primary method of ABM surveillance in the region. Low quality cerebrospinal fluid (CSF) samples and frequent consumption of antibiotics prior to sample collection lead to a high rate of false-negative results. To our knowledge, this study is the first to determine the frequency of ABM in Mozambique using real-time polymerase chain reaction (qPCR) and to compare results to those of culture sampling. Method Between March 2013 and March 2014, CSF samples were collected at 3 regional hospitals from patients under 5 years of age, who met World Health Organization case definition criteria for ABM. Macroscopic examination, cytochemical study, culture, and qPCR were performed on all samples. Results A total of 369 CSF samples were collected from children clinically suspected of ABM. qPCR showed a significantly higher detection rate of ABM-causing pathogens when compared to culture (52.3% [193/369] versus 7.3% [27/369], p = 0.000). The frequency of Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococci, and Neisseria meningitidis were 32.8% (121⁄369), 12.2%, (45⁄369), 3.0% (16⁄369) and 4.3% (11⁄369), respectively, significantly higher compared to that obtained on culture (p < 0.001 for each). Conclusion Our findings demonstrate that culture is less effective for the diagnosis of ABM than qPCR. The common use of culture rather than qPCR to identify ABM results in serious underestimation of the burden of the disease, and our findings strongly suggest that qPCR should be incorporated into surveillance activities for ABM. In addition, our data showed that S. pneumoniae represents the most common cause of ABM in children under 5 years of age. PMID:26393933

  20. Perinatal undernutrition modifies cell proliferation and brain-derived neurotrophic factor levels during critical time-windows for hypothalamic and hippocampal development in the male rat.

    PubMed

    Coupé, B; Dutriez-Casteloot, I; Breton, C; Lefèvre, F; Mairesse, J; Dickes-Coopman, A; Silhol, M; Tapia-Arancibia, L; Lesage, J; Vieau, D

    2009-01-01

    Maternal perinatal undernutrition (MPU) modifies the activity of the hypothalamic-pituitary-adrenal axis and sensitises to the development of metabolic and cognitive adult diseases. Because the hypothalamus and hippocampus are involved in the regulation of neuroendocrine activity, energy metabolism and cognition, we hypothesised that a maternal 50% food restriction (FR50) from day 14 of pregnancy (E14) until postnatal day 21 (P21) would affect the development of these structures in male rat offspring. Protein and mRNA levels of brain-derived neurotrophic factor (BDNF) and cell proliferation [analysed by 5-bromodeoxyuridine (BrdU) incorporation] were compared in both control and FR50 rats from E21 to P22. Although the pattern of the evolution of BDNF concentration and cell proliferation throughout development was not strikingly different between groups, several disturbances at specific developmental stages were observed. FR50 rats exhibited a delayed increase of hippocampal BDNF content whereas, in the hypothalamus, BDNF level was augmented from E21 to P14 and associated, at this latter stage, with an increased mRNA expression of TRkB-T2. In both groups, a correlation between BDNF content and the number of BrdU positive cells was noted in the dentate gyrus, whereas opposite variations were observed in CA1, CA2 and CA3 layers, and in the arcuate and ventromedial nuclei. In the hippocampus, P15-FR50 rats showed an increased number of BrdU positive cells in all regions, whereas, at P22, a decrease was observed in the CA2. In the hypothalamus, between E21 and P8, MPU increases the number of BrdU positive cells in all regions analysed and, until P15, marked differences were noticed in the median eminence, the paraventricular nucleus and the arcuate nucleus. Taken together, the results obtained in the present study show that MPU changes the time course of production of BDNF and cell proliferation in specific hippocampal and hypothalamic areas during sensitive

  1. An introduction to critical paths.

    PubMed

    Coffey, Richard J; Richards, Janet S; Remmert, Carl S; LeRoy, Sarah S; Schoville, Rhonda R; Baldwin, Phyllis J

    2005-01-01

    A critical path defines the optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure. Critical paths are developed through collaborative efforts of physicians, nurses, pharmacists, and others to improve the quality and value of patient care. They are designed to minimize delays and resource utilization and to maximize quality of care. Critical paths have been shown to reduce variation in the care provided, facilitate expected outcomes, reduce delays, reduce length of stay, and improve cost-effectiveness. The approach and goals of critical paths are consistent with those of total quality management (TQM) and can be an important part of an organization's TQM process.

  2. Critical Pedagogy for Critical Mathematics Education

    ERIC Educational Resources Information Center

    Tutak, Fatma Aslan; Bondy, Elizabeth; Adams, Thomasenia L.

    2011-01-01

    This article provides a brief introduction to critical pedagogy and further discussion on critical mathematics education. Critical mathematics education enables students to read the world with mathematics. Three emerging domains of mathematics education related to critical mathematics education are discussed in this manuscript: ethnomathematics,…

  3. Prioritizing the Care of Critically Ill Children in South Africa: How Does SCREEN Perform Against Other Triage Tools?

    PubMed

    Hansoti, Bhakti; Hodkinson, Peter; Wallis, Lee

    2017-03-21

    Childhood mortality remains unacceptably high. In low-resource settings, children with critical illness often present for care. Current triage strategies are time consuming and require trained health care workers. To address this limitation, our team developed a simple subjective tool, SCREEN (Sick Children Require Emergency Evaluation Now), which is easy to administer, to identify critically ill children. This article presents the development of the SCREEN program and evaluates its performance when compared with other commonly implemented triage tools in low-resource settings. We measured the sensitivity and specificity of SCREEN, to identify critically ill children, compared with 4 other previously validated triage tools: the Integrated Management of Childhood Illnesses, the Pediatric Early Warning, the Pediatric South African Triage Scale, and the World Health Organization Emergency Triage Treatment Tool. SCREEN has high sensitivity (100%-98.73%; P < 0.001) and specificity (64.41%-50.71%; P < 0.001) when compared with other validated triage tools. The SCREEN tool may offer a simple and effective method to identify critically ill children in low-resource environments.

  4. CCSDS Time-Critical Onboard Networking Service

    NASA Technical Reports Server (NTRS)

    Parkes, Steve; Schnurr, Rick; Marquart, Jane; Menke, Greg; Ciccone, Massimiliano

    2006-01-01

    The Consultative Committee for Space Data Systems (CCSDS) is developing recommendations for communication services onboard spacecraft. Today many different communication buses are used on spacecraft requiring software with the same basic functionality to be rewritten for each type of bus. This impacts on the application software resulting in custom software for almost every new mission. The Spacecraft Onboard Interface Services (SOIS) working group aims to provide a consistent interface to various onboard buses and sub-networks, enabling a common interface to the application software. The eventual goal is reusable software that can be easily ported to new missions and run on a range of onboard buses without substantial modification. The system engineer will then be able to select a bus based on its performance, power, etc and be confident that a particular choice of bus will not place excessive demands on software development. This paper describes the SOIS Intra-Networking Service which is designed to enable data transfer and multiplexing of a variety of internetworking protocols with a range of quality of service support, over underlying heterogeneous data links. The Intra-network service interface provides users with a common Quality of Service interface when transporting data across a variety of underlying data links. Supported Quality of Service (QoS) elements include: Priority, Resource Reservation and Retry/Redundancy. These three QoS elements combine and map into four TCONS services for onboard data communications: Best Effort, Assured, Reserved, and Guaranteed. Data to be transported is passed to the Intra-network service with a requested QoS. The requested QoS includes the type of service, priority and where appropriate, a channel identifier. The data is de-multiplexed, prioritized, and the required resources for transport are allocated. The data is then passed to the appropriate data link for transfer across the bus. The SOIS supported data links may inherently provide the quality of service support requested by the intra-network layer. In the case where the data link does not have the required level of support, the missing functionality is added by SOIS. As a result of this architecture, re-usable software applications can be designed and used across missions thereby promoting common mission operations. In addition, the protocol multiplexing function enables the blending of multiple onboard networks. This paper starts by giving an overview of the SOIS architecture in section 11, illustrating where the TCONS services fit into the overall architecture. It then describes the quality of service approach adopted, in section III. The prototyping efforts that have been going on are introduced in section JY. Finally, in section V the current status of the CCSDS recommendations is summarized.

  5. Critical Choices in a Time of Austerity

    DTIC Science & Technology

    2014-04-30

    Martin’s Automatic Identification Technology implementation, including RFID and UID. After successfully completing eight pilot projects, Kratz is now...guiding Lockheed Martin’s enterprise implementation of RFID . He also guides Lockheed Martin’s logistics strategic planning, performance-based

  6. Deconfined Quantum Critical Points

    NASA Astrophysics Data System (ADS)

    Senthi, T.; Vishwanath, Ashvin; Balents, Leon; Sachdev, Subir; Fisher, Matthew P. A.

    The theory of second-order phase transitions is one of the foundations of modern statistical mechanics and condensed-matter theory. A central concept is the observable order parameter, whose nonzero average value characterizes one or more phases. At large distances and long times, fluctuations of the order parameter(s) are described by a continuum field theory, and these dominate the physics near such phase transitions. We show that near second-order quantum phase transitions, subtle quantum interference effects can invalidate this paradigm, and we present a theory of quantum critical points in a variety of experimentally relevant two-dimensional antiferromagnets. The critical points separate phases characterized by conventional "confining" order parameters. Nevertheless, the critical theory contains an emergent gauge field and "deconfined" degrees of freedom associated with fractionalization of the order parameters. We propose that this paradigm for quantum criticality may be the key to resolving a number of experimental puzzles in correlated electron systems and offer a new perspective on the properties of complex materials.

  7. Deconfined quantum critical points.

    PubMed

    Senthil, T; Vishwanath, Ashvin; Balents, Leon; Sachdev, Subir; Fisher, Matthew P A

    2004-03-05

    The theory of second-order phase transitions is one of the foundations of modern statistical mechanics and condensed-matter theory. A central concept is the observable order parameter, whose nonzero average value characterizes one or more phases. At large distances and long times, fluctuations of the order parameter(s) are described by a continuum field theory, and these dominate the physics near such phase transitions. We show that near second-order quantum phase transitions, subtle quantum interference effects can invalidate this paradigm, and we present a theory of quantum critical points in a variety of experimentally relevant two-dimensional antiferromagnets. The critical points separate phases characterized by conventional "confining" order parameters. Nevertheless, the critical theory contains an emergent gauge field and "deconfined" degrees of freedom associated with fractionalization of the order parameters. We propose that this paradigm for quantum criticality may be the key to resolving a number of experimental puzzles in correlated electron systems and offer a new perspective on the properties of complex materials.

  8. Critical care unit organization and patient outcomes.

    PubMed

    Hass, Brian D

    2005-01-01

    The delivery of critical care medicine has seen many advances and changes over a relatively short period of time. This article explores some of the models of critical care delivery and the implications of these models on patient outcomes.

  9. Barriers to exercise prescription and participation in people with mental illness: the perspectives of nurses working in mental health.

    PubMed

    Stanton, R; Reaburn, P; Happell, B

    2015-08-01

    Exercise is valuable in the treatment of mental illness, yet personal and organizational barriers limit widespread implementation by nurses in mental health settings. Using a self-report questionnaire, we sought to identify how often nurses prescribe exercise and their level of agreement with previously identified barriers to exercise prescription and participation for mental health consumers. Nurses disagree that many of the previously identified barriers should impede exercise prescription for people with mental illness. Nurses agree that many of the barriers expressed by mental health consumers might prevent exercise participation. Our study provides valuable new insight into the role of nurses in the provision of exercise for people with mental illness; however, it is limited to a small sample. Confirmation of these findings in larger, geographically and professionally diverse groups is needed. Evidence is mounting for the efficacy of exercise in the treatment of people with mental illness. Nurses working in mental health settings are well placed to provide exercise advice for people with mental illness. However, quantitative examinations of the barriers to exercise prescription experienced by nurses, or their views regarding the barriers to exercise participation experienced by people with mental illness, are lacking. In this study, 34 nurses completed the Exercise in Mental Illness Questionnaire-Health Professionals Version (EMIQ-HP). This survey examined the frequency of exercise prescription and the level of agreement with statements regarding barriers to exercise prescription for, and exercise participation by, people with mental illness. The level of agreement scores for statements for each section was summed, with a higher score indicating a higher level of agreement. Nurses disagree with many of the barriers to exercise prescription presented in the literature. The level of agreement scores did not differ between nurses who prescribe exercise 'Always

  10. Critical Viewing: Stimulant to Critical Thinking.

    ERIC Educational Resources Information Center

    O'Reilly, Kevin; Splaine, John

    This document is intended to improve the critical viewing skills and increase the understanding and appreciation of what is viewed. Included are the chapters: (1) "Critical Thinking: The Parts of an Argument," intended to develop a process to help a person judge arguments in what is read, seen, and heard; (2) "Critical Viewing:…

  11. Critical thinking in nurse managers.

    PubMed

    Zori, Susan; Morrison, Barbara

    2009-01-01

    Formal education and support is needed for nurse managers to effectively function in their role in the current health care environment. Many nurse managers assume their positions based on expertise in a clinical role with little expertise in managerial and leadership skills. Operating as a manager and leader requires ongoing development of critical thinking skills and the inclination to use those skills. Critical thinking can have a powerful influence on the decision making and problem solving that nurse managers are faced with on a daily basis. The skills that typify critical thinking include analysis, evaluation, inference, and deductive and inductive reasoning. It is intuitive that nurse managers require both the skills and the dispositions of critical thinking to be successful in this pivotal role at a time of transformation in health care. Incorporating critical thinking into education and support programs for the nurse manager is necessary to position the nurse manager for success.

  12. Gradient liquid chromatographic retention time prediction for suspect screening applications: A critical assessment of a generalised artificial neural network-based approach across 10 multi-residue reversed-phase analytical methods.

    PubMed

    Barron, Leon P; McEneff, Gillian L

    2016-01-15

    For the first time, the performance of a generalised artificial neural network (ANN) approach for the prediction of 2492 chromatographic retention times (tR) is presented for a total of 1117 chemically diverse compounds present in a range of complex matrices and across 10 gradient reversed-phase liquid chromatography-(high resolution) mass spectrometry methods. Probabilistic, generalised regression, radial basis function as well as 2- and 3-layer multilayer perceptron-type neural networks were investigated to determine the most robust and accurate model for this purpose. Multi-layer perceptrons most frequently yielded the best correlations in 8 out of 10 methods. Averaged correlations of predicted versus measured tR across all methods were R(2)=0.918, 0.924 and 0.898 for the training, verification and test sets respectively. Predictions of blind test compounds (n=8-84 cases) resulted in an average absolute accuracy of 1.02±0.54min for all methods. Within this variation, absolute accuracy was observed to marginally improve for shorter runtimes, but was found to be relatively consistent with respect to analyte retention ranges (~5%). Finally, optimised and replicated network dependency on molecular descriptor data is presented and critically discussed across all methods. Overall, ANNs were considered especially suitable for suspects screening applications and could potentially be utilised in bracketed-type analyses in combination with high resolution mass spectrometry.

  13. Self-organized criticality

    NASA Astrophysics Data System (ADS)

    Turcotte, Donald L.

    1999-10-01

    The concept of self-organized criticality was introduced to explain the behaviour of the sandpile model. In this model, particles are randomly dropped onto a square grid of boxes. When a box accumulates four particles they are redistributed to the four adjacent boxes or lost off the edge of the grid. Redistributions can lead to further instabilities with the possibility of more particles being lost from the grid, contributing to the size of each avalanche. These model 'avalanches' satisfied a power-law frequency-area distribution with a slope near unity. Other cellular-automata models, including the slider-block and forest-fire models, are also said to exhibit self-organized critical behaviour. It has been argued that earthquakes, landslides, forest fires, and species extinctions are examples of self-organized criticality in nature. In addition, wars and stock market crashes have been associated with this behaviour. The forest-fire model is particularly interesting in terms of its relation to the critical-point behaviour of the site-percolation model. In the basic forest-fire model, trees are randomly planted on a grid of points. Periodically in time, sparks are randomly dropped on the grid. If a spark drops on a tree, that tree and adjacent trees burn in a model fire. The fires are the `avalanches' and they are found to satisfy power-law frequency-area distributions with slopes near unity. This forest-fire model is closely related to the site-percolation model, that exhibits critical behaviour. In the forest-fire model there is an inverse cascade of trees from small clusters to large clusters, trees are lost primarily from model fires that destroy the largest clusters. This quasi steady-state cascade gives a power-law frequency-area distribution for both clusters of trees and smaller fires. The site-percolation model is equivalent to the forest-fire model without fires. In this case there is a transient cascade of trees from small to large clusters and a power

  14. Critical Materials Institute

    ScienceCinema

    Alex King

    2016-07-12

    Ames Laboratory Director Alex King talks about the goals of the Critical Materials Institute in diversifying the supply of critical materials, developing substitute materials, developing tools and techniques for recycling critical materials, and forecasting materials needs to avoid future shortages.

  15. Critical Materials Institute

    SciTech Connect

    Alex King

    2013-01-09

    Ames Laboratory Director Alex King talks about the goals of the Critical Materials Institute in diversifying the supply of critical materials, developing substitute materials, developing tools and techniques for recycling critical materials, and forecasting materials needs to avoid future shortages.

  16. Critical Pedagogy for Transformative Optimism

    ERIC Educational Resources Information Center

    Mayo, Peter

    2006-01-01

    This essay critically highlights the main features of a study that attaches importance to the concepts of time and optimism and their effects on the achievement and goals of high and low achievers in a North American and a Brazilian context. The focus on the time factor that serves as a leitmotif throughout the study gives this work its…

  17. Suicide Clusters: A Critical Review.

    ERIC Educational Resources Information Center

    Gould, Madelyn S.; And Others

    1989-01-01

    Critically reviews anecdotal reports and ongoing research on suicide. Describes ongoing studies which use psychological autopsies of cluster outbreaks and statistical analyses of time and space clustering of suicides. Concludes that both anecdotal case reports and epidemiologic research suggest that significant time-space clustering of suicide…

  18. Critical Pedagogy for Transformative Optimism

    ERIC Educational Resources Information Center

    Mayo, Peter

    2006-01-01

    This essay critically highlights the main features of a study that attaches importance to the concepts of time and optimism and their effects on the achievement and goals of high and low achievers in a North American and a Brazilian context. The focus on the time factor that serves as a leitmotif throughout the study gives this work its…

  19. Critical Learning Skills for Business Students

    ERIC Educational Resources Information Center

    Jance, Marsha; Morgan, Anita

    2013-01-01

    A survey addressing critical skills for business students was developed and disseminated. Sixteen critical skills (such as critical thinking and time management) were identified as skills that need to be acquired in order for business students to be successful in their advanced courses and careers. The survey was disseminated and taken by several…

  20. Nuclear criticality safety guide

    SciTech Connect

    Pruvost, N.L.; Paxton, H.C.

    1996-09-01

    This technical reference document cites information related to nuclear criticality safety principles, experience, and practice. The document also provides general guidance for criticality safety personnel and regulators.

  1. The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill

    PubMed Central

    Friedrich, O.; Reid, M. B.; Van den Berghe, G.; Vanhorebeek, I.; Hermans, G.; Rich, M. M.; Larsson, L.

    2015-01-01

    Critical illness polyneuropathies (CIP) and myopathies (CIM) are common complications of critical illness. Several weakness syndromes are summarized under the term intensive care unit-acquired weakness (ICUAW). We propose a classification of different ICUAW forms (CIM, CIP, sepsis-induced, steroid-denervation myopathy) and pathophysiological mechanisms from clinical and animal model data. Triggers include sepsis, mechanical ventilation, muscle unloading, steroid treatment, or denervation. Some ICUAW forms require stringent diagnostic features; CIM is marked by membrane hypoexcitability, severe atrophy, preferential myosin loss, ultrastructural alterations, and inadequate autophagy activation while myopathies in pure sepsis do not reproduce marked myosin loss. Reduced membrane excitability results from depolarization and ion channel dysfunction. Mitochondrial dysfunction contributes to energy-dependent processes. Ubiquitin proteasome and calpain activation trigger muscle proteolysis and atrophy while protein synthesis is impaired. Myosin loss is more pronounced than actin loss in CIM. Protein quality control is altered by inadequate autophagy. Ca2+ dysregulation is present through altered Ca2+ homeostasis. We highlight clinical hallmarks, trigger factors, and potential mechanisms from human studies and animal models that allow separation of risk factors that may trigger distinct mechanisms contributing to weakness. During critical illness, altered inflammatory (cytokines) and metabolic pathways deteriorate muscle function. ICUAW prevention/treatment is limited, e.g., tight glycemic control, delaying nutrition, and early mobilization. Future challenges include identification of primary/secondary events during the time course of critical illness, the interplay between membrane excitability, bioenergetic failure and differential proteolysis, and finding new therapeutic targets by help of tailored animal models. PMID:26133937

  2. Productive criticism. Part 1: Criticism that works.

    PubMed

    Weisinger, H D

    1995-01-01

    Criticism affects almost all aspects of your job: the quality of work you do, how you feel about your performance, and your relationships with your boss, coworkers, and subordinates. Used productively, criticism is a powerful tool that helps you improve your work, enhance your working relationships, increase your job satisfaction, and achieve better overall results. Improperly used, it impedes performance, demoralizes you, discourages you from wanting to try again, and creates friction in the workplace. In short, the ability to give and take criticism significantly determines how well you do on the job. In Part I, we will examine the traditional negative approach to criticism and develop new management tools to turn criticism into an opportunity for growth and education. By explaining new evaluation and communication techniques, we will show the reader how to use productive criticism to increase job performance and satisfaction.

  3. Critical diagnoses (critical values) in anatomic pathology.

    PubMed

    Silverman, Jan F; Fletcher, Christopher D M; Frable, William J; Goldblum, John R; Pereira, Telma C; Swanson, Paul E

    2006-08-01

    Similar to critical values in clinical pathology, occasional diagnoses in surgical pathology and cytology may require urgent contact of the physician to facilitate rapid intervention or treatment. However, there are no established critical value (critical diagnosis) guidelines in anatomic pathology. As discussed herein, the Association of Directors of Anatomic and Surgical Pathology (ADASP) believes that establishing anatomic pathology critical diagnosis guidelines represents a practice improvement and patient safety initiative. The ADASP also recognizes that a generic anatomic pathology critical diagnosis guideline such as this should only be used as a template because the list needs to be customized at each individual hospital after consultation with relevant clinical services. Based on surveys of the membership of the ADASP, this document provides examples of possible critical diagnoses in anatomic pathology.

  4. Critical diagnoses (critical values) in anatomic pathology.

    PubMed

    Silverman, Jan F

    2006-06-01

    Similar to critical values in clinical pathology, occasional diagnoses in surgical pathology and cytology may require urgent contact of the physician to facilitate rapid intervention or treatment. However, there are no established critical value (critical diagnosis) guidelines in anatomic pathology. As discussed herein, the Association of Directors of Anatomic and Surgical Pathology (ADASP) believes that establishing anatomic pathology critical diagnosis guidelines represents a practice improvement and patient safety initiative. ADASP also recognizes that a generic anatomic pathology critical diagnosis guideline such as this should be used only as a template because the list needs to be customized at each individual hospital following consultation with relevant clinical services. Based on surveys of the membership of the ADASP, this document provides examples of possible critical diagnoses in anatomic pathology.

  5. Critical diagnoses (critical values) in anatomic pathology.

    PubMed

    2006-07-01

    Similar to critical values in clinical pathology, occasional diagnoses in surgical pathology and cytology may require urgent contact of the physician to facilitate rapid intervention or treatment. However, there are no established critical value (critical diagnosis) guidelines in anatomic pathology. As discussed herein, the Association of Directors of Anatomic and Surgical Pathology (ADASP) believes that establishing anatomic pathology critical diagnosis guidelines represents a practice improvement and patient safety initiative. ADASP also recognizes that a generic anatomic pathology critical diagnosis guideline such as this should only be used as a template, because the list needs to be customized at each individual hospital after consultation with relevant clinical services. Based on surveys of the membership of the ADASP, this document provides examples of possible critical diagnoses in anatomic pathology.

  6. Design of Critical Components

    NASA Technical Reports Server (NTRS)

    Hendricks, Robert C.; Zaretsky, Erwin V.

    2001-01-01

    Critical component design is based on minimizing product failures that results in loss of life. Potential catastrophic failures are reduced to secondary failures where components removed for cause or operating time in the system. Issues of liability and cost of component removal become of paramount importance. Deterministic design with factors of safety and probabilistic design address but lack the essential characteristics for the design of critical components. In deterministic design and fabrication there are heuristic rules and safety factors developed over time for large sets of structural/material components. These factors did not come without cost. Many designs failed and many rules (codes) have standing committees to oversee their proper usage and enforcement. In probabilistic design, not only are failures a given, the failures are calculated; an element of risk is assumed based on empirical failure data for large classes of component operations. Failure of a class of components can be predicted, yet one can not predict when a specific component will fail. The analogy is to the life insurance industry where very careful statistics are book-kept on classes of individuals. For a specific class, life span can be predicted within statistical limits, yet life-span of a specific element of that class can not be predicted.

  7. A Critical Humanist Curriculum

    ERIC Educational Resources Information Center

    Magill, Kevin; Rodriguez, Arturo

    2015-01-01

    This essay is a critical humanist discussion of curriculum; a departure from the technicist view of education [education meant to support a global capitalist economy] and an analysis of curriculum considering critical humanism, political economy and critical race theory among other modes of critical analysis and inquiry. Our discussion supports a…

  8. Critical Thinking Skills.

    ERIC Educational Resources Information Center

    Word's Worth: A Quarterly Newsletter of the Lifelong Learning Network, 1998

    1998-01-01

    This issue of a quarterly newsletter focuses on the theme of critical thinking skills. "Critical Thinking Skills: An Interview with Dr. Richard Paul" (Barbara Christopher) is the text of an interview in which the director of research at Sonoma State University's Center for Critical Thinking examines the meaning of critical thinking and…

  9. A Critical Humanist Curriculum

    ERIC Educational Resources Information Center

    Magill, Kevin; Rodriguez, Arturo

    2015-01-01

    This essay is a critical humanist discussion of curriculum; a departure from the technicist view of education [education meant to support a global capitalist economy] and an analysis of curriculum considering critical humanism, political economy and critical race theory among other modes of critical analysis and inquiry. Our discussion supports a…

  10. The critical care literature 2016.

    PubMed

    Winters, Michael E; Martinez, Joseph P; Mallemat, Haney; Brady, William J

    2017-10-01

    An emergency physician (EP) is often the first health care provider to evaluate, resuscitate, and manage a critically ill patient. Between 2001 and 2009, the annual hours of critical care delivered in emergency departments (EDs) across the United States increased >200%! (Herring et al., 2013). This trend has persisted since then. In addition to seeing more critically ill patients, EPs are often tasked with providing critical care long beyond the initial resuscitation period. In fact, >33% of critically ill patients who are brought to an ED remain there for >6h (Herring et al., 2013). During these crucial early hours of illness, detrimental pathophysiologic processes begin to take hold. During this time, lives can be saved or lost. Therefore, it is important for the EP to be knowledgeable about recent developments in critical care medicine. This review summarizes important articles published in 2016 pertaining to the care of select critically ill patients in the ED. The following topics are covered: intracerebral hemorrhage, traumatic brain injury, anti-arrhythmic therapy in cardiac arrest, therapeutic hypothermia, mechanical ventilation, sepsis, and septic shock. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. The use of health care services: is illness the only motivator?

    PubMed

    Gould, S J

    1989-01-01

    Increasingly, consumer researchers and marketers have turned their attention to the marketing of health care services. In that vein, this paper addresses the question of what determines a consumer's use of these services. Through a review of relevant studies, an examination is made of such factors as illness, social and behavioral variables, and changing attitudes toward health, which have been prompted by various social movements. It is concluded that while illness is a critical factor in the use of health care services, other factors are playing an increasingly important role. Strategic marketing implications are offered as to how health care marketers should address the illness factor in the promotion and delivery of care services. Finally, future research directions are suggested which would help to define and gauge the role of illness in the consumption and strategic marketing of health care services.

  12. Revalorizing the Critical Attitude for Critical Education

    ERIC Educational Resources Information Center

    Amsler, Sarah S.

    2011-01-01

    This article argues that at a moment of crisis in education, the defence of critical pedagogy is vitally important. However, it also suggests that such a defence should be more than a "cri de coeur" that asserts principles and methods of criticality against those of neoliberal or conservative education policy. Narratives of a totalising "crisis of…

  13. A Critical Look into Critical Pedagogy

    ERIC Educational Resources Information Center

    Pishghadam, Reza; Meidani, Elham Naji

    2012-01-01

    In line with postmodern philosophy, critical pedagogy has gained considerable importance and has become a valuable educational goal. The purpose of this study is to dig into the effects of critical pedagogy in a modernist educational system. To this aim, 15 Iranian university students were asked to write down their feelings at the end of a course…

  14. Critical Thinking and the Critical Person.

    ERIC Educational Resources Information Center

    Paul, Richard W.

    The paper's purpose is to clarify and develop some theoretical and practical implications of the concept of critical thinking, and the field of social studies is used as one example of the problem. The work of four leading critical theorists (Robert Ennis, Harvey Siegel, Michael Scriven, and R. S. Peters) is described and a distinction is made…

  15. Autism: a "critical period" disorder?

    PubMed

    LeBlanc, Jocelyn J; Fagiolini, Michela

    2011-01-01

    Cortical circuits in the brain are refined by experience during critical periods early in postnatal life. Critical periods are regulated by the balance of excitatory and inhibitory (E/I) neurotransmission in the brain during development. There is now increasing evidence of E/I imbalance in autism, a complex genetic neurodevelopmental disorder diagnosed by abnormal socialization, impaired communication, and repetitive behaviors or restricted interests. The underlying cause is still largely unknown and there is no fully effective treatment or cure. We propose that alteration of the expression and/or timing of critical period circuit refinement in primary sensory brain areas may significantly contribute to autistic phenotypes, including cognitive and behavioral impairments. Dissection of the cellular and molecular mechanisms governing well-established critical periods represents a powerful tool to identify new potential therapeutic targets to restore normal plasticity and function in affected neuronal circuits.

  16. How critical is chronic critical leg ischaemia?

    PubMed

    Kroese, A J; Stranden, E

    1998-01-01

    "Critical" according to the Oxford dictionary means: a "turning point" where an acute change for better or worse may be anticipated. Thus, the meaning of the word "critical" complies with its use in relation to ischaemia. We don't really know, prospectively, what will happen to the critically ischaemic limb, whether it will improve or worsen. The answer to the question "How critical is critical leg ischaemia (CLI)?" must be: "We don't know!" The addition of ankle systolic pressure as an objective haemodynamic measurement has not made the definition of the Second European Consensus Group significantly better than the original Fontaine classification, grade III and IV. For clinical practice the Fontaine classification will be sufficient. For scientific purposes macro- and microcirculatory assessments and information about the patient's risk profile should be added.

  17. Leader as critical thinker.

    PubMed

    Lemire, Judith A

    2002-01-01

    A leader possess the critical-thinking knowledge and skills that provide the framework from which complex problem solving evolves. This article explores the leader as critical thinker, including a progressive plan for integrating critical-thinking concepts and associated teaching strategies into the RN to BSN and graduate curricula. To improve the critical thinking of nurses, educators must emphasize the cognitive and disposition aspects of critical thinking; promote active and sequential learning; role model critical thinking; design practical that focus on leadership and critical thinking; and conduct valid and consistent evaluations. The acquisition and application of critical thinking and problem-solving skills are progressive and refined through life-long learning and experience. This expertise begins with a sound knowledge base of the critical thinking composite and problem-solving strategies.

  18. Safety Critical Mechanisms

    NASA Technical Reports Server (NTRS)

    Robertson, Brandan

    2008-01-01

    Spaceflight mechanisms have a reputation for being difficult to develop and operate successfully. This reputation is well earned. Many circumstances conspire to make this so: the environments in which the mechanisms are used are extremely severe, there is usually limited or no maintenance opportunity available during operation due to this environment, the environments are difficult to replicate accurately on the ground, the expense of the mechanism development makes it impractical to build and test many units for long periods of time before use, mechanisms tend to be highly specialized and not prone to interchangeability or off-the-shelf use, they can generate and store a lot of energy, and the nature of mechanisms themselves, as a combination of structures, electronics, etc. designed to accomplish specific dynamic performance, makes them very complex and subject to many unpredictable interactions of many types. In addition to their complexities, mechanism are often counted upon to provide critical vehicle functions that can result in catastrophic events should the functions not be performed. It is for this reason that mechanisms are frequently subjected to special scrutiny in safety processes. However, a failure tolerant approach, along with good design and development practices and detailed design reviews, can be developed to allow such notoriously troublesome mechanisms to be utilized confidently in safety-critical applications.

  19. [Nutrition in critical illness].

    PubMed

    Ökrös, Ilona

    2014-12-21

    Critically ill patients are often unable to eat by themselves over a long period of time, sometimes for weeks. In the acute phase, serious protein-energy malnutrition may develop with progressive muscle weakness, which may result in assisted respiration of longer duration as well as longer stay in intensive care unit and hospital. In view of the metabolic processes, energy and protein intake targets should be defined and the performance of metabolism should be monitored. Enteral nutrition is primarily recommended. However, parenteral supplementation is often necessary because of the disrupted tolerance levels of the gastrointestinal system. Apparently, an early parenteral supplementation started within a week would be of no benefit. Some experts believe that muscle loss can be reduced by increased target levels of protein. Further studies are needed on the effect of immune system feeding, fatty acids and micronutrients.

  20. Critical Infrastructure Modeling System

    SciTech Connect

    2004-10-01

    The Critical Infrastructure Modeling System (CIMS) is a 3D modeling and simulation environment designed to assist users in the analysis of dependencies within individual infrastructure and also interdependencies between multiple infrastructures. Through visual cuing and textual displays, a use can evaluate the effect of system perturbation and identify the emergent patterns that evolve. These patterns include possible outage areas from a loss of power, denial of service or access, and disruption of operations. Method of Solution: CIMS allows the user to model a system, create an overlay of information, and create 3D representative images to illustrate key infrastructure elements. A geo-referenced scene, satellite, aerial images or technical drawings can be incorporated into the scene. Scenarios of events can be scripted, and the user can also interact during run time to alter system characteristics. CIMS operates as a discrete event simulation engine feeding a 3D visualization.

  1. Time Urgency, Load and Managerial Decision Making,

    DTIC Science & Technology

    1981-02-01

    AD-A95 969 MILTON S HERSHEY M4EDICAL CENTER HERSHEY PA DEPT OF BE-ETC F/G 5/10 TIME URGENCY , LOAD AND MANAGERIAL DECISION MAKING. (U)AA: FEB 81 S...input, output, managers, planning, problem solving, retaliatory behavior, simulation, strategy, time urgency , Type A 20. ABSTRACT (Continue on revere...intermediate information load stressor levels. ILL. The present research cottsiders time urgency as an additional variable. Time urgency has been shown

  2. Man and Machines: Three Criticisms.

    ERIC Educational Resources Information Center

    Schneider, Edward F.

    As machines have become a more common part of daily life through the passage of time, the idea that the line separating man and machine is slowly fading has become more popular as well. This paper examines three critics of change through their most famous works. One of the most popular views of Mary Shelley's "Frankenstein" is that it is a…

  3. Innovations and Organizations: Critical Perspectives.

    ERIC Educational Resources Information Center

    Van de Ven, Andrew H.; Rogers, Everett M.

    1988-01-01

    Presents an overview of research on innovations and organizations. Criticizes past research and calls for a focus on process research in future investigations, moving from a stage-by-stage conception of the innovation process to a dynamic, continuous conception in which the variables involved are sequenced and analyzed through time. (SR)

  4. Anomalous critical fields in quantum critical superconductors

    PubMed Central

    Putzke, C.; Walmsley, P.; Fletcher, J. D.; Malone, L.; Vignolles, D.; Proust, C.; Badoux, S.; See, P.; Beere, H. E.; Ritchie, D. A.; Kasahara, S.; Mizukami, Y.; Shibauchi, T.; Matsuda, Y.; Carrington, A.

    2014-01-01

    Fluctuations around an antiferromagnetic quantum critical point (QCP) are believed to lead to unconventional superconductivity and in some cases to high-temperature superconductivity. However, the exact mechanism by which this occurs remains poorly understood. The iron-pnictide superconductor BaFe2(As1−xPx)2 is perhaps the clearest example to date of a high-temperature quantum critical superconductor, and so it is a particularly suitable system to study how the quantum critical fluctuations affect the superconducting state. Here we show that the proximity of the QCP yields unexpected anomalies in the superconducting critical fields. We find that both the lower and upper critical fields do not follow the behaviour, predicted by conventional theory, resulting from the observed mass enhancement near the QCP. Our results imply that the energy of superconducting vortices is enhanced, possibly due to a microscopic mixing of antiferromagnetism and superconductivity, suggesting that a highly unusual vortex state is realized in quantum critical superconductors. PMID:25477044

  5. Dose-response effect of ergocalciferol therapy on serum 25-hydroxyvitamin D concentration during critical illness.

    PubMed

    Dickerson, Roland N; Berry, Scott C; Ziebarth, Jamie D; Swanson, Joseph M; Maish, George O; Minard, Gayle; Brown, Rex O

    2015-10-01

    The aim of this study was to evaluate the dose-response relationship between ergocalciferol therapy and serum 25-hydroxyvitamin D concentrations in enterally fed, critically ill patients with traumatic injuries. A retrospective cohort of critically ill patients with traumatic injuries and vitamin D deficiency (25-OH vitamin D <50 nmol/L) were given either 50 000 IU of liquid ergocalciferol weekly, twice weekly, or three times weekly while in the intensive care unit (ICU). Serum 25-OH vitamin D and ionized calcium concentrations were monitored weekly. Ergocalciferol therapy was stopped when the serum 25-OH vitamin D was >75 nmol/L, if the patient experienced hypercalcemia (ionized calcium >1.34 mmol/L), when the patient was discharged from the ICU, or if enteral nutrition was discontinued. Sixty-five patients (16, 18, and 31 per dosage group) were examined. One (6%), two (11%), and eight (26%) patients achieved normal 25-OH vitamin D concentrations after 2 to 4 wk of ergocalciferol therapy for each dosage group, respectively (P < 0.001). Serum 25-OH vitamin D concentrations improved from 36 ± 6, 40 ± 7, and 37 ± 6 nmol/L to 50 ± 15, 54 ± 21, and 62 ± 17 nmol/L, respectively, after 2 wk of ergocalciferol therapy (P < 0.001) Two (13%), one (6%), and seven (23%) patients developed hypercalcemia for each dosage group, respectively (P = NS). Ergocalciferol therapy improved baseline serum 25-OH vitamin D concentrations but was inadequate for consistently achieving normal serum concentrations of 25-OH vitamin D during critical illness. The trend in increasing appearance of mild hypercalcemia for the highest dosage group is concerning. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Toward critical bioethics.

    PubMed

    Árnason, Vilhjálmur

    2015-04-01

    This article deals with the question as to what makes bioethics a critical discipline. It considers different senses of criticism and evaluates their strengths and weaknesses. A primary method in bioethics as a philosophical discipline is critical thinking, which implies critical evaluation of concepts, positions, and arguments. It is argued that the type of analytical criticism that restricts its critical role to critical thinking of this type often suffers from other intellectual flaws. Three examples are taken to demonstrate this: premature criticism, uncritical self-understanding of theoretical assumptions, and narrow framing of bioethical issues. Such flaws can lead both to unfair treatment of authors and to uncritical discussion of topics. In this context, the article makes use of Häyry's analysis of different rationalities in bioethical approaches and argues for the need to recognize the importance of communicative rationality for critical bioethics. A radically different critical approach in bioethics, rooted in social theory, focuses on analyses of power relations neglected in mainstream critical thinking. It is argued that, although this kind of criticism provides an important alternative in bioethics, it suffers from other shortcomings that are rooted in a lack of normative dimensions. In order to complement these approaches and counter their shortcomings, there is a need for a bioethics enlightened by critical hermeneutics. Such hermeneutic bioethics is aware of its own assumptions, places the issues in a wide context, and reflects critically on the power relations that stand in the way of understanding them. Moreover, such an approach is dialogical, which provides both a critical exercise of speech and a normative dimension implied in the free exchange of reasons and arguments. This discussion is framed by Hedgecoe's argument that critical bioethics needs four elements: to be empirically rooted, theory challenging, reflexive, and politely skeptical.

  7. Antibiotic dose optimization in critically ill patients.

    PubMed

    Cotta, M O; Roberts, J A; Lipman, J

    2015-12-01

    The judicious use of existing antibiotics is essential for preserving their activity against infections. In the era of multi-drug resistance, this is of particular importance in clinical areas characterized by high antibiotic use, such as the ICU. Antibiotic dose optimization in critically ill patients requires sound knowledge not only of the altered physiology in serious infections - including severe sepsis, septic shock and ventilator-associated pneumonia - but also of the pathogen-drug exposure relationship (i.e. pharmacokinetic/pharmacodynamic index). An important consideration is the fact that extreme shifts in organ function, such as those seen in hyperdynamic patients or those with multiple organ dysfunction syndrome, can have an impact upon drug exposure, and constant vigilance is required when reviewing antibiotic dosing regimens in the critically ill. The use of continuous renal replacement therapy and extracorporeal membrane oxygenation remain important interventions in these patients; however, both of these treatments can have a profound effect on antibiotic exposure. We suggest placing emphasis on the use of therapeutic drug monitoring and dose individualization when optimizing therapy in these settings. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  8. Reimagining Critical Theory

    ERIC Educational Resources Information Center

    Rexhepi, Jevdet; Torres, Carlos Alberto

    2011-01-01

    This paper discusses Critical Theory, a model of theorizing in the field of the political sociology of education. We argue for a "reimagined" Critical Theory to herald an empowering, liberatory education that fosters curiosity and critical thinking, and a means for successful bottom-up, top-down political engagement. We present arguments…

  9. Creating a Critical Thinker

    ERIC Educational Resources Information Center

    Piergiovanni, Polly R.

    2014-01-01

    A college education is expected to improve students' critical thinking skills. Keeping students active in class--through writing activities and class discussion--has been shown to help students think critically. In this article, creative hands-on activities, which are common in engineering courses, are shown to improve students' critical thinking…

  10. Foundations for Critical Thinking

    ERIC Educational Resources Information Center

    Bers, Trudy; Chun, Marc; Daly, William T.; Harrington, Christine; Tobolowsky, Barbara F.

    2015-01-01

    "Foundations for Critical Thinking" explores the landscape of critical-thinking skill development and pedagogy through foundational chapters and institutional case studies involving a range of students in diverse settings. By establishing a link between active learning and improved critical thinking, this resource encourages all higher…

  11. Reconceptualising Critical Digital Literacy

    ERIC Educational Resources Information Center

    Pangrazio, Luciana

    2016-01-01

    While it has proved a useful concept during the past 20 years, the notion of "critical digital literacy" requires rethinking in light of the fast-changing nature of young people's digital practices. This paper contrasts long-established notions of "critical digital literacy" (based primarily around the critical consumption of…

  12. Reconceptualising Critical Digital Literacy

    ERIC Educational Resources Information Center

    Pangrazio, Luciana

    2016-01-01

    While it has proved a useful concept during the past 20 years, the notion of "critical digital literacy" requires rethinking in light of the fast-changing nature of young people's digital practices. This paper contrasts long-established notions of "critical digital literacy" (based primarily around the critical consumption of…

  13. Poetry: Sources for Criticism.

    ERIC Educational Resources Information Center

    Van Noate, Judith, Comp.

    This handout is a guide to library resources in the J. Murrey Atkins Library at the University of North Carolina-Charlotte for the criticism of poetry. The guide enables the reader to find sources of criticism on poetry, including critical articles and essays about single poems, or writings on the work of a single author. The guide's sections…

  14. Teaching Critical Reflection

    ERIC Educational Resources Information Center

    Smith, Elizabeth

    2011-01-01

    Despite long-standing commitment to the notion of critical reflection across the healthcare professions it is unusual for critical theory and practice to be taught as explicit subjects in healthcare higher education. There is evidence to show that reflective techniques such as critical portfolios and reflective diaries can help students to…

  15. Creating a Critical Thinker

    ERIC Educational Resources Information Center

    Piergiovanni, Polly R.

    2014-01-01

    A college education is expected to improve students' critical thinking skills. Keeping students active in class--through writing activities and class discussion--has been shown to help students think critically. In this article, creative hands-on activities, which are common in engineering courses, are shown to improve students' critical thinking…

  16. Teaching Critical Reflection

    ERIC Educational Resources Information Center

    Smith, Elizabeth

    2011-01-01

    Despite long-standing commitment to the notion of critical reflection across the healthcare professions it is unusual for critical theory and practice to be taught as explicit subjects in healthcare higher education. There is evidence to show that reflective techniques such as critical portfolios and reflective diaries can help students to…

  17. Foundations for Critical Thinking

    ERIC Educational Resources Information Center

    Bers, Trudy; Chun, Marc; Daly, William T.; Harrington, Christine; Tobolowsky, Barbara F.

    2015-01-01

    "Foundations for Critical Thinking" explores the landscape of critical-thinking skill development and pedagogy through foundational chapters and institutional case studies involving a range of students in diverse settings. By establishing a link between active learning and improved critical thinking, this resource encourages all higher…

  18. Criticism, Visible and Invisible.

    ERIC Educational Resources Information Center

    Frye, Northrop

    1964-01-01

    The central activity of literary criticism, the understanding of literature, is related to the process of establishing a context for the works of literature being studied. Choosing not to discuss the factual elements of literary criticism, the author clarifies and concentrates on the "lower" and "upper" limits of criticism. While the "lower" limit…

  19. Reimagining Critical Theory

    ERIC Educational Resources Information Center

    Rexhepi, Jevdet; Torres, Carlos Alberto

    2011-01-01

    This paper discusses Critical Theory, a model of theorizing in the field of the political sociology of education. We argue for a "reimagined" Critical Theory to herald an empowering, liberatory education that fosters curiosity and critical thinking, and a means for successful bottom-up, top-down political engagement. We present arguments…

  20. Critical percolation in bidimensional coarsening

    NASA Astrophysics Data System (ADS)

    Cugliandolo, Leticia F.

    2016-11-01

    I discuss a recently unveiled feature in the dynamics of two dimensional coarsening systems on the lattice with Ising symmetry: they first approach a critical percolating state via the growth of a new length scale, and only later enter the usual dynamic scaling regime. The time needed to reach the critical percolating state diverges with the system size. These observations are common to Glauber, Kawasaki, and voter dynamics in pure and weakly disordered systems. An extended version of this account appeared in 2016 C. R. Phys. . I refer to the relevant publications for details.

  1. Criticality measurements for SNM accountability

    SciTech Connect

    Bohman, J.; Martin, E.R.; Butterfield, K.; Paternoster, R.

    1998-03-01

    Based on extensive operating experience with the Godiva IV fast metal burst assembly at Los Alamos National Laboratory, the authors were able to create data plots for reactivity worths of standard configurations at various temperatures and room return locations. These plots show that the material uncertainties in criticality measurements are within {+-} 20 grams out of the 65.4 kilogram HEU Godiva core. This is superior to active neutron well coincidence counter (AWCC) measurements. The criticality measurements have the additional advantage of not requiring disassembly of the reactor. No disassembly means the measurement takes less time--it can be done during each operation--and there is less dose to measurement personnel.

  2. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management

    PubMed Central

    Fleisher, David R; Gornowicz, Blake; Adams, Kathleen; Burch, Richard; Feldman, Edward J

    2005-01-01

    Background Cyclic Vomiting Syndrome (CVS) is a disorder characterized by recurrent, stereotypic episodes of incapacitating nausea, vomiting and other symptoms, separated by intervals of comparative wellness. This report describes the clinical features, co-morbidities and problems encountered in management of 41 adult patients who met the diagnostic criteria for CVS. Methods This is a retrospective study of adults with CVS seen between 1994 and 2003. Follow-up data were obtained by mailed questionnaires. Results Age of onset ranged from 2 to 49 years. The duration of CVS at the time of consultation ranged from less than 1 year to 49 years. CVS episodes were stereotypic in respect of their hours of onset, symptomatology and length. Ninety-three percent of patients had recognizable prodromes. Half of the patients experienced a constellation of symptoms consisting of CVS episodes, migraine diathesis, inter-episodic dyspeptic nausea and a history of panic attacks. Deterioration in the course of CVS is indicated by coalescence of episodes in time. The prognosis of CVS is favorable in the majority of patients. Conclusion CVS is a disabling disorder affecting adults as well as children. Because its occurrence in adults is little known, patients experience delayed or mis-diagnosis and ineffectual, sometimes inappropriately invasive management. PMID:16368014

  3. Teaching critical thinking

    PubMed Central

    Holmes, N. G.; Wieman, Carl E.; Bonn, D. A.

    2015-01-01

    The ability to make decisions based on data, with its inherent uncertainties and variability, is a complex and vital skill in the modern world. The need for such quantitative critical thinking occurs in many different contexts, and although it is an important goal of education, that goal is seldom being achieved. We argue that the key element for developing this ability is repeated practice in making decisions based on data, with feedback on those decisions. We demonstrate a structure for providing suitable practice that can be applied in any instructional setting that involves the acquisition of data and relating that data to scientific models. This study reports the results of applying that structure in an introductory physics laboratory course. Students in an experimental condition were repeatedly instructed to make and act on quantitative comparisons between datasets, and between data and models, an approach that is common to all science disciplines. These instructions were slowly faded across the course. After the instructions had been removed, students in the experimental condition were 12 times more likely to spontaneously propose or make changes to improve their experimental methods than a control group, who performed traditional experimental activities. The students in the experimental condition were also four times more likely to identify and explain a limitation of a physical model using their data. Students in the experimental condition also showed much more sophisticated reasoning about their data. These differences between the groups were seen to persist into a subsequent course taken the following year. PMID:26283351

  4. Teaching critical thinking.

    PubMed

    Holmes, N G; Wieman, Carl E; Bonn, D A

    2015-09-08

    The ability to make decisions based on data, with its inherent uncertainties and variability, is a complex and vital skill in the modern world. The need for such quantitative critical thinking occurs in many different contexts, and although it is an important goal of education, that goal is seldom being achieved. We argue that the key element for developing this ability is repeated practice in making decisions based on data, with feedback on those decisions. We demonstrate a structure for providing suitable practice that can be applied in any instructional setting that involves the acquisition of data and relating that data to scientific models. This study reports the results of applying that structure in an introductory physics laboratory course. Students in an experimental condition were repeatedly instructed to make and act on quantitative comparisons between datasets, and between data and models, an approach that is common to all science disciplines. These instructions were slowly faded across the course. After the instructions had been removed, students in the experimental condition were 12 times more likely to spontaneously propose or make changes to improve their experimental methods than a control group, who performed traditional experimental activities. The students in the experimental condition were also four times more likely to identify and explain a limitation of a physical model using their data. Students in the experimental condition also showed much more sophisticated reasoning about their data. These differences between the groups were seen to persist into a subsequent course taken the following year.

  5. Social class, ethnicity, and mental illness: the importance of being more than earnest.

    PubMed Central

    Vander Stoep, A; Link, B

    1998-01-01

    This paper revisits a landmark study of the prevalence of mental illness in the state of Massachusetts conducted by Edward Jarvis in the 19th century. Jarvis drew an improper conclusion about the relationship between social class, ethnicity, and insanity, asserting that the Irish foreign-born had a higher prevalence of insanity in each social stratum. A reanalysis of Jarvis' data shows that in both the pauper and independent social classes in Massachusetts, the prevalence of insanity was significantly lower among foreign-born persons than among native-born persons. On the basis of his misperception, Jarvis constructed elaborate etiological theories. These theories made a strong impact on the mental health service policies of his day. The effects of incomplete examination of data on etiological theories and mental health policy in current times are highlighted in this article. PMID:9736887

  6. Critical sound propagation in mixtures

    NASA Astrophysics Data System (ADS)

    Folk, R.; Moser, G.

    1998-01-01

    We calculate critical effects in the sound propagation in mixtures near consolute or plait points within a non-asymptotic renormalization group theory and derive general expressions for the frequency-dependent sound velocity and sound attenuation. The critical non-asymptotic time scale in the sound mode in mixtures is set by an effective order parameter Onsager coefficient containing a dynamical parameter related to the enhancement of the thermal conductivity in the mixture, not considered so far. The differences in the critical behavior near the consolute and plait point are due to the different non-asymptotic behavior of the zero-frequency sound velocity. We compare our predictions for the sound velocity and sound absorption near the plait point in 3He-4He mixtures.

  7. Information seeking over the course of illness: the experience of people with fibromyalgia.

    PubMed

    Chen, Annie T

    2012-12-01

    Although there is literature addressing the fibromyalgia illness experience, there has been limited work concerning how people with fibromyalgia utilize health information. The aim of this study was therefore to investigate the information needs and information-seeking patterns of such individuals, and how these might change over time. Data were collected through an online survey of fibromyalgia-related information behaviours (N = 190). The participants were recruited through two methods: an email invitation sent out over a university listserv including faculty, staff and students, and invitational posts on fibromyalgia discussion boards on various health-related websites. Respondents used the internet most frequently, but also placed great value on information from others, including healthcare practitioners, family and friends. Among the online sources, organization websites, health portals and health-related social networking sites were most frequently used. Topics of interest to people with fibromyalgia vary as they move from an initial stage of confusion, to diagnosis and eventually to a stage of equilibrium in which they are satisfied with their management of their condition. Aside from symptoms and treatments, topics often reflect a need to understand the meaning of their condition and coping skills. The areas of information need identified in the present study can be used to tailor patient education materials and information services to address contextual and temporal factors in the illness experiences of those with fibromyalgia. Copyright © 2012 John Wiley & Sons, Ltd.

  8. [Stigmatization on the way to recovery in mental illness - the factors associated with social functioning].

    PubMed

    Podogrodzka-Niell, Magdalena; Tyszkowska, Magdalena

    2014-01-01

    Persons with mental disorders often experience stigmatization. There is a number of social factors that may affect the process of recovery and at the same time, in certain circumstances, could be a source of stigma. Mentally ill may find strength in themselves to fight against the disease or the opposite - can internalize the negative attitudes of the society and become self-stigmatized. The patient's family, on the one hand, is often the only source of social support, on the other hand, can experience a destructive influence of courtesy-stigma. Mentally ill have to face social reluctance which is reinforced by stereotypical media coverage of mental disorders. The social network of patients is poor and often limited to a family system. Negative views about persons diagnosed with mental illness are most visible in the labour market. Patients experience many types of discrimination at work,have lower employment rates and lower mean wages than healthy ones. Structural discrimination is a form of stigma which is revealed in underfunded and inefficient system of mental health care. All the social factors mentioned above are necessary for recovery (positive stimulation of functioning), but can also increase stigma and become a significant barrier in the recovery of psychiatric patients. This paper highlights the complex and ambiguous nature of the relationship between social factors and the recovery of the mentally ill basing on the data from the literature.

  9. Charles Darwin's (1809-1882) illness - the role of post-traumatic stress disorder.

    PubMed

    Heyse-Moore, Louis

    2016-09-15

    During most of his adult life, in counterpoint to his fame in describing the theory of evolution, Charles Darwin was chronically ill. He consulted many doctors with only limited and temporary success. His symptoms were many and varied. His doctors favoured dyspepsia or suppressed gout as the diagnosis. The Water Cure was only effective initially. Many diagnoses have been proposed by physicians since then. Perhaps he suffered from post-traumatic stress disorder (PTSD), not instead of but as well as other physical problems. His symptoms match with criteria for PTSD. Traumatic episodes from his life are considered in this paper: his mother's painful, sudden death from an acute abdominal event when he was eight; his reaction to seeing operations without anaesthetic; the deaths of three of his children, including his beloved daughter, Annie, aged ten; and being overwhelmed by his chronic, unrelenting symptoms. Trauma had not been conceptualised as a diagnosis in Darwin's time. Rather, hysteria and, in war, irritable heart were names given to what is now called PTSD.

  10. Heat-related illnesses: the role of the occupational and environmental health nurse.

    PubMed

    Rogers, Bonnie; Stiehl, Kristin; Borst, Jennifer; Hess, Andrea; Hutchins, Shauna

    2007-07-01

    Heat-related illnesses can occur in workplaces where hot environments pose a threat to at-risk workers. Operations involving high air temperatures and humidity, radiant heat sources, direct physical contact with hot objects, or strenuous physical activities have potential for inducing heat stress in employees engaged in job functions in specific industries. Exposure to high temperatures can lead to a progression of symptoms in the body, which can result in widespread tissue damage, organ damage, and even death if not treated in a timely and effective manner. Strategies to reduce the effects of heat in the workplace include engineering controls, administrative controls, and personal protective equipment. Occupational and environmental health nurses must be able to recognize and treat the broad range of symptoms that can result from exposure to high temperatures. They must work together with interdisciplinary teams to provide training and education to the work force so that workers are able to take appropriate measures to prevent the onset of a heat-related illness, recognize the early symptoms, and seek treatment. Interdisciplinary teams must ensure that appropriate controls in the work environment reduce the risk of heat exposure and related heat stress disorders. Education and early intervention are key to avoiding heat-induced illness and eliminating or minimizing the effects of high temperature environments.

  11. Critical Literacy for Xenophobia: A Wake-Up Call

    ERIC Educational Resources Information Center

    Stevens, Lisa Patel; Stovall, David Omotoso

    2010-01-01

    Critical literacy has been on the map of literacy pedagogy internationally since the time of Freire, and more commonplace in the United States in the last few decades. However, in this column the authors argue that the common practices of critical literacy are insufficient for critical engagement with texts. The tools of critical literacy are…

  12. Critical Literacy for Xenophobia: A Wake-Up Call

    ERIC Educational Resources Information Center

    Stevens, Lisa Patel; Stovall, David Omotoso

    2010-01-01

    Critical literacy has been on the map of literacy pedagogy internationally since the time of Freire, and more commonplace in the United States in the last few decades. However, in this column the authors argue that the common practices of critical literacy are insufficient for critical engagement with texts. The tools of critical literacy are…

  13. Critical Psychologies for Critical Health Literacies

    ERIC Educational Resources Information Center

    Corcoran, Tim

    2014-01-01

    Health education is largely informed by psychological theories and practices that pursue reductionist views of people learning. However, critical attention is moving to understand health in ways that reconsider relationships to context and the forms of life within which everyday living takes place. This shift is apparent in theoretical…

  14. Critical Psychologies for Critical Health Literacies

    ERIC Educational Resources Information Center

    Corcoran, Tim

    2014-01-01

    Health education is largely informed by psychological theories and practices that pursue reductionist views of people learning. However, critical attention is moving to understand health in ways that reconsider relationships to context and the forms of life within which everyday living takes place. This shift is apparent in theoretical…

  15. Criticality Model Report

    SciTech Connect

    J.M. Scaglione

    2003-03-12

    The purpose of the ''Criticality Model Report'' is to validate the MCNP (CRWMS M&O 1998h) code's ability to accurately predict the effective neutron multiplication factor (k{sub eff}) for a range of conditions spanned by various critical configurations representative of the potential configurations commercial reactor assemblies stored in a waste package may take. Results of this work are an indication of the accuracy of MCNP for calculating eigenvalues, which will be used as input for criticality analyses for spent nuclear fuel (SNF) storage at the proposed Monitored Geologic Repository. The scope of this report is to document the development and validation of the criticality model. The scope of the criticality model is only applicable to commercial pressurized water reactor fuel. Valid ranges are established as part of the validation of the criticality model. This model activity follows the description in BSC (2002a).

  16. Critical incident reporting systems.

    PubMed

    Ahluwalia, Jag; Marriott, Lin

    2005-02-01

    Approximately 10% of all hospital admissions are complicated by critical incidents in which harm is caused to the patient - this amounts to more than 850,000 incidents annually. Critical incident reporting (CIR) systems refer to the structured reporting, collation and analysis of such incidents. This article describes the attributes required for an effective CIR system. Example neonatal trigger events and a management pathway for handling a critical incident report are described. The benefits and limitations of CIR systems, reactive and prospective approaches to the analysis of actual or potential critical incidents and the assessment of risk are also reviewed. Individual human error is but one contributor in the majority of critical incidents. Recognition of this and the fostering of an organisational culture that views critical incident reports as an opportunity to learn and to improve future patient care is vital if CIR systems are to be effective.

  17. Lung Ultrasound in the Critically Ill Neonate.

    PubMed

    Lichtenstein, Daniel A; Mauriat, Philippe

    2012-08-01

    Critical ultrasound is a new tool for first-line physicians, including neonate intensivists. The consideration of the lung as one major target allows to redefine the priorities. Simple machines work better than up-to-date ones. We use a microconvex probe. Ten standardized signs allow a majority of uses: the bat sign (pleural line), lung sliding and the A-line (normal lung surface), the quad sign and sinusoid sign indicating pleural effusion regardless its echogenicity, the tissue-like sign and fractal sign indicating lung consolidation, the B-line artifact and lung rockets (indicating interstitial syndrome), abolished lung sliding with the stratosphere sign, suggesting pneumothorax, and the lung point, indicating pneumothorax. Other signs are used for more sophisticated applications (distinguishing atelectasis from pneumonia for instance...). All these disorders were assessed in the adult using CT as gold standard with sensitivity and specificity ranging from 90 to 100%, allowing to consider ultrasound as a reasonable bedside gold standard in the critically ill. The same signs are found, with no difference in the critically ill neonate. Fast protocols such as the BLUE-protocol are available, allowing immediate diagnosis of acute respiratory failure using seven standardized profiles. Pulmonary edema e.g. yields anterior lung rockets associated with lung sliding, making the B-profile. The FALLS-protocol, inserted in a Limited Investigation including a simple model of heart and vessels, assesses acute circulatory failure using lung artifacts. Interventional ultrasound (mainly, thoracocenthesis) provides maximal safety. Referrals to CT can be postponed. CEURF proposes personnalized bedside trainings since 1990. Lung ultrasound opens physicians to a visual medicine.

  18. Lung Ultrasound in the Critically Ill Neonate

    PubMed Central

    Lichtenstein, Daniel A; Mauriat, Philippe

    2012-01-01

    Critical ultrasound is a new tool for first-line physicians, including neonate intensivists. The consideration of the lung as one major target allows to redefine the priorities. Simple machines work better than up-to-date ones. We use a microconvex probe. Ten standardized signs allow a majority of uses: the bat sign (pleural line), lung sliding and the A-line (normal lung surface), the quad sign and sinusoid sign indicating pleural effusion regardless its echogenicity, the tissue-like sign and fractal sign indicating lung consolidation, the B-line artifact and lung rockets (indicating interstitial syndrome), abolished lung sliding with the stratosphere sign, suggesting pneumothorax, and the lung point, indicating pneumothorax. Other signs are used for more sophisticated applications (distinguishing atelectasis from pneumonia for instance...). All these disorders were assessed in the adult using CT as gold standard with sensitivity and specificity ranging from 90 to 100%, allowing to consider ultrasound as a reasonable bedside gold standard in the critically ill. The same signs are found, with no difference in the critically ill neonate. Fast protocols such as the BLUE-protocol are available, allowing immediate diagnosis of acute respiratory failure using seven standardized profiles. Pulmonary edema e.g. yields anterior lung rockets associated with lung sliding, making the B-profile. The FALLS-protocol, inserted in a Limited Investigation including a simple model of heart and vessels, assesses acute circulatory failure using lung artifacts. Interventional ultrasound (mainly, thoracocenthesis) provides maximal safety. Referrals to CT can be postponed. CEURF proposes personnalized bedside trainings since 1990. Lung ultrasound opens physicians to a visual medicine. PMID:23255876

  19. Vulnerability of critical infrastructures : identifying critical nodes.

    SciTech Connect

    Cox, Roger Gary; Robinson, David Gerald

    2004-06-01

    The objective of this research was the development of tools and techniques for the identification of critical nodes within critical infrastructures. These are nodes that, if disrupted through natural events or terrorist action, would cause the most widespread, immediate damage. This research focuses on one particular element of the national infrastructure: the bulk power system. Through the identification of critical elements and the quantification of the consequences of their failure, site-specific vulnerability analyses can be focused at those locations where additional security measures could be effectively implemented. In particular, with appropriate sizing and placement within the grid, distributed generation in the form of regional power parks may reduce or even prevent the impact of widespread network power outages. Even without additional security measures, increased awareness of sensitive power grid locations can provide a basis for more effective national, state and local emergency planning. A number of methods for identifying critical nodes were investigated: small-world (or network theory), polyhedral dynamics, and an artificial intelligence-based search method - particle swarm optimization. PSO was found to be the only viable approach and was applied to a variety of industry accepted test networks to validate the ability of the approach to identify sets of critical nodes. The approach was coded in a software package called Buzzard and integrated with a traditional power flow code. A number of industry accepted test networks were employed to validate the approach. The techniques (and software) are not unique to power grid network, but could be applied to a variety of complex, interacting infrastructures.

  20. Critical Viscosity of Xenon

    NASA Technical Reports Server (NTRS)

    2001-01-01

    The Critical Viscosity of Xenon Experiment (CVX-2) on the STS-107 Research 1 mission in 2002 will measure the viscous behavior of xenon, a heavy inert gas used in flash lamps and ion rocket engines, at its critical point. Because xenon near the critical point will collapse under its own weight, experiments on Earth (green line) are limited as they get closer (toward the left) to the critical point. CVX in the microgravity of space (red line) moved into unmeasured territory that scientists had not been able to reach.