The Validity and Precision of the Comparative Interrupted Time-Series Design: Three Within-Study Comparisons

ERIC Educational Resources Information Center

St. Clair, Travis; Hallberg, Kelly; Cook, Thomas D.

2016-01-01

We explore the conditions under which short, comparative interrupted time-series (CITS) designs represent valid alternatives to randomized experiments in educational evaluations. To do so, we conduct three within-study comparisons, each of which uses a unique data set to test the validity of the CITS design by comparing its causal estimates to…

Supporting interruption management and multimodal interface design: three meta-analyses of task performance as a function of interrupting task modality.

PubMed

Lu, Sara A; Wickens, Christopher D; Prinet, Julie C; Hutchins, Shaun D; Sarter, Nadine; Sebok, Angelia

2013-08-01

The aim of this study was to integrate empirical data showing the effects of interrupting task modality on the performance of an ongoing visual-manual task and the interrupting task itself. The goal is to support interruption management and the design of multimodal interfaces. Multimodal interfaces have been proposed as a promising means to support interruption management.To ensure the effectiveness of this approach, their design needs to be based on an analysis of empirical data concerning the effectiveness of individual and redundant channels of information presentation. Three meta-analyses were conducted to contrast performance on an ongoing visual task and interrupting tasks as a function of interrupting task modality (auditory vs. tactile, auditory vs. visual, and single modality vs. redundant auditory-visual). In total, 68 studies were included and six moderator variables were considered. The main findings from the meta-analyses are that response times are faster for tactile interrupting tasks in case of low-urgency messages.Accuracy is higher with tactile interrupting tasks for low-complexity signals but higher with auditory interrupting tasks for high-complexity signals. Redundant auditory-visual combinations are preferable for communication tasks during high workload and with a small visual angle of separation. The three meta-analyses contribute to the knowledge base in multimodal information processing and design. They highlight the importance of moderator variables in predicting the effects of interruption task modality on ongoing and interrupting task performance. The findings from this research will help inform the design of multimodal interfaces in data-rich, event-driven domains.

Supply and demand: application of Lean Six Sigma methods to improve drug round efficiency and release nursing time.

PubMed

Kieran, Maríosa; Cleary, Mary; De Brún, Aoife; Igoe, Aileen

2017-10-01

To improve efficiency, reduce interruptions and reduce the time taken to complete oral drug rounds. Lean Six Sigma methods were applied to improve drug round efficiency using a pre- and post-intervention design. A 20-bed orthopaedic ward in a large teaching hospital in Ireland. Pharmacy, nursing and quality improvement staff. A multifaceted intervention was designed which included changes in processes related to drug trolley organization and drug supply planning. A communications campaign aimed at reducing interruptions during nurse-led during rounds was also developed and implemented. Average number of interruptions, average drug round time and variation in time taken to complete drug round. At baseline, the oral drug round took an average of 125 min. Following application of Lean Six Sigma methods, the average drug round time decreased by 51 min. The average number of interruptions per drug round reduced from an average of 12 at baseline to 11 following intervention, with a 75% reduction in drug supply interruptions. Lean Six Sigma methodology was successfully employed to reduce interruptions and to reduce time taken to complete the oral drug round. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

A Unified Framework for Estimating Minimum Detectable Effects for Comparative Short Interrupted Time Series Designs

ERIC Educational Resources Information Center

Price, Cristofer; Unlu, Fatih

2014-01-01

The Comparative Short Interrupted Time Series (C-SITS) design is a frequently employed quasi-experimental method, in which the pre- and post-intervention changes observed in the outcome levels of a treatment group is compared with those of a comparison group where the difference between the former and the latter is attributed to the treatment. The…

Do interruptions affect quality of work?

PubMed

Foroughi, Cyrus K; Werner, Nicole E; Nelson, Erik T; Boehm-Davis, Deborah A

2014-11-01

The aim of this study was to determine if interruptions affect the quality of work. Interruptions are commonplace at home and in the office. Previous research in this area has traditionally involved time and errors as the primary measures of disruption. Little is known about the effect interruptions have on quality of work. Fifty-four students outlined and wrote three essays using a within-subjects design. During Condition 1, interruptions occurred while participants were outlining. During Condition 2, interruptions occurred while they were writing. No interruptions occurred in Condition 3. Quality of work was significantly reduced in both interruption conditions when compared to the non-interruption condition. The number of words produced was significantly reduced when participants were interrupted while writing the essay but not when outlining the essay. This research represents a crucial first step in understanding the effect interruptions have on quality of work. Our research suggests that interruptions negatively impact quality of work during a complex, creative writing task. Since interruptions are such a prevalent part of daily life, more research needs to be conducted to determine what other tasks are negatively impacted. Moreover, the underlying mechanism(s) causing these decrements needs to be identified. Finally, strategies and systems need to be designed and put in place to help counteract the decline in quality of work caused by interruptions.

Interrupted Time Series Analysis: A Research Technique for Evaluating Social Programs for the Elderly

ERIC Educational Resources Information Center

Calsyn, Robert J.; And Others

1977-01-01

After arguing that treatment programs for the elderly need to be evaluated with better research designs, the authors illustrate how interrupted time series analysis can be used to evaluate programs for the elderly when random assignment to experimental and control groups is not possible. (Author)

Identifying Autocorrelation Generated by Various Error Processes in Interrupted Time-Series Regression Designs: A Comparison of AR1 and Portmanteau Tests

ERIC Educational Resources Information Center

Huitema, Bradley E.; McKean, Joseph W.

2007-01-01

Regression models used in the analysis of interrupted time-series designs assume statistically independent errors. Four methods of evaluating this assumption are the Durbin-Watson (D-W), Huitema-McKean (H-M), Box-Pierce (B-P), and Ljung-Box (L-B) tests. These tests were compared with respect to Type I error and power under a wide variety of error…

Using Exponential Smoothing to Specify Intervention Models for Interrupted Time Series.

ERIC Educational Resources Information Center

Mandell, Marvin B.; Bretschneider, Stuart I.

1984-01-01

The authors demonstrate how exponential smoothing can play a role in the identification of the intervention component of an interrupted time-series design model that is analogous to the role that the sample autocorrelation and partial autocorrelation functions serve in the identification of the noise portion of such a model. (Author/BW)

Using machine learning to identify structural breaks in single-group interrupted time series designs.

PubMed

Linden, Ariel; Yarnold, Paul R

2016-12-01

Single-group interrupted time series analysis (ITSA) is a popular evaluation methodology in which a single unit of observation is being studied, the outcome variable is serially ordered as a time series and the intervention is expected to 'interrupt' the level and/or trend of the time series, subsequent to its introduction. Given that the internal validity of the design rests on the premise that the interruption in the time series is associated with the introduction of the treatment, treatment effects may seem less plausible if a parallel trend already exists in the time series prior to the actual intervention. Thus, sensitivity analyses should focus on detecting structural breaks in the time series before the intervention. In this paper, we introduce a machine-learning algorithm called optimal discriminant analysis (ODA) as an approach to determine if structural breaks can be identified in years prior to the initiation of the intervention, using data from California's 1988 voter-initiated Proposition 99 to reduce smoking rates. The ODA analysis indicates that numerous structural breaks occurred prior to the actual initiation of Proposition 99 in 1989, including perfect structural breaks in 1983 and 1985, thereby casting doubt on the validity of treatment effects estimated for the actual intervention when using a single-group ITSA design. Given the widespread use of ITSA for evaluating observational data and the increasing use of machine-learning techniques in traditional research, we recommend that structural break sensitivity analysis is routinely incorporated in all research using the single-group ITSA design. © 2016 John Wiley & Sons, Ltd.

The Value of Interrupted Time-Series Experiments for Community Intervention Research

PubMed Central

Biglan, Anthony; Ary, Dennis; Wagenaar, Alexander C.

2015-01-01

Greater use of interrupted time-series experiments is advocated for community intervention research. Time-series designs enable the development of knowledge about the effects of community interventions and policies in circumstances in which randomized controlled trials are too expensive, premature, or simply impractical. The multiple baseline time-series design typically involves two or more communities that are repeatedly assessed, with the intervention introduced into one community at a time. It is particularly well suited to initial evaluations of community interventions and the refinement of those interventions. This paper describes the main features of multiple baseline designs and related repeated-measures time-series experiments, discusses the threats to internal validity in multiple baseline designs, and outlines techniques for statistical analyses of time-series data. Examples are given of the use of multiple baseline designs in evaluating community interventions and policy changes. PMID:11507793

Graphical Data Analysis on the Circle: Wrap-Around Time Series Plots for (Interrupted) Time Series Designs.

PubMed

Rodgers, Joseph Lee; Beasley, William Howard; Schuelke, Matthew

2014-01-01

Many data structures, particularly time series data, are naturally seasonal, cyclical, or otherwise circular. Past graphical methods for time series have focused on linear plots. In this article, we move graphical analysis onto the circle. We focus on 2 particular methods, one old and one new. Rose diagrams are circular histograms and can be produced in several different forms using the RRose software system. In addition, we propose, develop, illustrate, and provide software support for a new circular graphical method, called Wrap-Around Time Series Plots (WATS Plots), which is a graphical method useful to support time series analyses in general but in particular in relation to interrupted time series designs. We illustrate the use of WATS Plots with an interrupted time series design evaluating the effect of the Oklahoma City bombing on birthrates in Oklahoma County during the 10 years surrounding the bombing of the Murrah Building in Oklahoma City. We compare WATS Plots with linear time series representations and overlay them with smoothing and error bands. Each method is shown to have advantages in relation to the other; in our example, the WATS Plots more clearly show the existence and effect size of the fertility differential.

The Use of Piecewise Growth Models to Estimate Learning Trajectories and RtI Instructional Effects in a Comparative Interrupted Time-Series Design

ERIC Educational Resources Information Center

Zvoch, Keith

2016-01-01

Piecewise growth models (PGMs) were used to estimate and model changes in the preliteracy skill development of kindergartners in a moderately sized school district in the Pacific Northwest. PGMs were applied to interrupted time-series (ITS) data that arose within the context of a response-to-intervention (RtI) instructional framework. During the…

The Interrupted Time Series as Quasi-Experiment: Three Tests of Significance. A Fortran Program for the CDC 3400 Computer.

ERIC Educational Resources Information Center

Sween, Joyce; Campbell, Donald T.

Computational formulae for the following three tests of significance, useful in the interrupted time series design, are given: (1) a "t" test (Mood, 1950) for the significance of the first post-change observation from a value predicted by a linear fit of the pre-change observations; (2) an "F" test (Walker and Lev, 1953) of the…

Efficient system interrupt concept design at the microprogramming level

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

Fakharzadeh, M.M.

1989-01-01

Over the past decade the demand for high speed super microcomputers has been tremendously increased. To satisfy this demand many high speed 32-bit microcomputers have been designed. However, the currently available 32-bit systems do not provide an adequate solution to many highly demanding problems such as in multitasking, and in interrupt driven applications, which both require context switching. Systems for these purposes usually incorporate sophisticated software. In order to be efficient, a high end microprocessor based system must satisfy stringent software demands. Although these microprocessors use the latest technology in the fabrication design and run at a very high speed,more » they still suffer from insufficient hardware support for such applications. All too often, this lack also is the premier cause of execution inefficiency. In this dissertation a micro-programmable control unit and operation unit is considered in an advanced design. An automaton controller is designed for high speed micro-level interrupt handling. Different stack models are designed for the single task and multitasking environment. The stacks are used for storage of various components of the processor during the interrupt calls, procedure calls, and task switching. A universal (as an example seven port) register file is designed for high speed parameter passing, and intertask communication in the multitasking environment. In addition, the register file provides a direct path between ALU and the peripheral data which is important in real-time control applications. The overall system is a highly parallel architecture, with no pipeline and internal cache memory, which allows the designer to be able to predict the processor's behavior during the critical times.« less

A Study of the Effect of Proximally Autocorrelated Error on Tests of Significance for the Interrupted Time Series Quasi-Experimental Design.

ERIC Educational Resources Information Center

Sween, Joyce; Campbell, Donald T.

The primary purpose of the present study was to investigate the appropriateness of several tests of significance for use with interrupted time series data. The second purpose was to determine what effect the violation of the assumption of uncorrelated error would have on the three tests of significance. The three tests were the Mood test,…

Simulation-based power calculation for designing interrupted time series analyses of health policy interventions.

PubMed

Zhang, Fang; Wagner, Anita K; Ross-Degnan, Dennis

2011-11-01

Interrupted time series is a strong quasi-experimental research design to evaluate the impacts of health policy interventions. Using simulation methods, we estimated the power requirements for interrupted time series studies under various scenarios. Simulations were conducted to estimate the power of segmented autoregressive (AR) error models when autocorrelation ranged from -0.9 to 0.9 and effect size was 0.5, 1.0, and 2.0, investigating balanced and unbalanced numbers of time periods before and after an intervention. Simple scenarios of autoregressive conditional heteroskedasticity (ARCH) models were also explored. For AR models, power increased when sample size or effect size increased, and tended to decrease when autocorrelation increased. Compared with a balanced number of study periods before and after an intervention, designs with unbalanced numbers of periods had less power, although that was not the case for ARCH models. The power to detect effect size 1.0 appeared to be reasonable for many practical applications with a moderate or large number of time points in the study equally divided around the intervention. Investigators should be cautious when the expected effect size is small or the number of time points is small. We recommend conducting various simulations before investigation. Copyright © 2011 Elsevier Inc. All rights reserved.

Quasi-Experimental Designs for Causal Inference

ERIC Educational Resources Information Center

Kim, Yongnam; Steiner, Peter

2016-01-01

When randomized experiments are infeasible, quasi-experimental designs can be exploited to evaluate causal treatment effects. The strongest quasi-experimental designs for causal inference are regression discontinuity designs, instrumental variable designs, matching and propensity score designs, and comparative interrupted time series designs. This…

Blood Pressure Response to Interrupting Workplace Sitting Time With Non-Exercise Physical Activity: Results of a 12-month Cohort Study.

PubMed

Mainsbridge, Casey; Ahuja, Kiran; Williams, Andrew; Bird, Marie-Louise; Cooley, Dean; Pedersen, Scott John

2018-06-13

To evaluate the blood pressure (BP) effects of a yearlong e-health solution designed to interrupt prolonged occupational sitting time. BP data of 228 desk-based employees (45.1 ± 10.5 years) were analyzed at baseline, 3, 6, 9, and 12 months. Systolic BP significantly reduced from baseline for the first 9 months (1.0 to 3.4 mmHg; P < 0.01) while diastolic and mean arterial pressure decreased for the full 12-months (4 to 5 mmHg for diastolic pressure and 3.6 to 4.2 mmHg for MAP; all P < 0.01).Participants used the e-health solution 5.5 ± 2.0 times/day in the first 3 months which reduced to 4.2 ± 2.5 times/day by the end of the study (P < 0.05). An e-health solution designed to increase non-exercise physical activity by interrupting sitting time in the workplace is feasible and produced long-term reductions in blood pressure.

An Interrupted Time Series Analysis of the State College Nuisance Property Ordinance and an Assessment of Rental Property Managers as Place Manager/Intimate Handler of Offender

ERIC Educational Resources Information Center

Koehle, Gregory M.

2011-01-01

This research involves a legal impact study of the State College Nuisance Property Ordinance and an assessment of State College Rental Property Managers in the role of place manager/intimate handler of offender. The impact of the Ordinance was assessed by employing an interrupted time series design which examined five years of pre-ordinance…

Activation of Central Pattern Generator for Respiration Following Complete High Cervical Spinal Cord Interruption

DTIC Science & Technology

2017-09-01

periodical or series . Include any significant publication in the proceedings of a one- time conference or in the report of a one- time study... Interruption PRINCIPAL INVESTIGATOR: Vitaliy Marchenko,MD,PhD CONTRACTING ORGANIZATION DREXEL UNIVERSITY PHILADELPHIA PA 19104-2875 REPORT DATE...the author(s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other

An eye movement analysis of the effect of interruption modality on primary task resumption.

PubMed

Ratwani, Raj; Trafton, J Gregory

2010-06-01

We examined the effect of interruption modality (visual or auditory) on primary task (visual) resumption to determine which modality was the least disruptive. Theories examining interruption modality have focused on specific periods of the interruption timeline. Preemption theory has focused on the switch from the primary task to the interrupting task. Multiple resource theory has focused on interrupting tasks that are to be performed concurrently with the primary task. Our focus was on examining how interruption modality influences task resumption.We leverage the memory-for-goals theory, which suggests that maintaining an associative link between environmental cues and the suspended primary task goal is important for resumption. Three interruption modality conditions were examined: auditory interruption with the primary task visible, auditory interruption with a blank screen occluding the primary task, and a visual interruption occluding the primary task. Reaction time and eye movement data were collected. The auditory condition with the primary task visible was the least disruptive. Eye movement data suggest that participants in this condition were actively maintaining an associative link between relevant environmental cues on the primary task interface and the suspended primary task goal during the interruption. These data suggest that maintaining cue association is the important factor for reducing the disruptiveness of interruptions, not interruption modality. Interruption-prone computing environments should be designed to allow for the user to have access to relevant primary task cues during an interruption to minimize disruptiveness.

Improving memory after interruption: exploiting soft constraints and manipulating information access cost.

PubMed

Morgan, Phillip L; Patrick, John; Waldron, Samuel M; King, Sophia L; Patrick, Tanya

2009-12-01

Forgetting what one was doing prior to interruption is an everyday problem. The recent soft constraints hypothesis (Gray, Sims, Fu, & Schoelles, 2006) emphasizes the strategic adaptation of information processing strategy to the task environment. It predicts that increasing information access cost (IAC: the time, and physical and mental effort involved in accessing information) encourages a more memory-intensive strategy. Like interruptions, access costs are also intrinsic to most work environments, such as when opening documents and e-mails. Three experiments investigated whether increasing IAC during a simple copying task can be an effective method for reducing forgetting following interruption. IAC was designated Low (all information permanently visible), Medium (a mouse movement to uncover target information), or High (an additional few seconds to uncover such information). Experiment 1 found that recall improved across all three levels of IAC. Subsequent experiments found that High IAC facilitated resumption after interruption, particularly when interruption occurred on half of all trials (Experiment 2), and improved prospective memory following two different interrupting tasks, even when one involved the disruptive effect of using the same type of resource as the primary task (Experiment 3). The improvement of memory after interruption with increased IAC supports the prediction of the soft constraints hypothesis. The main disadvantage of a high access cost was a reduction in speed of task completion. The practicality of manipulating IAC as a design method for inducing a memory-intensive strategy to protect against forgetting is discussed. Copyright 2009 APA

Operating characteristics of superconducting fault current limiter using 24kV vacuum interrupter driven by electromagnetic repulsion switch

NASA Astrophysics Data System (ADS)

Endo, M.; Hori, T.; Koyama, K.; Yamaguchi, I.; Arai, K.; Kaiho, K.; Yanabu, S.

2008-02-01

Using a high temperature superconductor, we constructed and tested a model Superconducting Fault Current Limiter (SFCL). SFCL which has a vacuum interrupter with electromagnetic repulsion mechanism. We set out to construct high voltage class SFCL. We produced the electromagnetic repulsion switch equipped with a 24kV vacuum interrupter(VI). There are problems that opening speed becomes late. Because the larger vacuum interrupter the heavier weight of its contact. For this reason, the current which flows in a superconductor may be unable to be interrupted within a half cycles of current. In order to solve this problem, it is necessary to change the design of the coil connected in parallel and to strengthen the electromagnetic repulsion force at the time of opening the vacuum interrupter. Then, the design of the coil was changed, and in order to examine whether the problem is solvable, the current limiting test was conducted. We examined current limiting test using 4 series and 2 parallel-connected YBCO thin films. We used 12-centimeter-long YBCO thin film. The parallel resistance (0.1Ω) is connected with each YBCO thin film. As a result, we succeed in interrupting the current of superconductor within a half cycle of it. Furthermore, series and parallel-connected YBCO thin film could limit without failure.

Workflow interruptions and mental workload in hospital pediatricians: an observational study.

PubMed

Weigl, Matthias; Müller, Andreas; Angerer, Peter; Hoffmann, Florian

2014-09-24

Pediatricians' workload is increasingly thought to affect pediatricians' quality of work life and patient safety. Workflow interruptions are a frequent stressor in clinical work, impeding clinicians' attention and contributing to clinical malpractice. We aimed to investigate prospective associations of workflow interruptions with multiple dimensions of mental workload in pediatricians during clinical day shifts. In an Academic Children's Hospital a prospective study of 28 full shift observations was conducted among pediatricians providing ward coverage. The prevalence of workflow interruptions was based on expert observation using a validated observation instrument. Concurrently, Pediatricians' workload ratings were assessed with three workload dimensions of the well-validated NASA-Task Load Index: mental demands, effort, and frustration. Observed pediatricians were, on average, disrupted 4.7 times per hour. Most frequent were interruptions by colleagues (30.2%), nursing staff (29.7%), and by telephone/beeper calls (16.3%). Interruption measures were correlated with two workload outcomes of interest: frequent workflow interruptions were related to less cognitive demands, but frequent interruptions were associated with increased frustration. With regard to single sources, interruptions by colleagues showed the strongest associations to workload. The findings provide insights into specific pathways between different types of interruptions and pediatricians' mental workload. These findings suggest further research and yield a number of work and organization re-design suggestions for pediatric care.

Interruption as a test of the user-computer interface

NASA Technical Reports Server (NTRS)

Kreifeldt, J. G.; Mccarthy, M. E.

1981-01-01

In order to study the effects different logic systems might have on interrupted operation, an algebraic calculator and a reverse polish notation calculator were compared when trained users were interrupted during problem entry. The RPN calculator showed markedly superior resistance to interruption effects compared to the AN calculator although no significant differences were found when the users were not interrupted. Causes and possible remedies for interruption effects are speculated. It is proposed that because interruption is such a common occurrence, it be incorporated into comparative evaluation tests of different logic system and control/display system and that interruption resistance be adopted as a specific design criteria for such design.

The Design of Time-Series Comparisons under Resource Constraints.

ERIC Educational Resources Information Center

Willemain, Thomas R.; Hartunian, Nelson S.

1982-01-01

Two methods for dividing an interrupted time-series study between baseline and experimental phases when study resources are limited are compared. In fixed designs, the baseline duration is predetermined. In flexible designs the baseline duration is contingent on remaining resources and the match of results to prior expectations of the evaluator.…

Interrupted time series regression for the evaluation of public health interventions: a tutorial.

PubMed

Bernal, James Lopez; Cummins, Steven; Gasparrini, Antonio

2017-02-01

Interrupted time series (ITS) analysis is a valuable study design for evaluating the effectiveness of population-level health interventions that have been implemented at a clearly defined point in time. It is increasingly being used to evaluate the effectiveness of interventions ranging from clinical therapy to national public health legislation. Whereas the design shares many properties of regression-based approaches in other epidemiological studies, there are a range of unique features of time series data that require additional methodological considerations. In this tutorial we use a worked example to demonstrate a robust approach to ITS analysis using segmented regression. We begin by describing the design and considering when ITS is an appropriate design choice. We then discuss the essential, yet often omitted, step of proposing the impact model a priori. Subsequently, we demonstrate the approach to statistical analysis including the main segmented regression model. Finally we describe the main methodological issues associated with ITS analysis: over-dispersion of time series data, autocorrelation, adjusting for seasonal trends and controlling for time-varying confounders, and we also outline some of the more complex design adaptations that can be used to strengthen the basic ITS design.

Interrupted time series regression for the evaluation of public health interventions: a tutorial

PubMed Central

Bernal, James Lopez; Cummins, Steven; Gasparrini, Antonio

2017-01-01

Abstract Interrupted time series (ITS) analysis is a valuable study design for evaluating the effectiveness of population-level health interventions that have been implemented at a clearly defined point in time. It is increasingly being used to evaluate the effectiveness of interventions ranging from clinical therapy to national public health legislation. Whereas the design shares many properties of regression-based approaches in other epidemiological studies, there are a range of unique features of time series data that require additional methodological considerations. In this tutorial we use a worked example to demonstrate a robust approach to ITS analysis using segmented regression. We begin by describing the design and considering when ITS is an appropriate design choice. We then discuss the essential, yet often omitted, step of proposing the impact model a priori. Subsequently, we demonstrate the approach to statistical analysis including the main segmented regression model. Finally we describe the main methodological issues associated with ITS analysis: over-dispersion of time series data, autocorrelation, adjusting for seasonal trends and controlling for time-varying confounders, and we also outline some of the more complex design adaptations that can be used to strengthen the basic ITS design. PMID:27283160

Interrupted time series design: a useful approach for studying interventions targeting participation.

PubMed

Anaby, Dana; Lal, Shalini; Huszczynski, Justine; Maich, Jana; Rogers, Jade; Law, Mary

2014-11-01

Comparative effectiveness research (CER) strives for evidence to inform clinical decisions for specific clients in typical health care settings. While the randomized controlled trial (RCT) is well-aligned with the objectives of CER, this design may not be feasible or applicable to all research questions, particularly those pertaining to clinical decision making and individually based change. It is important, therefore, to consider alternative approaches, especially when studying complex and subjective outcomes such as children's participation. We propose the use of interrupted time series (ITS) quasi-experimental design for its potential application in determining the effectiveness of participation-focused interventions. In this perspective, ITS design is described, ascertaining its advantages and limitations, and suggestions are provided to overcome challenges to implementation. Results of a case study using the ITS approach to evaluate changes in participation of an adolescent with physical disabilities are described. Finally, strategies to implement this design in practice are suggested.

Nested Interrupt Analysis of Low Cost and High Performance Embedded Systems Using GSPN Framework

NASA Astrophysics Data System (ADS)

Lin, Cheng-Min

Interrupt service routines are a key technology for embedded systems. In this paper, we introduce the standard approach for using Generalized Stochastic Petri Nets (GSPNs) as a high-level model for generating CTMC Continuous-Time Markov Chains (CTMCs) and then use Markov Reward Models (MRMs) to compute the performance for embedded systems. This framework is employed to analyze two embedded controllers with low cost and high performance, ARM7 and Cortex-M3. Cortex-M3 is designed with a tail-chaining mechanism to improve the performance of ARM7 when a nested interrupt occurs on an embedded controller. The Platform Independent Petri net Editor 2 (PIPE2) tool is used to model and evaluate the controllers in terms of power consumption and interrupt overhead performance. Using numerical results, in spite of the power consumption or interrupt overhead, Cortex-M3 performs better than ARM7.

76 FR 25674 - Notice of Submission for OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-05

... for the rigorous comparative interrupted time series design including student records data collection...- experimental designs to explore the relationship between magnet programs and student achievement both for... this study. An OMB clearance request that (1) described the study design and full data collection...

Coping with interruptions in clinical nursing-A qualitative study.

PubMed

Laustsen, Sussie; Brahe, Liselotte

2018-04-01

To gain knowledge on how nurses' cope with interruptions in clinical practice. Interruptions may delay work routines and result in wasted time, disorganised planning and ineffective working procedures, affecting nurses' focus and overview in different ways. Research has identified a growing problem linking errors or adverse events with interruptions. It may affect patient safety if nurses are not paying attention to interruptions. Little is known about how nurses cope with interruptions DESIGN: The study was inspired by ethnographic fieldwork with a hermeneutical phenomenological approach. Observations were performed combined with semi-structured qualitative interviews. Managing interruptions depend on level of competence, working environment, dialogue and matching of expectations, collegial roles and implicit rules. Working procedures impact on how nurses are exposed to unnecessary interruptions. The latter affects overview and the ability to put the foot down and decline being interrupted. Professional competencies for example prioritising, keeping focus and collaborating across disciplines are needed to cope with interruptions. Culture work and matching of expectations are important to reflect on and discuss personal- and group behaviour caused by interruptions. We need to focus on the role of each nurse in the professional team, types of personality and unspoken rules. Professional competencies for example prioritising, keeping focus and cooperating across disciplines are needed to cope with interruptions. Coping with interruptions is important for the nursing profession, quality of care and patient safety. Changing practice requires multidisciplinary cooperation accepting different agendas at personal, group and organisational levels. Nurses must understand the meaning and nature of different types of interruptions to develop coping strategies and maintain quality in care and patient safety in multidisciplinary teamwork. © 2018 John Wiley & Sons Ltd.

76 FR 58251 - Notice of Proposed Information Collection Requests

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-20

... relationship between receipt of RTT funds and student outcomes using an interrupted time series design; and (4... estimates of the number of respondents and hours of response time. Copies of the proposed information...

Peri-operative communication patterns and media usage--implications for systems design.

PubMed

Karlsen, Ero S; Toussaint, Pieter Jelle

2010-01-01

Inter-hospital communication amounts for a great deal of clinicians' work time. While communication is essential to coordinate care, it can also be time consuming and interruptive, and breakdown in communication is an important source of medical errors. One contributor to the interruptive nature of communication is the use of synchronous media, and there is clearly a potential for novel technologies. To assess communication patterns and media usage we performed an ethnographic field study in the peri-operative environment at a Norwegian hospital, as well as interviews with nurses. We analyze the results with regards to choice of media, characteristics of the conversations taking place and meta-messages, and account for addressing, obtrusiveness and information richness in the message exchanges. We find a relative high degree of interruptiveness in communication, and ascribe it to 1) a lack of situational awareness between locations in the peri-operative domain, as well as 2) use of synchronous media. This suggests that design of novel technology for intra-hospital communication should aim at supporting sender-receiver awareness and signaling of availability.

76 FR 13136 - Notice of Submission for OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-10

... design; (3) analyze the impact of receipt of RTT funds on student outcomes using an interrupted time series design; and (4) investigate the relationship between STM turnaround models (and strategies within...-performing schools. The evaluation is designed to (1) study the implementation of RTT and SIG; (2) analyze...

Single-Case Designs Technical Documentation

ERIC Educational Resources Information Center

Kratochwill, T. R.; Hitchcock, J.; Horner, R. H.; Levin, J. R.; Odom, S. L.; Rindskopf, D. M; Shadish, W. R.

2010-01-01

In an effort to expand the pool of scientific evidence available for review, the What Works Clearinghouse (WWC) assembled a panel of national experts in single-case design (SCD) and analysis to draft SCD Standards. SCDs are adaptations of interrupted time-series designs and can provide a rigorous experimental evaluation of intervention effects.…

75 FR 78230 - Notice of Proposed Information Collection Requests

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-15

... discontinuity design; (3) analyze the impact of receipt of RTT funds on student outcomes using an interrupted time series design; and (4) investigate the relationship between STM turnaround models (and strategies... (STMs) in the lowest-performing schools. The evaluation is designed to (1) study the implementation of...

Physicians interrupted by mobile devices in hospitals: understanding the interaction between devices, roles, and duties.

PubMed

Solvoll, Terje; Scholl, Jeremiah; Hartvigsen, Gunnar

2013-03-07

A common denominator of modern hospitals is a variety of communication problems. In particular, interruptions from mobile communication devices are a cause of great concern for many physicians. To characterize how interruptions from mobile devices disturb physicians in their daily work. The gathered knowledge will be subsequently used as input for the design and development of a context-sensitive communication system for mobile communications suitable for hospitals. This study adheres to an ethnographic and interpretive field research approach. The data gathering consisted of participant observations, non-structured and mostly ad hoc interviews, and open-ended discussions with a selected group of physicians. Eleven physicians were observed for a total of 135 hours during May and June 2009. The study demonstrates to what degree physicians are interrupted by mobile devices in their daily work and in which situations they are interrupted, such as surgery, examinations, and during patients/relatives high-importance level conversations. The participants in the study expected, and also indicated, that wireless phones probably led to more interruptions immediately after their introduction in a clinic, when compared to a pager, but this changed after a short while. The unpleasant feeling experienced by the caller when interrupting someone by calling them differs compared to sending a page message, which leaves it up to the receiver when to return the call. Mobile devices, which frequently interrupt physicians in hospitals, are a problem for both physicians and patients. The results from this study contribute to knowledge being used as input for designing and developing a prototype for a context-sensitive communication system for mobile communication suitable for hospitals. We combined these findings with results from earlier studies and also involved actual users to develop the prototype, CallMeSmart. This system intends to reduce such interruptions and at the same time minimize the number of communication devices needed per user.

A Methodological Framework for Model Selection in Interrupted Time Series Studies.

PubMed

Lopez Bernal, J; Soumerai, S; Gasparrini, A

2018-06-06

Interrupted time series is a powerful and increasingly popular design for evaluating public health and health service interventions. The design involves analysing trends in the outcome of interest and estimating the change in trend following an intervention relative to the counterfactual (the expected ongoing trend if the intervention had not occurred). There are two key components to modelling this effect: first, defining the counterfactual; second, defining the type of effect that the intervention is expected to have on the outcome, known as the impact model. The counterfactual is defined by extrapolating the underlying trends observed before the intervention to the post-intervention period. In doing this, authors must consider the pre-intervention period that will be included, any time varying confounders, whether trends may vary within different subgroups of the population and whether trends are linear or non-linear. Defining the impact model involves specifying the parameters that model the intervention, including for instance whether to allow for an abrupt level change or a gradual slope change, whether to allow for a lag before any effect on the outcome, whether to allow a transition period during which the intervention is being implemented and whether a ceiling or floor effect might be expected. Inappropriate model specification can bias the results of an interrupted time series analysis and using a model that is not closely tailored to the intervention or testing multiple models increases the risk of false positives being detected. It is important that authors use substantive knowledge to customise their interrupted time series model a priori to the intervention and outcome under study. Where there is uncertainty in model specification, authors should consider using separate data sources to define the intervention, running limited sensitivity analyses or undertaking initial exploratory studies. Copyright © 2018. Published by Elsevier Inc.

Adding Design Elements to Improve Time Series Designs: No Child Left behind as an Example of Causal Pattern-Matching

ERIC Educational Resources Information Center

Wong, Manyee; Cook, Thomas D.; Steiner, Peter M.

2015-01-01

Some form of a short interrupted time series (ITS) is often used to evaluate state and national programs. An ITS design with a single treatment group assumes that the pretest functional form can be validly estimated and extrapolated into the postintervention period where it provides a valid counterfactual. This assumption is problematic. Ambiguous…

Technology-mediated awareness: facilitating the handling of (un)wanted interruptions in a hospital setting.

PubMed

Klemets, Joakim; Evjemo, Tor Erik

2014-09-01

Nurses' work in hospital departments is highly collaborative and includes communication with a variety of actors. To further support nurses' communications, wireless phones, on which nurses receive both nurse calls and ordinary phone calls, have been introduced. However, while they ensure high availability among the mobile nurses, these phones also contribute to an increased number of interruptions. This paper aims to discover whether all interruptions caused by the wireless phones are unwanted. Further, it investigates how nurses handle these interruptions in a hospital setting in order to construct a foundation for guidelines to use in designing these types of systems. Qualitative and ethnographically inspired fieldwork, including workshops with both ordinary and student nurses from a Norwegian hospital, was undertaken. Patients from two hospital departments were interviewed. Nurses struggle to handle interruptions caused by the wireless nurse call system. Deciding whether to abort an activity or not to respond to an interruption is regarded as stressful. The decision is further complicated by the complex nature of the interruptions. At the same time, patients anticipate that nurses are able to make these judgements with limited information. Nurses' work is highly collaborative, and nurses depend on one another to carry out their work and manage interruptions. The dual nature of the interruptions is complex, and whether an interruption is wanted or unwanted depends on many factors. Nurses manage interruptions mainly by making their own activities visible and monitoring colleagues' work. Therefore, nurses' awareness of colleagues' activities is a key factor in how they handle interruptions in the form of nurse calls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The Validity of the Comparative Interrupted Time Series Design for Evaluating the Effect of School-Level Interventions.

PubMed

Jacob, Robin; Somers, Marie-Andree; Zhu, Pei; Bloom, Howard

2016-06-01

In this article, we examine whether a well-executed comparative interrupted time series (CITS) design can produce valid inferences about the effectiveness of a school-level intervention. This article also explores the trade-off between bias reduction and precision loss across different methods of selecting comparison groups for the CITS design and assesses whether choosing matched comparison schools based only on preintervention test scores is sufficient to produce internally valid impact estimates. We conduct a validation study of the CITS design based on the federal Reading First program as implemented in one state using results from a regression discontinuity design as a causal benchmark. Our results contribute to the growing base of evidence regarding the validity of nonexperimental designs. We demonstrate that the CITS design can, in our example, produce internally valid estimates of program impacts when multiple years of preintervention outcome data (test scores in the present case) are available and when a set of reasonable criteria are used to select comparison organizations (schools in the present case). © The Author(s) 2016.

False Dichotomies and Health Policy Research Designs: Randomized Trials Are Not Always the Answer.

PubMed

Soumerai, Stephen B; Ceccarelli, Rachel; Koppel, Ross

2017-02-01

Some medical scientists argue that only data from randomized controlled trials (RCTs) are trustworthy. They claim data from natural experiments and administrative data sets are always spurious and cannot be used to evaluate health policies and other population-wide phenomena in the real world. While many acknowledge biases caused by poor study designs, in this article we argue that several valid designs using administrative data can produce strong findings, particularly the interrupted time series (ITS) design. Many policy studies neither permit nor require an RCT for cause-and-effect inference. Framing our arguments using Campbell and Stanley's classic research design monograph, we show that several "quasi-experimental" designs, especially interrupted time series (ITS), can estimate valid effects (or non-effects) of health interventions and policies as diverse as public insurance coverage, speed limits, hospital safety programs, drug abuse regulation and withdrawal of drugs from the market. We further note the recent rapid uptake of ITS and argue for expanded training in quasi-experimental designs in medical and graduate schools and in post-doctoral curricula.

Enhancing causal interpretations of quality improvement interventions

PubMed Central

Cable, G

2001-01-01

In an era of chronic resource scarcity it is critical that quality improvement professionals have confidence that their project activities cause measured change. A commonly used research design, the single group pre-test/post-test design, provides little insight into whether quality improvement interventions cause measured outcomes. A re-evaluation of a quality improvement programme designed to reduce the percentage of bilateral cardiac catheterisations for the period from January 1991 to October 1996 in three catheterisation laboratories in a north eastern state in the USA was performed using an interrupted time series design with switching replications. The accuracy and causal interpretability of the findings were considerably improved compared with the original evaluation design. Moreover, the re-evaluation provided tangible evidence in support of the suggestion that more rigorous designs can and should be more widely employed to improve the causal interpretability of quality improvement efforts. Evaluation designs for quality improvement projects should be constructed to provide a reasonable opportunity, given available time and resources, for causal interpretation of the results. Evaluators of quality improvement initiatives may infrequently have access to randomised designs. Nonetheless, as shown here, other very rigorous research designs are available for improving causal interpretability. Unilateral methodological surrender need not be the only alternative to randomised experiments. Key Words: causal interpretations; quality improvement; interrupted time series design; implementation fidelity PMID:11533426

A robust interrupted time series model for analyzing complex health care intervention data.

PubMed

Cruz, Maricela; Bender, Miriam; Ombao, Hernando

2017-12-20

Current health policy calls for greater use of evidence-based care delivery services to improve patient quality and safety outcomes. Care delivery is complex, with interacting and interdependent components that challenge traditional statistical analytic techniques, in particular, when modeling a time series of outcomes data that might be "interrupted" by a change in a particular method of health care delivery. Interrupted time series (ITS) is a robust quasi-experimental design with the ability to infer the effectiveness of an intervention that accounts for data dependency. Current standardized methods for analyzing ITS data do not model changes in variation and correlation following the intervention. This is a key limitation since it is plausible for data variability and dependency to change because of the intervention. Moreover, present methodology either assumes a prespecified interruption time point with an instantaneous effect or removes data for which the effect of intervention is not fully realized. In this paper, we describe and develop a novel robust interrupted time series (robust-ITS) model that overcomes these omissions and limitations. The robust-ITS model formally performs inference on (1) identifying the change point; (2) differences in preintervention and postintervention correlation; (3) differences in the outcome variance preintervention and postintervention; and (4) differences in the mean preintervention and postintervention. We illustrate the proposed method by analyzing patient satisfaction data from a hospital that implemented and evaluated a new nursing care delivery model as the intervention of interest. The robust-ITS model is implemented in an R Shiny toolbox, which is freely available to the community. Copyright © 2017 John Wiley & Sons, Ltd.

Multiprocessor architectural study

NASA Technical Reports Server (NTRS)

Kosmala, A. L.; Stanten, S. F.; Vandever, W. H.

1972-01-01

An architectural design study was made of a multiprocessor computing system intended to meet functional and performance specifications appropriate to a manned space station application. Intermetrics, previous experience, and accumulated knowledge of the multiprocessor field is used to generate a baseline philosophy for the design of a future SUMC* multiprocessor. Interrupts are defined and the crucial questions of interrupt structure, such as processor selection and response time, are discussed. Memory hierarchy and performance is discussed extensively with particular attention to the design approach which utilizes a cache memory associated with each processor. The ability of an individual processor to approach its theoretical maximum performance is then analyzed in terms of a hit ratio. Memory management is envisioned as a virtual memory system implemented either through segmentation or paging. Addressing is discussed in terms of various register design adopted by current computers and those of advanced design.

Situation Awareness and Interruption Handling During Medication Administration.

PubMed

Sitterding, Mary Cathryn; Ebright, Patricia; Broome, Marion; Patterson, Emily S; Wuchner, Staci

2014-08-01

Medication administration error remains a leading cause of preventable death. A gap exists in understanding attentional dynamics, such as nurse situation awareness (SA) while managing interruptions during medication administration. The aim was to describe SA during medication administration and interruption handling strategies. A cross-sectional, descriptive design was used. Cognitive task analysis (CTA) methods informed analysis of 230 interruptions. Themes were analyzed by SA level. The nature of the stimuli noticed emerged as a Level 1 theme, in contrast to themes of uncertainty, relevance, and expectations (Level 2 themes). Projected or anticipated interventions (Level 3 themes) reflected workload balance between team and patient foregrounds. The prevalence of cognitive time-sharing during the medication administration process was remarkable. Findings substantiated the importance of the concept of SA within nursing as well as the contribution of CTA in understanding the cognitive work of nursing during medication administration. © The Author(s) 2014.

Driven to distraction: The nature and apparent purpose of interruptions in critical care and implications for HIT.

PubMed

Mamykina, Lena; Carter, Eileen J; Sheehan, Barbara; Stanley Hum, R; Twohig, Bridget C; Kaufman, David R

2017-05-01

To examine the apparent purpose of interruptions in a Pediatric Intensive Care Unit and opportunities to reduce their burden with informatics solutions. In this prospective observational study, researchers shadowed clinicians in the unit for one hour at a time, recording all interruptions participating clinicians experienced or initiated, their starting time, duration, and a short description that could help to infer their apparent purpose. All captured interruptions were classified inductively on their source and apparent purpose and on the optimal representational media for fulfilling their apparent purpose. The researchers observed thirty-four one-hour sessions with clinicians in the unit, including 21 nurses and 13 residents and house physicians. The physicians were interrupted on average 11.9 times per hour and interrupted others 8.8 times per hour. Nurses were interrupted 8.6 times per hour and interrupted others 5.1 times per hour. The apparent purpose of interruptions included Information Seeking and Sharing (n=259, 46.3%), Directives and Requests (n=70, 12%), Shared Decision-Making (n=49, 8.8%), Direct Patient Care (n=36, 6.4%), Social (n=71, 12.7%), Device Alarms (n=28, 5%), and Non-Clinical (n=10, 1.8%); 6.6% were not classified due to insufficient description. Of all captured interruptions, 29.5% were classified as being better served with informational displays or computer-mediated communication. Deeper understanding of the purpose of interruptions in critical care can help to distinguish between interruptions that require face-to-face conversation and those that can be eliminated with informatics solutions. The proposed taxonomy of interruptions and representational analysis can be used to further advance the science of interruptions in clinical care. Copyright © 2017 Elsevier Inc. All rights reserved.

Safe and effective nursing shift handover with NURSEPASS: An interrupted time series.

PubMed

Smeulers, Marian; Dolman, Christine D; Atema, Danielle; van Dieren, Susan; Maaskant, Jolanda M; Vermeulen, Hester

2016-11-01

Implementation of a locally developed evidence based nursing shift handover blueprint with a bedside-safety-check to determine the effect size on quality of handover. A mixed methods design with: (1) an interrupted time series analysis to determine the effect on handover quality in six domains; (2) descriptive statistics to analyze the intercepted discrepancies by the bedside-safety-check; (3) evaluation sessions to gather experiences with the new handover process. We observed a continued trend of improvement in handover quality and a significant improvement in two domains of handover: organization/efficiency and contents. The bedside-safety-check successfully identified discrepancies on drains, intravenous medications, bandages or general condition and was highly appreciated. Use of the nursing shift handover blueprint showed promising results on effectiveness as well as on feasibility and acceptability. However, to enable long term measurement on effectiveness, evaluation with large scale interrupted times series or statistical process control is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

Direct current hybrid breakers: A design and its realization

NASA Astrophysics Data System (ADS)

Atmadji, Ali Mahfudz Surya

2000-12-01

The use of semiconductors for electric power circuit breakers instead of conventional breakers remains a utopia when designing fault current interrupters for high power networks. The major problems concerning power semiconductor circuit breakers are the excessive heat losses and their sensitivity to transients. However, conventional breakers are capable of dealing with such matters. A combination of the two methods, or so-called `hybrid breakers', would appear to be a solution; however, hybrid breakers use separate parallel branches for conducting the main current and interrupting the short-circuit current. Such breakers are intended for protecting direct current (DC) traction systems. In this thesis hybrid switching techniques for current limitation and purely solidstate current interruption are investigated for DC breakers. This work analyzes the transient behavior of hybrid breakers and compares their operations with conventional breakers and similar solid-state devices in DC systems. Therefore a hybrid breaker was constructed and tested in a specially designed high power test circuit. A vacuum breaker was chosen as the main breaker in the main conducting path; then a commutation path was connected across the vacuum breaker where it provided current limitation and interruption. The commutation path operated only during any current interruption and the process required additional circuits. These included a certain energy storage, overvoltage suppressor and commutation switch. So that when discharging this energy, a controlled counter-current injection could be produced. That counter-current opposed the main current in the breaker by superposition in order to create a forced current-zero. One-stage and two-stage commutation circuits have been treated extensively. This study project contains both theoretical and experimental investigations. A direct current shortcircuit source was constructed capable of delivering power equivalent to a fault. It supplied a direct voltage of 1kVDC which was rectified having been obtained from a 3-phase lOkV/380V supply. The source was successfully tested to deliver a fault current of 7kA with a time constant of 5ms. The hybrid breaker that was developed could provide protection for 750VDC traction systems. The breaker was equipped with a fault- recognizing circuit based on a current level triggering. An electronic circuit was built for this need and was included in the system. It monitored the system continuously and took action by generating trip signals when a fault was recognized. Interruption was followed by a suitable timing of the fast contact separation in the main breaker and the current-zero creation. An electrodynamically driven mechanism was successfully tested having a dead-time of 300μs to separate the main breaker contacts. Furthermore, a maximum peak current injection of RA at a frequency of 500Hz could be obtained in order to produce an artificial current-zero in the vacuum breaker. A successful current interruption with a prospective value of RA was achieved by the hybrid switching technique. In addition, measures were taken to prevent overvoltages. Experimentally, the concept of a hybrid breaker was compared with the functioning of all mechanical (air breaker) and all electronical (IGCT breaker) versions. Although a single stage interrupting method was verified experimentally, two two-stage interrupting methods were analyzed theoretically.

The Effect of Interruption Duration and Demand on Resuming Suspended Goals

ERIC Educational Resources Information Center

Monk, Christopher A.; Trafton, J. Gregory; Boehm-Davis, Deborah A.

2008-01-01

The time to resume task goals after an interruption varied depending on the duration and cognitive demand of interruptions, as predicted by the memory for goals model (Altmann & Trafton, 2002). Three experiments using an interleaved tasks interruption paradigm showed that longer and more demanding interruptions led to longer resumption times in a…

A Coordinated Patient Transport System for ICU Patients Requiring Surgery: Impact on Operating Room Efficiency and ICU Workflow.

PubMed

Brown, Michael J; Kor, Daryl J; Curry, Timothy B; Marmor, Yariv; Rohleder, Thomas R

2015-01-01

Transfer of intensive care unit (ICU) patients to the operating room (OR) is a resource-intensive, time-consuming process that often results in patient throughput inefficiencies, deficiencies in information transfer, and suboptimal nurse to patient ratios. This study evaluates the implementation of a coordinated patient transport system (CPTS) designed to address these issues. Using data from 1,557 patient transfers covering the 2006-2010 period, interrupted time series and before and after designs were used to analyze the effect of implementing a CPTS at Mayo Clinic, Rochester. Using a segmented regression for the interrupted time series, on-time OR start time deviations were found to be significantly lower after the implementation of CPTS (p < .0001). The implementation resulted in a fourfold improvement in on-time OR starts (p < .01) while significantly reducing idle OR time (p < .01). A coordinated patient transfer process for moving patient from ICUs to ORs can significantly improve OR efficiency, reduce nonvalue added time, and ensure quality of care by preserving appropriate care provider to patient ratios.

An Improved Cross-Layering Design for IPv6 Fast Handover with IEEE 802.16m Entry Before Break Handover

NASA Astrophysics Data System (ADS)

Kim, Ronny Yongho; Jung, Inuk; Kim, Young Yong

IEEE 802.16m is an advanced air interface standard which is under development for IMT-Advanced systems, known as 4G systems. IEEE 802.16m is designed to provide a high data rate and a Quality of Service (QoS) level in order to meet user service requirements, and is especially suitable for mobilized environments. There are several factors that have great impact on such requirements. As one of the major factors, we mainly focus on latency issues. In IEEE 802.16m, an enhanced layer 2 handover scheme, described as Entry Before Break (EBB) was proposed and adopted to reduce handover latency. EBB provides significant handover interruption time reduction with respect to the legacy IEEE 802.16 handover scheme. Fast handovers for mobile IPv6 (FMIPv6) was standardized by Internet Engineering Task Force (IETF) in order to provide reduced handover interruption time from IP layer perspective. Since FMIPv6 utilizes link layer triggers to reduce handover latency, it is very critical to jointly design FMIPv6 with its underlying link layer protocol. However, FMIPv6 based on new handover scheme, EBB has not been proposed. In this paper, we propose an improved cross-layering design for FMIPv6 based on the IEEE 802.16m EBB handover. In comparison with the conventional FMIPv6 based on the legacy IEEE 802.16 network, the overall handover interruption time can be significantly reduced by employing the proposed design. Benefits of this improvement on latency reduction for mobile user applications are thoroughly investigated with both numerical analysis and simulation on various IP applications.

Effects of beam interruption time on tumor control probability in single-fractionated carbon-ion radiotherapy for non-small cell lung cancer

NASA Astrophysics Data System (ADS)

Inaniwa, T.; Kanematsu, N.; Suzuki, M.; Hawkins, R. B.

2015-05-01

Carbon-ion radiotherapy treatment plans are designed on the assumption that the beams are delivered instantaneously, irrespective of actual dose-delivery time structure in a treatment session. As the beam lines are fixed in the vertical and horizontal directions at our facility, beam delivery is interrupted in multi-field treatment due to the necessity of patient repositioning within the fields. Single-fractionated treatment for non-small cell lung cancer (NSCLC) is such a case, in which four treatment fields in multiple directions are delivered in one session with patient repositioning during the session. The purpose of this study was to investigate the effects of the period of dose delivery, including interruptions due to patient repositioning, on tumor control probability (TCP) of NSCLC. All clinical doses were weighted by relative biological effectiveness (RBE) evaluated for instantaneous irradiation. The rate equations defined in the microdosimetric kinetic model (MKM) for primary lesions induced in DNA were applied to the single-fractionated treatment of NSCLC. Treatment plans were made for an NSCLC case for various prescribed doses ranging from 25 to 50 Gy (RBE), on the assumption of instantaneous beam delivery. These plans were recalculated by varying the interruption time τ ranging from 0 to 120 min between the second and third fields for continuous irradiations of 3 min per field based on the MKM. The curative doses that would result in a TCP of 90% were deduced for the respective interruption times. The curative dose was 34.5 Gy (RBE) for instantaneous irradiation and 36.6 Gy (RBE), 39.2 Gy (RBE), 41.2 Gy (RBE), 43.3 Gy (RBE) and 44.4 Gy (RBE) for τ = 0 min, 15 min, 30 min, 60 min and 120 min, respectively. The realistic biological effectiveness of therapeutic carbon-ion beam decreased with increasing interruption time. These data suggest that the curative dose can increase by 20% or more compared to the planned dose if the interruption time extends to 30 min or longer. These effects should be considered in carbon-ion radiotherapy treatment planning if a longer dose-delivery procedure time is anticipated.

Reduction of a linear complex model for respiratory system during Airflow Interruption.

PubMed

Jablonski, Ireneusz; Mroczka, Janusz

2010-01-01

The paper presents methodology of a complex model reduction to its simpler version - an identifiable inverse model. Its main tool is a numerical procedure of sensitivity analysis (structural and parametric) applied to the forward linear equivalent designed for the conditions of interrupter experiment. Final result - the reduced analog for the interrupter technique is especially worth of notice as it fills a major gap in occlusional measurements, which typically use simple, one- or two-element physical representations. Proposed electrical reduced circuit, being structural combination of resistive, inertial and elastic properties, can be perceived as a candidate for reliable reconstruction and quantification (in the time and frequency domain) of dynamical behavior of the respiratory system in response to a quasi-step excitation by valve closure.

Multiple Questions Require Multiple Designs: An Evaluation of the 1981 Changes to the AFDC Program.

ERIC Educational Resources Information Center

Hedrick, Terry E.; Shipman, Stephanie L.

1988-01-01

Changes made in 1981 to the Aid to Families with Dependent Children (AFDC) program under the Omnibus Budget Reconciliation Act were evaluated. Multiple quasi-experimental designs (interrupted time series, non-equivalent comparison groups, and simple pre-post designs) used to address evaluation questions illustrate the issues faced by evaluators in…

78 FR 15001 - 36(b)(1) Arms Sales Notification

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-08

... complete night time missions down to starlight and extreme low light conditions. The AN/AVS-9 is designed... responds to threats autonomously with a specific series of measures designed to protect the aircraft from... without interrupting his field of view through the cockpit canopy, the system uses a magnetic transmitter...

Research Designs for Intervention Research with Small Samples II: Stepped Wedge and Interrupted Time-Series Designs.

PubMed

Fok, Carlotta Ching Ting; Henry, David; Allen, James

2015-10-01

The stepped wedge design (SWD) and the interrupted time-series design (ITSD) are two alternative research designs that maximize efficiency and statistical power with small samples when contrasted to the operating characteristics of conventional randomized controlled trials (RCT). This paper provides an overview and introduction to previous work with these designs and compares and contrasts them with the dynamic wait-list design (DWLD) and the regression point displacement design (RPDD), which were presented in a previous article (Wyman, Henry, Knoblauch, and Brown, Prevention Science. 2015) in this special section. The SWD and the DWLD are similar in that both are intervention implementation roll-out designs. We discuss similarities and differences between the SWD and DWLD in their historical origin and application, along with differences in the statistical modeling of each design. Next, we describe the main design characteristics of the ITSD, along with some of its strengths and limitations. We provide a critical comparative review of strengths and weaknesses in application of the ITSD, SWD, DWLD, and RPDD as small sample alternatives to application of the RCT, concluding with a discussion of the types of contextual factors that influence selection of an optimal research design by prevention researchers working with small samples.

Research Designs for Intervention Research with Small Samples II: Stepped Wedge and Interrupted Time-Series Designs

PubMed Central

Ting Fok, Carlotta Ching; Henry, David; Allen, James

2015-01-01

The stepped wedge design (SWD) and the interrupted time-series design (ITSD) are two alternative research designs that maximize efficiency and statistical power with small samples when contrasted to the operating characteristics of conventional randomized controlled trials (RCT). This paper provides an overview and introduction to previous work with these designs, and compares and contrasts them with the dynamic wait-list design (DWLD) and the regression point displacement design (RPDD), which were presented in a previous article (Wyman, Henry, Knoblauch, and Brown, 2015) in this Special Section. The SWD and the DWLD are similar in that both are intervention implementation roll-out designs. We discuss similarities and differences between the SWD and DWLD in their historical origin and application, along with differences in the statistical modeling of each design. Next, we describe the main design characteristics of the ITSD, along with some of its strengths and limitations. We provide a critical comparative review of strengths and weaknesses in application of the ITSD, SWD, DWLD, and RPDD as small samples alternatives to application of the RCT, concluding with a discussion of the types of contextual factors that influence selection of an optimal research design by prevention researchers working with small samples. PMID:26017633

Formal Verification of a Power Controller Using the Real-Time Model Checker UPPAAL

NASA Technical Reports Server (NTRS)

Havelund, Klaus; Larsen, Kim Guldstrand; Skou, Arne

1999-01-01

A real-time system for power-down control in audio/video components is modeled and verified using the real-time model checker UPPAAL. The system is supposed to reside in an audio/video component and control (read from and write to) links to neighbor audio/video components such as TV, VCR and remote-control. In particular, the system is responsible for the powering up and down of the component in between the arrival of data, and in order to do so in a safe way without loss of data, it is essential that no link interrupts are lost. Hence, a component system is a multitasking system with hard real-time requirements, and we present techniques for modeling time consumption in such a multitasked, prioritized system. The work has been carried out in a collaboration between Aalborg University and the audio/video company B&O. By modeling the system, 3 design errors were identified and corrected, and the following verification confirmed the validity of the design but also revealed the necessity for an upper limit of the interrupt frequency. The resulting design has been implemented and it is going to be incorporated as part of a new product line.

The use of segmented regression in analysing interrupted time series studies: an example in pre-hospital ambulance care.

PubMed

Taljaard, Monica; McKenzie, Joanne E; Ramsay, Craig R; Grimshaw, Jeremy M

2014-06-19

An interrupted time series design is a powerful quasi-experimental approach for evaluating effects of interventions introduced at a specific point in time. To utilize the strength of this design, a modification to standard regression analysis, such as segmented regression, is required. In segmented regression analysis, the change in intercept and/or slope from pre- to post-intervention is estimated and used to test causal hypotheses about the intervention. We illustrate segmented regression using data from a previously published study that evaluated the effectiveness of a collaborative intervention to improve quality in pre-hospital ambulance care for acute myocardial infarction (AMI) and stroke. In the original analysis, a standard regression model was used with time as a continuous variable. We contrast the results from this standard regression analysis with those from segmented regression analysis. We discuss the limitations of the former and advantages of the latter, as well as the challenges of using segmented regression in analysing complex quality improvement interventions. Based on the estimated change in intercept and slope from pre- to post-intervention using segmented regression, we found insufficient evidence of a statistically significant effect on quality of care for stroke, although potential clinically important effects for AMI cannot be ruled out. Segmented regression analysis is the recommended approach for analysing data from an interrupted time series study. Several modifications to the basic segmented regression analysis approach are available to deal with challenges arising in the evaluation of complex quality improvement interventions.

The time-course of recovery from interruption during reading: eye movement evidence for the role of interruption lag and spatial memory.

PubMed

Cane, James E; Cauchard, Fabrice; Weger, Ulrich W

2012-01-01

Two experiments examined how interruptions impact reading and how interruption lags and the reader's spatial memory affect the recovery from such interruptions. Participants read paragraphs of text and were interrupted unpredictably by a spoken news story while their eye movements were monitored. Time made available for consolidation prior to responding to the interruption did not aid reading resumption. However, providing readers with a visual cue that indicated the interruption location did aid task resumption substantially in Experiment 2. Taken together, the findings show that the recovery from interruptions during reading draws on spatial memory resources and can be aided by processes that support spatial memory. Practical implications are discussed.

ECCM Scheme against Interrupted Sampling Repeater Jammer Based on Parameter-Adjusted Waveform Design

PubMed Central

Wei, Zhenhua; Peng, Bo; Shen, Rui

2018-01-01

Interrupted sampling repeater jamming (ISRJ) is an effective way of deceiving coherent radar sensors, especially for linear frequency modulated (LFM) radar. In this paper, for a simplified scenario with a single jammer, we propose a dynamic electronic counter-counter measure (ECCM) scheme based on jammer parameter estimation and transmitted signal design. Firstly, the LFM waveform is transmitted to estimate the main jamming parameters by investigating the discontinuousness of the ISRJ’s time-frequency (TF) characteristics. Then, a parameter-adjusted intra-pulse frequency coded signal, whose ISRJ signal after matched filtering only forms a single false target, is designed adaptively according to the estimated parameters, i.e., sampling interval, sampling duration and repeater times. Ultimately, for typical jamming scenes with different jamming signal ratio (JSR) and duty cycle, we propose two particular ISRJ suppression approaches. Simulation results validate the effective performance of the proposed scheme for countering the ISRJ, and the trade-off relationship between the two approaches is demonstrated. PMID:29642508

RUPOK - a web-map application for assessment of impacts of natural hazards on the transportation infrastructure

NASA Astrophysics Data System (ADS)

Bíl, Michal; Kubeček, Jan; Andrášik, Richard; Bílová, Martina; Sedoník, Jiří

2016-04-01

We present a web-map application (www.rupok.cz) designed for visualization of losses caused by natural hazards to the transportation infrastructure. This application is an output of a project in which we analyzed direct, indirect and network-wide impacts of major natural disasters which hit the CZ as of 1997. When natural disasters hit a road network the results are often a number of closed road sections. Certain roads may be, however, destroyed, whereas the majority of them are usually only closed and can be reopened after a short period of time. While the computation of direct losses (the cost of remedial works) is fairly simple, the evaluation of indirect and network-wide costs is much more difficult. We created a database of interrupted road and highway sections due to natural processes which includes data since 1997 and which is automatically updated. 6,828 records concerning interrupted communications located on 2,879 road sections are included in the database for the 1997 - 2014 time period. Flooding caused 37 % of the traffic interruptions, followed by fallen trees (22 %), landsliding (5 %) and rockfalls (2 %). The RUPOK webpage contains information on the probabilities of transportation section interruptions due to natural processes as well as the impacts of possible interruptions. The direct losses are depicted as monetary values per road section unit. The values are calculated on the basis of official tables including the prices for construction works. The indirect losses were calculated on the basis of the best alternative route expenses and as traffic intensities affected by a road section interruption.

8 CFR 245a.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... having interrupted his or her continuous residence as required at the time of filing an application. (2... in lieu of, the Federal Citizenship Text series); (3) Be designed to provide at least 60 hours of... the alien shall be regarded as having resided continuously in the United States if, at the time of...

8 CFR 245a.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... having interrupted his or her continuous residence as required at the time of filing an application. (2... in lieu of, the Federal Citizenship Text series); (3) Be designed to provide at least 60 hours of... the alien shall be regarded as having resided continuously in the United States if, at the time of...

Focusing on the Whole Student: An Evaluation of Massachusetts's Wraparound Zone Initiative

ERIC Educational Resources Information Center

Gandhi, Allison Gruner; Slama, Rachel; Park, So Jung; Russo, Patrick; Winner, Kendra; Bzura, Robin; Jones, Wehmah; Williamson, Sandra

2018-01-01

We used a comparative interrupted time series design to examine the impact of the Massachusetts' Wraparound Zone Initiative on student achievement, attendance, retention, and suspension. This initiative was designed to create coordinated district systems that allow schools to proactively and systematically address students' nonacademic needs. The…

A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety

PubMed Central

Larcos, George; Prgomet, Mirela; Georgiou, Andrew; Westbrook, Johanna

2017-01-01

Background Errors by nuclear medicine technologists during the preparation of radiopharmaceuticals or at other times can cause patient harm and may reflect the impact of interruptions, busy work environments and deficient systems or processes. We aimed to: (a) characterise the rate and nature of interruptions technologists experience and (b) identify strategies that support safety. Methods We performed 100 hours of observation of 11 technologists at a major public hospital and measured the proportions of time spent in eight categories of work tasks, location of task, interruption rate and type and multitasking (tasks conducted in parallel). We catalogued specific safety-oriented strategies used by technologists. Results Technologists completed 5227 tasks and experienced 569 interruptions (mean, 4.5 times per hour; 95% CI 4.1 to 4.9). The highest interruption rate occurred when technologists were in transit between rooms (10.3 per hour (95% CI 8.3 to 12.5)). Interruptions during radiopharmaceutical preparation occurred a mean of 4.4 times per hour (95% CI 3.3 to 5.6). Most (n=426) tasks were interrupted once only and all tasks were resumed after interruption. Multitasking occurred 16.6% of the time. At least some interruptions were initiated by other technologists to convey important information and/or to render assistance. Technologists employed a variety of verbal and non-verbal strategies in all work areas (notably in the hot-lab) to minimise the impact of interruptions and optimise the safe conduct of procedures. Although most were due to individual choices, some strategies reflected overt or subliminal departmental policy. Conclusions Some interruptions appear beneficial. Technologists' self-initiated strategies to support safe work practices appear to be an important element in supporting a resilient work environment in nuclear medicine. PMID:27707869

ICE System: Interruptible control expert system. M.S. Thesis

NASA Technical Reports Server (NTRS)

Vezina, James M.

1990-01-01

The Interruptible Control Expert (ICE) System is based on an architecture designed to provide a strong foundation for real-time production rule expert systems. Three principles are adopted to guide the development of ICE. A practical delivery platform must be provided, no specialized hardware can be used to solve deficiencies in the software design. Knowledge of the environment and the rule-base is exploited to improve the performance of a delivered system. The third principle of ICE is to respond to the most critical event, at the expense of the more trivial tasks. Minimal time is spent on classifying the potential importance of environmental events with the majority of the time used for finding the responses. A feature of the system, derived from all three principles, is the lack of working memory. By using a priori information, a fixed amount of memory can be specified for the hardware platform. The absence of working memory removes the dangers of garbage collection during the continuous operation of the controller.

30 CFR 18.54 - High-voltage continuous mining machines.

Code of Federal Regulations, 2010 CFR

2010-07-01

... and Design Requirements § 18.54 High-voltage continuous mining machines. (a) Separation of high... removed. (c) Circuit-interrupting devices. Circuit-interrupting devices must be designed and installed to... ground. (e) Onboard ungrounded, three-phase power circuit. A continuous mining machine designed with an...

30 CFR 18.54 - High-voltage continuous mining machines.

Code of Federal Regulations, 2013 CFR

2013-07-01

... and Design Requirements § 18.54 High-voltage continuous mining machines. (a) Separation of high... removed. (c) Circuit-interrupting devices. Circuit-interrupting devices must be designed and installed to... ground. (e) Onboard ungrounded, three-phase power circuit. A continuous mining machine designed with an...

30 CFR 18.54 - High-voltage continuous mining machines.

Code of Federal Regulations, 2014 CFR

2014-07-01

... and Design Requirements § 18.54 High-voltage continuous mining machines. (a) Separation of high... removed. (c) Circuit-interrupting devices. Circuit-interrupting devices must be designed and installed to... ground. (e) Onboard ungrounded, three-phase power circuit. A continuous mining machine designed with an...

30 CFR 18.54 - High-voltage continuous mining machines.

Code of Federal Regulations, 2012 CFR

2012-07-01

... and Design Requirements § 18.54 High-voltage continuous mining machines. (a) Separation of high... removed. (c) Circuit-interrupting devices. Circuit-interrupting devices must be designed and installed to... ground. (e) Onboard ungrounded, three-phase power circuit. A continuous mining machine designed with an...

30 CFR 18.54 - High-voltage continuous mining machines.

Code of Federal Regulations, 2011 CFR

2011-07-01

... and Design Requirements § 18.54 High-voltage continuous mining machines. (a) Separation of high... removed. (c) Circuit-interrupting devices. Circuit-interrupting devices must be designed and installed to... ground. (e) Onboard ungrounded, three-phase power circuit. A continuous mining machine designed with an...

Interruption of the Tower of London Task: Support for a Goal-Activation Approach

ERIC Educational Resources Information Center

Hodgetts, Helen M.; Jones, Dylan M.

2006-01-01

Unexpected interruptions introduced during the execution phase of simple Tower of London problems incurred a time cost when the interrupted goal was retrieved, and this cost was exacerbated the longer the goal was suspended. Furthermore, time taken to retrieve goals was greater following a more complex interruption, indicating the processing…

Three axis electronic flight motion simulator real time control system design and implementation

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

Gao, Zhiyuan; Miao, Zhonghua, E-mail: zhonghua-miao@163.com; Wang, Xiaohua

2014-12-15

A three axis electronic flight motion simulator is reported in this paper including the modelling, the controller design as well as the hardware implementation. This flight motion simulator could be used for inertial navigation test and high precision inertial navigation system with good dynamic and static performances. A real time control system is designed, several control system implementation problems were solved including time unification with parallel port interrupt, high speed finding-zero method of rotary inductosyn, zero-crossing management with continuous rotary, etc. Tests were carried out to show the effectiveness of the proposed real time control system.

Three axis electronic flight motion simulator real time control system design and implementation.

PubMed

Gao, Zhiyuan; Miao, Zhonghua; Wang, Xuyong; Wang, Xiaohua

2014-12-01

A three axis electronic flight motion simulator is reported in this paper including the modelling, the controller design as well as the hardware implementation. This flight motion simulator could be used for inertial navigation test and high precision inertial navigation system with good dynamic and static performances. A real time control system is designed, several control system implementation problems were solved including time unification with parallel port interrupt, high speed finding-zero method of rotary inductosyn, zero-crossing management with continuous rotary, etc. Tests were carried out to show the effectiveness of the proposed real time control system.

Individual Differences in Working-Memory Capacity and Task Resumption Following Interruptions

ERIC Educational Resources Information Center

Foroughi, Cyrus K.; Werner, Nicole E.; McKendrick, Ryan; Cades, David M.; Boehm-Davis, Deborah A.

2016-01-01

Previous research has shown that there is a time cost (i.e., a resumption lag) associated with resuming a task following an interruption and that the longer the duration of the interruption, the greater the time cost (i.e., resumption lag increases as interruption duration increases). The memory-for-goals model (Altmann & Trafton, 2002)…

Work conditions, mental workload and patient care quality: a multisource study in the emergency department.

PubMed

Weigl, Matthias; Müller, Andreas; Holland, Stephan; Wedel, Susanne; Woloshynowych, Maria

2016-07-01

Workflow interruptions, multitasking and workload demands are inherent to emergency departments (ED) work systems. Potential effects of ED providers' work on care quality and patient safety have, however, been rarely addressed. We aimed to investigate the prevalence and associations of ED staff's workflow interruptions, multitasking and workload with patient care quality outcomes. We applied a mixed-methods design in a two-step procedure. First, we conducted a time-motion study to observe the rate of interruptions and multitasking activities. Second, during 20-day shifts we assessed ED staff's reports on workflow interruptions, multitasking activities and mental workload. Additionally, we assessed two care quality indicators with standardised questionnaires: first, ED patients' evaluations of perceived care quality; second, patient intrahospital transfers evaluated by ward staff. The study was conducted in a medium-sized community ED (16 600 annual visits). ED personnel's workflow was disrupted on average 5.63 times per hour. 30% of time was spent on multitasking activities. During 20 observations days, data were gathered from 76 ED professionals, 239 patients and 205 patient transfers. After aggregating daywise data and controlling for staffing levels, prospective associations revealed significant negative associations between ED personnel's mental workload and patients' perceived quality of care. Conversely, workflow interruptions were positively associated with patient-related information on discharge and overall quality of transfer. Our investigation indicated that ED staff's capability to cope with demanding work conditions was associated with patient care quality. Our findings contribute to an improved understanding of the complex effects of interruptions and multitasking in the ED environment for creating safe and efficient ED work and care systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The impact of intra-operative interruptions on surgeons' perceived workload: an observational study in elective general and orthopedic surgery.

PubMed

Weigl, Matthias; Antoniadis, Sophia; Chiapponi, Costanza; Bruns, Christiane; Sevdalis, Nick

2015-01-01

Surgeons' intra-operative workload is critical for effective and safe surgical performance. Detrimental conditions in the operating room (OR) environment may add to perceived workload and jeopardize surgical performance and outcomes. This study aims to evaluate the impact of different intra-operative workflow interruptions on surgeons' capacity to manage their workload safely and efficiently. This was an observational study of intra-operative interruptions and self-rated workload in two surgical specialties (general, orthopedic/trauma surgery). Intra-operative interruptions were assessed via expert observation using a well-validated observation tool. Surgeons, nurses, and anesthesiologists assessed their intra-operative workload directly after case completion based on three items of the validated Surgery Task Load Index (mental demand, situational stress, distraction). A total of 56 elective cases (35 open, 21 laparoscopic) with 94 workload ratings were included. Mean intra-operative duration was 1 h 37 min. Intra-operative interruptions were on average observed 9.78 times per hour. People who entered/exited the OR (30.6 %) as well as telephone-/beeper-related disruptions (23.6 %) occurred most often. Equipment and OR environment-related interruptions were associated with highest interference with team functioning particularly in laparoscopic procedures. After identifying task and procedural influences, partial correlational analyses revealed that case-irrelevant communications were negatively associated with surgeons' mental fatigue and situational stress, whereas surgeons' reported distraction was increased by case-irrelevant communication and procedural disruptions. OR nurses' and anesthesiologists' perceived workload was also related to intra-operative interruption events. Our study documents the unique contribution of different interruptions on surgeons' workload; whereas case-irrelevant communications may be beneficial for mental fatigue and stress in routine cases, procedural interruptions and case-irrelevant communication may contribute to surgeons' mental focus deteriorating. Well-designed OR environments, surgical leadership, and awareness can help to control unnecessary interruptions for effective and safe surgical care.

A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety.

PubMed

Larcos, George; Prgomet, Mirela; Georgiou, Andrew; Westbrook, Johanna

2017-06-01

Errors by nuclear medicine technologists during the preparation of radiopharmaceuticals or at other times can cause patient harm and may reflect the impact of interruptions, busy work environments and deficient systems or processes. We aimed to: (a) characterise the rate and nature of interruptions technologists experience and (b) identify strategies that support safety. We performed 100 hours of observation of 11 technologists at a major public hospital and measured the proportions of time spent in eight categories of work tasks, location of task, interruption rate and type and multitasking (tasks conducted in parallel). We catalogued specific safety-oriented strategies used by technologists. Technologists completed 5227 tasks and experienced 569 interruptions (mean, 4.5 times per hour; 95% CI 4.1 to 4.9). The highest interruption rate occurred when technologists were in transit between rooms (10.3 per hour (95% CI 8.3 to 12.5)). Interruptions during radiopharmaceutical preparation occurred a mean of 4.4 times per hour (95% CI 3.3 to 5.6). Most (n=426) tasks were interrupted once only and all tasks were resumed after interruption. Multitasking occurred 16.6% of the time. At least some interruptions were initiated by other technologists to convey important information and/or to render assistance. Technologists employed a variety of verbal and non-verbal strategies in all work areas (notably in the hot-lab) to minimise the impact of interruptions and optimise the safe conduct of procedures. Although most were due to individual choices, some strategies reflected overt or subliminal departmental policy. Some interruptions appear beneficial. Technologists' self-initiated strategies to support safe work practices appear to be an important element in supporting a resilient work environment in nuclear medicine. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Comparison of tensile strength among simple interrupted, cruciate, intradermal, and subdermal suture patterns for incision closure in ex vivo canine skin specimens.

PubMed

Zellner, Eric M; Hedlund, Cheryl S; Kraus, Karl H; Burton, Andrew F; Kieves, Nina R

2016-06-15

OBJECTIVE To compare suture placement time, tension at skin separation and suture line failure, and mode of failure among 4 suture patterns. DESIGN Randomized trial. SAMPLE 60 skin specimens from the pelvic limbs of 30 purpose-bred Beagles. PROCEDURES Skin specimens were harvested within 2 hours after euthanasia and tested within 6 hours after harvest. An 8-cm incision was made in each specimen and sutured with 1 of 4 randomly assigned suture patterns (simple interrupted, cruciate, intradermal, or subdermal). Suture placement time and percentage of skin apposition were evaluated. Specimens were mounted in a calibrated material testing machine and distracted until suture line failure. Tensile strength at skin-edge separation and suture-line failure and mode of failure were compared among the 4 patterns. RESULTS Mean suture placement time for the cruciate pattern was significantly less than that for other patterns. Percentage of skin apposition did not differ among the 4 patterns. Mean tensile strength at skin-edge separation and suture-line failure for the simple interrupted and cruciate patterns were significantly higher than those for the intradermal and subdermal patterns. Mean tensile strength at skin-edge separation and suture-line failure did not differ significantly between the intradermal and subdermal patterns or the simple interrupted and cruciate patterns. The primary mode of failure for the simple interrupted pattern was suture breakage, whereas that for the cruciate, intradermal, and subdermal patterns was tissue failure. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested external skin sutures may be preferred for closure of incisions under tension to reduce risk of dehiscence.

Determining the Social Effects of a Legal Reform; the British Breathalyser Crackdown of 1967

ERIC Educational Resources Information Center

Ross, H. Laurence; And Others

1970-01-01

An application of the Interrupted Time-Series, a quasi-experimental research design, in the sociology of law (law and social change). The effects of British Road Safety Act of 1967, concerning drinking and driving, were analyzed. (SE)

Persistent threats to validity in single-group interrupted time series analysis with a cross over design.

PubMed

Linden, Ariel

2017-04-01

The basic single-group interrupted time series analysis (ITSA) design has been shown to be susceptible to the most common threat to validity-history-the possibility that some other event caused the observed effect in the time series. A single-group ITSA with a crossover design (in which the intervention is introduced and withdrawn 1 or more times) should be more robust. In this paper, we describe and empirically assess the susceptibility of this design to bias from history. Time series data from 2 natural experiments (the effect of multiple repeals and reinstatements of Louisiana's motorcycle helmet law on motorcycle fatalities and the association between the implementation and withdrawal of Gorbachev's antialcohol campaign with Russia's mortality crisis) are used to illustrate that history remains a threat to ITSA validity, even in a crossover design. Both empirical examples reveal that the single-group ITSA with a crossover design may be biased because of history. In the case of motorcycle fatalities, helmet laws appeared effective in reducing mortality (while repealing the law increased mortality), but when a control group was added, it was shown that this trend was similar in both groups. In the case of Gorbachev's antialcohol campaign, only when contrasting the results against those of a control group was the withdrawal of the campaign found to be the more likely culprit in explaining the Russian mortality crisis than the collapse of the Soviet Union. Even with a robust crossover design, single-group ITSA models remain susceptible to bias from history. Therefore, a comparable control group design should be included, whenever possible. © 2016 John Wiley & Sons, Ltd.

How Regrouping Alerts in Computerized Physician Order Entry Layout Influences Physicians' Prescription Behavior: Results of a Crossover Randomized Trial.

PubMed

Wipfli, Rolf; Ehrler, Frederic; Bediang, Georges; Bétrancourt, Mireille; Lovis, Christian

2016-06-02

As demonstrated in several publications, low positive predictive value alerts in computerized physician order entry (CPOE) induce fatigue and may interrupt physicians unnecessarily during prescription of medication. Although it is difficult to increase the consideration of medical alerts by physician through an improvement of their predictive value, another approach consists to act on the way they are presented. The interruption management model inspired us to propose an alternative alert display strategy of regrouping the alerts in the screen layout, as a possible solution for reducing the interruption in physicians' workflow. In this study, we compared 2 CPOE designs based on a particular alert presentation strategy: one design involved regrouping the alerts in a single place on the screen, and in the other, the alerts were located next to the triggering information. Our objective was to evaluate experimentally whether the new design led to fewer interruptions in workflow and if it affected alert handling. The 2 CPOE designs were compared in a controlled crossover randomized trial. All interactions with the system and eye movements were stored for quantitative analysis. The study involved a group of 22 users consisting of physicians and medical students who solved medical scenarios containing prescription tasks. Scenario completion time was shorter when the alerts were regrouped (mean 117.29 seconds, SD 36.68) than when disseminated on the screen (mean 145.58 seconds, SD 75.07; P=.045). Eye tracking revealed that physicians fixated longer on alerts in the classic design (mean 119.71 seconds, SD 76.77) than in the centralized alert design (mean 70.58 seconds, SD 33.53; P=.001). Visual switches between prescription and alert areas, indicating interruption, were reduced with centralized alerts (mean 41.29, SD 21.26) compared with the classic design (mean 57.81, SD 35.97; P=.04). Prescription behavior (ie, prescription changes after alerting), however, did not change significantly between the 2 strategies of display. The After-Scenario Questionnaire (ASQ) that was filled out after each scenario showed that overall satisfaction was significantly rated lower when alerts were regrouped (mean 4.37, SD 1.23) than when displayed next to the triggering information (mean 5.32, SD 0.94; P=.02). Centralization of alerts in a table might be a way to motivate physicians to manage alerts more actively, in a meaningful way, rather than just being interrupted by them. Our study could not provide clear recommendations yet, but provides objective data through a cognitive psychological approach. Future tests should work on standardized scenarios that would enable to not only measure physicians' behavior (visual fixations and handling of alerts) but also validate those actions using clinical criteria.

Analysis of Smartphone Interruptions on Academic General Internal Medicine Wards. Frequent Interruptions may cause a 'Crisis Mode' Work Climate.

PubMed

Vaisman, Alon; Wu, Robert C

2017-01-04

Hospital-based medical services are increasingly utilizing team-based pagers and smartphones to streamline communications. However, an unintended consequence may be higher volumes of interruptions potentially leading to medical error. There is likely a level at which interruptions are excessive and cause a 'crisis mode' climate. We retrospectively collected phone, text messaging, and email interruptions directed to hospital-assigned smartphones on eight General Internal Medicine (GIM) teams at two tertiary care centres in Toronto, Ontario from April 2013 to September 2014. We also calculated the number of times these interruptions exceeded a pre-specified threshold per hour, termed 'crisis mode', defined as at least five interruptions in 30 minutes. We analyzed the correlation between interruptions and date, site, and patient volumes. A total of 187,049 interruptions were collected over an 18-month period. Daily weekday interruptions rose sharply in the morning, peaking between 11 AM to 12 PM and measuring 4.8 and 3.7 mean interruptions/hour at each site, respectively. Mean daily interruptions per team totaled 46.2 ± 3.6 at Site 1 and 39.2 ± 4.2 at Site 2. The 'crisis mode' threshold was exceeded, on average, 2.3 times/day per GIM team during weekdays. In a multivariable linear regression analysis, site (β6.43 CI95% 5.44 - 7.42, p<0.001), day of the week (with Friday having the most interruptions) (β0.481 CI95% 0.236 - 0.730, p<0.05) and patient census (β1.55 CI95% 1.42 - 1.67, p<0.05) were all predictive of daily interruption volume although there was a significant interaction effect between site and patient census (β-0.941 CI95% -1.18 - -0.703, p<0.05). Interruptions were related to site-specific features, including volume, suggesting that future interventions should target the culture of individual hospitals. Excessive interruptions may have implications for patient safety especially when exceeding a maximal threshold over short periods of time.

Dealing with task interruptions in complex dynamic environments: are two heads better than one?

PubMed

Tremblay, Sébastien; Vachon, François; Lafond, Daniel; Kramer, Chelsea

2012-02-01

This study examined whether teaming up mitigates individual vulnerability to task interruptions in complex dynamic situations. Omnipresent in everyday multitasking environments, task interruptions are usually detrimental to individual performance. This is particularly crucial in dynamic command and control (C2) safety-critical contexts because of the additional challenge imposed by the continually evolving situation during the interruption. We employed a firefighting microworld to simulate C2 in the context of supervisory control to examine the relative impact of interruptions on participants working in a functional dyad versus operators working alone. Although task interruption was detrimental to participants' efficacy of monitoring resources, the negative impact of interruption was reduced for those working in teams. Teaming up translated into faster resumption time, but only if both teammates were interrupted simultaneously. Interrupting only one team member was associated with increased postinterruption communications and slower resumption time. These findings suggest that in complex dynamic situations working in a small team confers more resistance to task interruption than working alone by virtue of the reduced individual workload typical of teamwork. The benefit of collaborative work seems nevertheless mediated by the coordination and communication overhead associated with teamwork. The present findings have practical implications for operators dealing with unexpected events such as task interruptions in C2 environments.

Interruptions in a level one trauma center: a case study.

PubMed

Brixey, Juliana J; Tang, Zhihua; Robinson, David J; Johnson, Craig W; Johnson, Todd R; Turley, James P; Patel, Vimla L; Zhang, Jiajie

2008-04-01

The emergency department has been characterized as interrupt-driven. Government agencies and patient safety organizations recognize that interruptions contribute to medical errors. The purpose of this study was to observe, record, and contextualize activities and interruptions experienced by physicians and Registered Nurses (RNs) working in a Level One Trauma Center. A case study that relied on an ethnographic study design using the shadowing method. A convenience sample of physicians and RNs, each with at least 6 months of experience in the Emergency Department (ED), were asked to participate. In these kinds of detailed qualitative investigations, it is quite common to have a small sample size. Ethical approval: Approval was obtained from institutional ethic committees prior to initiating the study. Community consent was obtained from the ED staff through in-service education. All observations were made in the trauma section of the ED of a tertiary teaching hospital. The hospital is situated in a major medical center in the Gulf Coast region of the United States of America (USA). Five attending ED physicians were observed for a total of 29h, 31min. Eight RNs were shadowed for a total of 40 h, 9min. Interruptions and activities were categorized using the Hybrid Method to Categorize Interruptions and Activities (HyMCIA). Registered Nurses received slightly more interruptions per hour than physicians. People, pagers, and telephones were identified as mediums through which interruptions were delivered. The physical environment was found to contribute to interruptions in workflow because of physical design and when supplies were not available. Physicians and RNs usually returned to the original, interrupted activity more often than leaving the activity unfinished. This research provides an enhanced understanding of interruptions in workflow in the ED, the identification of work constraints, and the need to develop interventions to manage interruptions. It is crucial that interruptions be delivered in such a way that there is minimal negative impact on performance. The significance and importance of the interruption must always be weighed against the negative impact that it has on smooth, efficient workflow.

Charging system using solar panels and a highly resonant wireless power transfer model for small UAS applications

NASA Astrophysics Data System (ADS)

Hallman, Sydney N.; Huck, Robert C.; Sluss, James J.

2016-05-01

The use of a wireless charging system for small, unmanned aircraft system applications is useful for both military and commercial consumers. An efficient way to keep the aircraft's batteries charged without interrupting flight would be highly marketable. While the general concepts behind highly resonant wireless power transfer are discussed in a few publications, the details behind the system designs are not available even in academic journals, especially in relation to avionics. Combining a highly resonant charging system with a solar panel charging system can produce enough power to extend the flight time of a small, unmanned aircraft system without interruption. This paper provides an overview of a few of the wireless-charging technologies currently available and outlines a preliminary design for an aircraft-mounted battery charging system.

Fast interrupt platform for extended DOS

NASA Technical Reports Server (NTRS)

Duryea, T. W.

1995-01-01

Extended DOS offers the unique combination of a simple operating system which allows direct access to the interrupt tables, 32 bit protected mode access to 4096 MByte address space, and the use of industry standard C compilers. The drawback is that fast interrupt handling requires both 32 bit and 16 bit versions of each real-time process interrupt handler to avoid mode switches on the interrupts. A set of tools has been developed which automates the process of transforming the output of a standard 32 bit C compiler to 16 bit interrupt code which directly handles the real mode interrupts. The entire process compiles one set of source code via a make file, which boosts productivity by making the management of the compile-link cycle very simple. The software components are in the form of classes written mostly in C. A foreground process written as a conventional application which can use the standard C libraries can communicate with the background real-time classes via a message passing mechanism. The platform thus enables the integration of high performance real-time processing into a conventional application framework.

Embedded real-time operating system micro kernel design

NASA Astrophysics Data System (ADS)

Cheng, Xiao-hui; Li, Ming-qiang; Wang, Xin-zheng

2005-12-01

Embedded systems usually require a real-time character. Base on an 8051 microcontroller, an embedded real-time operating system micro kernel is proposed consisting of six parts, including a critical section process, task scheduling, interruption handle, semaphore and message mailbox communication, clock managent and memory managent. Distributed CPU and other resources are among tasks rationally according to the importance and urgency. The design proposed here provides the position, definition, function and principle of micro kernel. The kernel runs on the platform of an ATMEL AT89C51 microcontroller. Simulation results prove that the designed micro kernel is stable and reliable and has quick response while operating in an application system.

Dendritic cell immunotherapy followed by cART interruption during HIV-1 infection induces plasma protein markers of cellular immunity and neutrophil recruitment

PubMed Central

Cooper, Jason D.; Tomasik, Jakub; Bahn, Sabine; Aerts, Joeri L.; Osterhaus, Albert D. M. E.; Gruters, Rob A.; Andeweg, Arno C.

2018-01-01

Objectives To characterize the host response to dendritic cell-based immunotherapy and subsequent combined antiretroviral therapy (cART) interruption in HIV-1-infected individuals at the plasma protein level. Design An autologous dendritic cell (DC) therapeutic vaccine was administered to HIV-infected individuals, stable on cART. The effect of vaccination was evaluated at the plasma protein level during the period preceding cART interruption, during analytical therapy interruption and at viral reactivation. Healthy controls and post-exposure prophylactically treated healthy individuals were included as controls. Methods Plasma marker (‘analyte’) levels including cytokines, chemokines, growth factors, and hormones were measured in trial participants and control plasma samples using a multiplex immunoassay. Analyte levels were analysed using principle component analysis, cluster analysis and limma. Blood neutrophil counts were analysed using linear regression. Results Plasma analyte levels of HIV-infected individuals are markedly different from those of healthy controls and HIV-negative individuals receiving post-exposure prophylaxis. Viral reactivation following cART interruption also affects multiple analytes, but cART interruption itself only has only a minor effect. We find that Thyroxine-Binding Globulin (TBG) levels and late-stage neutrophil numbers correlate with the time off cART after DC vaccination. Furthermore, analysis shows that cART alters several regulators of blood glucose levels, including C-peptide, chromogranin-A and leptin. HIV reactivation is associated with the upregulation of CXCR3 ligands. Conclusions Chronic HIV infection leads to a change in multiple plasma analyte levels, as does virus reactivation after cART interruption. Furthermore, we find evidence for the involvement of TBG and neutrophils in the response to DC-vaccination in the setting of HIV-infection. PMID:29389978

Analysis of Smartphone Interruptions on Academic General Internal Medicine Wards

PubMed Central

C.Wu, Robert

2017-01-01

Summary Introduction Hospital-based medical services are increasingly utilizing team-based pagers and smartphones to streamline communications. However, an unintended consequence may be higher volumes of interruptions potentially leading to medical error. There is likely a level at which interruptions are excessive and cause a ‘crisis mode’ climate. Methods We retrospectively collected phone, text messaging, and email interruptions directed to hospital-assigned smartphones on eight General Internal Medicine (GIM) teams at two tertiary care centres in Toronto, Ontario from April 2013 to September 2014. We also calculated the number of times these interruptions exceeded a pre-specified threshold per hour, termed ‘crisis mode’, defined as at least five interruptions in 30 minutes. We analyzed the correlation between interruptions and date, site, and patient volumes. Results A total of 187,049 interruptions were collected over an 18-month period. Daily weekday interruptions rose sharply in the morning, peaking between 11 AM to 12 PM and measuring 4.8 and 3.7 mean interruptions/hour at each site, respectively. Mean daily interruptions per team totaled 46.2 ± 3.6 at Site 1 and 39.2 ± 4.2 at Site 2. The ‘crisis mode’ threshold was exceeded, on average, 2.3 times/day per GIM team during weekdays. In a multivariable linear regression analysis, site (β6.43 CI95% 5.44 – 7.42, p<0.001), day of the week (with Friday having the most interruptions) (β0.481 CI95% 0.236 – 0.730, p<0.05) and patient census (β1.55 CI95% 1.42 – 1.67, p<0.05) were all predictive of daily interruption volume although there was a significant interaction effect between site and patient census (β-0.941 CI95% -1.18 – -0.703, p<0.05). Conclusion Interruptions were related to site-specific features, including volume, suggesting that future interventions should target the culture of individual hospitals. Excessive interruptions may have implications for patient safety especially when exceeding a maximal threshold over short periods of time. PMID:28066851

Single-Site, Results-Level Evaluation of Quality Awareness Training.

ERIC Educational Resources Information Center

Murray, Brian; Raffaele, Gary C.

1997-01-01

An interrupted time-series design pooling 6 12-year series evaluated the long-term effects of a quality training intervention in a factory. Training positively affected quality of goods and dollar utility. Production process was an important contextual factor in assessing the effect size of the intervention. (SK)

78 FR 28764 - Airworthiness Directives; The Boeing Company

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... time given in AD 2011-12-09. (i) Ground Fault Interrupt (GFI) Relay Position Change For airplanes in..., -400, and -500 series airplanes. This proposed AD was prompted by fuel system reviews conducted by the... result of those findings, we issued a regulation titled ``Transport Airplane Fuel Tank System Design...

EASAMS' Ariane 5 on-board software experience

NASA Astrophysics Data System (ADS)

Birnie, Steven Andrew

The design and development of the prototype flight software for the Ariane 5 satellite launch vehicle is considered. This was specified as being representative of the eventual real flight program in terms of timing constraints and target computer loading. The usability of HOOD (Hierarchical Object Oriented Design) and Ada for development of such preemptive multitasking computer programs was verified. Features of the prototype development included: design methods supplementary to HOOD for representation of concurrency aspects; visibility of Ada enumerated type literals across HOOD parent-child interfaces; deterministic timings achieved by modification of Ada delays; and linking of interrupts to Ada task entries.

Resident perceptions of the impact of paging on intraoperative education.

PubMed

Rose, Joel S; Waibel, Brett H; Schenarts, Paul J

2012-06-01

Our purpose was to evaluate the impact of paging on perceptions of intraoperative learning. Intraoperative logs of pager interruptions were kept by surgical residents at a university hospital over a 30-day period. The postgraduate year, number of pages, category of caller, reason for call, and level of urgency were recorded during each operation. At the conclusion of each operation, residents also completed a two-item survey with responses on a 5-point scale (1 = strongly disagree to 5 = strongly agree), querying if interruptions negatively impacted the intraoperative experience and if a message taken by a third party was effective in limiting interruptions. Logs were completed for 124 of 204 operations. Fifty-five per cent of operations were interrupted at least once with 49 per cent interrupted two to five times and 6 per cent were interrupted six or more times. Junior residents had 69 per cent of their operations interrupted compared with 39 per cent of senior residents (P = 0.001). Ninety-two per cent of pages were nonurgent. Residents did not perceive pager interruptions negatively impacted their educational experience (mean 2.3) but were neutral with respect if messages taken by a third party decreased interruptions (mean 3.8). Although our hypothesis was that pager interruptions were frequent and disrupt resident education, our data demonstrate the opposite.

Interrupted time series analysis in drug utilization research is increasing: systematic review and recommendations.

PubMed

Jandoc, Racquel; Burden, Andrea M; Mamdani, Muhammad; Lévesque, Linda E; Cadarette, Suzanne M

2015-08-01

To describe the use and reporting of interrupted time series methods in drug utilization research. We completed a systematic search of MEDLINE, Web of Science, and reference lists to identify English language articles through to December 2013 that used interrupted time series methods in drug utilization research. We tabulated the number of studies by publication year and summarized methodological detail. We identified 220 eligible empirical applications since 1984. Only 17 (8%) were published before 2000, and 90 (41%) were published since 2010. Segmented regression was the most commonly applied interrupted time series method (67%). Most studies assessed drug policy changes (51%, n = 112); 22% (n = 48) examined the impact of new evidence, 18% (n = 39) examined safety advisories, and 16% (n = 35) examined quality improvement interventions. Autocorrelation was considered in 66% of studies, 31% reported adjusting for seasonality, and 15% accounted for nonstationarity. Use of interrupted time series methods in drug utilization research has increased, particularly in recent years. Despite methodological recommendations, there is large variation in reporting of analytic methods. Developing methodological and reporting standards for interrupted time series analysis is important to improve its application in drug utilization research, and we provide recommendations for consideration. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

The effect of interruptions during training on the time to the first trial and race start in Thoroughbred racehorses.

PubMed

Bolwell, C F; Rogers, C W; French, N P; Firth, E C

2013-02-01

Few studies have investigated the effect of having interruptions during training on future training and racing performance in Thoroughbred racehorses. The aim of this paper was to investigate the effect of having an interruption before the first trial on starting in a trial or a race. A prospective cohort study was used to record the training activity of a cohort of Thoroughbred racehorses, over two racing seasons. Fourteen racehorse trainers recorded information on the distances worked at canter and at fast speeds (<15s/200 m) and provided reasons for horses not training, or for having interruptions (break from training). Trial and racing results were obtained from the New Zealand Thoroughbred Racing online database. A Cox proportional hazards regression model was used to investigate two outcome measures of performance: (1) time to the first trial and (2) time to the first race. The type of interruption that had occurred before the first trial was the main exposure of interest, and was grouped into: no interruption, voluntary (no known condition or disease present) and involuntary interruptions (due to the presence of a condition or disease). A total of 160/200 (80%) horses started in at least one trial and 100/205 (48%) horses started in at least one race during the study period. The median time to starting in a trial or a race differed significantly (p<0.001) with the type of interruption. The hazard of starting in a trial was lower for horses experiencing voluntary and involuntary interruptions (p<0.001) but there was no association with starting in a race, after adjusting for confounding variables. As age at the start of training increased the hazard of starting in a trial decreased. Horses accumulating longer distances at 15s/200 m had a higher hazard of starting in a trial, whilst horses accumulating fewer events at high speed and fewer trials had a reduced hazard of starting in a race. There was significant clustering at the trainer level for both the outcomes investigated. Interruptions to training had an effect on the time to, and hazard of, a trial but not a race start. The timing of these interruptions may have implications for future racing success and career longevity. Copyright © 2012 Elsevier B.V. All rights reserved.

Results of a randomized trial of HERMES-assisted versus non-HERMES-assisted laparoscopic antireflux surgery.

PubMed

Luketich, J D; Fernando, H C; Buenaventura, P O; Christie, N A; Grondin, S C; Schauer, P R

2002-09-01

Speech recognition technology is a recent development in minimally invasive surgery. This study was designed to assess the impact of HERMES on operating room efficiency and user satisfaction. Patients undergoing laparoscopic antireflux operations by surgeons experienced in minimally invasive surgery were randomized to HERMES-assisted or standard laparoscopic operations. The variables of interest were circulating nurse's time spent adjusting devices that are voice-controlled by HERMES, number of adjustments to devices requested, and surgeon and nurse satisfaction measured on a scale from 1 (dissatisfied) to 10 (satisfied). A total of 30 cases were studied. In the non-HERMES cases, nurses were interrupted to make device adjustments an average of 15.3 times per case versus 0.33 times per case in the with-HERMES cases (p < 0.01). The interruptions during the non-HERMES cases averaged 4.35 min per case versus 0.16 min per case in the with-HERMES cases (p = 0.03). Average satisfaction scores for HERMES operations as opposed to non-HERMES operations were 9.2 versus 5.3 for nurses (p < 0.01) and 9.0 versus 5.1 for surgeons (p < 0.01). Physician and nurse acceptance of HERMES was very high because of the smoother interruption-free environment.

Opioid interruptions, pain, and withdrawal symptoms in nursing home residents.

PubMed

Redding, Sarah E; Liu, Sophia; Hung, William W; Boockvar, Kenneth S

2014-11-01

Interruptions in opioid use have the potential to cause pain relapse and withdrawal symptoms. The objectives of this study were to observe patterns of opioid interruption during acute illness in nursing home residents and examine associations between interruptions and pain and withdrawal symptoms. Patients from 3 nursing homes in a metropolitan area who were prescribed opioids were assessed for symptoms of pain and withdrawal by researchers blinded to opioid dosage received, using the Brief Pain Inventory Scale and the Clinical Opioid Withdrawal Scale, respectively, during prespecified time periods. The prespecified time periods were 2 weeks after onset of acute illness (eg, urinary tract infection), and 2 weeks after hospital admission and nursing home readmission, if they occurred. Opioid dosing was recorded and a significant interruption was defined as a complete discontinuation or a reduction in dose of >50% for ≥1 day. The covariates age, sex, race, comorbid conditions, initial opioid dose, and initial pain level were recorded. Symptoms pre- and post-opioid interruptions were compared and contrasted with those in a group without opioid interruptions. Sixty-six patients receiving opioids were followed for a mean of 10.9 months and experienced a total of 104 acute illnesses. During 64 (62%) illnesses, patients experienced any reduction in opioid dosing, with a mean (SD) dose reduction of 63.9% (29.9%). During 39 (38%) illnesses, patients experienced a significant opioid interruption. In a multivariable model, residence at 1 of the 3 nursing homes was associated with a lower risk of interruption (odds ratio = 0.073; 95% CI, 0.009 to 0.597; P < 0.015). In patients with interruptions, there were statistically insignificant changes in mean (SD) pain score (difference -0.50 [2.66]; 95% CI, -3.16 to 2.16) and withdrawal score (difference -0.91 [3.12]; 95% CI, -4.03 to 2.21) after the interruption as compared with before interruption. However, when compared with patients without interruptions, patients with interruptions experienced larger increases in pain scores during the follow-up periods (difference 0.09 points per day; 95% CI, -0.01 to 0.019; P = 0.08). In particular, patients who received the highest quartile of opioid dose before interruption experienced increases in pain scores over time that were 0.22 points per day larger (95% CI, 0.02 to 0.41; P = 0.03) than those without interruption. Withdrawal scores were not associated with opioid interruption regardless of dose before interruption. Nursing home patients often experience interruptions in opioid dosing, which can be associated with worse pain, but not withdrawal symptoms, during acute illnesses. Clinicians should be aware of the potential risks and effects of opioid interruptions during acute illnesses in this patient group. Published by Elsevier Inc.

Interrupted Time Series Versus Statistical Process Control in Quality Improvement Projects.

PubMed

Andersson Hagiwara, Magnus; Andersson Gäre, Boel; Elg, Mattias

2016-01-01

To measure the effect of quality improvement interventions, it is appropriate to use analysis methods that measure data over time. Examples of such methods include statistical process control analysis and interrupted time series with segmented regression analysis. This article compares the use of statistical process control analysis and interrupted time series with segmented regression analysis for evaluating the longitudinal effects of quality improvement interventions, using an example study on an evaluation of a computerized decision support system.

Avoidable interruptions during drug administration in an intensive rehabilitation ward: improvement project.

PubMed

Buchini, Sara; Quattrin, Rosanna

2012-04-01

To record the frequency of interruptions and their causes, to identify 'avoidable' interruptions and to build an improvement project to reduce 'avoidable' interruptions. In Italy each year 30,000-35,000 deaths per year are attributed to health-care system errors, of which 19% are caused by medication errors. The factors that contribute to drug management error also include interruptions and carelessness during treatment administration. A descriptive study design was used to record the frequency of interruptions and their causes and to identify 'avoidable' interruptions in an intensive rehabilitation ward in Northern Italy. A data collection grid was used to record the data over a 6-month period. A total of 3000 work hours were observed. During the study period 1170 interruptions were observed. The study identified 14 causes of interruption. The study shows that of the 14 cases of interruptions at least nine can be defined as 'avoidable'. An improvement project has been proposed to reduce unnecessary interruptions and distractions to avoid making errors. An additional useful step to reduce the incidence of treatment errors would be to implement the use of a single patient medication sheet for the recording of drug prescription, preparation and administration and also the incident reporting. © 2011 Blackwell Publishing Ltd.

Embedded interruptions and task complexity influence schema-related cognitive load progression in an abstract learning task.

PubMed

Wirzberger, Maria; Esmaeili Bijarsari, Shirin; Rey, Günter Daniel

2017-09-01

Cognitive processes related to schema acquisition comprise an essential source of demands in learning situations. Since the related amount of cognitive load is supposed to change over time, plausible temporal models of load progression based on different theoretical backgrounds are inspected in this study. A total of 116 student participants completed a basal symbol sequence learning task, which provided insights into underlying cognitive dynamics. Two levels of task complexity were determined by the amount of elements within the symbol sequence. In addition, interruptions due to an embedded secondary task occurred at five predefined stages over the task. Within the resulting 2x5-factorial mixed between-within design, the continuous monitoring of efficiency in learning performance enabled assumptions on relevant resource investment. From the obtained results, a nonlinear change of learning efficiency over time seems most plausible in terms of cognitive load progression. Moreover, different effects of the induced interruptions show up in conditions of task complexity, which indicate the activation of distinct cognitive mechanisms related to structural aspects of the task. Findings are discussed in the light of evidence from research on memory and information processing. Copyright © 2017 Elsevier B.V. All rights reserved.

Causes and occurrences of interruptions during ED triage.

PubMed

Johnson, Kimberly D; Motavalli, Michele; Gray, Dean; Kuehn, Connie

2014-09-01

Interruptions have been shown to cause errors and delays in the treatment of emergency patients and pose a real threat during the triage process. Missteps during the triage assessment can send a patient down the wrong treatment path and lead to delays. The purpose of this project was to identify the types and frequency of interruptions during the ED triage interview process. A focus group of emergency nurses was organized to identify the types of interruptions that commonly occur during the triage interview. These interruptions would be validated through observations in triage. A tally sheet was developed and implemented to determine how often each interruption occurred during an 8-hour shift. Triage nurses completed the tally sheets while working the first shift (7 am to 3 pm). This shift was selected because patient intake in the US Department of Veterans Affairs Emergency Department is highest during this time. The categories of interruptions identified included provision of conveniences to visitors, coworker-related interruptions, patient care-related interruptions, locating of family members in the emergency department, and other miscellaneous interruptions. Tally sheets were completed by the triage nurses during 10 shifts. On average, triage nurses were interrupted 48.2 times during an 8-hour shift (7 interruptions per hour). After reviewing the data, we found that only 22% of interruptions were related to patient care. More frequently, the causes of interruptions were not related to patient care: opening the door (33%), providing conveniences to visitors (21%), waiting patients or family members asking "How much longer?" (14%), and other causes (10%). Frequent interruptions can interfere with concentration and may affect patient care. Non-patient care-related interruptions not only can be frustrating to the triage nurse but also can be offensive to triage patients; they ultimately delay care and may even affect the quality of care. However, because scarce research is available regarding interruptions during ED triage, the effects on patient outcomes are unclear. Additional research needs to be conducted to explore the causes and effects of interruptions to the triage process. Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Heterogeneity in application, design, and analysis characteristics was found for controlled before-after and interrupted time series studies included in Cochrane reviews.

PubMed

Polus, Stephanie; Pieper, Dawid; Burns, Jacob; Fretheim, Atle; Ramsay, Craig; Higgins, Julian P T; Mathes, Tim; Pfadenhauer, Lisa M; Rehfuess, Eva A

2017-11-01

The aim of the study was to examine the application, design, and analysis characteristics of controlled before-after (CBA) and interrupted time series (ITS) studies and their use in Cochrane reviews. We searched the Cochrane library for reviews including these study designs from May 2012 to March 2015 and purposively selected, where available, two reviews each across 10 prespecified intervention types. We randomly selected two CBA and two ITS studies from each review. Two researchers independently extracted information from the studies and the respective reviews. Sixty-nine reviews considered CBA and ITS studies for inclusion. We analyzed 21 CBA and 16 ITS studies from 11 to 8 reviews, respectively. Cochrane reviews inconsistently defined and labeled CBA and ITS studies. Many studies did not meet the Cochrane definition or the minimum criteria provided by Cochrane Effective Practice and Organisation of Care. The studies present a heterogeneous set of study features and applied a large variety of analyses. While CBA and ITS studies represent important study designs to evaluate the effects of interventions, especially on a population or organizational level, unclear study design features challenge unequivocal classification and appropriate use. We discuss options for more specific definitions and explicit criteria for CBA and ITS studies. Copyright © 2017 Elsevier Inc. All rights reserved.

Reducing the Disruptive Effects of Interruptions With Noninvasive Brain Stimulation.

PubMed

Blumberg, Eric J; Foroughi, Cyrus K; Scheldrup, Melissa R; Peterson, Matthew S; Boehm-Davis, Debbie A; Parasuraman, Raja

2015-09-01

The authors determine whether transcranial direct current stimulation (tDCS) can reduce resumption time when an ongoing task is interrupted. Interruptions are common and disruptive. Working memory capacity has been shown to predict resumption lag (i.e., time to successfully resume a task after interruption). Given that tDCS applied to brain areas associated with working memory can enhance performance, tDCS has the potential to improve resumption lag when a task is interrupted. Participants were randomly assigned to one of four groups that received anodal (active) stimulation of 2 mA tDCS to one of two target brain regions, left and right dorsolateral prefrontal cortex (DLPFC), or to one of two control areas, active stimulation of the left primary motor cortex or sham stimulation of the right DLPFC, while completing a financial management task that was intermittently interrupted with math problem solving. Anodal stimulation to the right and left DLPFC significantly reduced resumption lags compared to the control conditions (sham and left motor cortex stimulation). Additionally, there was no speed-accuracy tradeoff (i.e., the improvement in resumption time was not accompanied by an increased error rate). Noninvasive brain stimulation can significantly decrease resumption lag (improve performance) after a task is interrupted. Noninvasive brain stimulation offers an easy-to-apply tool that can significantly improve interrupted task performance. © 2014, Human Factors and Ergonomics Society.

The Voltage Distribution Characteristics of a Hybrid Circuit Breaker During High Current Interruption

NASA Astrophysics Data System (ADS)

Cheng, Xian; Duan, Xiongying; Liao, Minfu; Huang, Zhihui; Luo, Yan; Zou, Jiyan

2013-08-01

Hybrid circuit breaker (HCB) technology based on a vacuum interrupter and a SF6 interrupter in series has become a new research direction because of the low-carbon requirements for high voltage switches. The vacuum interrupter has an excellent ability to deal with the steep rising part of the transient recovery voltage (TRV), while the SF6 interrupter can withstand the peak part of the voltage easily. An HCB can take advantage of the interrupters in the current interruption process. In this study, an HCB model based on the vacuum ion diffusion equations, ion density equation, and modified Cassie-Mayr arc equation is explored. A simulation platform is constructed by using a set of software called the alternative transient program (ATP). An HCB prototype is also designed, and the short circuit current is interrupted by the HCB under different action sequences of contacts. The voltage distribution of the HCB is analyzed through simulations and tests. The results demonstrate that if the vacuum interrupter withstands the initial TRV and interrupts the post-arc current first, then the recovery speed of the dielectric strength of the SF6 interrupter will be fast. The voltage distribution between two interrupters is determined by their post-arc resistance, which happens after current-zero, and subsequently, it is determined by the capacitive impedance after the post-arc current decays to zero.

Bonding, Achievement, and Activities: School Bonding, Academic Achievement, and Participation in Extracurricular Activities

ERIC Educational Resources Information Center

Howard, Anissa K.; Ziomek-Daigle, Jolie

2009-01-01

Utilizing a single-group interrupted time series design (Creswell, 2003), this pilot study examined the relationship between academic achievement, school bonding, and the extracurricular activity participation of "uninvolved" students (n=11) who participated in a voluntary support group at a suburban high school in the southeast. Results…

F.A.C.E. Time (Families and Communities Educating): Accommodating Newcomers in Elementary School

ERIC Educational Resources Information Center

Cairo, Aminata; Sumney, Diane; Blackman, Jill; Joyner, Katie

2012-01-01

In American public schools refugees from overseas and Latino migrant children typically find themselves in English learning programs, usually designated as English as a Second Language (ESL), Limited English Proficiency (LEP), or English Language Learners (ELL) programs. Often, these children have received little, interrupted, or no prior…

[Current situation of enteral nutrition interruptions in sepsis children in pediatric intensive care unit].

PubMed

Fang, B L; Qian, S Y; Jia, X L; Li, Z; Liu, J

2016-09-01

To analyze the interruptions of enteral nutrition (EN) and it's relationship to prognosis in children with sepsis in pediatric intensive care unit (PICU). Daily EN intake and reasons for EN interruptions were prospectively observed and recorded in children with sepsis who were admitted to our PICU from November 2012 to April 2013. Clinical prognosis was compared between children with and without EN interruptions by t, rank-sum and χ(2) tests. Totally 60 consecutive children were included, 42 males, median age 9.67 (5.36, 37.0) months; 50 children suffered from EN interruptions, while 10 children did not. Median time to EN initiation was 2.59 (1.53, 3.67) h; EN was interrupted in 83% (50/60) of children, for a total of 108 times and 696 h, the most common reasons were fibrobronchoscopy and radiologic procedures, 27 and 29 times respectively. Children spent 0.04 (0.02, 0.08) of their total observation period without EN nutrition due to EN interruptions, and was not correlated with pediatric critically ill score (r=0.12, P=0.38). Children with EN interruptions suffered from longer PICU duration ((12±7) vs. (7±4) d, t=2.18, P=0.03), but there was no significant difference in the 28(th) hospital day's mortality between these two groups (6 cases vs. 1 case, χ(2)=0.00, P=1.00). EN is frequently interrupted due to procedures needed fasting, EN intolerance and other reasons in children with sepsis. EN interruptions may have something to do with prolonged PICU length of stay, but the relationship needs to be examined in future studies.

Demonstration program for Omega receiver prototype microcomputer data processing

NASA Technical Reports Server (NTRS)

Lilley, R. W.

1976-01-01

The JOLT (TM) commercial microcomputer, based on the MOS Technology 6502 processor chip, for use in Omega navigation system is evaluated. A computer program was prepared in hand-assembled code to demonstrate receiver operation. The processor provides binary processing with interrupts enabled, a carriage return is given to initialize the teleprinter, and a jump is performed to enter the program loop to wait for an interrupt. The program loop operates continuously testing the interrupt flag. The interrupt routine reads the receiver status word and determines whether the current time-slot is the A slot. If so, the interrupt flag, which is also the data index pointer, is reset to zero. The status word is stored in the status buffer. If the time-slot is not A, the interrupt flag/pointer is incremented by one to index the phase and status to the proper buffer words for later use by the print routine.

Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses.

PubMed

Bellandi, Tommaso; Cerri, Alessandro; Carreras, Giulia; Walter, Scott; Mengozzi, Cipriana; Albolino, Sara; Mastrominico, Eleonora; Renzetti, Fernando; Tartaglia, Riccardo; Westbrook, Johanna

2018-01-01

The aim of this study was to obtain baseline data on doctors' and nurses' work activities and rates of interruptions and multitasking to improve work organisation and processes. Data were collected in six surgical units with the WOMBAT (Work Observation Method by Activity Timing) tool. Results show that doctors and nurses received approximately 13 interruptions per hour, or one interruption every 4.5 min. Compared to doctors, nurses were more prone to interruptions in most activities, while doctors performed multitasking (33.47% of their time, 95% CI 31.84-35.17%) more than nurses (15.23%, 95% CI 14.24-16.25%). Overall, the time dedicated to patient care is relatively limited for both professions (37.21%, 95% CI 34.95-39.60% for doctors, 27.22%, 95% CI 25.18-29.60% for nurses) compared to the time spent for registration of data and professional communication, that accounts for two-thirds of doctors' time and nearly half of nurses' time. Further investigation is needed on strategies to manage job demands and professional communications. Practitioner Summary: This study offers further findings on the characteristics and frequency of multitasking and interruptions in surgery, with a comparison of how they affect doctors and nurses. Further investigation is needed to improve the management of job demands and communications according to the results.

Interruptions in emergency medicine: things are not always what they seem.

PubMed

Walter, Scott R

2018-06-20

We have all felt the cognitive disjuncture of being interrupted during an important task. Most ED physicians will readily proffer the high frequency and/or burden of interruptions during their work, and of the many observational studies of interruptions in healthcare EDs do indeed have high interruption rates[2]. In experimental psychology, where many of these ideas originated, there is plenty of evidence that interruptions negatively affect performance. Interruptions have been associated with reduced performance on complex tasks[3,4], increased sequence errors[5], increased task completion time and augmented annoyance and anxiety[6]. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Progressive Care Nurses Improving Patient Safety by Limiting Interruptions During Medication Administration.

PubMed

Flynn, Fran; Evanish, Julie Q; Fernald, Josephine M; Hutchinson, Dawn E; Lefaiver, Cheryl

2016-08-01

Because of the high frequency of interruptions during medication administration, the effectiveness of strategies to limit interruptions during medication administration has been evaluated in numerous quality improvement initiatives in an effort to reduce medication administration errors. To evaluate the effectiveness of evidence-based strategies to limit interruptions during scheduled, peak medication administration times in 3 progressive cardiac care units (PCCUs). A secondary aim of the project was to evaluate the impact of limiting interruptions on medication errors. The percentages of interruptions and medication errors before and after implementation of evidence-based strategies to limit interruptions were measured by using direct observations of nurses on 2 PCCUs. Nurses in a third PCCU served as a comparison group. Interruptions (P < .001) and medication errors (P = .02) decreased significantly in 1 PCCU after implementation of evidence-based strategies to limit interruptions. Avoidable interruptions decreased 83% in PCCU1 and 53% in PCCU2 after implementation of the evidence-based strategies. Implementation of evidence-based strategies to limit interruptions in PCCUs decreases avoidable interruptions and promotes patient safety. ©2016 American Association of Critical-Care Nurses.

Challenges to validity in single-group interrupted time series analysis.

PubMed

Linden, Ariel

2017-04-01

Single-group interrupted time series analysis (ITSA) is a popular evaluation methodology in which a single unit of observation is studied; the outcome variable is serially ordered as a time series, and the intervention is expected to "interrupt" the level and/or trend of the time series, subsequent to its introduction. The most common threat to validity is history-the possibility that some other event caused the observed effect in the time series. Although history limits the ability to draw causal inferences from single ITSA models, it can be controlled for by using a comparable control group to serve as the counterfactual. Time series data from 2 natural experiments (effect of Florida's 2000 repeal of its motorcycle helmet law on motorcycle fatalities and California's 1988 Proposition 99 to reduce cigarette sales) are used to illustrate how history biases results of single-group ITSA results-as opposed to when that group's results are contrasted to those of a comparable control group. In the first example, an external event occurring at the same time as the helmet repeal appeared to be the cause of a rise in motorcycle deaths, but was only revealed when Florida was contrasted with comparable control states. Conversely, in the second example, a decreasing trend in cigarette sales prior to the intervention raised question about a treatment effect attributed to Proposition 99, but was reinforced when California was contrasted with comparable control states. Results of single-group ITSA should be considered preliminary, and interpreted with caution, until a more robust study design can be implemented. © 2016 John Wiley & Sons, Ltd.

Selective attention as a protagonist in contemporary workplace stress: implications for the interruption age.

PubMed

Tams, Stefan; Thatcher, Jason; Grover, Varun; Pak, Richard

2015-01-01

The ubiquity of instant messages and email notifications in contemporary work environments has opened a Pandora's Box. This box is filled with countless interruptions coming from laptops, smartphones, and other devices, all of which constantly call for employees' attention. In this interruption era, workplace stress is a pervasive problem. To examine this problem, the present study hypothesizes that the three-way interaction among the frequency with which interrupting stimuli appear, their salience, and employees' deficits in inhibiting attentional responses to them impacts mental workload perceptions, ultimately leading to stress. The study, further, probes a related form of self-efficacy as a potential suppressor of interruption-based stress. The study used a 2 (low vs. high frequency) × 2 (low vs. high salience) mixed model design. The 128 subjects completed a test of their inhibitory deficits and rated their mental workload perceptions and experiences of stress following a computer-based task. Inhibitory deficits and increased interruption salience can alter the perception of mental workload in contemporary work environments for the worse, but interruption self-efficacy can help offset any resulting interruption-based stress. This study extends the literatures on work interruptions as well as on stress and coping in the workplace.

[Design of new anti-tumor agents interrupting deregulated signaling pathways induced by tyrosine kinase proteins. Inhibition of protein-protein interaction involving Grb2].

PubMed

Vidal, Michel; Liu, Wang Qing; Gril, Brunile; Assayag, Franck; Poupon, Marie-France; Garbay, Christiane

2004-01-01

Cellular signaling pathways induced by growth-factor receptors are frequently deregulated in cancer. Anti-tumor agents that inhibit their enzymatic tyrosine kinase activity have been designed and are now used in human chemotherapy. We propose here an alternative way to interrupt over-expressed signaling by inhibiting protein-protein interactions that involve either the over-expressed proteins or proteins located downstream. The adaptor protein Grb2 over-expressed in connection with HER2/ErbB2/neu in Ras signaling pathway was chosen as a target. Peptides with very high affinity for Grb2 were rationally designed from structural data. Their capacity to interrupt the signaling pathway, their anti-proliferative activity as well as their potential anti-tumor properties are described.

Assessing Motion Induced Interruptions Using a Motion Platform

DTIC Science & Technology

2013-09-01

same way that cars have shock absorbers to decrease jolt from potholes and bumps in the road, ships may have the potential to be designed to better...Integration (HSI) seeks to assure human performance to reduce operating costs. This thesis seeks to develop a model for ship design in relation to Motion...Induced Interruptions (MII). The model is based on the premise that MIIs affect specific domains of HSI in an adverse way. Future ship design

Simulation-Based Testing of Pager Interruptions During Laparoscopic Cholecystectomy.

PubMed

Sujka, Joseph A; Safcsak, Karen; Bhullar, Indermeet S; Havron, William S

2018-01-30

To determine if pager interruptions affect operative time, safety, or complications and management of pager issues during a simulated laparoscopic cholecystectomy. Twelve surgery resident volunteers were tested on a Simbionix Lap Mentor II simulator. Each resident performed 6 randomized simulated laparoscopic cholecystectomies; 3 with pager interruptions (INT) and 3 without pager interruptions (NO-INT). The pager interruptions were sent in the form of standardized patient vignettes and timed to distract the resident during dissection of the critical view of safety and clipping of the cystic duct. The residents were graded on a pass/fail scale for eliciting appropriate patient history and management of the pager issue. Data was extracted from the simulator for the following endpoints: operative time, safety metrics, and incidence of operative complications. The Mann-Whitney U test and contingency table analysis were used to compare the 2 groups (INT vs. NO-INT). Level I trauma center; Simulation laboratory. Twelve general surgery residents. There was no significant difference between the 2 groups in any of the operative endpoints as measured by the simulator. However, in the INT group, only 25% of the time did the surgery residents both adequately address the issue and provide effective patient management in response to the pager interruption. Pager interruptions did not affect operative time, safety, or complications during the simulated procedure. However, there were significant failures in the appropriate evaluations and management of pager issues. Consideration for diversion of patient care issues to fellow residents not operating to improve quality and safety of patient care outside the operating room requires further study. Copyright © 2018. Published by Elsevier Inc.

Mediated interruptions of anaesthesia providers using predictions of workload from anaesthesia information management system data.

PubMed

Epstein, R H; Dexter, F

2012-09-01

Perioperative interruptions generated electronically from anaesthesia information management systems (AIMS) can provide useful feedback, but may adversely affect task performance if distractions occur at inopportune moments. Ideally such interruptions would occur only at times when their impact would be minimal. In this study of AIMS data, we evaluated the times of comments, drugs, fluids and periodic assessments (e.g. electrocardiogram diagnosis and train-of-four) to develop recommendations for the timing of interruptions during the intraoperative period. The 39,707 cases studied were divided into intervals between: 1) enter operating room; 2) induction; 3) intubation; 4) surgical incision; and 5) end surgery. Five-minute intervals of no documentation were determined for each case. The offsets from the start of each interval when >50% of ongoing cases had completed initial documentation were calculated (MIN50). The primary endpoint for each interval was the percentage of all cases still ongoing at MIN50. Results were that the intervals from entering the operating room to induction and from induction to intubation were unsuitable for interruptions confirming prior observational studies of anaesthesia workload. At least 13 minutes after surgical incision was the most suitable time for interruptions with 92% of cases still ongoing. Timing was minimally affected by the type of anaesthesia, surgical facility, surgical service, prone positioning or scheduled case duration. The implication of our results is that for mediated interruptions, waiting at least 13 minutes after the start of surgery is appropriate. Although we used AIMS data, operating room information system data is also suitable.

A systematic review of the psychological literature on interruption and its patient safety implications.

PubMed

Li, Simon Y W; Magrabi, Farah; Coiera, Enrico

2012-01-01

To understand the complex effects of interruption in healthcare. As interruptions have been well studied in other domains, the authors undertook a systematic review of experimental studies in psychology and human-computer interaction to identify the task types and variables influencing interruption effects. 63 studies were identified from 812 articles retrieved by systematic searches. On the basis of interruption profiles for generic tasks, it was found that clinical tasks can be distinguished into three broad types: procedural, problem-solving, and decision-making. Twelve experimental variables that influence interruption effects were identified. Of these, six are the most important, based on the number of studies and because of their centrality to interruption effects, including working memory load, interruption position, similarity, modality, handling strategies, and practice effect. The variables are explained by three main theoretical frameworks: the activation-based goal memory model, prospective memory, and multiple resource theory. This review provides a useful starting point for a more comprehensive examination of interruptions potentially leading to an improved understanding about the impact of this phenomenon on patient safety and task efficiency. The authors provide some recommendations to counter interruption effects. The effects of interruption are the outcome of a complex set of variables and should not be considered as uniformly predictable or bad. The task types, variables, and theories should help us better to identify which clinical tasks and contexts are most susceptible and assist in the design of information systems and processes that are resilient to interruption.

Methods for estimating confidence intervals in interrupted time series analyses of health interventions.

PubMed

Zhang, Fang; Wagner, Anita K; Soumerai, Stephen B; Ross-Degnan, Dennis

2009-02-01

Interrupted time series (ITS) is a strong quasi-experimental research design, which is increasingly applied to estimate the effects of health services and policy interventions. We describe and illustrate two methods for estimating confidence intervals (CIs) around absolute and relative changes in outcomes calculated from segmented regression parameter estimates. We used multivariate delta and bootstrapping methods (BMs) to construct CIs around relative changes in level and trend, and around absolute changes in outcome based on segmented linear regression analyses of time series data corrected for autocorrelated errors. Using previously published time series data, we estimated CIs around the effect of prescription alerts for interacting medications with warfarin on the rate of prescriptions per 10,000 warfarin users per month. Both the multivariate delta method (MDM) and the BM produced similar results. BM is preferred for calculating CIs of relative changes in outcomes of time series studies, because it does not require large sample sizes when parameter estimates are obtained correctly from the model. Caution is needed when sample size is small.

Implementation Plan for Flexible Automation in U.S. Shipyards

DTIC Science & Technology

1985-01-01

process steps, cramped work sites, interrupted geometries , irregular or novel shapes, and other factors that affect automatability. We also try to...held by 2 hands in awkward places. Interrupt geometry of plates and beams. Cannot predict outcome. Creates need to measure and recut. Automation, if...of standard. enough over time I every job. I Rearrange work.Redefine work units. Too many interruptions Time, space, geometry only a little work gets

A Verification Method of Inter-Task Cooperation in Embedded Real-time Systems and its Evaluation

NASA Astrophysics Data System (ADS)

Yoshida, Toshio

In software development process of embedded real-time systems, the design of the task cooperation process is very important. The cooperating process of such tasks is specified by task cooperation patterns. Adoption of unsuitable task cooperation patterns has fatal influence on system performance, quality, and extendibility. In order to prevent repetitive work caused by the shortage of task cooperation performance, it is necessary to verify task cooperation patterns in an early software development stage. However, it is very difficult to verify task cooperation patterns in an early software developing stage where task program codes are not completed yet. Therefore, we propose a verification method using task skeleton program codes and a real-time kernel that has a function of recording all events during software execution such as system calls issued by task program codes, external interrupts, and timer interrupt. In order to evaluate the proposed verification method, we applied it to the software development process of a mechatronics control system.

Wide variation in cardiopulmonary resuscitation interruption intervals among commercially available automated external defibrillators may affect survival despite high defibrillation efficacy.

PubMed

Snyder, David; Morgan, Carl

2004-09-01

Recent studies have associated interruptions of cardiopulmonary resuscitation imposed by automated external defibrillators (AEDs) with poor resuscitation outcome. In particular, the "hands-off" interval between precordial compressions and subsequent defibrillation shock has been implicated. We sought to determine the range of variation among current-generation AEDs with respect to this characteristic. Seven AEDs from six manufacturers were characterized via stopwatch and arrhythmia simulator with respect to the imposed hands-off interval. All AEDs were equipped with new batteries, and measurements were repeated five times for each AED. A wide variation in the hands-off interval between precordial compressions and shock delivery was observed, ranging from 5.2 to 28.4 secs, with only one AED achieving an interruption of <10 secs. Laboratory and clinical data suggest that this range of variation could be responsible for a more than two-fold variation in patient resuscitation success, an effect that far exceeds any defibrillation efficacy differences that may hypothetically exist. In addition to defibrillation waveform and dose, researchers should consider the hands-off cardiopulmonary resuscitation interruption interval between cardiopulmonary resuscitation and subsequent defibrillation shock to be an important covariate of outcome in resuscitation studies. Defibrillator design should minimize this interval to avoid potential adverse consequences on patient survival.

Getting a Feel for the Market: The Use of Privatized School Management in Philadelphia

ERIC Educational Resources Information Center

Byrnes, Vaughan

2009-01-01

This study evaluates the impact of the privatization of education services in the Philadelphia School District, using an interrupted time series design. The sample observes 88 middle-grades schools, beginning with the 1996-97 school year, and finds that, by 2006, four years postintervention, the achievement growth rate of schools run by…

Operational Failures and Interruptions in Hospital Nursing

PubMed Central

Tucker, Anita L; Spear, Steven J

2006-01-01

Objective To describe the work environment of hospital nurses with particular focus on the performance of work systems supplying information, materials, and equipment for patient care. Data Sources Primary observation, semistructured interviews, and surveys of hospital nurses. Study Design We sampled a cross-sectional group of six U.S. hospitals to examine the frequency of work system failures and their impact on nurse productivity. Data Collection We collected minute-by-minute data on the activities of 11 nurses. In addition, we conducted interviews with six of these nurses using questions related to obstacles to care. Finally, we created and administered two surveys in 48 nursing units, one for nurses and one for managers, asking about the frequency of specific work system failures. Principal Findings Nurses we observed experienced an average of 8.4 work system failures per 8-hour shift. The five most frequent types of failures, accounting for 6.4 of these obstacles, involved medications, orders, supplies, staffing, and equipment. Survey questions asking nurses how frequently they experienced these five categories of obstacles yielded similar frequencies. For an average 8-hour shift, the average task time was only 3.1 minutes, and in spite of this, nurses were interrupted mid-task an average of eight times per shift. Conclusions Our findings suggest that nurse effectiveness can be increased by creating improvement processes triggered by the occurrence of work system failures, with the goal of reducing future occurrences. Second, given that nursing work is fragmented and unpredictable, designing processes that are robust to interruption can help prevent errors. PMID:16704505

Impact of Frequent Interruption on Nurses' Patient-Controlled Analgesia Programming Performance.

PubMed

Campoe, Kristi R; Giuliano, Karen K

2017-12-01

The purpose was to add to the body of knowledge regarding the impact of interruption on acute care nurses' cognitive workload, total task completion times, nurse frustration, and medication administration error while programming a patient-controlled analgesia (PCA) pump. Data support that the severity of medication administration error increases with the number of interruptions, which is especially critical during the administration of high-risk medications. Bar code technology, interruption-free zones, and medication safety vests have been shown to decrease administration-related errors. However, there are few published data regarding the impact of number of interruptions on nurses' clinical performance during PCA programming. Nine acute care nurses completed three PCA pump programming tasks in a simulation laboratory. Programming tasks were completed under three conditions where the number of interruptions varied between two, four, and six. Outcome measures included cognitive workload (six NASA Task Load Index [NASA-TLX] subscales), total task completion time (seconds), nurse frustration (NASA-TLX Subscale 6), and PCA medication administration error (incorrect final programming). Increases in the number of interruptions were associated with significant increases in total task completion time ( p = .003). We also found increases in nurses' cognitive workload, nurse frustration, and PCA pump programming errors, but these increases were not statistically significant. Complex technology use permeates the acute care nursing practice environment. These results add new knowledge on nurses' clinical performance during PCA pump programming and high-risk medication administration.

Quasi-experimental study designs series-paper 7: assessing the assumptions.

PubMed

Bärnighausen, Till; Oldenburg, Catherine; Tugwell, Peter; Bommer, Christian; Ebert, Cara; Barreto, Mauricio; Djimeu, Eric; Haber, Noah; Waddington, Hugh; Rockers, Peter; Sianesi, Barbara; Bor, Jacob; Fink, Günther; Valentine, Jeffrey; Tanner, Jeffrey; Stanley, Tom; Sierra, Eduardo; Tchetgen, Eric Tchetgen; Atun, Rifat; Vollmer, Sebastian

2017-09-01

Quasi-experimental designs are gaining popularity in epidemiology and health systems research-in particular for the evaluation of health care practice, programs, and policy-because they allow strong causal inferences without randomized controlled experiments. We describe the concepts underlying five important quasi-experimental designs: Instrumental Variables, Regression Discontinuity, Interrupted Time Series, Fixed Effects, and Difference-in-Differences designs. We illustrate each of the designs with an example from health research. We then describe the assumptions required for each of the designs to ensure valid causal inference and discuss the tests available to examine the assumptions. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors Contributing to the Interrupted Decay of Hurricane Joaquin (2015) in a Moderate Vertical Wind Shear Environment

DTIC Science & Technology

2017-06-01

at 1200 UTC 3 October with maximum winds of 135 knots (kt) and minimum sea-level pressure of 934 millibars (mb). The time frame for the interrupted ...DeMaria et al. (2005). Figure 17. SHIPS Shear and 200 mb Divergence Since 1800 UTC 4 October was the time of the interruption of the rapid decay of...right) calculations. 43 Time series of CIMSS VWS magnitude (m/s, red line) and direction (degrees, blue line) from which the VWS vector is coming

Alert dwell time: introduction of a measure to evaluate interruptive clinical decision support alerts

PubMed Central

McDaniel, Robert B; Burlison, Jonathan D; Baker, Donald K; Hasan, Murad; Robertson, Jennifer; Hartford, Christine; Howard, Scott C; Sablauer, Andras

2016-01-01

Metrics for evaluating interruptive prescribing alerts have many limitations. Additional methods are needed to identify opportunities to improve alerting systems and prevent alert fatigue. In this study, the authors determined whether alert dwell time—the time elapsed from when an interruptive alert is generated to when it is dismissed—could be calculated by using historical alert data from log files. Drug–drug interaction (DDI) alerts from 3 years of electronic health record data were queried. Alert dwell time was calculated for 25,965 alerts, including 777 unique DDIs. The median alert dwell time was 8 s (range, 1–4913 s). Resident physicians had longer median alert dwell times than other prescribers (P < .001). The 10 most frequent DDI alerts (n = 8759 alerts) had shorter median dwell times than alerts that only occurred once (P < .001). This metric can be used in future research to evaluate the effectiveness and efficiency of interruptive prescribing alerts. PMID:26499101

Mitigating errors caused by interruptions during medication verification and administration: interventions in a simulated ambulatory chemotherapy setting.

PubMed

Prakash, Varuna; Koczmara, Christine; Savage, Pamela; Trip, Katherine; Stewart, Janice; McCurdie, Tara; Cafazzo, Joseph A; Trbovich, Patricia

2014-11-01

Nurses are frequently interrupted during medication verification and administration; however, few interventions exist to mitigate resulting errors, and the impact of these interventions on medication safety is poorly understood. The study objectives were to (A) assess the effects of interruptions on medication verification and administration errors, and (B) design and test the effectiveness of targeted interventions at reducing these errors. The study focused on medication verification and administration in an ambulatory chemotherapy setting. A simulation laboratory experiment was conducted to determine interruption-related error rates during specific medication verification and administration tasks. Interventions to reduce these errors were developed through a participatory design process, and their error reduction effectiveness was assessed through a postintervention experiment. Significantly more nurses committed medication errors when interrupted than when uninterrupted. With use of interventions when interrupted, significantly fewer nurses made errors in verifying medication volumes contained in syringes (16/18; 89% preintervention error rate vs 11/19; 58% postintervention error rate; p=0.038; Fisher's exact test) and programmed in ambulatory pumps (17/18; 94% preintervention vs 11/19; 58% postintervention; p=0.012). The rate of error commission significantly decreased with use of interventions when interrupted during intravenous push (16/18; 89% preintervention vs 6/19; 32% postintervention; p=0.017) and pump programming (7/18; 39% preintervention vs 1/19; 5% postintervention; p=0.017). No statistically significant differences were observed for other medication verification tasks. Interruptions can lead to medication verification and administration errors. Interventions were highly effective at reducing unanticipated errors of commission in medication administration tasks, but showed mixed effectiveness at reducing predictable errors of detection in medication verification tasks. These findings can be generalised and adapted to mitigate interruption-related errors in other settings where medication verification and administration are required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Mitigating errors caused by interruptions during medication verification and administration: interventions in a simulated ambulatory chemotherapy setting

PubMed Central

Prakash, Varuna; Koczmara, Christine; Savage, Pamela; Trip, Katherine; Stewart, Janice; McCurdie, Tara; Cafazzo, Joseph A; Trbovich, Patricia

2014-01-01

Background Nurses are frequently interrupted during medication verification and administration; however, few interventions exist to mitigate resulting errors, and the impact of these interventions on medication safety is poorly understood. Objective The study objectives were to (A) assess the effects of interruptions on medication verification and administration errors, and (B) design and test the effectiveness of targeted interventions at reducing these errors. Methods The study focused on medication verification and administration in an ambulatory chemotherapy setting. A simulation laboratory experiment was conducted to determine interruption-related error rates during specific medication verification and administration tasks. Interventions to reduce these errors were developed through a participatory design process, and their error reduction effectiveness was assessed through a postintervention experiment. Results Significantly more nurses committed medication errors when interrupted than when uninterrupted. With use of interventions when interrupted, significantly fewer nurses made errors in verifying medication volumes contained in syringes (16/18; 89% preintervention error rate vs 11/19; 58% postintervention error rate; p=0.038; Fisher's exact test) and programmed in ambulatory pumps (17/18; 94% preintervention vs 11/19; 58% postintervention; p=0.012). The rate of error commission significantly decreased with use of interventions when interrupted during intravenous push (16/18; 89% preintervention vs 6/19; 32% postintervention; p=0.017) and pump programming (7/18; 39% preintervention vs 1/19; 5% postintervention; p=0.017). No statistically significant differences were observed for other medication verification tasks. Conclusions Interruptions can lead to medication verification and administration errors. Interventions were highly effective at reducing unanticipated errors of commission in medication administration tasks, but showed mixed effectiveness at reducing predictable errors of detection in medication verification tasks. These findings can be generalised and adapted to mitigate interruption-related errors in other settings where medication verification and administration are required. PMID:24906806

Auditory training of speech recognition with interrupted and continuous noise maskers by children with hearing impairment

PubMed Central

Sullivan, Jessica R.; Thibodeau, Linda M.; Assmann, Peter F.

2013-01-01

Previous studies have indicated that individuals with normal hearing (NH) experience a perceptual advantage for speech recognition in interrupted noise compared to continuous noise. In contrast, adults with hearing impairment (HI) and younger children with NH receive a minimal benefit. The objective of this investigation was to assess whether auditory training in interrupted noise would improve speech recognition in noise for children with HI and perhaps enhance their utilization of glimpsing skills. A partially-repeated measures design was used to evaluate the effectiveness of seven 1-h sessions of auditory training in interrupted and continuous noise. Speech recognition scores in interrupted and continuous noise were obtained from pre-, post-, and 3 months post-training from 24 children with moderate-to-severe hearing loss. Children who participated in auditory training in interrupted noise demonstrated a significantly greater improvement in speech recognition compared to those who trained in continuous noise. Those who trained in interrupted noise demonstrated similar improvements in both noise conditions while those who trained in continuous noise only showed modest improvements in the interrupted noise condition. This study presents direct evidence that auditory training in interrupted noise can be beneficial in improving speech recognition in noise for children with HI. PMID:23297921

Interruptions disrupt reading comprehension.

PubMed

Foroughi, Cyrus K; Werner, Nicole E; Barragán, Daniela; Boehm-Davis, Deborah A

2015-06-01

Previous research suggests that being interrupted while reading a text does not disrupt the later recognition or recall of information from that text. This research is used as support for Ericsson and Kintsch's (1995) long-term working memory (LT-WM) theory, which posits that disruptions while reading (e.g., interruptions) do not impair subsequent text comprehension. However, to fully comprehend a text, individuals may need to do more than recognize or recall information that has been presented in the text at a later time. Reading comprehension often requires individuals to connect and synthesize information across a text (e.g., successfully identifying complex topics such as themes and tones) and not just make a familiarity-based decision (i.e., recognition). The goal for this study was to determine whether interruptions while reading disrupt reading comprehension when the questions assessing comprehension require participants to connect and synthesize information across the passage. In Experiment 1, interruptions disrupted reading comprehension. In Experiment 2, interruptions disrupted reading comprehension but not recognition of information from the text. In Experiment 3, the addition of a 15-s time-out prior to the interruption successfully removed these negative effects. These data suggest that the time it takes to process the information needed to successfully comprehend text when reading is greater than that required for recognition. Any interference (e.g., an interruption) that occurs during the comprehension process may disrupt reading comprehension. This evidence supports the need for transient activation of information in working memory for successful text comprehension and does not support LT-WM theory. (c) 2015 APA, all rights reserved).

Functional Interrupts and Destructive Failures from Single Event Effect Testing of Point-Of-Load Devices

NASA Technical Reports Server (NTRS)

Chen, Dakai; Phan, Anthony; Kim, Hak; Swonger, James; Musil, Paul; LaBel, Kenneth

2013-01-01

We show examples of single event functional interrupt and destructive failure in modern POL devices. The increasing complexity and diversity of the design and process introduce hard SEE modes that are triggered by various mechanisms.

College Preparatory Curriculum for All: Academic Consequences of Requiring Algebra and English I for Ninth Graders in Chicago

ERIC Educational Resources Information Center

Allensworth, Elaine; Nomi, Takako; Montgomery, Nicholas; Lee, Valerie E.

2009-01-01

There is a national movement to universalize the high school curriculum so that all students graduate prepared for college. The present work evaluates a policy in Chicago that ended remedial classes and mandated college preparatory course work for all students. Based on an interrupted time-series cohort design with multiple comparisons, this study…

The Design of a Real Time Operating System for a Fault Tolerant Microcomputer

DTIC Science & Technology

1986-12-01

Scheduler then enqueues all the new jobs for the new frame. Upon completion of the Purge and Task Scheduler routines the Cycle Interrupt Handler returns...the scheduling of new tasks in a new minor cycle to make room for the new jobs . The purge operation will usually not remove the same number of jobs each

The impact of public transportation strikes on use of a bicycle share program in London: interrupted time series design.

PubMed

Fuller, Daniel; Sahlqvist, Shannon; Cummins, Steven; Ogilvie, David

2012-01-01

To investigate the immediate and sustained effects of two London Underground strikes on use of a public bicycle share program. An interrupted time series design was used to examine the impact of two 24 hour strikes on the total number of trips per day and mean trip duration per day on the London public bicycle share program. The strikes occurred on September 6th and October 4th 2010 and limited service on the London Underground. The mean total number of trips per day over the whole study period was 14,699 (SD=5390) while the mean trip duration was 18.5 minutes (SD=3.7). Significant increases in daily trip count were observed following strike 1 (3864: 95% CI 125 to 7604) and strike 2 (11,293: 95% CI 5169 to 17,416). Events that greatly constrain the primary motorised mode of transportation for a population may have unintended short-term effects on travel behaviour. These findings suggest that limiting transportation options may have the potential to increase population levels of physical activity by promoting the use of cycling. Copyright © 2011 Elsevier Inc. All rights reserved.

Institutional Narcissism, Arrogant Organization Disorder and Interruptions in Organizational Learning

ERIC Educational Resources Information Center

Godkin, Lynn; Allcorn, Seth

2009-01-01

Purpose: This article aims to present an alternative approach to diagnosing behavioral barriers to organizational learning. Design/methodology/approach: The paper juxtaposes interruptions in organizational learning with characteristics of narcissism and arrogant organization disorder. Psychoanalytically informed theory and DSM-IV criteria are…

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Quasi-Experimental Designs.

PubMed

Schweizer, Marin L; Braun, Barbara I; Milstone, Aaron M

2016-10-01

Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt, nonrandomized interventions. Quasi-experimental studies can be categorized into 3 major types: interrupted time-series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship, including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies. Infect Control Hosp Epidemiol 2016;1-6.

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship – Quasi-Experimental Designs

PubMed Central

Schweizer, Marin L.; Braun, Barbara I.; Milstone, Aaron M.

2016-01-01

Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt non-randomized interventions. Quasi-experimental studies can be categorized into three major types: interrupted time series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies. PMID:27267457

Interruptions and Failure in Higher Education: Evidence from ISEG-UTL

ERIC Educational Resources Information Center

Chagas, Margarida; Fernandaes, Graca Leao

2011-01-01

Failure in higher education (HE) is the outcome of multiple time-dependent determinants. Interruptions in students' individual school trajectories are one of them, and that is why research on this topic has been attracting much attention these days. From an individual point of view, it is expected that interruptions in school trajectory, whatever…

The Zone of Inertia: Absorptive Capacity and Organizational Change

ERIC Educational Resources Information Center

Godkin, Lynn

2010-01-01

Purpose: The purpose of this paper is to describe how interruptions in organizational learning effect institutional absorptive capacity and contribute to organizational inertia. Design/methodology/approach: An exploratory model is presented as a heuristic to describe how interruptions in organizational learning affect absorptive capacity.…

Kinetic analysis of downward step posture according to the foothold heights and visual information blockage in cargo truck

PubMed Central

Hyun, Seung-Hyun; Ryew, Che-Cheong

2018-01-01

The study was undertaken to compare and analyze kinetic variables during downward foot-on according to the foothold heights under interrupted-visual information on 25-t cargo truck. Skilled adult male drivers (n=10) engaged in cargo truck driving over 1 year participated in the experiment. The results obtained from cinematographic and ground reaction force data during downward foot-on as follows; First, leg stiffness, peak vertical force (PVF) and loading rate showed significant difference as an increase of foothold heights, that is, interrupted-visual information showed greater impulse force than as was not. Second, variables of center of pressure (COP) with interrupted-visual information did not showed difference, but anterior-posterior COP and COP area showed an increasing tendency as an increase of foothold heights. Third, dynamic posture stability index (overall, medial-lateral, anterior-posterior, and vertical) showed significant difference as an increase of foothold height, that is, interrupted-visual information showed lower index than as was not. Therefore it will be possible to control successfully the leg stiffness, loading rate, and PVF when preparing an estimate for air phase time and impulse force through habitual cognition and confirmation at landing during downward foot-on from cargo truck. Identifying these potential differences may enable clinicians to assess type of injury and design exercise rehabilitation protocols specific. PMID:29740569

The Consequences of Model Misidentification in the Interrupted Time-Series Experiment.

ERIC Educational Resources Information Center

Padia, William L.

Campbell (l969) argued for the interrupted time-series experiment as a useful methodology for testing intervention effects in the social sciences. The validity of the statistical hypothesis testing of time-series, is, however, dependent upon the proper identification of the underlying stochastic nature of the data. Several types of model…

30 CFR 75.815 - Disconnect devices.

Code of Federal Regulations, 2011 CFR

2011-07-01

... phase-to-phase voltage of the circuit in which they are installed, and for the full-load current of the... explosion-proof enclosures, must be capable of interrupting the full-load current of the circuit or designed and installed to cause the current to be interrupted automatically prior to the opening of the...

30 CFR 75.815 - Disconnect devices.

Code of Federal Regulations, 2010 CFR

2010-07-01

... phase-to-phase voltage of the circuit in which they are installed, and for the full-load current of the... explosion-proof enclosures, must be capable of interrupting the full-load current of the circuit or designed and installed to cause the current to be interrupted automatically prior to the opening of the...

33 CFR 159.89 - Power interruption: Type I and II devices.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Power interruption: Type I and II devices. 159.89 Section 159.89 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) POLLUTION MARINE SANITATION DEVICES Design, Construction, and Testing § 159.89 Power...

Towards a Politics of Interruption: High School Design as Politically Relevant Pedagogy

ERIC Educational Resources Information Center

Stovall, David

2007-01-01

The following essay seeks to highlight the use of engaged qualitative community-based research in education to respond to conditions of structural inequality. As "the politics of interruption", the process of creating neighborhood public high schools is centred in community accountability. Responsibility in this mode…

Object-oriented millisecond timers for the PC.

PubMed

Hamm, J P

2001-11-01

Object-oriented programming provides a useful structure for designing reusable code. Accurate millisecond timing is essential for many areas of research. With this in mind, this paper provides a Turbo Pascal unit containing an object-oriented millisecond timer. This approach allows for multiple timers to be running independently. The timers may also be set at different levels of temporal precision, such as 10(-3) (milliseconds) or 10(-5) sec. The object also is able to store the time of a flagged event for later examination without interrupting the ongoing timing operation.

Traditions of research into interruptions in healthcare: A conceptual review.

PubMed

McCurdie, Tara; Sanderson, Penelope; Aitken, Leanne M

2017-01-01

Researchers from diverse theoretical backgrounds have studied workplace interruptions in healthcare, leading to a complex and conflicting body of literature. Understanding pre-existing viewpoints may advance the field more effectively than attempts to remove bias from investigations. To identify research traditions that have motivated and guided interruptions research, and to note research questions posed, gaps in approach, and possible avenues for future research. A critical review was conducted of research on interruptions in healthcare. Two researchers identified core research communities based on the community's motivations, philosophical outlook, and methods. Among the characteristics used to categorise papers into research communities were the predominant motivation for studying interruptions, the research questions posed, and key contributions to the body of knowledge on interruptions in healthcare. In cases where a paper approached an equal number of characteristics from two traditions, it was placed in a blended research community. A total of 141 papers were identified and categorised; all papers identified were published from 1994 onwards. Four principal research communities emerged: epidemiology, quality improvement, cognitive systems engineering (CSE), and applied cognitive psychology. Blends and areas of mutual influence between the research communities were identified that combine the benefits of individual traditions, but there was a notable lack of blends incorporating quality improvement initiatives. The question most commonly posed by researchers across multiple communities was: what is the impact of interruptions? Impact was measured as a function of task time or risk in the epidemiology tradition, situation awareness in the CSE tradition, or resumption lag (time to resume an interrupted task) in the applied cognitive psychology tradition. No single question about interruptions in healthcare was shared by all four of the core communities. Much research on workplace interruptions in healthcare can be described in terms of fundamental values of four distinct research traditions and the communities that bring the values and methods: of those research traditions to their investigations. Blends between communities indicate that mutual influence has occurred as interruptions research has progressed. It is clear from this review that there is no single or privileged perspective to study interruptions. Instead, these findings suggest that researchers investigating interruptions in healthcare would benefit from being more aware of different perspectives from their own, especially when they consider workplace interventions to reduce interruptions. Copyright © 2016. Published by Elsevier Ltd.

Capturing the Cumulative Effects of School Reform: An 11-Year Study of the Impacts of America's Choice on Student Achievement

ERIC Educational Resources Information Center

May, Henry; Supovitz, Jonathan A.

2006-01-01

This article presents the results of an 11-year longitudinal study of the impact of America's Choice comprehensive school reform (CSR) design on student learning gains in Rochester, New York. A quasi-experimental interrupted time-series approach using Bayesian hierarchical growth curve analysis with crossed random effects is used to compare the…

Effects of a Brief Team Training Program on Surgical Teams' Nontechnical Skills: An Interrupted Time-Series Study.

PubMed

Gillespie, Brigid M; Harbeck, Emma; Kang, Evelyn; Steel, Catherine; Fairweather, Nicole; Panuwatwanich, Kriengsak; Chaboyer, Wendy

2017-04-27

Up to 60% of adverse events in surgery are the result of poor communication and teamwork. Nontechnical skills in surgery (NOTSS) are critical to the success of surgery and patient safety. The study aim was to evaluate the effect of a brief team training intervention on teams' observed NOTSS. Pretest-posttest interrupted time-series design with statistical process control analysis was used to detect longitudinal changes in teams' NOTSS. We evaluated NOTSS using the revised NOTECHS weekly for 20 to 25 weeks before and after implementation of a team training program. We observed 179 surgical procedures with cardiac, vascular, upper gastrointestinal, and hepatobiliary teams. Mean posttest NOTECHS scores increased across teams, showing special cause variation. There were also significant before and after improvements in NOTECHS scores in respect to professional role and in the use of the Surgical Safety Checklist. Our results suggest associated improvements in teams' NOTSS after implementation of the team training program.

Forgetting induced speeding: Can prospective memory failure account for drivers exceeding the speed limit?

PubMed

Bowden, Vanessa K; Visser, Troy A W; Loft, Shayne

2017-06-01

It is generally assumed that drivers speed intentionally because of factors such as frustration with the speed limit or general impatience. The current study examined whether speeding following an interruption could be better explained by unintentional prospective memory (PM) failure. In these situations, interrupting drivers may create a PM task, with speeding the result of drivers forgetting their newly encoded intention to travel at a lower speed after interruption. Across 3 simulated driving experiments, corrected or uncorrected speeding in recently reduced speed zones (from 70 km/h to 40 km/h) increased on average from 8% when uninterrupted to 33% when interrupted. Conversely, the probability that participants traveled under their new speed limit in recently increased speed zones (from 40 km/h to 70 km/h) increased from 1% when uninterrupted to 23% when interrupted. Consistent with a PM explanation, this indicates that interruptions lead to a general failure to follow changed speed limits, not just to increased speeding. Further testing a PM explanation, Experiments 2 and 3 manipulated variables expected to influence the probability of PM failures and subsequent speeding after interruptions. Experiment 2 showed that performing a cognitively demanding task during the interruption, when compared with unfilled interruptions, increased the probability of initially speeding from 1% to 11%, but that participants were able to correct (reduce) their speed. In Experiment 3, providing participants with 10s longer to encode the new speed limit before interruption decreased the probability of uncorrected speeding after an unfilled interruption from 30% to 20%. Theoretical implications and implications for road design interventions are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Medication administration and interruptions in nursing homes: A qualitative observational study.

PubMed

Odberg, Kristian Ringsby; Hansen, Britt Saetre; Aase, Karina; Wangensteen, Sigrid

2018-03-01

To contribute in-depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized? Medication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety. A qualitative observational study design was applied. Data were collected using partial participant observations. An inductive content analysis was performed. Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staff's apparent freedom as to how and where to perform medication-related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes. A process of normalisation has taken place whereby staff put up with second-rate technological solutions, noise and interruptions when they are performing medication-related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach. Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence. © 2017 John Wiley & Sons Ltd.

The Chronic Detrimental Impact of Interruptions in a Simulated Submarine Track Management Task.

PubMed

Loft, Shayne; Sadler, Andreas; Braithwaite, Janelle; Huf, Samuel

2015-12-01

The objective of this article is to examine the extent to which interruptions negatively impact situation awareness and long-term performance in a submarine track management task where pre- and postinterruption display scenes remained essentially identical. Interruptions in command and control task environments can degrade performance well beyond the first postinterruption action typically measured for sequential static tasks, because individuals need to recover their situation awareness for multiple unfolding display events. Participants in the current study returned to an unchanged display scene following interruption and therefore could be more immune to such long-term performance deficits. The task required participants to monitor a display to detect contact heading changes and to make enemy engagement decisions. Situation awareness (Situation Present Assessment Method) and subjective workload (NASA-Task Load Index) were measured. The interruption replaced the display for 20 s with a blank screen, during which participants completed a classification task. Situation awareness after returning from interruption was degraded. Participants were slower to make correct engagement decisions and slower and less accurate in detecting heading changes, despite these task decisions being made at least 40 s following the interruption. Interruptions negatively impacted situation awareness and long-term performance because participants needed to redetermine the location and spatial relationship between the displayed contacts when returning from interruption, either because their situation awareness for the preinterruption scene decayed or because they did not encode the preinterruption scene. Interruption in work contexts such as submarines is unavoidable, and further understanding of how operators are affected is required to improve work design and training. © 2015, Human Factors and Ergonomics Society.

Designing a Virtual-Memory Implementation Using the Motorola MC68010 16- Bit Microprocessor with Multi-Processor Capability Interfaced to the VMEbus

DTIC Science & Technology

1990-06-01

RAM and ROM output enable signals. Figure C.7 shows the logic for the interrupt priority level (IPLO* through IPL2 *) and the interrupt acknowledge...IACK681* signal is sent to the DUART when a level one interrupt acknowledge is output by the CPU. The logic for the IACK681* and the IPLO* through IPL2 ...signals are actually implemented with an EPLD. Listing D.4 in Appendix D presents the Abel description of the IACK681* and IPLO* through IPL2

Alert dwell time: introduction of a measure to evaluate interruptive clinical decision support alerts.

PubMed

McDaniel, Robert B; Burlison, Jonathan D; Baker, Donald K; Hasan, Murad; Robertson, Jennifer; Hartford, Christine; Howard, Scott C; Sablauer, Andras; Hoffman, James M

2016-04-01

Metrics for evaluating interruptive prescribing alerts have many limitations. Additional methods are needed to identify opportunities to improve alerting systems and prevent alert fatigue. In this study, the authors determined whether alert dwell time-the time elapsed from when an interruptive alert is generated to when it is dismissed-could be calculated by using historical alert data from log files. Drug-drug interaction (DDI) alerts from 3 years of electronic health record data were queried. Alert dwell time was calculated for 25,965 alerts, including 777 unique DDIs. The median alert dwell time was 8 s (range, 1-4913 s). Resident physicians had longer median alert dwell times than other prescribers (P < 001). The 10 most frequent DDI alerts (n = 8759 alerts) had shorter median dwell times than alerts that only occurred once (P < 001). This metric can be used in future research to evaluate the effectiveness and efficiency of interruptive prescribing alerts. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Characterizing Physician Listening Behavior During Hospitalist Handoffs using the HEAR Checklist

PubMed Central

Greenstein, Elizabeth A.; Arora, Vineet M.; Staisiunas, Paul G.; Banerjee, Stacy S.; Farnan, Jeanne M.

2015-01-01

Background The increasing fragmentation of healthcare has resulted in more patient handoffs. Many professional groups, including the Accreditation Council on Graduate Medical Education and the Society of Hospital Medicine, have made recommendations for safe and effective handoffs. Despite the two-way nature of handoff communication, the focus of these efforts has largely been on the person giving information. Objective To observe and characterize the listening behaviors of handoff receivers during hospitalist handoffs. Design Prospective observational study of shift change and service change handoffs on a non-teaching hospitalist service at a single academic tertiary care institution. Measurements The “HEAR Checklist”, a novel tool created based on review of effective listening behaviors, was used by third party observers to characterize active and passive listening behaviors and interruptions during handoffs. Results In 48 handoffs (25 shift change, 23 service change), active listening behaviors (e.g. read-back (17%), note-taking (23%), and reading own copy of the written signout (27%)) occurred less frequently than passive listening behaviors (e.g. affirmatory statements (56%) nodding (50%) and eye contact (58%)) (p<0.01). Read-back occurred only 8 times (17%). In 11 handoffs (23%) receivers took notes. Almost all (98%) handoffs were interrupted at least once, most often by side conversations, pagers going off, or clinicians arriving. Handoffs with more patients, such as service change, were associated with more interruptions (r= 0.46, p<0.01). Conclusions Using the “HEAR Checklist”, we can characterize hospitalist handoff listening behaviors. While passive listening behaviors are common, active listening behaviors that promote memory retention are rare. Handoffs are often interrupted, most commonly by side conversations. Future handoff improvement efforts should focus on augmenting listening and minimizing interruptions. PMID:23258389

Toy Modification Note: Build It Yourself Battery Interrupter. Revised.

ERIC Educational Resources Information Center

Vanderheiden, Gregg C.; Brandenburg, S.

This toy modification note presents illustrated instructions on how to build a battery interrupter that permits on/off control of battery-operated toys without modification of the toys themselves. The device allows for a separate control switch which can be custom designed to fit a handicapped user's needs. Information on the construction and use…

10 CFR 205.374 - Responses from “entities” designated in the application.

Code of Federal Regulations, 2011 CFR

2011-01-01

... analysis of the impact the requested action would have on its system reliability and its ability to supply its own interruptible and firm customers. The effects of the requested action on the ability to serve firm loads shall be clearly distinguished from the ability to serve contractually interruptible loads...

10 CFR 205.374 - Responses from “entities” designated in the application.

Code of Federal Regulations, 2013 CFR

2013-01-01

... analysis of the impact the requested action would have on its system reliability and its ability to supply its own interruptible and firm customers. The effects of the requested action on the ability to serve firm loads shall be clearly distinguished from the ability to serve contractually interruptible loads...

10 CFR 205.374 - Responses from “entities” designated in the application.

Code of Federal Regulations, 2012 CFR

2012-01-01

... analysis of the impact the requested action would have on its system reliability and its ability to supply its own interruptible and firm customers. The effects of the requested action on the ability to serve firm loads shall be clearly distinguished from the ability to serve contractually interruptible loads...

10 CFR 205.374 - Responses from “entities” designated in the application.

Code of Federal Regulations, 2014 CFR

2014-01-01

... analysis of the impact the requested action would have on its system reliability and its ability to supply its own interruptible and firm customers. The effects of the requested action on the ability to serve firm loads shall be clearly distinguished from the ability to serve contractually interruptible loads...

Multiple-Feed Design For DSN/SETI Antenna

NASA Technical Reports Server (NTRS)

Slobin, S. D.; Bathker, D. A.

1988-01-01

Frequency bands changed with little interruption of operation. Modification of feedhorn mounting on existing 34-m-diameter antenna in Deep Space Network (DSN) enables antenna to be shared by Search for Extra-Terrestrial Intelligence (SET) program with minimal interruption of DSN spacecraft tracking. Modified antenna useful in terrestrial communication systems requiring frequent changes of operating frequencies.

Investigating lexical competition and the cost of phonemic restoration.

PubMed

Balling, Laura Winther; Morris, David Jackson; Tøndering, John

2017-12-01

Due to phonemic restoration, listeners can reliably perceive words when a phoneme is replaced with noise. The cost associated with this process was investigated along with the effect of lexical uniqueness on phonemic restoration, using data from a lexical decision experiment where noise replaced phonemes that were either uniqueness points (the phoneme at which a word deviates from all nonrelated words that share the same onset) or phonemes immediately prior to these. A baseline condition was also included with no noise-interrupted stimuli. Results showed a significant cost of phonemic restoration, with 100 ms longer word identification times and a 14% decrease in word identification accuracy for interrupted stimuli compared to the baseline. Regression analysis of response times from the interrupted conditions showed no effect of whether the interrupted phoneme was a uniqueness point, but significant effects for several temporal attributes of the stimuli, including the duration and position of the interrupted segment. These results indicate that uniqueness points are not distinct breakpoints in the cohort reduction that occurs during lexical processing, but that temporal properties of the interrupted stimuli are central to auditory word recognition. These results are interpreted in the context of models of speech perception.

Series and parallel arc-fault circuit interrupter tests.

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

Johnson, Jay Dean; Fresquez, Armando J.; Gudgel, Bob

2013-07-01

While the 2011 National Electrical Codeª (NEC) only requires series arc-fault protection, some arc-fault circuit interrupter (AFCI) manufacturers are designing products to detect and mitigate both series and parallel arc-faults. Sandia National Laboratories (SNL) has extensively investigated the electrical differences of series and parallel arc-faults and has offered possible classification and mitigation solutions. As part of this effort, Sandia National Laboratories has collaborated with MidNite Solar to create and test a 24-string combiner box with an AFCI which detects, differentiates, and de-energizes series and parallel arc-faults. In the case of the MidNite AFCI prototype, series arc-faults are mitigated by openingmore » the PV strings, whereas parallel arc-faults are mitigated by shorting the array. A range of different experimental series and parallel arc-fault tests with the MidNite combiner box were performed at the Distributed Energy Technologies Laboratory (DETL) at SNL in Albuquerque, NM. In all the tests, the prototype de-energized the arc-faults in the time period required by the arc-fault circuit interrupt testing standard, UL 1699B. The experimental tests confirm series and parallel arc-faults can be successfully mitigated with a combiner box-integrated solution.« less

Effects of a Televised Two-City Safer Sex Mass Media Campaign Targeting High-Sensation-Seeking and Impulsive-Decision-Making Young Adults

ERIC Educational Resources Information Center

Zimmerman, Rick S.; Palmgreen, Philip M.; Noar, Seth M.; Lustria, Mia Liza A.; Lu, Hung-Yi; Horosewski, Mary Lee

2007-01-01

This study evaluates the ability of a safer sex televised public service announcement (PSA) campaign to increase safer sexual behavior among at-risk young adults. Independent, monthly random samples of 100 individuals were surveyed in each city for 21 months as part of an interrupted-time-series design with a control community. The 3-month…

Managing Multiple Tasks in Complex, Dynamic Environments

NASA Technical Reports Server (NTRS)

Freed, Michael; Null, Cynthia H. (Technical Monitor)

1998-01-01

Sketchy planners are designed to achieve goals in realistically complex, time-pressured, and uncertain task environments. However, the ability to manage multiple, potentially interacting tasks in such environments requires extensions to the functionality these systems typically provide. This paper identifies a number of factors affecting how interacting tasks should be prioritized, interrupted, and resumed, and then describes a sketchy planner called APEX that takes account of these factors when managing multiple tasks.

Improving the participation of youth with physical disabilities in community activities: An interrupted time series design.

PubMed

Law, Mary; Anaby, Dana; Imms, Christine; Teplicky, Rachel; Turner, Laura

2015-04-01

Youth with physical disabilities experience restrictions to participation in community-based leisure activities; however, there is little evidence about how to improve their involvement. This study examined whether an intervention to remove environmental barriers and develop strategies using a coaching approach improved youth participation in leisure activities. An Interrupted Time Series design was employed, where replication of the intervention effect was examined across individualised participation goals and across participants. Six adolescents with a physical disability participated in a 12-week intervention. An occupational therapist worked with each youth and his/her family to set three leisure goals based on problems identified using the Canadian Occupational Performance Measure (COPM). A coaching approach was used to collaboratively identify and implement strategies to remove environmental barriers. Interventions for each goal were introduced at different time points. Outcomes were evaluated using the COPM. Improvements in COPM performance scores were clinically significant for 83% of the identified activities; an average change of 4.5 points in the performance scale (SD = 1.95) was observed. Statistical analysis using the celeration line demonstrated that the proportion of data points falling above the line increased in the intervention phase for 94% of the activities, indicating a significant treatment effect. This study is the first to examine an intervention aimed at increasing leisure participation by changing only the environment. The results indicate that environment-focussed interventions are feasible and effective in promoting youth participation. Such findings can inform the design of a larger study and guide occupational therapy practice. © 2015 Occupational Therapy Australia.

Tracheal intubation during pediatric cardiopulmonary resuscitation: A videography-based assessment in an emergency department resuscitation room.

PubMed

Donoghue, Aaron; Hsieh, Ting-Chang; Nishisaki, Akira; Myers, Sage

2016-02-01

To describe procedural characteristics of tracheal intubation (TI) during cardiopulmonary resuscitation (CPR) in a pediatric emergency department, and to characterize interruptions in CPR associated with TI performance. Retrospective single center case series. Resuscitations in a pediatric ED are videorecorded for quality improvement. Children who underwent TI while receiving chest compressions were eligible for inclusion. Intubations done by methods other than direct laryngoscopy were excluded. Background data included patient age and training background of intubator. Data on intubation attempts (success, laryngoscopy time) and chest compressions (interruptions, duration of pauses) were collected. Between December 2012 and February 2014, 32 patients had 59 TI attempts performed during CPR. Overall first attempt success at TI was 15/32 (47%); a median of 2 attempts were made per patient (range 1 to 4). Median laryngoscopy time was 47s (range 8-115s). 32/59 (54%) TI attempts had an associated interruption in CPR; the median interruption duration was 25s (range 3-64s). TI attempts without interruption in CPR were successful in 20/32 (63%) compared to 11/27 (41%) when CPR was paused (p=0.09). Laryngoscopy time was not significantly different between TI attempts with (47±21s) and without (47±26s; p=0.2) interruptions in compressions. 25/32 (78%) of pauses exceeded 10s in duration. TI during pediatric CPR results in significant interruptions in chest compressions. Procedural outcomes were not significantly different between attempts with and without compressions paused. In children receiving CPR, TI should be performed without pausing chest compressions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Methods, applications, interpretations and challenges of interrupted time series (ITS) data: protocol for a scoping review.

PubMed

Ewusie, Joycelyne E; Blondal, Erik; Soobiah, Charlene; Beyene, Joseph; Thabane, Lehana; Straus, Sharon E; Hamid, Jemila S

2017-07-02

Interrupted time series (ITS) design involves collecting data across multiple time points before and after the implementation of an intervention to assess the effect of the intervention on an outcome. ITS designs have become increasingly common in recent times with frequent use in assessing impact of evidence implementation interventions. Several statistical methods are currently available for analysing data from ITS designs; however, there is a lack of guidance on which methods are optimal for different data types and on their implications in interpreting results. Our objective is to conduct a scoping review of existing methods for analysing ITS data, to summarise their characteristics and properties, as well as to examine how the results are reported. We also aim to identify gaps and methodological deficiencies. We will search electronic databases from inception until August 2016 (eg, MEDLINE and JSTOR). Two reviewers will independently screen titles, abstracts and full-text articles and complete the data abstraction. The anticipated outcome will be a summarised description of all the methods that have been used in analysing ITS data in health research, how those methods were applied, their strengths and limitations and the transparency of interpretation/reporting of the results. We will provide summary tables of the characteristics of the included studies. We will also describe the similarities and differences of the various methods. Ethical approval is not required for this study since we are just considering the methods used in the analysis and there will not be identifiable patient data. Results will be disseminated through open access peer-reviewed publications. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Characteristics of Interruptions During Medication Administration:An Integrative Review of Direct Observational Studies.

PubMed

Schroers, Ginger

2018-06-26

The purpose of this review was to synthesize and summarize data gathered by direct observation of the characteristics of interruptions in the context of nursing medication administration in hospital settings. Interruptions are prevalent during the medication administration process performed by nurses in hospital settings and have been found to be associated with an increase in frequency and severity of nursing medication administration errors. In addition, interruptions decrease task efficiency, leading to longer medication administration completion times. Integrative review. The electronic databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMED, PsyARTICLES, and Google Scholar were searched using the terms "interruptions" AND "medication administration" AND "direct observation". Nine articles met the inclusion criteria. Interruptions are likely to occur at least once during nursing medication administration processes in hospital settings. This finding applies to medication administered to one patient, termed a medication pass, and medication administered to multiple patients, termed a mediation round. Interruptions are most commonly caused by another nurse, staff member, or are self-initiated, and last approximately one minute in length. A raised awareness among staff of the most common sources of interruptions may encourage changes that lead to a decrease in the occurrence of interruptions. In addition, nurse leaders can apply an understanding of the common characteristics of interruptions to guide research, policies, and educational methods aimed at interruption management strategies. The findings from this review can be used to guide the identification and development of targeted interventions and strategies that would have the most substantial impact to reduce and manage interruptions during medication administration. Interruption management strategies have the potential to lead to a decrease in medication errors and an increase in task efficiency. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Feasibility of sedation and analgesia interruption following cannulation in neonates on extracorporeal membrane oxygenation

PubMed Central

Wildschut, E. D.; Hanekamp, M. N.; Vet, N. J.; Houmes, R. J.; Ahsman, M. J.; Mathot, R. A. A.; de Wildt, S. N.

2010-01-01

Purpose In most extracorporeal membrane oxygenation (ECMO) centers patients are heavily sedated to prevent accidental decannulation and bleeding complications. In ventilated adults not on ECMO, daily sedation interruption protocols improve short- and long-term outcome. This study aims to evaluate safety and feasibility of sedation interruption following cannulation in neonates on ECMO. Methods Prospective observational study in 20 neonates (0.17–5.8 days of age) admitted for ECMO treatment. Midazolam (n = 20) and morphine (n = 18) infusions were discontinued within 30 min after cannulation. Pain and sedation were regularly assessed using COMFORT-B and visual analog scale (VAS) scores. Midazolam and/or morphine were restarted and titrated according to protocolized treatment algorithms. Results Median (interquartile range, IQR) time without any sedatives was 10.3 h (5.0–24.1 h). Median interruption duration for midazolam was 16.5 h (6.6–29.6 h), and for morphine was 11.2 h (6.7–39.4 h). During this period no accidental extubations, decannulations or bleeding complications occurred. Conclusions This is the first study to show that interruption of sedatives and analgesics following cannulation in neonates on ECMO is safe and feasible. Interruption times are 2–3 times longer than reported for adult ICU patients not on ECMO. Further trials are needed to substantiate these findings and evaluate short- and long-term outcomes. PMID:20508914

Fast turn-on osmium coated cathode

NASA Astrophysics Data System (ADS)

Marrian, C. R. K.; Haas, G. A.; Shih, A.

1984-03-01

This abstract discloses a fast turn-on refractory coated cathode comprising a porous tungsten metal matrix impregnated with barium calcium aluminate and coated with osmium. The osmium coating has a planned series of interruptions with each interruption being on the order of several microns in width to thereby expose the tungsten. These interruptions permit the barium and oxygen from the impregnant to rise to the cathode surface during activation or reactivation to form a desired near monolayer of barium and oxygen to enhance electron emission. Thus, this cathode design provides a fast turn-on characteristic even after shelf storage.

Ada 9X Project Report: Ada 9X Revision Issues. Release 1

DTIC Science & Technology

1990-04-01

interrupts in Ada. Users are using specialized run-time executives which promote semaphores , monitors , etc ., as well as interrupt support, are using...The focus here is on two specific problems: 1. lack of time-out on operations . 2. no efficient way to program a shared-variable monitor for the... operation . 43 !Issue implementation [3 - Remote Operations for Real-Time Systems ] The real-time implementation standards should define various remote

The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE): method and design considerations.

PubMed

Boudreaux, Edwin D; Miller, Ivan; Goldstein, Amy B; Sullivan, Ashley F; Allen, Michael H; Manton, Anne P; Arias, Sarah A; Camargo, Carlos A

2013-09-01

Due to the concentration of individuals at-risk for suicide, an emergency department visit represents an opportune time for suicide risk screening and intervention. The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) uses a quasi-experimental, interrupted time series design to evaluate whether (1) a practical approach to universally screening ED patients for suicide risk leads to improved detection of suicide risk and (2) a multi-component intervention delivered during and after the ED visit improves suicide-related outcomes. This paper summarizes the ED-SAFE's study design and methods within the context of considerations relevant to effectiveness research in suicide prevention and pertinent human participants concerns. 1440 suicidal individuals, from 8 general ED's nationally will be enrolled during three sequential phases of data collection (480 individuals/phase): (1) Treatment as Usual; (2) Universal Screening; and (3) Intervention. Data from the three phases will inform two separate evaluations: Screening Outcome (Phases 1 and 2) and Intervention (Phases 2 and 3). Individuals will be followed for 12 months. The primary study outcome is a composite reflecting completed suicide, attempted suicide, aborted or interrupted attempts, and implementation of rescue procedures during an outcome assessment. While 'classic' randomized control trials (RCT) are typically selected over quasi-experimental designs, ethical and methodological issues may make an RCT a poor fit for complex interventions in an applied setting, such as the ED. ED-SAFE represents an innovative approach to examining the complex public health issue of suicide prevention through a multi-phase, quasi-experimental design embedded in 'real world' clinical settings. Copyright © 2013 Elsevier Inc. All rights reserved.

Prediction of SFL Interruption Performance from the Results of Arc Simulation during High-Current Phase

NASA Astrophysics Data System (ADS)

Lee, Jong-Chul; Lee, Won-Ho; Kim, Woun-Jea

2015-09-01

The design and development procedures of SF6 gas circuit breakers are still largely based on trial and error through testing although the development costs go higher every year. The computation cannot cover the testing satisfactorily because all the real processes arc not taken into account. But the knowledge of the arc behavior and the prediction of the thermal-flow inside the interrupters by numerical simulations are more useful than those by experiments due to the difficulties to obtain physical quantities experimentally and the reduction of computational costs in recent years. In this paper, in order to get further information into the interruption process of a SF6 self-blast interrupter, which is based on a combination of thermal expansion and the arc rotation principle, gas flow simulations with a CFD-arc modeling are performed during the whole switching process such as high-current period, pre-current zero period, and current-zero period. Through the complete work, the pressure-rise and the ramp of the pressure inside the chamber before current zero as well as the post-arc current after current zero should be a good criterion to predict the short-line fault interruption performance of interrupters.

A Comparison of Alternative Approaches to the Analysis of Interrupted Time-Series.

ERIC Educational Resources Information Center

Harrop, John W.; Velicer, Wayne F.

1985-01-01

Computer generated data representative of 16 Auto Regressive Integrated Moving Averages (ARIMA) models were used to compare the results of interrupted time-series analysis using: (1) the known model identification, (2) an assumed (l,0,0) model, and (3) an assumed (3,0,0) model as an approximation to the General Transformation approach. (Author/BW)

Selecting and Improving Quasi-Experimental Designs in Effectiveness and Implementation Research.

PubMed

Handley, Margaret A; Lyles, Courtney R; McCulloch, Charles; Cattamanchi, Adithya

2018-04-01

Interventional researchers face many design challenges when assessing intervention implementation in real-world settings. Intervention implementation requires holding fast on internal validity needs while incorporating external validity considerations (such as uptake by diverse subpopulations, acceptability, cost, and sustainability). Quasi-experimental designs (QEDs) are increasingly employed to achieve a balance between internal and external validity. Although these designs are often referred to and summarized in terms of logistical benefits, there is still uncertainty about (a) selecting from among various QEDs and (b) developing strategies to strengthen the internal and external validity of QEDs. We focus here on commonly used QEDs (prepost designs with nonequivalent control groups, interrupted time series, and stepped-wedge designs) and discuss several variants that maximize internal and external validity at the design, execution and implementation, and analysis stages.

Medication room madness: calming the chaos.

PubMed

Conrad, Carole; Fields, Willa; McNamara, Tracey; Cone, Maryann; Atkins, Patricia

2010-01-01

Nurses work in stressful environments, encountering interruptions and distractions at almost every turn. The aim of this medication safety project was to improve the physical design and organizational layout of the medication room, reduce nurse interruptions and distractions, and create a standard medication process for enhanced patient safety and efficiency. This successful change improved the medication administration process, decreased medication errors, and enhanced nursing satisfaction.

Apparatus for and method of testing an electrical ground fault circuit interrupt device

DOEpatents

Andrews, L.B.

1998-08-18

An apparatus for testing a ground fault circuit interrupt device includes a processor, an input device connected to the processor for receiving input from an operator, a storage media connected to the processor for storing test data, an output device connected to the processor for outputting information corresponding to the test data to the operator, and a calibrated variable load circuit connected between the processor and the ground fault circuit interrupt device. The ground fault circuit interrupt device is configured to trip a corresponding circuit breaker. The processor is configured to receive signals from the calibrated variable load circuit and to process the signals to determine a trip threshold current and/or a trip time. A method of testing the ground fault circuit interrupt device includes a first step of providing an identification for the ground fault circuit interrupt device. Test data is then recorded in accordance with the identification. By comparing test data from an initial test with test data from a subsequent test, a trend of performance for the ground fault circuit interrupt device is determined. 17 figs.

Apparatus for and method of testing an electrical ground fault circuit interrupt device

DOEpatents

Andrews, Lowell B.

1998-01-01

An apparatus for testing a ground fault circuit interrupt device includes a processor, an input device connected to the processor for receiving input from an operator, a storage media connected to the processor for storing test data, an output device connected to the processor for outputting information corresponding to the test data to the operator, and a calibrated variable load circuit connected between the processor and the ground fault circuit interrupt device. The ground fault circuit interrupt device is configured to trip a corresponding circuit breaker. The processor is configured to receive signals from the calibrated variable load circuit and to process the signals to determine a trip threshold current and/or a trip time. A method of testing the ground fault circuit interrupt device includes a first step of providing an identification for the ground fault circuit interrupt device. Test data is then recorded in accordance with the identification. By comparing test data from an initial test with test data from a subsequent test, a trend of performance for the ground fault circuit interrupt device is determined.

Ressox Control of QZSS During Communication Interruption

DTIC Science & Technology

2009-11-01

Note 1289 (Hewlett-Packard), pp. 60. [5] F. Tappero, A. Dempster, T . Iwata, M. Imae, T . Ikegami , Y. Fukuyama, K. Hagimoto, and A. Iwasaki, 2006...interval, which means an overlapping integral number, set at 2, and t is the time difference measured by TCU. During PI control, applied voltage...Kishimoto, H. Hase, A. Matsumoto, T . Tsuruta, S. Kogure, N. Inaba, M. Sawabe, T . Kawanishi, S. Yoshitomi, and K. Terada, 2007, “QZSS System Design

Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence

PubMed Central

2014-01-01

Background Medication non-adherence is prevalent. We assessed the effect of electronic prescribing (e-prescribing) with formulary decision support on preferred formulary tier usage, copayment, and concomitant adherence. Methods We retrospectively analyzed 14,682 initial pharmaceutical claims for angiotensin receptor blocker and inhaled steroid medications among 14,410 patients of 2189 primary care physicians (PCPs) who were offered e-prescribing with formulary decision support, including 297 PCPs who adopted it. Formulary decision support was initially non-interruptive, such that formulary tier symbols were displayed adjacent to medication names. Subsequently, interruptive formulary decision support alerts also interrupted e-prescribing when preferred-tier alternatives were available. A difference in differences design was used to compare the pre-post differences in medication tier for each new prescription attributed to non-adopters, low user (<30% usage rate), and high user PCPs (>30% usage rate). Second, we modeled the effect of formulary tier on prescription copayment. Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication. Results Compared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications (vs. non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place (OR 1.9 [95% CI 1.0-3.4], p = 0.04), but no more likely to prescribe preferred-tier when only non-interruptive formulary decision support was in place (p = 0.90). Preferred-tier claims had only slightly lower mean monthly copayments than non-preferred tier claims (angiotensin receptor blocker: $10.60 versus $11.81, inhaled steroid: $14.86 versus $16.42, p < 0.0001). Medication possession ratio was 8% lower for each $1.00 increase in monthly copayment to the one quarter power (p < 0.0001). However, we detected no significant direct association between formulary decision support usage and adherence. Conclusion Interruptive formulary decision support shifted prescribing toward preferred tiers, but these medications were only minimally less expensive in the studied patient population. In this context, formulary decision support did not significantly increase adherence. To impact cost-related non-adherence, formulary decision support will likely need to be paired with complementary drug benefit design. Formulary decision support should be studied further, with particular attention to its effect on adherence in the setting of different benefit designs. PMID:25167807

Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence.

PubMed

Pevnick, Joshua M; Li, Ning; Asch, Steven M; Jackevicius, Cynthia A; Bell, Douglas S

2014-08-28

Medication non-adherence is prevalent. We assessed the effect of electronic prescribing (e-prescribing) with formulary decision support on preferred formulary tier usage, copayment, and concomitant adherence. We retrospectively analyzed 14,682 initial pharmaceutical claims for angiotensin receptor blocker and inhaled steroid medications among 14,410 patients of 2189 primary care physicians (PCPs) who were offered e-prescribing with formulary decision support, including 297 PCPs who adopted it. Formulary decision support was initially non-interruptive, such that formulary tier symbols were displayed adjacent to medication names. Subsequently, interruptive formulary decision support alerts also interrupted e-prescribing when preferred-tier alternatives were available. A difference in differences design was used to compare the pre-post differences in medication tier for each new prescription attributed to non-adopters, low user (<30% usage rate), and high user PCPs (>30% usage rate). Second, we modeled the effect of formulary tier on prescription copayment. Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication. Compared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications (vs. non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place (OR 1.9 [95% CI 1.0-3.4], p = 0.04), but no more likely to prescribe preferred-tier when only non-interruptive formulary decision support was in place (p = 0.90). Preferred-tier claims had only slightly lower mean monthly copayments than non-preferred tier claims (angiotensin receptor blocker: $10.60 versus $11.81, inhaled steroid: $14.86 versus $16.42, p < 0.0001). Medication possession ratio was 8% lower for each $1.00 increase in monthly copayment to the one quarter power (p < 0.0001). However, we detected no significant direct association between formulary decision support usage and adherence. Interruptive formulary decision support shifted prescribing toward preferred tiers, but these medications were only minimally less expensive in the studied patient population. In this context, formulary decision support did not significantly increase adherence. To impact cost-related non-adherence, formulary decision support will likely need to be paired with complementary drug benefit design. Formulary decision support should be studied further, with particular attention to its effect on adherence in the setting of different benefit designs.

Dependence of the electrical and optical properties on growth interruption in AlAs/In0.53Ga0.47As/InAs resonant tunneling diodes

PubMed Central

2011-01-01

The dependence of interface roughness of pseudomorphic AlAs/In0.53Ga0.47As/InAs resonant tunneling diodes [RTDs] grown by molecular beam epitaxy on interruption time was studied by current-voltage [I-V] characteristics, photoluminescence [PL] spectroscopy, and transmission electron microscopy [TEM]. We have observed that a splitting in the quantum-well PL due to island formation in the quantum well is sensitive to growth interruption at the AlAs/In0.53Ga0.47As interfaces. TEM images also show flatter interfaces with a few islands which only occur by applying an optimum value of interruption time. The symmetry of I-V characteristics of RTDs with PL and TEM results is consistent because tunneling current is highly dependent on barrier thickness and interface roughness. PMID:22112249

Dependence of the electrical and optical properties on growth interruption in AlAs/In0.53Ga0.47As/InAs resonant tunneling diodes.

PubMed

Zhang, Yang; Guan, Min; Liu, Xingfang; Zeng, Yiping

2011-11-23

The dependence of interface roughness of pseudomorphic AlAs/In0.53Ga0.47As/InAs resonant tunneling diodes [RTDs] grown by molecular beam epitaxy on interruption time was studied by current-voltage [I-V] characteristics, photoluminescence [PL] spectroscopy, and transmission electron microscopy [TEM]. We have observed that a splitting in the quantum-well PL due to island formation in the quantum well is sensitive to growth interruption at the AlAs/In0.53Ga0.47As interfaces. TEM images also show flatter interfaces with a few islands which only occur by applying an optimum value of interruption time. The symmetry of I-V characteristics of RTDs with PL and TEM results is consistent because tunneling current is highly dependent on barrier thickness and interface roughness.

Acute glucoregulatory and vascular outcomes of three strategies for interrupting prolonged sitting time in postmenopausal women: A pilot, laboratory-based, randomized, controlled, 4-condition, 4-period crossover trial.

PubMed

Kerr, Jacqueline; Crist, Katie; Vital, Daniela G; Dillon, Lindsay; Aden, Sabrina A; Trivedi, Minaxi; Castellanos, Luis R; Godbole, Suneeta; Li, Hongying; Allison, Matthew A; Khemlina, Galina L; Takemoto, Michelle L; Schenk, Simon; Sallis, James F; Grace, Megan; Dunstan, David W; Natarajan, Loki; LaCroix, Andrea Z; Sears, Dorothy D

2017-01-01

Prolonged sitting is associated with cardiometabolic and vascular disease. Despite emerging evidence regarding the acute health benefits of interrupting prolonged sitting time, the effectiveness of different modalities in older adults (who sit the most) is unclear. In preparation for a future randomized controlled trial, we enrolled 10 sedentary, overweight or obese, postmenopausal women (mean age 66 years ±9; mean body mass index 30.6 kg/m2 ±4.2) in a 4-condition, 4-period crossover feasibility pilot study in San Diego to test 3 different sitting interruption modalities designed to improve glucoregulatory and vascular outcomes compared to a prolonged sitting control condition. The interruption modalities included: a) 2 minutes standing every 20 minutes; b) 2 minutes walking every hour; and c) 10 minutes standing every hour. During each 5-hr condition, participants consumed two identical, standardized meals. Blood samples, blood pressure, and heart rate were collected every 30 minutes. Endothelial function of the superficial femoral artery was measured at baseline and end of each 5-hr condition using flow-mediated dilation (FMD). Participants completed each condition on separate days, in randomized order. This feasibility pilot study was not powered to detect statistically significant differences in the various outcomes, however, analytic methods (mixed models) were used to test statistical significance within the small sample size. Nine participants completed all 4 study visits, one participant completed 3 study visits and then was lost to follow up. Net incremental area under the curve (iAUC) values for postprandial plasma glucose and insulin during the 5-hr sitting interruption conditions were not significantly different compared to the control condition. Exploratory analyses revealed that the 2-minute standing every 20 minutes and the 2-minute walking every hour conditions were associated with a significantly lower glycemic response to the second meal compared to the first meal (i.e., condition-matched 2-hour post-lunch glucose iAUC was lower than 2-hour post-breakfast glucose iAUC) that withstood Bonferroni correction (p = 0.0024 and p = 0.0084, respectively). Using allometrically scaled data, the 10-minute standing every hour condition resulted in an improved FMD response, which was significantly greater than the control condition after Bonferroni correction (p = 0.0033). This study suggests that brief interruptions in prolonged sitting time have modality-specific glucoregulatory and vascular benefits and are feasible in an older adult population. Larger laboratory and real-world intervention studies of pragmatic and effective methods to change sitting habits are needed. ClinicalTrials.gov NCT02743286.

Program interruptions and short-stay transfers represent potential targets for inpatient rehabilitation care-improvement efforts

PubMed Central

Middleton, Addie; Graham, James E.; Krishnan, Shilpa; Ottenbacher, Kenneth J.

2016-01-01

Objective To present comprehensive descriptive summaries of program interruptions and short-stay transfers among Medicare fee-for-service beneficiaries receiving inpatient rehabilitation following stroke, traumatic brain injury (TBI), and traumatic spinal cord injury (SCI). Design Retrospective cohort study of Medicare beneficiaries with any of the three conditions of interest who were admitted to inpatient rehabilitation directly from an acute hospital between July 1, 2012 and November 15, 2013. Results In the final sample (stroke: n=71 769; TBI: n=7109; SCI: n=659), program interruption rates were 0.9% (stroke), 0.8% (TBI), and 1.4% (SCI). Short-stay transfer rates were 22.3% (stroke), 21.8% (TBI), and 31.6% (SCI). 14.7% of short-stay transfers and 12.3% of interruptions resulting in a return to acute care were identified as potentially preventable among those with stroke, 10.2% of transfers and 11.7% of interruptions among those with TBI, and 3.8% of transfers and 11.1% of interruptions among those with SCI. Conclusions Broad healthcare policies aimed at improving quality and reducing costs are currently being implemented. Reducing program interruptions and short-stay transfers during inpatient rehabilitative care represents a potential target for care-improvement efforts. Future research focused on identifying modifiable risk factors for potentially undesirable outcomes will allow for targeted preventative interventions. PMID:27631389

Perceptual weighting of the envelope and fine structure across frequency bands for sentence intelligibility: Effect of interruption at the syllabic-rate and periodic-rate of speech

PubMed Central

Fogerty, Daniel

2011-01-01

Listeners often only have fragments of speech available to understand the intended message due to competing background noise. In order to maximize successful speech recognition, listeners must allocate their perceptual resources to the most informative acoustic properties. The speech signal contains temporally-varying acoustics in the envelope and fine structure that are present across the frequency spectrum. Understanding how listeners perceptually weigh these acoustic properties in different frequency regions during interrupted speech is essential for the design of assistive listening devices. This study measured the perceptual weighting of young normal-hearing listeners for the envelope and fine structure in each of three frequency bands for interrupted sentence materials. Perceptual weights were obtained during interruption at the syllabic rate (i.e., 4 Hz) and the periodic rate (i.e., 128 Hz) of speech. Potential interruption interactions with fundamental frequency information were investigated by shifting the natural pitch contour higher relative to the interruption rate. The availability of each acoustic property was varied independently by adding noise at different levels. Perceptual weights were determined by correlating a listener’s performance with the availability of each acoustic property on a trial-by-trial basis. Results demonstrated similar relative weights across the interruption conditions, with emphasis on the envelope in high-frequencies. PMID:21786914

The impact of early discharge laws on the health of newborns.

PubMed

Evans, William N; Garthwaite, Craig; Wei, Heng

2008-07-01

Using an interrupted time series design and a census of births in California over a 6-year period, we show that state and federal laws passed in the late 1990s designed to increase the length of postpartum hospital stays reduced considerably the fraction of newborns that were discharged early. The law had little impact on re-admission rates for privately insured, vaginally delivered newborns, but reduced re-admission rates for privately insured c-section-delivered and Medicaid-insured vaginally delivered newborns by statistically significant amounts. Our calculations suggest the program was not cost saving.

Acute effects of aircraft noise on cardiovascular admissions - an interrupted time-series analysis of a six-day closure of London Heathrow Airport caused by volcanic ash.

PubMed

Pearson, Tim; Campbell, Michael J; Maheswaran, Ravi

2016-08-01

Acute noise exposure may acutely increase blood pressure but the hypothesis that acute exposure to aircraft noise may trigger cardiovascular events has not been investigated. This study took advantage of a six-day closure of a major airport in April 2010 caused by volcanic ash to examine if there was a decrease in emergency cardiovascular hospital admissions during or immediately after the closure period, using an interrupted daily time-series study design. The population living within the 55dB(A) noise contour was substantial at 0.7 million. The average daily admission count was 13.9 (SD 4.4). After adjustment for covariates, there was no evidence of a decreased risk of hospital admission from cardiovascular disease during the closure period (relative risk 0.97 (95% CI 0.75-1.26)). Using lags of 1-7 days gave similar results. Further studies are needed to investigate if transient aircraft noise exposure can trigger acute cardiovascular events. Copyright © 2016. Published by Elsevier Ltd.

A reanalysis of cluster randomized trials showed interrupted time-series studies were valuable in health system evaluation.

PubMed

Fretheim, Atle; Zhang, Fang; Ross-Degnan, Dennis; Oxman, Andrew D; Cheyne, Helen; Foy, Robbie; Goodacre, Steve; Herrin, Jeph; Kerse, Ngaire; McKinlay, R James; Wright, Adam; Soumerai, Stephen B

2015-03-01

There is often substantial uncertainty about the impacts of health system and policy interventions. Despite that, randomized controlled trials (RCTs) are uncommon in this field, partly because experiments can be difficult to carry out. An alternative method for impact evaluation is the interrupted time-series (ITS) design. Little is known, however, about how results from the two methods compare. Our aim was to explore whether ITS studies yield results that differ from those of randomized trials. We conducted single-arm ITS analyses (segmented regression) based on data from the intervention arm of cluster randomized trials (C-RCTs), that is, discarding control arm data. Secondarily, we included the control group data in the analyses, by subtracting control group data points from intervention group data points, thereby constructing a time series representing the difference between the intervention and control groups. We compared the results from the single-arm and controlled ITS analyses with results based on conventional aggregated analyses of trial data. The findings were largely concordant, yielding effect estimates with overlapping 95% confidence intervals (CI) across different analytical methods. However, our analyses revealed the importance of a concurrent control group and of taking baseline and follow-up trends into account in the analysis of C-RCTs. The ITS design is valuable for evaluation of health systems interventions, both when RCTs are not feasible and in the analysis and interpretation of data from C-RCTs. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

The Relationship between the Current Waveform just before the Current Zero and the Interruption Ability in the High-speed VCB

NASA Astrophysics Data System (ADS)

Niwa, Yoshimitsu; Matsuzaki, Jun; Yokokura, Kunio

The high-speed vacuum circuit breaker, which forced the fault current to zero was investigated. The test circuit breaker consisted of a vacuum interrupter and a high frequency current source. The vacuum interrupter, which had the axial magnetic field electrode and the disk shape electrode, was tested. The arcing period of the high-speed vacuum circuit breaker is much shorter than that of conventional circuit breaker. The arc behavior of the test electrodes immediately after the contact separation was observed by a high-speed video camcorder. The relation between the current waveform just before the current zero and the interruption ability by varying the high frequency current source was investigated experimentally. The results demonstrate the interruption ability and the arc behavior of the high-speed vacuum circuit breaker. The high current interruption was made possible by the low current period just before the current zero, although the arcing time is short and the arc is concentrated.

Simulated Crisis in Obstetric Anesthesia: Design and Evaluation of a Distance Education Presentation

PubMed Central

Murray, W. Bosseau; Schneider, Art; Underberg, Karin; Henry, Jody; Foster, Pat; Vaduva, Sorin; Venable, J. Clark; Shindel, Michelle

2001-01-01

Patient simulators are useful tools for training residents and all levels of medical personnel. Simulator usefulness, in small group sessions, is limited by the costs of training large numbers of people. We present an interrupted methodology designed to involve a large group at a location remote from the simulator. The goal was to enable the remote participants to take part in decision making while under time pressure. Two volunteers were chosen as hands-on participants while eighteen remaining anesthesiology residents observed from a lecture room via a closed circuit audio/video feed. A series of five crises in obstetric anesthesia was presented. After each crisis the simulation was paused and the observers were given three minutes to formulate a differential diagnosis and plan to be carried out. At the end of the session facilitators led a debriefing session with all participants. Surveys completed after the simulation indicated that most residents felt personally involved in the simulation, despite being physically removed from it. Surveys also showed that residents believed they learned more from this format than they would have from a lecture. Residents recalled an average of 3.4 crises two days after the session. This paper presents a model for distance education using a simulator and shows that residents believed remote, interrupted, interactive simulator training is valuable. The interrupted nature and involvement of remotely located peers differentiate this methodology from a passive viewing of a remote session. Further study is warranted to quantify the effectiveness of group and/or distance training with a simulator. PMID:27175412

PCIE interface design for high-speed image storage system based on SSD

NASA Astrophysics Data System (ADS)

Wang, Shiming

2015-02-01

This paper proposes and implements a standard interface of miniaturized high-speed image storage system, which combines PowerPC with FPGA and utilizes PCIE bus as the high speed switching channel. Attached to the PowerPC, mSATA interface SSD(Solid State Drive) realizes RAID3 array storage. At the same time, a high-speed real-time image compression patent IP core also can be embedded in FPGA, which is in the leading domestic level with compression rate and image quality, making that the system can record higher image data rate or achieve longer recording time. The notebook memory card buckle type design is used in the mSATA interface SSD, which make it possible to complete the replacement in 5 seconds just using single hand, thus the total length of repeated recordings is increased. MSI (Message Signaled Interrupts) interruption guarantees the stability and reliability of continuous DMA transmission. Furthermore, only through the gigabit network, the remote display, control and upload to backup function can be realized. According to an optional 25 frame/s or 30 frame/s, upload speeds can be up to more than 84 MB/s. Compared with the existing FLASH array high-speed memory systems, it has higher degree of modularity, better stability and higher efficiency on development, maintenance and upgrading. Its data access rate is up to 300MB/s, realizing the high speed image storage system miniaturization, standardization and modularization, thus it is fit for image acquisition, storage and real-time transmission to server on mobile equipment.

Effectiveness of honey on radiation-induced oral mucositis, time to mucositis, weight loss, and treatment interruptions among patients with head and neck malignancies: A meta-analysis and systematic review of literature.

PubMed

Co, Jayson L; Mejia, Michael Benedict A; Que, Jocelyn C; Dizon, Janine Margarita R

2016-07-01

Mucositis is a disabling effect of radiotherapy in head and neck cancers. There is no current standard on management of radiation-induced mucositis. Honey has been shown to reduce radiation-induced mucositis. A systematic review and meta-analysis were undertaken to assess the ability of honey in reducing the severity of oral mucositis, time to mucositis, weight loss, and treatment interruptions. Eight studies were included and showed that honey was significantly better in lowering the risk for treatment interruptions, weight loss, and delaying time to mucositis, but not severity of mucositis. There is current evidence that honey is beneficial for patients with head and neck cancers by decreasing treatment interruptions, weight loss, and delaying the onset of oral mucositis, but not in decreasing peak mucositis score. In light of the results, honey is a reasonable treatment for radiation-induced mucositis, but more randomized clinical trials (RCTs) should be done. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1119-1128, 2016. © 2016 Wiley Periodicals, Inc.

When Interrupted Intervention Leads to Failure: A Correlation Study of the Three-Tiered Reading Model in Grades K-2

ERIC Educational Resources Information Center

Weis, Beverly Lynn

2012-01-01

The three-tiered reading model is a widely practiced instructional scheme that moves students in and out of reading intervention groups during the school year. Though designed to treat students who need extra help learning to read, this interruption of reading interventions may hinder some students' progress. The purpose of this study was to…

Estimating Economic and Logistic Utility of Connecting to Unreliable Power Grids

DTIC Science & Technology

2016-06-17

the most unreliable host nation grids almost always have a higher availability than solar photovoltaics ( PV ), which for most parts of the world will...like solar , and still design a facility energy architecture that benefits from that source when available. Index Terms—facilities management, energy...Maintenance PV Photovoltaic SAIDI System Average Interruption Duration Index SAIFI System Average Interruption Frequency Index SHP Simplified Host

The Effect of Interruptions on Part 121 Air Carrier Operations

NASA Technical Reports Server (NTRS)

Damos, Diane L.

1998-01-01

The primary purpose of this study was to determine the relative priorities of various events and activities by examining the probability that a given activity was interrupted by a given event. The analysis will begin by providing frequency of interruption data by crew position (captain versus first officer) and event type. Any differences in the pattern of interruptions between the first officers and the captains will be explored and interpreted in terms of standard operating procedures. Subsequent data analyses will focus on comparing the frequency of interruptions for different types of activities and for the same activities under normal versus emergency conditions. Briefings and checklists will receive particular attention. The frequency with which specific activities are interrupted under multiple- versus single-task conditions also will be examined; because the majority of multiple-task data were obtained under laboratory conditions, LOFT-type tapes offer a unique opportunity to examine concurrent task performance under 'real-world' conditions. A second purpose of this study is to examine the effects of the interruptions on performance. More specifically, when possible, the time to resume specific activities will be compared to determine if pilots are slower to resume certain types of activities. Errors in resumption or failures to resume specific activities will be noted and any patterns in these errors will be identified. Again, particular attention will be given to the effects of interruptions on the completion of checklists and briefings. Other types of errors and missed events (i.e., the crew should have responded to the event but did not) will be examined. Any methodology using interruptions to examine task prioritization must be able to identify when an interruption has occurred and describe the ongoing activities that were interrupted. Both of these methodological problems are discussed In detail in the following section,

Design, application and testing of the Work Observation Method by Activity Timing (WOMBAT) to measure clinicians' patterns of work and communication.

PubMed

Westbrook, Johanna I; Ampt, Amanda

2009-04-01

Evidence regarding how health information technologies influence clinicians' patterns of work and support efficient practices is limited. Traditional paper-based data collection methods are unable to capture clinical work complexity and communication patterns. The use of electronic data collection tools for such studies is emerging yet is rarely assessed for reliability or validity. Our aim was to design, apply and test an observational method which incorporated the use of an electronic data collection tool for work measurement studies which would allow efficient, accurate and reliable data collection, and capture greater degrees of work complexity than current approaches. We developed an observational method and software for personal digital assistants (PDAs) which captures multiple dimensions of clinicians' work tasks, namely what task, with whom, and with what; tasks conducted in parallel (multi-tasking); interruptions and task duration. During field-testing over 7 months across four hospital wards, fifty-two nurses were observed for 250 h. Inter-rater reliability was tested and validity was measured by (i) assessing whether observational data reflected known differences in clinical role work tasks and (ii) by comparing observational data with participants' estimates of their task time distribution. Observers took 15-20 h of training to master the method and data collection process. Only 1% of tasks observed did not match the classification developed and were classified as 'other'. Inter-rater reliability scores of observers were maintained at over 85%. The results discriminated between the work patterns of enrolled and registered nurses consistent with differences in their roles. Survey data (n=27) revealed consistent ratings of tasks by nurses, and their rankings of most to least time-consuming tasks were significantly correlated with those derived from the observational data. Over 40% of nurses' time was spent in direct care or professional communication, with 11.8% of time spent multi-tasking. Nurses were interrupted approximately every 49 min. One quarter of interruptions occurred while nurses were preparing or administering medications. This method efficiently produces reliable and valid data. The multi-dimensional nature of the data collected provides greater insights into patterns of clinicians' work and communication than has previously been possible using other methods.

A MAC Protocol for Medical Monitoring Applications of Wireless Body Area Networks

PubMed Central

Shu, Minglei; Yuan, Dongfeng; Zhang, Chongqing; Wang, Yinglong; Chen, Changfang

2015-01-01

Targeting the medical monitoring applications of wireless body area networks (WBANs), a hybrid medium access control protocol using an interrupt mechanism (I-MAC) is proposed to improve the energy and time slot utilization efficiency and to meet the data delivery delay requirement at the same time. Unlike existing hybrid MAC protocols, a superframe structure with a longer length is adopted to avoid unnecessary beacons. The time slots are mostly allocated to nodes with periodic data sources. Short interruption slots are inserted into the superframe to convey the urgent data and to guarantee the real-time requirements of these data. During these interruption slots, the coordinator can break the running superframe and start a new superframe. A contention access period (CAP) is only activated when there are more data that need to be delivered. Experimental results show the effectiveness of the proposed MAC protocol in WBANs with low urgent traffic. PMID:26046596

Global interrupt and barrier networks

DOEpatents

Blumrich, Matthias A.; Chen, Dong; Coteus, Paul W.; Gara, Alan G.; Giampapa, Mark E; Heidelberger, Philip; Kopcsay, Gerard V.; Steinmacher-Burow, Burkhard D.; Takken, Todd E.

2008-10-28

A system and method for generating global asynchronous signals in a computing structure. Particularly, a global interrupt and barrier network is implemented that implements logic for generating global interrupt and barrier signals for controlling global asynchronous operations performed by processing elements at selected processing nodes of a computing structure in accordance with a processing algorithm; and includes the physical interconnecting of the processing nodes for communicating the global interrupt and barrier signals to the elements via low-latency paths. The global asynchronous signals respectively initiate interrupt and barrier operations at the processing nodes at times selected for optimizing performance of the processing algorithms. In one embodiment, the global interrupt and barrier network is implemented in a scalable, massively parallel supercomputing device structure comprising a plurality of processing nodes interconnected by multiple independent networks, with each node including one or more processing elements for performing computation or communication activity as required when performing parallel algorithm operations. One multiple independent network includes a global tree network for enabling high-speed global tree communications among global tree network nodes or sub-trees thereof. The global interrupt and barrier network may operate in parallel with the global tree network for providing global asynchronous sideband signals.

A real-time programming system.

PubMed

Townsend, H R

1979-03-01

The paper describes a Basic Operating and Scheduling System (BOSS) designed for a small computer. User programs are organised as self-contained modular 'processes' and the way in which the scheduler divides the time of the computer equally between them, while arranging for any process which has to respond to an interrupt from a peripheral device to be given the necessary priority, is described in detail. Next the procedures provided by the operating system to organise communication between processes are described, and how they are used to construct dynamically self-modifying real-time systems. Finally, the general philosophy of BOSS and applications to a multi-processor assembly are discussed.

Using "Short" Interrupted Time-Series Analysis To Measure the Impacts of Whole-School Reforms: With Applications to a Study of Accelerated Schools.

ERIC Educational Resources Information Center

Bloom, Howard S.

2002-01-01

Introduces an new approach for measuring the impact of whole school reforms. The approach, based on "short" interrupted time-series analysis, is explained, its statistical procedures are outlined, and how it was used in the evaluation of a major whole-school reform, Accelerated Schools is described (H. Bloom and others, 2001). (SLD)

Comparison Groups in Short Interrupted Time-Series: An Illustration Evaluating No Child Left Behind

ERIC Educational Resources Information Center

Wong, Manyee; Cook, Thomas D.; Steiner, Peter M.

2009-01-01

Interrupted time-series (ITS) are often used to assess the causal effect of a planned or even unplanned shock introduced into an on-going process. The pre-intervention slope is supposed to index the causal counterfactual, and deviations from it in mean, slope or variance are used to indicate an effect. However, a secure causal inference is only…

Modelling the time at which overcrowding and feed interruption emerge on the swine premises under movement restrictions during a classical swine fever outbreak.

PubMed

Weng, H Y; Yadav, S; Olynk Widmar, N J; Croney, C; Ash, M; Cooper, M

2017-03-01

A stochastic risk model was developed to estimate the time elapsed before overcrowding (TOC) or feed interruption (TFI) emerged on the swine premises under movement restrictions during a classical swine fever (CSF) outbreak in Indiana, USA. Nursery (19 to 65 days of age) and grow-to-finish (40 to 165 days of age) pork production operations were modelled separately. Overcrowding was defined as the total weight of pigs on premises exceeding 100% to 115% of the maximum capacity of the premises, which was computed as the total weight of the pigs at harvest/transition age. Algorithms were developed to estimate age-specific weight of the pigs on premises and to compare the daily total weight of the pigs with the threshold weight defining overcrowding to flag the time when the total weight exceeded the threshold (i.e. when overcrowding occurred). To estimate TFI, an algorithm was constructed to model a swine producer's decision to discontinue feed supply by incorporating the assumptions that a longer estimated epidemic duration, a longer time interval between the age of pigs at the onset of the outbreak and the harvest/transition age, or a longer progression of an ongoing outbreak would increase the probability of a producer's decision to discontinue the feed supply. Adverse animal welfare conditions were modelled to emerge shortly after an interruption of feed supply. Simulations were run with 100 000 iterations each for a 365-day period. Overcrowding occurred in all simulated iterations, and feed interruption occurred in 30% of the iterations. The median (5th and 95th percentiles) TOC was 24 days (10, 43) in nursery operations and 78 days (26, 134) in grow-to-finish operations. Most feed interruptions, if they emerged, occurred within 15 days of an outbreak. The median (5th and 95th percentiles) time at which either overcrowding or feed interruption emerged was 19 days (4, 42) in nursery and 57 days (4, 130) in grow-to-finish operations. The study findings suggest that overcrowding and feed interruption could emerge early during a CSF outbreak among swine premises under movement restrictions. The outputs derived from the risk model could be used to estimate and evaluate associated mitigation strategies for alleviating adverse animal welfare conditions resulting from movement restrictions.

Practice increases procedural errors after task interruption.

PubMed

Altmann, Erik M; Hambrick, David Z

2017-05-01

Positive effects of practice are ubiquitous in human performance, but a finding from memory research suggests that negative effects are possible also. The finding is that memory for items on a list depends on the time interval between item presentations. This finding predicts a negative effect of practice on procedural performance under conditions of task interruption. As steps of a procedure are performed more quickly, memory for past performance should become less accurate, increasing the rate of skipped or repeated steps after an interruption. We found this effect, with practice generally improving speed and accuracy, but impairing accuracy after interruptions. The results show that positive effects of practice can interact with architectural constraints on episodic memory to have negative effects on performance. In practical terms, the results suggest that practice can be a risk factor for procedural errors in task environments with a high incidence of task interruption. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Treating Comorbid Anxiety in Adolescents With ADHD Using a Cognitive Behavior Therapy Program Approach.

PubMed

Houghton, Stephen; Alsalmi, Nadiyah; Tan, Carol; Taylor, Myra; Durkin, Kevin

2017-11-01

To evaluate an 8-week cognitive behavior therapy (CBT) treatment specifically designed for adolescents with ADHD and comorbid anxiety. Using a multiple baseline design, nine adolescents (13 years to 16 years 9 months) received a weekly CBT, which focused on four identified anxiety-arousing times. Participants self-recorded their levels of anxiety for each of the four times during baseline, intervention, and a maintenance phase. Anxiety was also assessed using the Multidimensional Anxiety Scale for Children (MASC). Paired samples t tests supported the success of the intervention. Interrupted time-series data for each participant revealed varying rates of success across the four times, however. The MASC data revealed significant reductions in Physical Symptoms of Anxiety, Social Anxiety, Separation Anxiety, Harm Avoidance, and Total Anxiety. The data demonstrate the efficacy of a CBT program for the treatment of comorbid anxiety in adolescents with ADHD.

A Prospective Randomized Trial of Apixaban Dosing During Atrial Fibrillation Ablation: The AEIOU Trial.

PubMed

Reynolds, Matthew R; Allison, J Scott; Natale, Andrea; Weisberg, Ian L; Ellenbogen, Kenneth A; Richards, Mark; Hsieh, Wen-Hua; Sutherland, Julie; Cannon, Christopher P

2018-05-01

This study sought to determine whether uninterrupted apixaban would have similar rates of bleeding and thromboembolic events as does minimally interrupted apixaban at the time of atrial fibrillation (AF) ablation and to compare those results with rates in historical patients treated with uninterrupted warfarin. The safety, efficacy, and optimal dosing regimen for apixaban at the time of AF ablation are uncertain. This prospective, multicenter clinical trial enrolled 306 patients undergoing catheter ablation for nonvalvular AF and randomized 300 to uninterrupted versus minimally interrupted (holding 1 dose) periprocedural apixaban. A retrospective cohort of patients treated with uninterrupted warfarin at the same centers was matched to the apixaban-treated subjects for comparison. Endpoints included clinically significant bleeding, major bleeding, and nonhemorrhagic stroke or systemic embolism (SE) from the time of ablation through 30 days. There were no stroke or SE events. Clinically significant bleeding occurred in 11.3% of 150 evaluable patients on uninterrupted apixaban and 9.7% of 145 evaluable patients on interrupted apixaban (risk difference: 1.7% [95% confidence interval: -5.5% to 8.8%]; p = NS). Rates of major bleeding were 1.3% with uninterrupted apixaban, and 2.1% with interrupted (risk difference: -0.7%; p = NS). The rates of clinically significant and major bleeding were similar for all apixaban patients combined (10.5% and 1.7%), compared with the matched warfarin group (9.8% and 1.4%). Both uninterrupted and minimally interrupted apixaban at the time of AF ablation were associated with a very low rate of thromboembolic events, and rates of both major (<2%) and clinically significant bleeding were similar to uninterrupted warfarin. (Apixaban Evaluation of Interrupted Or Uninterrupted Anticoagulation for Ablation of Atrial Fibrillation [AEIOU]; NCT02608099). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effects of physical activity calorie expenditure (PACE) labeling: study design and baseline sample characteristics.

PubMed

Viera, Anthony J; Tuttle, Laura; Olsson, Emily; Gras-Najjar, Julie; Gizlice, Ziya; Hales, Derek; Linnan, Laura; Lin, Feng-Chang; Noar, Seth M; Ammerman, Alice

2017-09-12

Obesity and physical inactivity are responsible for more than 365,000 deaths per year and contribute substantially to rising healthcare costs in the US, making clear the need for effective public health interventions. Calorie labeling on menus has been implemented to guide consumer ordering behaviors, but effects on calories purchased has been minimal. In this project, we tested the effect of physical activity calorie expenditure (PACE) food labels on actual point-of-decision food purchasing behavior as well as physical activity. Using a two-group interrupted time series cohort study design in three worksite cafeterias, one cafeteria was assigned to the intervention condition, and the other two served as controls. Calories from food purchased in the cafeteria were assessed by photographs of meals (accompanied by notes made on-site) using a standardized calorie database and portion size-estimation protocol. Primary outcomes will be average calories purchased and minutes of moderate to vigorous physical activity (MVPA) by individuals in the cohorts. We will compare pre-post changes in study outcomes between study groups using piecewise generalized linear mixed model regressions (segmented regressions) with a single change point in our interrupted time-series study. The results of this project will provide evidence of the effectiveness of worksite cafeteria menu labeling, which could potentially inform policy intervention approaches. Labels that convey information in a more readily understandable manner may be more effective at motivating behavior change. Strengths of this study include its cohort design and its robust data capture methods using food photographs and accelerometry.

Architecture for a 1-GHz Digital RADAR

NASA Technical Reports Server (NTRS)

Mallik, Udayan

2011-01-01

An architecture for a Direct RF-digitization Type Digital Mode RADAR was developed at GSFC in 2008. Two variations of a basic architecture were developed for use on RADAR imaging missions using aircraft and spacecraft. Both systems can operate with a pulse repetition rate up to 10 MHz with 8 received RF samples per pulse repetition interval, or at up to 19 kHz with 4K received RF samples per pulse repetition interval. The first design describes a computer architecture for a Continuous Mode RADAR transceiver with a real-time signal processing and display architecture. The architecture can operate at a high pulse repetition rate without interruption for an infinite amount of time. The second design describes a smaller and less costly burst mode RADAR that can transceive high pulse repetition rate RF signals without interruption for up to 37 seconds. The burst-mode RADAR was designed to operate on an off-line signal processing paradigm. The temporal distribution of RF samples acquired and reported to the RADAR processor remains uniform and free of distortion in both proposed architectures. The majority of the RADAR's electronics is implemented in digital CMOS (complementary metal oxide semiconductor), and analog circuits are restricted to signal amplification operations and analog to digital conversion. An implementation of the proposed systems will create a 1-GHz, Direct RF-digitization Type, L-Band Digital RADAR--the highest band achievable for Nyquist Rate, Direct RF-digitization Systems that do not implement an electronic IF downsample stage (after the receiver signal amplification stage), using commercially available off-the-shelf integrated circuits.

Insulation Technology in Dry Air and Vacuum for a 72kV Low Pressured Dry Air Insulated Switchgear

NASA Astrophysics Data System (ADS)

Yoshida, Tadahiro; Koga, Hiromi; Harada, Takakazu; Miki, Shinichi; Arioka, Masahiro; Sato, Shinji; Yoshida, Satoru; Inoue, Naoaki; Maruyama, Akihiko; Takeuchi, Toshie

A new 72kV rated low pressured dry air insulated switchgear applying electromagnetic actuation and function that supports CBM has been developed. First, dielectric characteristics in dry air under lightning impulse application has been investigated at bare and insulator covered electrodes. Dependence of the breakdown electric field strength on the effective area has been clarified to apply the configuration design of the insulation mold for the vacuum interrupter. In addition, moisture volume dependence on surface resistance has been clarified to decide moisture volume in gas pressure tank. Next, a new vacuum circuit breaker (VCB) has been designed. To keep dimensions from former 72kV SF6 gas insulated switchgear, distance between contacts in vacuum interrupter is needed to be shorter than that of former switchgear. Voltage withstand capability between electrodes practically designed for vacuum interrupter has been investigated under dc voltage application simulated the small capacitive current breaking test. Gap configuration including contacts and slits has been optimized and distance has been shortened 11% from former switchgear. As a result, the new low pressured dry air insulated switchgear has been designed comparably in outer size to former SF6 gas insulated switchgear. Using dry air as an insulation medium with low pressure has been able to reduce the environmental burden.

AMTEC powered residential furnace and auxiliary power

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

Ivanenok, J.F. III; Sievers, R.K.

1996-12-31

Residential gas furnaces normally rely on utility grid electric power to operate the fans and/or the pumps used to circulate conditioned air or water and they are thus vulnerable to interruptions of utility grid service. Experience has shown that such interruptions can occur during the heating season, and can lead to serious consequences. A gas furnace coupled to an AMTEC conversion system retains the potential to produce heat and electricity (gas lines are seldom interrupted during power outages), and can save approximately $47/heating season compared to a conventional gas furnace. The key to designing a power system is understanding, andmore » predicting, the cell performance characteristics. The three main processes that must be understood and modeled to fully characterize an AMTEC cell are the electro-chemical, sodium vapor flow, and heat transfer. This paper will show the results of the most recent attempt to model the heat transfer in a multi-tube AMTEC cell and then discusses the conceptual design of a self-powered residential furnace.« less

Effectiveness of a 'Do not interrupt' bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study.

PubMed

Westbrook, Johanna I; Li, Ling; Hooper, Tamara D; Raban, Magda Z; Middleton, Sandy; Lehnbom, Elin C

2017-09-01

To evaluate the effectiveness of a 'Do not interrupt' bundled intervention to reduce non-medication-related interruptions to nurses during medication administration. A parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered. Over 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy. Nurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Basis for the power supply reliability study of the 1 MW neutron source

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

McGhee, D.G.; Fathizadeh, M.

1993-07-01

The Intense Pulsed Neutron Source (IPNS) upgrade to 1 MW requires new power supply designs. This paper describes the tools and the methodology needed to assess the reliability of the power supplies. Both the design and operation of the power supplies in the synchrotron will be taken into account. To develop a reliability budget, the experiments to be conducted with this accelerator are reviewed, and data is collected on the number and duration of interruptions possible before an experiment is required to start over. Once the budget is established, several accelerators of this type will be examined. The budget ismore » allocated to the different accelerator systems based on their operating experience. The accelerator data is usually in terms of machine availability and system down time. It takes into account mean time to failure (MTTF), time to diagnose, time to repair or replace the failed components, and time to get the machine back online. These estimated times are used as baselines for the design. Even though we are in the early stage of design, available data can be analyzed to estimate the MTTF for the power supplies.« less

30 Do nice guys finish last?

PubMed

Turner, Chris; Turner, Jake

2017-12-01

: Emergency medicine is widely recognised as an intense specialty. Interruptions are known to derail thoughts, increasing cognitive load and result in longer periods before deep thought is re-established. Although approachability and warmth are regarded as important factors in clinicians we wondered what impact these characteristics had on the number of interruptions. A team of 6 medical students were trained in the use of abespoke tool to record shop floor activities. Over 4 months we conducted 100 hours of minute by minute time and motion study of emergency medicine consultants during their clinical shifts, and noted how often they were interrupted. At the end of shifts the assessors were asked a set of qualitative questions on the behaviour and attitudes of the consultants. These questions were completed in seclusion and in an anonymous format, to minimise the chance of bias/influence. QUESTIONS INCLUDED: 'How friendly was the consultant with other staff?' 'How friendly was this consultant with patients?' And, 'How would you rate this consultant's 'general positivity'?'We then assessed whether consultants that scored 'higher' inthese areas were more likely to be interrupted. Our hypothesis was that consultants who were more friendly were less intimidating for juniors and nurses to approach with questions, and so may suffer from an increase in cognitive load due to being interrupted and questioned more frequently than consultants who were felt to be less approachable.We found that consultants who scored 1(highest) in friendliness had an average of 7.38 interruptions per hour, compared to consultants who scored 3 or greater, who had an average of 3.59. Our average interruptions were close to those found in previous publications (between 6 and 9 interruptions per hour), however there was a large amount of inter-consultant variability, with one consultant during one shift being interrupted over 12 times per hour on average. If the results of this study are replicable, then it may raise questions about how best to manage this extra cognitive load. Although some may argue that being seen as slightly less friendly has an advantage in the reduction of interruptions, this may come at a cost to patient safety. There is clearly a fine balance to be made.emermed;34/12/A879-c/F1F1F1Figure 1Average interruptions per hour by friendliness score. © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Evaluation of occupational health interventions using a randomized controlled trial: challenges and alternative research designs.

PubMed

Schelvis, Roosmarijn M C; Oude Hengel, Karen M; Burdorf, Alex; Blatter, Birgitte M; Strijk, Jorien E; van der Beek, Allard J

2015-09-01

Occupational health researchers regularly conduct evaluative intervention research for which a randomized controlled trial (RCT) may not be the most appropriate design (eg, effects of policy measures, organizational interventions on work schedules). This article demonstrates the appropriateness of alternative designs for the evaluation of occupational health interventions, which permit causal inferences, formulated along two study design approaches: experimental (stepped-wedge) and observational (propensity scores, instrumental variables, multiple baseline design, interrupted time series, difference-in-difference, and regression discontinuity). For each design, the unique characteristics are presented including the advantages and disadvantages compared to the RCT, illustrated by empirical examples in occupational health. This overview shows that several appropriate alternatives for the RCT design are feasible and available, which may provide sufficiently strong evidence to guide decisions on implementation of interventions in workplaces. Researchers are encouraged to continue exploring these designs and thus contribute to evidence-based occupational health.

Single event upset suspectibility testing of the Xilinx Virtex II FPGA

NASA Technical Reports Server (NTRS)

Carmichael, C.; Swift, C.; Yui, G.

2002-01-01

Heavy ion testing of the Xilinx Virtex II was conducted on the configuration, block RAM and user flip flop cells to determine their static single-event upset susceptibility using LETs of 1.2 to 60 MeVcm^2/mg. A software program specifically designed to count errors in the FPGA was used to reveal L1/e, values (the LET at which the cross section is l/e times the saturation cross-section) and single-event functional-interrupt failures.

The Physics Analysis of a Gas Attenuator with Argon as a Working Gas

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

Ryutov,, D.D.

2010-12-07

A gas attenuator is an important element of the LCLS facility. The attenuator must operate in a broad range of x-ray energies, provide attenuation coefficient between 1 and 10{sup 4} with the accuracy of 1% and, at the same time, be reliable and allow for many months of un-interrupted operation. S. Shen has recently carried out a detailed design study of the attenuator based on the use of nitrogen as a working gas. In this note we assess the features of the attenuator based on the use of argon. We concentrate on the physics issues, not the design features.

Separate Medication Preparation Rooms Reduce Interruptions and Medication Errors in the Hospital Setting: A Prospective Observational Study.

PubMed

Huckels-Baumgart, Saskia; Baumgart, André; Buschmann, Ute; Schüpfer, Guido; Manser, Tanja

2016-12-21

Interruptions and errors during the medication process are common, but published literature shows no evidence supporting whether separate medication rooms are an effective single intervention in reducing interruptions and errors during medication preparation in hospitals. We tested the hypothesis that the rate of interruptions and reported medication errors would decrease as a result of the introduction of separate medication rooms. Our aim was to evaluate the effect of separate medication rooms on interruptions during medication preparation and on self-reported medication error rates. We performed a preintervention and postintervention study using direct structured observation of nurses during medication preparation and daily structured medication error self-reporting of nurses by questionnaires in 2 wards at a major teaching hospital in Switzerland. A volunteer sample of 42 nurses was observed preparing 1498 medications for 366 patients over 17 hours preintervention and postintervention on both wards. During 122 days, nurses completed 694 reporting sheets containing 208 medication errors. After the introduction of the separate medication room, the mean interruption rate decreased significantly from 51.8 to 30 interruptions per hour (P < 0.01), and the interruption-free preparation time increased significantly from 1.4 to 2.5 minutes (P < 0.05). Overall, the mean medication error rate per day was also significantly reduced after implementation of the separate medication room from 1.3 to 0.9 errors per day (P < 0.05). The present study showed the positive effect of a hospital-based intervention; after the introduction of the separate medication room, the interruption and medication error rates decreased significantly.

Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation.

PubMed

Raunsø, Jakob; Selmer, Christian; Olesen, Jonas Bjerring; Charlot, Mette Gitz; Olsen, Anne-Marie S; Bretler, Ditte-Marie; Nielsen, Jørn Dalsgaard; Dominguez, Helena; Gadsbøll, Niels; Køber, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian; Hansen, Morten Lock

2012-08-01

It is presently unknown whether patients with atrial fibrillation (AF) are at increased risk of thrombo-embolic adverse events after interruption of warfarin treatment. The purpose of this study was to assess the risk and timing of thrombo-embolism after warfarin treatment interruption. A retrospective, nationwide cohort study of all patients in Denmark treated with warfarin after a first hospitalization with AF in the period 1997-2008. Incidence rate ratios (IRRs) of thrombo-embolic events and all-cause mortality were calculated using the Poisson regression analyses. In total, 48 989 AF patients receiving warfarin treatment were included. Of these, 35 396 patients had at least one episode of warfarin treatment interruption. In all, 8255 deaths or thrombo-embolic events occurred during treatment interruption showing an initial clustering of events with 2717, 835, 500, and 427 events occurring during 0-90, 91-180, 181-270, and 271-360 days after treatment interruption, respectively. Correspondingly, the crude incidence rates were 31.6, 17.7, 12.3, and 11.4 events per 100 patient-years. In a multivariable analysis, the first 90-day interval of treatment interruption was associated with a markedly higher risk of death or thrombo-embolism (IRR 2.5; 95% confidence interval 2.3-2.8) vs. the interval of 271-360 days. In patients with AF, an interruption of warfarin treatment is associated with a significantly increased short-term risk of death or thrombo-embolic events within the first 90 days of treatment interruption.

Eventual Suicide in Interrupted and Uninterrupted Attempters: A Challenge to the Cry-for-Help Hypothesis.

ERIC Educational Resources Information Center

Steer, Robert A.; And Others

1988-01-01

Followed patients (N=499) hospitalized for suicide attempts (attempters) between 1970 and 1975 until 1982. Found under six percent eventually committed suicide. Found the interrupted attempters were approximately three times more likely to commit suicide than were the uninterrupted attempters. (Author/ABL)

Current interruption in inductive storage systems with inertial current source

NASA Astrophysics Data System (ADS)

Vitkovitsky, I. M.; Conte, D.; Ford, R. D.; Lupton, W. H.

1980-03-01

Utilization of inertial current source inductive storage with high power output requires a switch with short opening time. This switch must operate as a circuit breaker, i.e., be capable to carry the current for a time period characteristic of inertial systems, such as homopolar generators. For reasonable efficiency, its opening time must be fast to minimize the energy dissipated in downstream fuse stages required for any additional pulse compression. A switch that satisfies these criteria, as well as other requirements such as that for high voltage operation associated with high power output, is an explosively driven switch consisting of large number of gaps arranged in series. The performance of this switch in limiting and/or interrupting currents produced by large generators has been studied. Single switch modules were designed and tested for limiting the commutating current output of 1 MW, 60 Hz, generator and 500 KJ capacitor banks. Current limiting and commutation were evaluated, using these sources, for currents ranging up to 0.4 MA. The explosive opening of the switch was found to provide an effective first stage for further pulse compression. It opens in tens of microseconds, commutates current at high efficiency ( = 905) recovers very rapidly over a wide range of operating conditions.

Face and construct validation of a next generation virtual reality (Gen2-VR) surgical simulator.

PubMed

Sankaranarayanan, Ganesh; Li, Baichun; Manser, Kelly; Jones, Stephanie B; Jones, Daniel B; Schwaitzberg, Steven; Cao, Caroline G L; De, Suvranu

2016-03-01

Surgical performance is affected by distractors and interruptions to surgical workflow that exist in the operating room. However, traditional surgical simulators are used to train surgeons in a skills laboratory that does not recreate these conditions. To overcome this limitation, we have developed a novel, immersive virtual reality (Gen2-VR) system to train surgeons in these environments. This study was to establish face and construct validity of our system. The study was a within-subjects design, with subjects repeating a virtual peg transfer task under three different conditions: Case I: traditional VR; Case II: Gen2-VR with no distractions and Case III: Gen2-VR with distractions and interruptions. In Case III, to simulate the effects of distractions and interruptions, music was played intermittently, the camera lens was fogged for 10 s and tools malfunctioned for 15 s at random points in time during the simulation. At the completion of the study subjects filled in a 5-point Likert scale feedback questionnaire. A total of sixteen subjects participated in this study. Friedman test showed significant difference in scores between the three conditions (p < 0.0001). Post hoc analysis using Wilcoxon signed-rank tests with Bonferroni correction further showed that all the three conditions were significantly different from each other (Case I, Case II, p < 0.0001), (Case I, Case III, p < 0.0001) and (Case II, Case III, p = 0.009). Subjects rated that fog (mean 4.18) and tool malfunction (median 4.56) significantly hindered their performance. The results showed that Gen2-VR simulator has both face and construct validity and that it can accurately and realistically present distractions and interruptions in a simulated OR, in spite of limitations of the current HMD hardware technology.

Utilizing direct skin feeding assays for development of vaccines that interrupt malaria transmission: A systematic review of methods and case study.

PubMed

Brickley, Elizabeth B; Coulibaly, Mamadou; Gabriel, Erin E; Healy, Sara A; Hume, Jen C C; Sagara, Issaka; Traore, Sekou F; Doumbo, Ogobara; Duffy, Patrick E

2016-11-21

Shifting the malaria priorities from a paradigm of control and elimination to a goal of global eradication calls for renewed attention to the interruption of malaria transmission. Sustained progress toward eradication will require both improved understanding of infectious reservoirs and efficient development of novel transmission-blocking interventions, such as rapidly acting and highly efficacious therapeutics and vaccines. Here, we review the direct skin feeding assay (DSF), which has been proposed as a valuable tool for measuring the in natura transmission of malaria parasites from human hosts to mosquito vectors across heterogeneous populations. To capture the methodological breadth of this assay's use, we first systematically review and qualitatively synthesize previously published investigations using DSFs to study malaria transmission in humans. Then, using a recent Phase 1 trial in Mali of the Pfs25H-EPA/Alhydrogel® vaccine candidate (NCT01867463) designed to interrupt Plasmodium falciparum transmission as a case study, we describe the potential opportunities and current limitations of utilizing the endpoints measured by DSF in making early clinical decisions for individually randomized transmission-interrupting intervention candidates. Using simulations based on the data collected in the clinical trial, we demonstrate that the capacity of the DSF to serve as an evaluative tool is limited by the statistical power constraints of the "effective sample size" (i.e. the number of subjects that are capable of transmitting at the time of feeding). Altogether, our findings suggest DSFs have great potential utility for assessing the public health impacts of emerging antimalarial tools, but additional research is needed to address issues of scalability and to establish correlation with community-wide clinical endpoints as well as complementary in vitro measures, such as standard membrane feeding assays. Published by Elsevier Ltd.

Face and Construct Validation of a Next Generation Virtual Reality (Gen2-VR©) Surgical Simulator

PubMed Central

Sankaranarayanan, Ganesh; Li, Baichun; Manser, Kelly; Jones, Stephanie B.; Jones, Daniel B.; Schwaitzberg, Steven; Cao, Caroline G. L.; De, Suvranu

2015-01-01

Introduction Surgical performance is affected by distractors and interruptions to surgical workflow that exist in the operating room. However, traditional surgical simulators are used to train surgeons in a skills lab that does not recreate these conditions. To overcome this limitation, we have developed a novel, immersive virtual reality (Gen2-VR©) system to train surgeons in these environments. This study was to establish face and construct validity of our system. Methods and Procedures The study was a within-subjects design, with subjects repeating a virtual peg transfer task under three different conditions: CASE I: traditional VR; CASE II: Gen2-VR© with no distractions and CASE III: Gen2-VR© with distractions and interruptions.. In Case III, to simulate the effects of distractions and interruptions, music was played intermittently, the camera lens was fogged for 10 seconds and tools malfunctioned for 15 seconds at random points in time during the simulation. At the completion of the study subjects filled in a 5-point Likert scale feedback questionnaire. A total of sixteen subjects participated in this study. Results Friedman test showed significant difference in scores between the three conditions (p < 0.0001). Post hoc analysis using Wilcoxon Signed Rank tests with Bonferroni correction further showed that all the three conditions were significantly different from each other (Case I, Case II, p < 0.001), (Case I, Case III, p < 0.001) and (Case II, Case III, p = 0.009). Subjects rated that fog (mean= 4.18) and tool malfunction (median = 4.56) significantly hindered their performance. Conclusion The results showed that Gen2-VR© simulator has both face and construct validity and it can accurately and realistically present distractions and interruptions in a simulated OR, in spite of limitations of the current HMD hardware technology. PMID:26092010

A 2.5 Gigawatt Liquid Dielectric Coaxial Pulse Forming Line

DTIC Science & Technology

1987-06-01

operation. The fuses provide protection against long term faults. The 3 phase vacuum contactor is a convenient means of remotely applying or...is electronically sensed and the vacuum contactor opens thereby interrupting the input power. The opening time of the vacuum contactor is less than...less than 5 microseconds and at the same time a trigger signal is sent to the vacuum contactor which opens and interrupts the primary power. The PFL

On Why It Is Impossible to Prove that the BDX90 Dispatcher Implements a Time-sharing System

NASA Technical Reports Server (NTRS)

Boyer, R. S.; Moore, J. S.

1983-01-01

The Software Implemented Fault Tolerance SIFT system, is written in PASCAL except for about a page of machine code. The SIFT system implements a small time sharing system in which PASCAL programs for separate application tasks are executed according to a schedule with real time constraints. The PASCAL language has no provision for handling the notion of an interrupt such as the B930 clock interrupt. The PASCAL language also lacks the notion of running a PASCAL subroutine for a given amount of time, suspending it, saving away the suspension, and later activating the suspension. Machine code was used to overcome these inadequacies of PASCAL. Code which handles clock interrupts and suspends processes is called a dispatcher. The time sharing/virtual machine idea is completely destroyed by the reconfiguration task. After termination of the reconfiguration task, the tasks run by the dispatcher have no relation to those run before reconfiguration. It is impossible to view the dispatcher as a time-sharing system implementing virtual BDX930s running concurrently when one process can wipe out the others.

An Innovative Approach to Improve Communication and Reduce Physician Stress and Burnout in a University Affiliated Residency Program.

PubMed

Lapointe, Ryan; Bhesania, Siddharth; Tanner, Tristan; Peruri, Adithya; Mehta, Parag

2018-05-28

Ineffective communication between nursing staff and residents leads to numerous educational and patient-care interruptions, increasing resident stress and overall workload. We developed an innovative and simple, secure electronic health record (EHR) base text paging system to communicate with internal medicine residents. The goal is to avoid unnecessary interruption during patient care or educational activities and reduce stress. Traditional paging system can send a phone number to call back. We developed and implemented a HIPPA-compliant, EHR-integrated text paging at a busy 591-bed urban hospital. Access was granted to unit clerks, nursing staff, case managers, and physicians. Senders could either send a traditional telephone number page or a text page through our EHR. The recipient could then either acknowledge receipt of the page or take appropriate actions. Afterward, Internal medicine residents were polled on overall satisfaction difference between basic phone based numeric paging and the enhanced EHR text paging system. Educational interruptions (averaging over 7 pages) decreased from 64% to 16%. Patient care interruptions fell from 68% to 12%. 88% of residents felt that 50% or less of the pages were non-emergent and did not require an immediate action. 92% of 25 surveyed internal medicine residents preferred text paging over numeric paging and responded through the EHR 60% of the time by placing direct orders. Time savings using the new system over a 3-month span amounted to 72.5 h in transmission time alone. Text paging among medical caregivers and internal medicine residents through EHR-associated communication reduced patient care and educational interruptions. It saved time spent sending pages, answering unnecessary pages and it improved resident's subjective stress and satisfaction levels.

An interrupted time series evaluation of a hepatitis C intervention for persons with HIV.

PubMed

Proeschold-Bell, Rae Jean; Hoeppner, Bettina; Taylor, Baishakhi; Cohen, Sarah; Blouin, Rachel; Stringfield, Beth; Muir, Andrew J

2011-11-01

Accurate HCV knowledge is lacking among high-risk groups, including people with HIV/AIDS (PLWHA). Liver disease primarily due to HCV has emerged as a serious cause of mortality among PLWHA. We used an Interrupted Time Series design to evaluate a social-ecologically based intervention for PLWHA, where an infectious disease clinic serving a six-county intervention area was monitored before (7 months) and after (17 months) intervention onset. The intervention included education of PLWHA and medical providers, HIV/HCV support groups, and adaptation of the patient chart top sheet to include HCV test information. Clinic-level outcomes were assessed prospectively every other week for 2 years by interviewing patients (n = 259) with clinic appointments on assessment days. Abrupt, gradual and delayed intervention effects were tested. Weighted regression analyses showed higher average HCV knowledge and a higher prevalence of patients reporting HCV discussion with their medical providers after intervention onset. A delayed effect was found for HCV awareness, and a gradually increasing effect was found for knowing one's HCV status. Other communities may consider adopting this intervention. Additional HCV interventions for PLWHA with HIV are needed.

An Interrupted Time Series Evaluation of a Hepatitis C Intervention for Persons With HIV

PubMed Central

Proeschold-Bell, Rae Jean; Hoeppner, Bettina; Taylor, Baishakhi; Cohen, Sarah; Blouin, Rachel; Stringfield, Beth; Muir, Andrew J.

2011-01-01

Accurate HCV knowledge is lacking among high-risk groups, including people with HIV/AIDS (PLWHA). Liver disease primarily due to HCV has emerged as a serious cause of mortality among PLWHA. We used an interrupted time series design to evaluate a social-ecologically based intervention for PLWHA, where an infectious disease clinic serving a six-county intervention area was monitored before (7 months) and after (17 months) intervention onset. The intervention included education of PLWHA and medical providers, HIV/HCV support groups and resource guides, and adaptation of the patient chart top sheet to include HCV test information. Clinic-level outcomes were assessed prospectively every other week for two years by interviewing patients (n=259) with clinic appointments on assessment days. Abrupt, gradual and delayed intervention effects were tested. Weighted regression analyses showed higher average HCV knowledge and a higher prevalence of patients reporting HCV discussion with their medical providers after intervention onset. A delayed effect was found for HCV awareness, and a gradually increasing effect was found for knowing one‘s HCV status. Other communities may consider adopting this intervention. Additional HCV interventions for PLWHA with HIV are needed. PMID:21191643

Use of interrupted time series analysis in evaluating health care quality improvements.

PubMed

Penfold, Robert B; Zhang, Fang

2013-01-01

Interrupted time series (ITS) analysis is arguably the strongest quasi-experimental research design. ITS is particularly useful when a randomized trial is infeasible or unethical. The approach usually involves constructing a time series of population-level rates for a particular quality improvement focus (eg, rates of attention-deficit/hyperactivity disorder [ADHD] medication initiation) and testing statistically for a change in the outcome rate in the time periods before and time periods after implementation of a policy/program designed to change the outcome. In parallel, investigators often analyze rates of negative outcomes that might be (unintentionally) affected by the policy/program. We discuss why ITS is a useful tool for quality improvement. Strengths of ITS include the ability to control for secular trends in the data (unlike a 2-period before-and-after t test), ability to evaluate outcomes using population-level data, clear graphical presentation of results, ease of conducting stratified analyses, and ability to evaluate both intended and unintended consequences of interventions. Limitations of ITS include the need for a minimum of 8 time periods before and 8 after an intervention to evaluate changes statistically, difficulty in analyzing the independent impact of separate components of a program that are implemented close together in time, and existence of a suitable control population. Investigators must also be careful not to make individual-level inferences when population-level rates are used to evaluate interventions (though ITS can be used with individual-level data). A brief description of ITS is provided, including a fully implemented (but hypothetical) study of the impact of a program to reduce ADHD medication initiation in children younger than 5 years old and insured by Medicaid in Washington State. An example of the database needed to conduct an ITS is provided, as well as SAS code to implement a difference-in-differences model using preschool-age children in California as a comparison group. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

The significance of sense of coherence for the perceptions of task characteristics and stress during interruptions amongst a sample of public health nurses in Hong Kong: implications for nursing management.

PubMed

Shiu, A T

1998-08-01

The study aimed to investigate the significance of sense of coherence (SOC) for the perceptions of task characteristics and for stress perceptions during interruptions of public health nurses (PHNs) with children in Hong Kong. The research design employed the experience sampling method. Convenience sampling was used to recruit 20 subjects. During stage one of the study a watch was worn that gave a signal at six random times each day for seven days to complete an experience sampling diary. PHNs on average responded to 34 signals (80%) to complete the diaries which collected data on work and family juggling, task characteristics, and their effects on mood states. At stage two respondents completed the SOC scale which measured confidence in life as comprehensible, manageable, and meaningful. Two major findings provide the focus for this paper. First, results indicate that there was positive correlation between SOC and perceived task characteristics. Second, results reveal that when interruptions occurred, PHNs with high SOC had higher positive affect and lower negative affect than PHNs with low SOC. These results suggest that SOC as a salutogenic model helps PHNs to cope with the family and work juggling as well as the occupational stress. Implications for nursing management on strengthening SOC of PHNs are discussed.

ASTP Technical Air-To-Ground Voice Transcription

NASA Technical Reports Server (NTRS)

1975-01-01

The transcription of the technical air-to-ground voice communication of the Apollo-Soyuz Test Project mission was presented. The transcript was divided into three columns giving, respectively, the time, speaker, and text. All times are expressed in Greenwich mean time for the appropriate Julian dates. The speaker column indicates the source of transmission; the text column contains the verbatim transcript of the communications. Special symbols were used to report garbling, pauses or self-interruptions, interruptions by other speakers or abrupt terminations, emphasized words, obliterations, and material translated from Russian.

Aquatic Exercises were Associated with an Acceptable State of Symptoms in Patients with Inflammatory Rheumatic Diseases: Results from a Study with Interrupted Time-Series Design.

PubMed

Christie, Anne; Hagen, Kåre Birger; Mowinckel, Petter; Dagfinrud, Hanne

2014-12-10

The aim of this study was two-fold: to compare symptoms and daily activity in patients with inflammatory rheumatic diseases across periods with and without aquatic exercises, and to examine whether the patients reached an acceptable state of symptoms during the periods with aquatic exercises. Thirty-six patients reported pain, fatigue, stiffness and ability to carry out daily activities across periods with and without aquatic exercises. The study has an interrupted time-series design and variables were collected with text messages on mobile phones twice a week over a period of 35 weeks. There was a significant reduction in pain, fatigue, stiffness and enhanced level of daily activity (p > 0.05) during periods of aquatic exercises compared to periods without. Further, a significantly higher proportion of patients reached an acceptable state for both pain and fatigue during periods with aquatic exercises. Living with an inflammatory rheumatic disease is a lifelong challenge. Pain and fatigue are considered major obstacles for daily functioning and adequate self-management strategies are requested. Based on the high proportion of patients reporting to be in an acceptable state of both pain and fatigue during periods with aquatic exercises, the intervention should be regarded as an important self-management tool rather than a treatment option assuming long-lasting effects. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

Unique Conformation in a Natural Interruption Sequence of Type XIX Collagen Revealed by Its High-Resolution Crystal Structure.

PubMed

Xu, Tingting; Zhou, Cong-Zhao; Xiao, Jianxi; Liu, Jinsong

2018-02-20

Naturally occurring interruptions in nonfibrillar collagen play key roles in molecular flexibility, collagen degradation, and ligand binding. The structural feature of the interruption sequences and the molecular basis for their functions have not been well studied. Here, we focused on a G5G type natural interruption sequence G-POALO-G from human type XIX collagen, a homotrimer collagen, as this sequence possesses distinct properties compared with those of a pathological similar Gly mutation sequence in collagen mimic peptides. We determined the crystal structures of the host-guest peptide (GPO) 3 -GPOALO-(GPO) 4 to 1.03 Å resolution in two crystal forms. In these structures, the interruption zone brings localized disruptions to the triple helix and introduces a light 6-8° bend with the same directional preference to the whole molecule, which may correspond structurally to the first physiological kink site in type XIX collagen. Furthermore, at the G5G interruption site, the presence of Ala and Leu residues, both with free N-H groups, allows the formation of more direct and water-mediated interchain hydrogen bonds than in the related Gly → Ala structure. These could partly explain the difference in thermal stability between the different interruptions. In addition, our structures provide a detailed view of the dynamic property of such an interrupted zone with respect to hydrogen bonding topology, torsion angles, and helical parameters. Our results, for the first time, also identified the binding of zinc to the end of the triple helix. These findings will shed light on how the interruption sequence influences the conformation of the collagen molecule and provide a structural basis for further functional studies.

When daily planning improves employee performance: The importance of planning type, engagement, and interruptions.

PubMed

Parke, Michael R; Weinhardt, Justin M; Brodsky, Andrew; Tangirala, Subrahmaniam; DeVoe, Sanford E

2018-03-01

Does planning for a particular workday help employees perform better than on other days they fail to plan? We investigate this question by identifying 2 distinct types of daily work planning to explain why and when planning improves employees' daily performance. The first type is time management planning (TMP)-creating task lists, prioritizing tasks, and determining how and when to perform them. We propose that TMP enhances employees' performance by increasing their work engagement, but that these positive effects are weakened when employees face many interruptions in their day. The second type is contingent planning (CP) in which employees anticipate possible interruptions in their work and plan for them. We propose that CP helps employees stay engaged and perform well despite frequent interruptions. We investigate these hypotheses using a 2-week experience-sampling study. Our findings indicate that TMP's positive effects are conditioned upon the amount of interruptions, but CP has positive effects that are not influenced by the level of interruptions. Through this study, we help inform workers of the different planning methods they can use to increase their daily motivation and performance in dynamic work environments. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The mythology of anticoagulation therapy interruption for dental surgery.

PubMed

Wahl, Michael J

2018-01-01

Continuous anticoagulation therapy is used to prevent heart attacks, strokes, and other embolic complications. When patients receiving anticoagulation therapy undergo dental surgery, a decision must be made about whether to continue anticoagulation therapy and risk bleeding complications or briefly interrupt anticoagulation therapy and increase the risk of developing embolic complications. Results from decades of studies of thousands of dental patients receiving anticoagulation therapy reveal that bleeding complications requiring more than local measures for hemostasis have been rare and never fatal. However, embolic complications (some of which were fatal and others possibly permanently debilitating) sometimes have occurred in patients whose anticoagulation therapy was interrupted for dental procedures. Although there is now virtually universal consensus among national medical and dental groups and other experts that anticoagulation therapy should not be interrupted for most dental surgery, there are still some arguments made supporting anticoagulation therapy interruption. An analysis of these arguments shows them to be based on a collection of myths and half-truths rather than on logical scientific conclusions. The time has come to stop anticoagulation therapy interruption for dental procedures. Copyright © 2018 American Dental Association. Published by Elsevier Inc. All rights reserved.

Improving Memory after Interruption: Exploiting Soft Constraints and Manipulating Information Access Cost

ERIC Educational Resources Information Center

Morgan, Phillip L.; Patrick, John; Waldron, Samuel M.; King, Sophia L.; Patrick, Tanya

2009-01-01

Forgetting what one was doing prior to interruption is an everyday problem. The recent soft constraints hypothesis (Gray, Sims, Fu, & Schoelles, 2006) emphasizes the strategic adaptation of information processing strategy to the task environment. It predicts that increasing information access cost (IAC: the time, and physical and mental effort…

77 FR 37638 - Noncommercial Educational Station Fundraising for Third-Party Non-Profit Organizations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-22

... educational (NCE) broadcast stations to conduct on-air fundraising activities that interrupt regular... eliminate the need for NCE stations to seek a waiver of the Commission's rules to interrupt regular... Responses: 2,200 respondents/30,800 responses. Estimated Time per Response: 0.25 to 1.5 hours. Frequency of...

Enhancing the Simulation Speed of Sensor Network Applications by Asynchronization of Interrupt Service Routines

PubMed Central

Joe, Hyunwoo; Woo, Duk-Kyun; Kim, Hyungshin

2013-01-01

Sensor network simulations require high fidelity and timing accuracy to be used as an implementation and evaluation tool. The cycle-accurate and instruction-level simulator is the known solution for these purposes. However, this type of simulation incurs a high computation cost since it has to model not only the instruction level behavior but also the synchronization between multiple sensors for their causality. This paper presents a novel technique that exploits asynchronous simulations of interrupt service routines (ISR). We can avoid the synchronization overheads when the interrupt service routines are simulated without preemption. If the causality errors occur, we devise a rollback procedure to restore the original synchronized simulation. This concept can be extended to any instruction-level sensor network simulator. Evaluation results show our method can enhance the simulation speed up to 52% in the case of our experiments. For applications with longer interrupt service routines and smaller number of preemptions, the speedup becomes greater. In addition, our simulator is 2 to 11 times faster than the well-known sensor network simulator. PMID:23966200

Measuring the relationship between interruptions, multitasking and prescribing errors in an emergency department: a study protocol

PubMed Central

Raban, Magdalena Z; Walter, Scott R; Douglas, Heather E; Strumpman, Dana; Mackenzie, John; Westbrook, Johanna I

2015-01-01

Introduction Interruptions and multitasking are frequent in clinical settings, and have been shown in the cognitive psychology literature to affect performance, increasing the risk of error. However, comparatively less is known about their impact on errors in clinical work. This study will assess the relationship between prescribing errors, interruptions and multitasking in an emergency department (ED) using direct observations and chart review. Methods and analysis The study will be conducted in an ED of a 440-bed teaching hospital in Sydney, Australia. Doctors will be shadowed at proximity by observers for 2 h time intervals while they are working on day shift (between 0800 and 1800). Time stamped data on tasks, interruptions and multitasking will be recorded on a handheld computer using the validated Work Observation Method by Activity Timing (WOMBAT) tool. The prompts leading to interruptions and multitasking will also be recorded. When doctors prescribe medication, type of chart and chart sections written on, along with the patient's medical record number (MRN) will be recorded. A clinical pharmacist will access patient records and assess the medication orders for prescribing errors. The prescribing error rate will be calculated per prescribing task and is defined as the number of errors divided by the number of medication orders written during the prescribing task. The association between prescribing error rates, and rates of prompts, interruptions and multitasking will be assessed using statistical modelling. Ethics and dissemination Ethics approval has been obtained from the hospital research ethics committee. Eligible doctors will be provided with written information sheets and written consent will be obtained if they agree to participate. Doctor details and MRNs will be kept separate from the data on prescribing errors, and will not appear in the final data set for analysis. Study results will be disseminated in publications and feedback to the ED. PMID:26463224

Measuring the relationship between interruptions, multitasking and prescribing errors in an emergency department: a study protocol.

PubMed

Raban, Magdalena Z; Walter, Scott R; Douglas, Heather E; Strumpman, Dana; Mackenzie, John; Westbrook, Johanna I

2015-10-13

Interruptions and multitasking are frequent in clinical settings, and have been shown in the cognitive psychology literature to affect performance, increasing the risk of error. However, comparatively less is known about their impact on errors in clinical work. This study will assess the relationship between prescribing errors, interruptions and multitasking in an emergency department (ED) using direct observations and chart review. The study will be conducted in an ED of a 440-bed teaching hospital in Sydney, Australia. Doctors will be shadowed at proximity by observers for 2 h time intervals while they are working on day shift (between 0800 and 1800). Time stamped data on tasks, interruptions and multitasking will be recorded on a handheld computer using the validated Work Observation Method by Activity Timing (WOMBAT) tool. The prompts leading to interruptions and multitasking will also be recorded. When doctors prescribe medication, type of chart and chart sections written on, along with the patient's medical record number (MRN) will be recorded. A clinical pharmacist will access patient records and assess the medication orders for prescribing errors. The prescribing error rate will be calculated per prescribing task and is defined as the number of errors divided by the number of medication orders written during the prescribing task. The association between prescribing error rates, and rates of prompts, interruptions and multitasking will be assessed using statistical modelling. Ethics approval has been obtained from the hospital research ethics committee. Eligible doctors will be provided with written information sheets and written consent will be obtained if they agree to participate. Doctor details and MRNs will be kept separate from the data on prescribing errors, and will not appear in the final data set for analysis. Study results will be disseminated in publications and feedback to the ED. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Predictors of perioperative major bleeding in patients who interrupt warfarin for an elective surgery or procedure: Analysis of the BRIDGE trial.

PubMed

Clark, Nathan P; Douketis, James D; Hasselblad, Vic; Schulman, Sam; Kindzelski, Andrei L; Ortel, Thomas L

2018-01-01

The use of low-molecular weight heparin bridge therapy during warfarin interruption for elective surgery/procedures increases bleeding. Other predictors of bleeding in this setting are not well described. BRIDGE was a randomized, double-blind, placebo-controlled trial of bridge therapy with dalteparin 100 IU/kg twice daily in patients with atrial fibrillation requiring warfarin interruption. Bleeding outcomes were documented from the time of warfarin interruption until up to 37 days postprocedure. Multiple logistic regression and time-dependent hazard models were used to identify major bleeding predictors. We analyzed 1,813 patients of whom 895 received bridging and 918 received placebo. Median patient age was 72.6 years, and 73.3% were male. Forty-one major bleeding events occurred at a median time of 7.0 days (interquartile range, 4.0-18.0 days) postprocedure. Bridge therapy was a baseline predictor of major bleeding (odds ratio [OR]=2.4, 95% CI: 1.2-4.8), as were a history of renal disease (OR=2.9, 95% CI: 1.4-6.0), and high-bleeding risk procedures (vs low-bleeding risk procedures) (OR=2.9, 95% CI: 1.4-5.9). Perioperative aspirin use (OR=3.6, 95% CI: 1.1-11.9) and postprocedure international normalized ratio >3.0 (OR=2.1, 95% CI: 1.5-3.1) were time-dependent predictors of major bleeding. Major bleeding was most common in the first 10 days compared with 11-37 days postprocedure (OR=3.5, 95% CI: 1.8-6.9). In addition to bridge therapy, perioperative aspirin use, postprocedure international normalized ratio >3.0, a history of renal failure, and having a high-bleeding risk procedure increase the risk of major bleeding around the time of an elective surgery/procedure requiring warfarin interruption. Copyright © 2017 Elsevier Inc. All rights reserved.

A stitch in time saves nine: suture technique does not affect intestinal growth in a young, growing animal model.

PubMed

Gurien, Lori A; Wyrick, Deidre L; Smith, Samuel D; Maxson, R Todd

2016-05-01

Although this issue remains unexamined, pediatric surgeons commonly use simple interrupted suture for bowel anastomosis, as it is thought to improve intestinal growth postoperatively compared to continuous running suture. However, effects on intestinal growth are unclear. We compared intestinal growth using different anastomotic techniques during the postoperative period in young rats. Young, growing rats underwent small bowel transection and anastomosis using either simple interrupted or continuous running technique. At 7-weeks postoperatively after a four-fold growth, the anastomotic site was resected. Diameters and burst pressures were measured. Thirteen rats underwent anastomosis with simple interrupted technique and sixteen with continuous running method. No differences were found in body weight at first (102.46 vs 109.75g) or second operations (413.85 vs 430.63g). Neither the diameters (0.69 vs 0.79cm) nor burst pressures were statistically different, although the calculated circumference was smaller in the simple interrupted group (2.18 vs 2.59cm; p=0.03). No ruptures occurred at the anastomotic line. This pilot study is the first to compare continuous running to simple interrupted intestinal anastomosis in a pediatric model and showed no difference in growth. Adopting continuous running techniques for bowel anastomosis in young children may lead to faster operative time without affecting intestinal growth. Copyright © 2016 Elsevier Inc. All rights reserved.

Plasmacytoid dendritic cell and functional HIV Gag p55-specific T cells before treatment interruption can inform set-point plasma HIV viral load after treatment interruption in chronically suppressed HIV-1(+) patients.

PubMed

Papasavvas, Emmanouil; Foulkes, Andrea; Yin, Xiangfan; Joseph, Jocelin; Ross, Brian; Azzoni, Livio; Kostman, Jay R; Mounzer, Karam; Shull, Jane; Montaner, Luis J

2015-07-01

The identification of immune correlates of HIV control is important for the design of immunotherapies that could support cure or antiretroviral therapy (ART) intensification-related strategies. ART interruptions may facilitate this task through exposure of an ART partially reconstituted immune system to endogenous virus. We investigated the relationship between set-point plasma HIV viral load (VL) during an ART interruption and innate/adaptive parameters before or after interruption. Dendritic cell (DC), natural killer (NK) cell and HIV Gag p55-specific T-cell functional responses were measured in paired cryopreserved peripheral blood mononuclear cells obtained at the beginning (on ART) and at set-point of an open-ended interruption from 31 ART-suppressed chronically HIV-1(+) patients. Spearman correlation and linear regression modeling were used. Frequencies of plasmacytoid DC (pDC), and HIV Gag p55-specific CD3(+)  CD4(-)  perforin(+)  IFN-γ(+) cells at the beginning of interruption associated negatively with set-point plasma VL. Inclusion of both variables with interaction into a model resulted in the best fit (adjusted R(2)  = 0·6874). Frequencies of pDC or HIV Gag p55-specific CD3(+)  CD4(-)  CSFE(lo)  CD107a(+) cells at set-point associated negatively with set-point plasma VL. The dual contribution of pDC and anti-HIV T-cell responses to viral control, supported by our models, suggests that these variables may serve as immune correlates of viral control and could be integrated in cure or ART-intensification strategies. © 2015 John Wiley & Sons Ltd.

Interrupted reperfusion reduces the activation of NADPH oxidase after cerebral I/R injury.

PubMed

Shen, Jia; Bai, Xiao-Yin; Qin, Yuan; Jin, Wei-Wei; Zhou, Jing-Yin; Zhou, Ji-Ping; Yan, Ying-Gang; Wang, Qiong; Bruce, Iain C; Chen, Jiang-Hua; Xia, Qiang

2011-06-15

Interrupted reperfusion reduces ischemia/reperfusion (I/R) injury. This study was designed to determine whether NADPH oxidase participates in the neural protection against global I/R injury after interrupted reperfusion. Mice were randomly divided into five groups: sham (sham-operated), I/R (20-min global I/R), RR (I/R+interrupted reperfusion), Apo (I/R+apocynin administration), and RR+Apo. Behavioral tests (pole test, beam walking, and Morris water maze) and Nissl staining were undertaken in all five groups; superoxide levels, expression of gp91(phox) and p47(phox), p47(phox) translocation, and Rac1 activation were measured in the sham, I/R, and RR groups. The motor coordination, bradykinesia, and spatial learning and memory, as well as the neuron survival rates, were better in the RR, Apo, and RR+Apo groups than in the I/R group. The NADPH oxidase-dependent superoxide levels, p47(phox) and gp91(phox) expression, p47(phox) translocation, and Rac1 activation were lower in the RR group than in the I/R group. In conclusion, the neural protective effect of interrupted reperfusion is at least partly mediated by decreasing the expression and assembly of NADPH oxidase and the levels of NADPH oxidase-derived superoxide. The most striking reduction Rac1-GTP in the RR group suggests that interrupted reperfusion also acts on the activation of assembled NADPH oxidase by reducing the availability of Rac1-GTP. Copyright © 2011 Elsevier Inc. All rights reserved.

Recent shifts in Himalayan vegetation activity trends in response to climatic change and environmental drivers

NASA Astrophysics Data System (ADS)

Mishra, N. B.; Mainali, K. P.

2016-12-01

Climatic changes along with anthropogenic disturbances are causing dramatic ecological impacts in mid to high latitude mountain vegetation including in the Himalayas which are ecologically sensitive environments. Given the challenges associated with in situ vegetation monitoring in the Himalayas, remote sensing based quantification of vegetation dynamics can provide essential ecological information on changes in vegetation activity that may consist of alternative sequence of greening and/or browning periods. This study utilized a trend break analysis procedure for detection of monotonic as well as abrupt (either interruption or reversal) trend changes in smoothed normalized difference vegetation index satellite time-series data over the Himalayas. Overall, trend breaks in vegetation greenness showed high spatio-temporal variability in distribution considering elevation, ecoregion and land cover/use stratifications. Interrupted greening was spatially most dominant in all Himalayan ecoregions followed by abrupt browning. Areas showing trend reversal and monotonic trends appeared minority. Trend type distribution was strongly dependent on elevation as majority of greening (with or without interruption) occurred at lower elevation areas at higher elevation were dominantly. Ecoregion based stratification of trend types highlighted some exception to this elevational dependence as high altitude ecoregions of western Himalayas showed significantly less browning compared to the ecoregions in eastern Himalaya. Land cover/use based analysis of trend distribution showed that interrupted greening was most dominant in closed needleleafed forest following by rainfed cropland and mosaic croplands while interrupted browning most dominant in closed to open herbaceous vegetation found at higher elevation areas followed by closed needleleafed forest and closed to open broad leafed evergreen forests. Spatial analysis of trend break timing showed that for majority of areas experiencing interrupted greening, break in trend occurred later compared to areas with interrupted browning where break trend was observed much earlier. These results have significant implications for environmental management in the context of climate change and ecosystem dynamics in the Himalayas.

A controlled time-series trial of clinical reminders: using computerized firm systems to make quality improvement research a routine part of mainstream practice.

PubMed Central

Goldberg, H. I.; Neighbor, W. E.; Cheadle, A. D.; Ramsey, S. D.; Diehr, P.; Gore, E.

2000-01-01

OBJECTIVE: To explore the feasibility of conducting unobtrusive interventional research in community practice settings by integrating firm-system techniques with time-series analysis of relational-repository data. STUDY SETTING: A satellite teaching clinic divided into two similar, but geographically separated, primary care group practices called firms. One firm was selected by chance to receive the study intervention. Forty-two providers and 2,655 patients participated. STUDY DESIGN: A nonrandomized controlled trial of computer-generated preventive reminders. Net effects were determined by quantitatively combining population-level data from parallel experimental and control interrupted time series extending over two-month baseline and intervention periods. DATA COLLECTION: Mean rates at which mammography, colorectal cancer screening, and cholesterol testing were performed on patients due to receive each maneuver at clinic visits were the trial's outcome measures. PRINCIPAL FINDINGS: Mammography performance increased on the experimental firm by 154 percent (0.24 versus 0.61, p = .03). No effect on fecal occult blood testing was observed. Cholesterol ordering decreased on both the experimental (0.18 versus 0.1 1, p = .02) and control firms (0.13 versus 0.07, p = .03) coincident with national guidelines retreating from recommending screening for young adults. A traditional uncontrolled interrupted time-series design would have incorrectly attributed the experimental-firm decrease to the introduction of reminders. The combined analysis properly indicated that no net prompting effect had occurred, as the difference between firms in cholesterol testing remained stochastically stable over time (0.05 versus 0.04, p = .75). A logistic-regression analysis applied to individual-level data produced equivalent findings. The trial incurred no supplementary data collection costs. CONCLUSIONS: The apparent validity and practicability of our reminder implementation study should encourage others to develop computerized firm systems capable of conducting controlled time-series trials. Images Fig. 1 PMID:10737451

Effects of Interrupting Children's Sedentary Behaviors With Activity on Metabolic Function: A Randomized Trial.

PubMed

Belcher, Britni R; Berrigan, David; Papachristopoulou, Alexia; Brady, Sheila M; Bernstein, Shanna B; Brychta, Robert J; Hattenbach, Jacob D; Tigner, Ira L; Courville, Amber B; Drinkard, Bart E; Smith, Kevin P; Rosing, Douglas R; Wolters, Pamela L; Chen, Kong Y; Yanovski, Jack A

2015-10-01

Limited data suggest that interrupting sedentary behaviors with activity improves metabolic parameters in adults. We tested whether interrupting sitting with short, moderate-intensity walking bouts improved glucose tolerance in children. Participants underwent two experimental conditions in random order on different days: continuous sitting for 3 hours or sitting interrupted by walking (3 min of moderate-intensity walking every 30 min). Insulin, C-peptide, glucose, and free fatty acids were measured every 30 minutes for 3 hours during an oral glucose tolerance test. Area under the curve (AUC) was calculated from hormone and substrate measurements. Children were given a buffet meal after each condition. The study was conducted at the National Institutes of Health Hatfield Clinical Research Center. Twenty-eight normal-weight 7-11 year olds participated. Patterns of substrate/hormone secretion and AUC, as well as energy intake, were examined by experimental condition. Interrupting sitting resulted in a 32% lower insulin AUC (P < .001), 17% lower C-peptide AUC (P < .001), and 7% lower glucose AUC (P = .018) vs continuous sitting. Mixed model results indicated that insulin (P = .036) and free fatty acid concentrations (P = .009) were significantly lower in the interrupted vs the continuous sitting condition. Lunchtime buffet meal energy intake did not significantly differ between the conditions (975 ± 387 vs 963 ± 309 kcal; P = .85). Interrupting sedentary time with brief moderate-intensity walking improved short-term metabolic function in non-overweight children without increasing subsequent energy intake. These findings suggest that interrupting sedentary behavior may be a promising prevention strategy for reducing cardiometabolic risk in children.

Development of 72/84kV Dry Air Insulated Dead Tank Type VCB

NASA Astrophysics Data System (ADS)

Saito, Hitoshi; Nagatake, Kazuhiro; Komatsu, Hideki; Takeshita, Yukihiro; Matsui, Yoshihiko; Katsumata, Kiyohito; Sakaki, Masayuki

As a circuit breaker for over 84kV, SF6 gas circuit breaker (GCB) has been used for a long time, in virtue of its excellent characteristics as arc extinction and insulating medium. Although, SF6 gas has very high global warming potential (GWP) of 23,900, and it was designated to regulation object in COP3 in Kyoto in 1997. A lot of efforts have been done to reduce the amount of SF6 gas usage and emission from conventional equipments. On the other hand, SF6 gas free equipment has been researching and one strong candidate is air-insulated type switchgears with vacuum interrupters. In last few years, air-insulated switchgears, which include GIS, Cubicle type GIS (C-GIS) and dead tank type VCB, have been developed in succession. So far, we have already more than three years operation record for the air-insulated dead tank type VCB, and over 100 units is in-service in power systems. Recently, VCB technology, that is essential for SF6 gas-free equipments, has been advanced in the field of high-voltage, large current interruption and environment-conscious design. In this paper, the advanced dead tank type VCB and its technology is descried.

Effects-Driven Participatory Design: Learning from Sampling Interruptions.

PubMed

Brandrup, Morten; Østergaard, Kija Lin; Hertzum, Morten; Karasti, Helena; Simonsen, Jesper

2017-01-01

Participatory design (PD) can play an important role in obtaining benefits from healthcare information technologies, but we contend that to fulfil this role PD must incorporate feedback from real use of the technologies. In this paper we describe an effects-driven PD approach that revolves around a sustained focus on pursued effects and uses the experience sampling method (ESM) to collect real-use feedback. To illustrate the use of the method we analyze a case that involves the organizational implementation of electronic whiteboards at a Danish hospital to support the clinicians' intra- and interdepartmental coordination. The hospital aimed to reduce the number of phone calls involved in coordinating work because many phone calls were seen as unnecessary interruptions. To learn about the interruptions we introduced an app for capturing quantitative data and qualitative feedback about the phone calls. The investigation showed that the electronic whiteboards had little potential for reducing the number of phone calls at the operating ward. The combination of quantitative data and qualitative feedback worked both as a basis for aligning assumptions to data and showed ESM as an instrument for triggering in-situ reflection. The participant-driven design and redesign of the way data were captured by means of ESM is a central contribution to the understanding of how to conduct effects-driven PD.

30 CFR 18.53 - High-voltage longwall mining systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... and Design Requirements § 18.53 High-voltage longwall mining systems. (a) In each high-voltage motor...-interrupting devices must be designed and installed to prevent automatic reclosure. (d) Transformers with high... “open” position; (iv) When located in an explosion-proof enclosure, the device must be designed and...

30 CFR 18.53 - High-voltage longwall mining systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... and Design Requirements § 18.53 High-voltage longwall mining systems. (a) In each high-voltage motor...-interrupting devices must be designed and installed to prevent automatic reclosure. (d) Transformers with high... “open” position; (iv) When located in an explosion-proof enclosure, the device must be designed and...

30 CFR 18.53 - High-voltage longwall mining systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... and Design Requirements § 18.53 High-voltage longwall mining systems. (a) In each high-voltage motor...-interrupting devices must be designed and installed to prevent automatic reclosure. (d) Transformers with high... “open” position; (iv) When located in an explosion-proof enclosure, the device must be designed and...

30 CFR 18.53 - High-voltage longwall mining systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... and Design Requirements § 18.53 High-voltage longwall mining systems. (a) In each high-voltage motor...-interrupting devices must be designed and installed to prevent automatic reclosure. (d) Transformers with high... “open” position; (iv) When located in an explosion-proof enclosure, the device must be designed and...

30 CFR 18.53 - High-voltage longwall mining systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... and Design Requirements § 18.53 High-voltage longwall mining systems. (a) In each high-voltage motor...-interrupting devices must be designed and installed to prevent automatic reclosure. (d) Transformers with high... “open” position; (iv) When located in an explosion-proof enclosure, the device must be designed and...

Contextual Cues Aid Recovery from Interruption: The Role of Associative Activation

ERIC Educational Resources Information Center

Hodgetts, Helen M.; Jones, Dylan M.

2006-01-01

A series of experiments introduced interruptions to the execution phase of simple Tower of London problems and found that the opportunity for preparation before the break in task reduced the time cost at resumption. Retrieval of the suspended goal was facilitated when participants were given the opportunity to encode retrieval cues during an…

Effects of elevated temperatures during interruption of irradiation on Harwell Red 4034 PMMA and Kodak Biomax alanine film dosimetry systems

NASA Astrophysics Data System (ADS)

Sidereas, P.; Patil, D. S.; Garcia, R.; Tracy, R. P.; Holzman, J. M.

2007-11-01

In the industrial setting it is not uncommon for a process interruption to occur during irradiation. In this event, dosimeters may be exposed to prolonged periods of elevated temperature without exposure to ionizing radiation. Once the process is restarted, the same dosimeters are exposed to ionizing radiation in order to achieve target dose. The goal of this experiment was to simulate a process interruption within limits and quantify the effects of a combination of factors (heat, time, and fractionation) on dosimeter response. We present an in-depth experimental study on the response of dosimeters that have been irradiated, stored for a fixed period of time at several temperatures, and then re-irradiated. This study was performed using Harwell Red 4034 polymethylmethacrylate (PMMA) and Kodak BioMax alanine film dosimeters.

A prospective interrupted time series study of interventions to improve the quality, rating, framing and structure of goal-setting in community-based brain injury rehabilitation.

PubMed

Hassett, Leanne; Simpson, Grahame; Cotter, Rachel; Whiting, Diane; Hodgkinson, Adeline; Martin, Diane

2015-04-01

To investigate whether the introduction of an electronic goals system followed by staff training improved the quality, rating, framing and structure of goals written by a community-based brain injury rehabilitation team. Interrupted time series design. Two interventions were introduced six months apart. The first intervention comprised the introduction of an electronic goals system. The second intervention comprised a staff goal training workshop. An audit protocol was devised to evaluate the goals. A random selection of goal statements from the 12 months prior to the interventions (Time 1 baseline) were compared with all goal statements written after the introduction of the electronic goals system (Time 2) and staff training (Time 3). All goals were de-identified for client and time-period, and randomly ordered. A total of 745 goals (Time 1 n = 242; Time 2 n = 283; Time 3 n = 220) were evaluated. Compared with baseline, the introduction of the electronic goals system alone significantly increased goal rating, framing and structure (χ(2) tests 144.7, 18.9, 48.1, respectively, p < 0.001). The addition of staff training meant that the improvement in goal quality, which was only a trend at Time 2, was statistically significant at Time 3 (χ(2) 15.0, p ≤ 001). The training also led to a further significant increase in the framing and structuring of goals over the electronic goals system (χ(2) 11.5, 12.5, respectively, p ≤ 0.001). An electronic goals system combined with staff training improved the quality, rating, framing and structure of goal statements. © The Author(s) 2014.

An improved portmanteau test for autocorrelated errors in interrupted time-series regression models.

PubMed

Huitema, Bradley E; McKean, Joseph W

2007-08-01

A new portmanteau test for autocorrelation among the errors of interrupted time-series regression models is proposed. Simulation results demonstrate that the inferential properties of the proposed Q(H-M) test statistic are considerably more satisfactory than those of the well known Ljung-Box test and moderately better than those of the Box-Pierce test. These conclusions generally hold for a wide variety of autoregressive (AR), moving averages (MA), and ARMA error processes that are associated with time-series regression models of the form described in Huitema and McKean (2000a, 2000b).

Effectiveness of a nurse educational oral feeding programme on feeding outcomes in neonates: protocol for an interrupted time series design.

PubMed

Touzet, Sandrine; Beissel, Anne; Denis, Angélique; Pillet, Fabienne; Gauthier-Moulinier, Hélène; Hommey, Sophie; Claris, Olivier

2016-04-15

Oral feeding is a complex physiological process. Several scales have been developed to assess the ability of the neonate to begin suck feedings and assist caregivers in determining feeding advancement. However, feeding premature neonates remains an ongoing challenge and depends above all on caregivers' feeding expertise. We will evaluate the effect of a nurse training programme on the achievement of full oral feeding with premature neonates. The study design will be an interrupted time series design with 3 phases: (1) A 6-month baseline period; (2) a 22-month intervention period and (3) a 6-month postintervention period. The intervention will consist of an educational programme, for nurses and assistant nurses, on feeding patterns in neonates. The training modules will be composed of a 2-day conference, 2 interactive multidisciplinary workshops, and routine practice nurse coaching. A total of 120 nurses and 12 assistant nurses, who work at the neonatal unit during the study period, will participate in the study. All premature neonates of <34 weeks postmenstrual age (PMA) will be included. The primary outcome will be the age of tube withdrawal PMA and chronological age are taken into account. The secondary outcomes will be the transition time, length of hospital stay, competent suckle feeding without cardiorespiratory compromise, rate of neonates presenting with feeding issues or feeding rejection signs, and current neonatal pathologies or deaths during hospital stay. A segmented regression analysis will be performed to assess the impact of the programme. Approval for the study was obtained from the Hospital Ethics Committee, and the Institutional Review Board, as well as the French Data Protection Agency. The findings from the study will be disseminated through peer-reviewed journals, national and international conference presentations and public events. NCT02404272 (https://clinicaltrials.gov). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effectiveness of a nurse educational oral feeding programme on feeding outcomes in neonates: protocol for an interrupted time series design

PubMed Central

Touzet, Sandrine; Beissel, Anne; Denis, Angélique; Pillet, Fabienne; Gauthier-Moulinier, Hélène; Hommey, Sophie; Claris, Olivier

2016-01-01

Introduction Oral feeding is a complex physiological process. Several scales have been developed to assess the ability of the neonate to begin suck feedings and assist caregivers in determining feeding advancement. However, feeding premature neonates remains an ongoing challenge and depends above all on caregivers' feeding expertise. We will evaluate the effect of a nurse training programme on the achievement of full oral feeding with premature neonates. Methods and analysis The study design will be an interrupted time series design with 3 phases: (1) A 6-month baseline period; (2) a 22-month intervention period and (3) a 6-month postintervention period. The intervention will consist of an educational programme, for nurses and assistant nurses, on feeding patterns in neonates. The training modules will be composed of a 2-day conference, 2 interactive multidisciplinary workshops, and routine practice nurse coaching. A total of 120 nurses and 12 assistant nurses, who work at the neonatal unit during the study period, will participate in the study. All premature neonates of <34 weeks postmenstrual age (PMA) will be included. The primary outcome will be the age of tube withdrawal PMA and chronological age are taken into account. The secondary outcomes will be the transition time, length of hospital stay, competent suckle feeding without cardiorespiratory compromise, rate of neonates presenting with feeding issues or feeding rejection signs, and current neonatal pathologies or deaths during hospital stay. A segmented regression analysis will be performed to assess the impact of the programme. Ethics and dissemination Approval for the study was obtained from the Hospital Ethics Committee, and the Institutional Review Board, as well as the French Data Protection Agency. The findings from the study will be disseminated through peer-reviewed journals, national and international conference presentations and public events. Trial registration number NCT02404272 (https://clinicaltrials.gov). PMID:27084282

A multifaceted intervention to improve sepsis management in general hospital wards with evaluation using segmented regression of interrupted time series.

PubMed

Marwick, Charis A; Guthrie, Bruce; Pringle, Jan E C; Evans, Josie M M; Nathwani, Dilip; Donnan, Peter T; Davey, Peter G

2014-12-01

Antibiotic administration to inpatients developing sepsis in general hospital wards was frequently delayed. We aimed to reproduce improvements in sepsis management reported in other settings. Ninewells Hospital, an 860-bed teaching hospital with quality improvement (QI) experience, in Scotland, UK. The intervention wards were 22 medical, surgical and orthopaedic inpatient wards. A multifaceted intervention, informed by baseline process data and questionnaires and interviews with junior doctors, evaluated using segmented regression analysis of interrupted time series (ITS) data. MEASURES FOR IMPROVEMENT: Primary outcome measure: antibiotic administration within 4 hours of sepsis onset. Secondary measures: antibiotics within 8 hours; mean and median time to antibiotics; medical review within 30 min for patients with a standardised early warning system score .4; blood cultures taken before antibiotic administration; blood lactate level measured. The intervention included printed and electronic clinical guidance, educational clinical team meetings including baseline performance data, audit and monthly feedback on performance. Performance against all study outcome measures improved postintervention but differences were small and ITS analysis did not attribute the observed changes to the intervention. Rigorous analysis of this carefully designed improvement intervention could not confirm significant effects. Statistical analysis of many such studies is inadequate, and there is insufficient reporting of negative studies. In light of recent evidence, involving senior clinical team members in verbal feedback and action planning may have made the intervention more effective. Our focus on rigorous intervention design and evaluation was at the expense of iterative refinement, which likely reduced the effect. This highlights the necessary, but challenging, requirement to invest in all three components for effective QI.

[Vaccine cold chain interruption in a primary care center and economic evaluation].

PubMed

Larena Fernández, Israel; Vara Callau, Marta; Peña Blasco, Guillermo; Atance Melendo, Esther; Gay Gasanz, Blanca; Pérez-Aramendía, María Jesús Blasco

Cold chain control is one of the most important facts to ensure the effectiveness of vaccines links, which requires specific material and human resources for management. The principal objective is to evaluate the interruptions in cold chain of the last 6 years and the possible cost savings that would result in further improvements. A retrospective and descriptive study based on a review of all cold chain interruptions during the last 6 years, at Valdefierro Primary Health Center. We had 5 interruptions, the maximum temperature reached was 23.1±3.4°C and the longest interruption lasted 25.2±20.7hours. 1611 vaccines were affected and 165 discarded. Total economic loss was 2.098,10 € and 33.611,64 € were savings. The electrical failure was the disruption cause in 5 cases. Equipment and staff are essential. The center did some corrective actions, such as minimizing refrigerator time control, minimum stock control, considering population changes, and the center has requested a electrical supply system. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

[Acoustic characteristics of adductor spasmodic dysphonia].

PubMed

Yang, Yang; Wang, Li-Ping

2008-06-01

To explore the acoustic characteristics of adductor spasmodic dysphonia. The acoustic characteristics, including acoustic signal of recorded voice, three-dimensional sonogram patterns and subjective assessment of voice, between 10 patients (7 women, 3 men) with adductor spasmodic dysphonia and 10 healthy volunteers (5 women, 5 men), were compared. The main clinical manifestation of adductor spasmodic dysphonia included the disorders of sound quality, rhyme and fluency. It demonstrated the tension dysphonia when reading, acoustic jitter, momentary fluctuation of frequency and volume, voice squeezing, interruption, voice prolongation, and losing normal chime. Among 10 patients, there were 1 mild dysphonia (abnormal syllable number < 25%), 6 moderate dysphonia (abnormal syllable number 25%-49%), 1 severe dysphonia (abnormal syllable number 50%-74%) and 2 extremely severe dysphonia (abnormal syllable number > or = 75%). The average reading time in 10 patients was 49 s, with reading time extension and aphasia area interruption in acoustic signals, whereas the average reading time in health control group was 30 s, without voice interruption. The aphasia ratio averaged 42%. The respective symptom syllable in different patients demonstrated in the three-dimensional sonogram. There were voice onset time prolongation, irregular, interrupted and even absent vowel formants. The consonant of symptom syllables displayed absence or prolongation of friction murmur in the block-friction murmur occasionally. The acoustic characteristics of adductor spasmodic dysphonia is the disorders of sound quality, rhyme and fluency. The three-dimensional sonogram of the symptom syllables show distinctive changes of proportional vowels or consonant phonemes.

Temporal trends of time to antiretroviral treatment initiation, interruption and modification: examination of patients diagnosed with advanced HIV in Australia.

PubMed

Wright, Stephen T; Law, Matthew G; Cooper, David A; Keen, Phillip; McDonald, Ann; Middleton, Melanie; Woolley, Ian; Kelly, Mark; Petoumenos, Kathy

2015-01-01

HIV prevention strategies are moving towards reducing plasma HIV RNA viral load in all HIV-positive persons, including those undiagnosed, treatment naïve, on or off antiretroviral therapy. A proxy population for those undiagnosed are patients that present late to care with advanced HIV. The objectives of this analysis are to examine factors associated with patients presenting with advanced HIV, and establish rates of treatment interruption and modification after initiating ART. We deterministically linked records from the Australian HIV Observational Database to the Australian National HIV Registry to obtain information related to HIV diagnosis. Logistic regression was used to identify factors associated with advanced HIV diagnosis. We used survival methods to evaluate rates of ART initiation by diagnosis CD4 count strata and by calendar year of HIV diagnosis. Cox models were used to determine hazard of first ART treatment interruption (duration >30 days) and time to first major ART modification. Factors associated (p<0.05) with increased odds of advanced HIV diagnosis were sex, older age, heterosexual mode of HIV exposure, born overseas and rural-regional care setting. Earlier initiation of ART occurred at higher rates in later periods (2007-2012) in all diagnosis CD4 count groups. We found an 83% (69, 91%) reduction in the hazard of first treatment interruption comparing 2007-2012 versus 1996-2001 (p<0.001), and no difference in ART modification for patients diagnosed with advanced HIV. Recent HIV diagnoses are initiating therapy earlier in all diagnosis CD4 cell count groups, potentially lowering community viral load compared to earlier time periods. We found a marked reduction in the hazard of first treatment interruption, and found no difference in rates of major modification to ART by HIV presentation status in recent periods.

High Drop-off Along the HIV Care Continuum and ART Interruption Among Female Sex Workers in the Dominican Republic.

PubMed

Zulliger, Rose; Barrington, Clare; Donastorg, Yeycy; Perez, Martha; Kerrigan, Deanna

2015-06-01

Engagement in HIV care offers clear individual and societal benefits, but little evidence exists on the care experiences of key populations. A cross-sectional survey was conducted with 268 female sex workers (FSWs) living with HIV in Santo Domingo, Dominican Republic, to describe the HIV care continuum and to determine factors associated with antiretroviral therapy (ART) interruption. FSWs disengaged throughout the care continuum with the highest drop-off after ART initiation. Most participants were linked to care (92%), retained in care (85%), and initiated onto ART (78%), but ART discontinuation and irregular adherence were frequent. Only 48% of participants had an undetectable HIV viral load. Overall, 36% of participants ever initiated onto ART reported lifetime experience with ART interruption. The odds of ART interruption were 3.24 times higher among women who experienced FSW-related discrimination [95% confidence interval (CI): 1.28 to 8.20], 2.41 times higher among women who used any drug (95% CI: 1.09 to 5.34), and 2.35 times higher among women who worked in an FSW establishment (95% CI: 1.20 to 4.60). Internalized stigma related to FSW was associated with higher odds of interruption (adjusted odds ratio: 1.09; 95% CI: 1.02 to 1.16), and positive perceptions of HIV providers were protective (adjusted odds ratio: 0.91; 95% CI: 0.85 to 0.98). FSWs living with HIV confront multiple barriers throughout the HIV care continuum, many of which are related to the social context and stigmatization of sex work. Given the clear importance of maximizing the potential benefits of engagement in HIV care, there is an urgent need for interventions to support FSWs throughout the HIV care continuum.

An interrupted time series analysis showed suboptimal improvement in reporting quality of trial abstract.

PubMed

Chhapola, Viswas; Tiwari, Soumya; Brar, Rekha; Kanwal, Sandeep Kumar

2016-03-01

To assess and compare the immediate and long-term change in reporting quality of randomized controlled trial (RCT) abstracts published in Pediatrics, The Journal of Pediatrics, and JAMA Pediatrics before and after the publication of Consolidated Standards of Reporting Trial (CONSORT)-abstract statement. Study had "Interrupted time-series" design. Eligible RCT abstracts were retrieved by PubMed search in two study periods from January 2003 to December 2007 (pre-CONSORT) and January 2010 to December 2014 (post-CONSORT). These abstracts were matched with the CONSORT checklist for abstracts. The primary outcome measure was CONSORT-abstract score defined as number of CONSORT items correctly reported divided by 18 and expressed as percentage. The mean percentage scores were used to compare reporting quality between pre- and post-CONSORT using segmented linear regression. A total of 424 RCT abstracts in pre-CONSORT and 467 in post-CONSORT were analyzed. A significant change in slope of regression line between two time periods (0.151 [confidence interval CI, 0.004-0.298], P = 0.044) was observed. Intercepts did not show a significant difference (-2.39 [CI, 4.93-0.157], P = 0.065). The overall reporting quality of RCT abstracts in the high-impact pediatrics journals was suboptimal (<50%); however, it improved when assessed over a 5-year period, implying slow but gradual adoption of guideline. Copyright © 2016 Elsevier Inc. All rights reserved.

Interrupted time-series analysis: studying trends in neurosurgery.

PubMed

Wong, Ricky H; Smieliauskas, Fabrice; Pan, I-Wen; Lam, Sandi K

2015-12-01

OBJECT Neurosurgery studies traditionally have evaluated the effects of interventions on health care outcomes by studying overall changes in measured outcomes over time. Yet, this type of linear analysis is limited due to lack of consideration of the trend's effects both pre- and postintervention and the potential for confounding influences. The aim of this study was to illustrate interrupted time-series analysis (ITSA) as applied to an example in the neurosurgical literature and highlight ITSA's potential for future applications. METHODS The methods used in previous neurosurgical studies were analyzed and then compared with the methodology of ITSA. RESULTS The ITSA method was identified in the neurosurgical literature as an important technique for isolating the effect of an intervention (such as a policy change or a quality and safety initiative) on a health outcome independent of other factors driving trends in the outcome. The authors determined that ITSA allows for analysis of the intervention's immediate impact on outcome level and on subsequent trends and enables a more careful measure of the causal effects of interventions on health care outcomes. CONCLUSIONS ITSA represents a significant improvement over traditional observational study designs in quantifying the impact of an intervention. ITSA is a useful statistical procedure to understand, consider, and implement as the field of neurosurgery evolves in sophistication in big-data analytics, economics, and health services research.

29 CFR 1910.303 - General.

Code of Federal Regulations, 2012 CFR

2012-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Electrical Design Safety Standards for Electrical Systems § 1910.303..., including, for parts designed to enclose and protect other equipment, the adequacy of the protection thus... from grounds other than those required or permitted by this subpart. (4) Interrupting rating. Equipment...

29 CFR 1910.303 - General.

Code of Federal Regulations, 2010 CFR

2010-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Electrical Design Safety Standards for Electrical Systems § 1910.303..., including, for parts designed to enclose and protect other equipment, the adequacy of the protection thus... from grounds other than those required or permitted by this subpart. (4) Interrupting rating. Equipment...

29 CFR 1910.303 - General.

Code of Federal Regulations, 2013 CFR

2013-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Electrical Design Safety Standards for Electrical Systems § 1910.303..., including, for parts designed to enclose and protect other equipment, the adequacy of the protection thus... from grounds other than those required or permitted by this subpart. (4) Interrupting rating. Equipment...

29 CFR 1910.303 - General.

Code of Federal Regulations, 2014 CFR

2014-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Electrical Design Safety Standards for Electrical Systems § 1910.303..., including, for parts designed to enclose and protect other equipment, the adequacy of the protection thus... from grounds other than those required or permitted by this subpart. (4) Interrupting rating. Equipment...

29 CFR 1910.303 - General.

Code of Federal Regulations, 2011 CFR

2011-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Electrical Design Safety Standards for Electrical Systems § 1910.303..., including, for parts designed to enclose and protect other equipment, the adequacy of the protection thus... from grounds other than those required or permitted by this subpart. (4) Interrupting rating. Equipment...

The effect of high temperature interruptions during inductive period on the extent of flowering and on metabolic responses in olives (Olea europaea L.)

USDA-ARS?s Scientific Manuscript database

The effect of the duration of high temperature interruption and the timing of it’s occurrence during inductive period on the extent of inhibition of inflorescence production in ‘Arbequina’ olive trees was investigated. Trees kept under inductive conditions in different growth chambers were subjected...

Cyclic fatigue resistance of two nickel-titanium rotary instruments in interrupted rotation.

PubMed

Pedullà, E; Lizio, A; Scibilia, M; Grande, N M; Plotino, G; Boninelli, S; Rapisarda, E; Lo Giudice, G

2017-02-01

To investigate the influence of interrupted rotation on cyclic fatigue of two nickel-titanium rotary instruments. Cyclic fatigue of 300 new ProTaper Next size X1; X2 and Mtwo size 10, .04 taper; size 15, .05 taper; size 20, .06 taper and size 25, .06 taper instruments was tested in continuous or interrupted rotation. Fifty files of the same brand and size were randomly assigned to five groups (n = 10). Group 1 instruments were tested in continuous rotation; groups 2 and 3 in paused rotation for 1 s every 10 or 20 s, respectively; groups 4 and 5 in interrupted rotation for 5 s every 10 or 20 s, respectively. Cyclic fatigue was expressed in time to fracture (TtF) in an artificial canal with 60° angle and 5 mm radius of curvature. The fracture surface was examined with a scanning electron microscope (SEM). Data were evaluated by two-way analysis of variance. Cyclic fatigue of groups 2 and 4 of ProTaper Next X2 and Mtwo size 25, .06 taper was significantly lower than that of group 1 of the same instruments (P < 0.01). ProTaper Next X2 had significantly reduced cyclic fatigue in groups 3 and 5 (P < 0.05). No differences were found by interrupting the rotation for 1 or 5 s in all instruments (P > 0.05). Fatigue of other instruments was not affected by interrupted rotation (P > 0.05). Interrupted rotation reduced cyclic fatigue resistance of ProTaper Next X2 and Mtwo size 25, .06 taper, especially when a higher number of interruptions was performed. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities.

PubMed

Yelland, Jane; Riggs, Elisha; Szwarc, Josef; Casey, Sue; Dawson, Wendy; Vanpraag, Dannielle; East, Chris; Wallace, Euan; Teale, Glyn; Harrison, Bernie; Petschel, Pauline; Furler, John; Goldfeld, Sharon; Mensah, Fiona; Biro, Mary Anne; Willey, Sue; Cheng, I-Hao; Small, Rhonda; Brown, Stephanie

2015-04-30

The risk of poor maternal and perinatal outcomes in high-income countries such as Australia is greatest for those experiencing extreme social and economic disadvantage. Australian data show that women of refugee background have higher rates of stillbirth, fetal death in utero and perinatal mortality compared with Australian born women. Policy and health system responses to such inequities have been slow and poorly integrated. This protocol describes an innovative programme of quality improvement and reform in publically funded universal health services in Melbourne, Australia, that aims to address refugee maternal and child health inequalities. A partnership of 11 organisations spanning health services, government and research is working to achieve change in the way that maternity and early childhood health services support families of refugee background. The aims of the programme are to improve access to universal health care for families of refugee background and build organisational and system capacity to address modifiable risk factors for poor maternal and child health outcomes. Quality improvement initiatives are iterative, co-designed by partners and implemented using the Plan Do Study Act framework in four maternity hospitals and two local government maternal and child health services. Bridging the Gap is designed as a multi-phase, quasi-experimental study. Evaluation methods include use of interrupted time series design to examine health service use and maternal and child health outcomes over a 3-year period of implementation. Process measures will examine refugee families' experiences of specific initiatives and service providers' views and experiences of innovation and change. It is envisaged that the Bridging the Gap program will provide essential evidence to support service and policy innovation and knowledge about what it takes to implement sustainable improvements in the way that health services support vulnerable populations, within the constraints of existing resources.

Pacifier use and interruption of exclusive breastfeeding: Systematic review and meta-analysis.

PubMed

Buccini, Gabriela Dos Santos; Pérez-Escamilla, Rafael; Paulino, Larissa Munari; Araújo, Clarice Lopes; Venancio, Sonia Isoyama

2017-07-01

Identifying modifiable risk factor for exclusive breastfeeding (EBF) interruption is key for improving child health globally. There is no consensus about the effect of pacifier use on EBF interruption. Thus, the aim of this systematic review was to investigate the association between pacifier use and EBF interruption during the first six month. A search of CINAHL, Scopus, Web of Science, LILACS and Medline; from inception through 30 December 2014 without restriction of language yielded 1,866 publications (PROSPERO protocol CRD42014014527). Predetermined inclusion/exclusion criteria peer reviewed yielded 46 studies: two clinical trials, 20 longitudinal, and 24 cross-sectional studies. Meta-analysis was performed and meta-regression explored heterogeneity across studies. The pooled effect of the association between pacifier use and EBF interruption was 2.48 OR (95% CI = 2.16-2.85). Heterogeneity was explained by the study design (40.2%), followed by differences in the measurement and categorization of pacifier use, the methodological quality of the studies and the socio-economic context. Two RCT's with very limited external validity found a null association, but 44 observational studies, including 20 prospective cohort studies, did find a consistent association between pacifier use and risk of EBF interruption (OR = 2.28; 95% CI = 1.78-2.93). Our findings support the current WHO recommendation on pacifier use as it focuses on the risk of poor breastfeeding outcomes as a result of pacifier use. Future studies that take into account the risks and benefits of pacifier use are needed to clarify this recommendation. © 2016 John Wiley & Sons Ltd.

SU-E-T-171: Missing Dose in Integrated EPID Images.

PubMed

King, B; Seymour, E; Nitschke, K

2012-06-01

A dosimetric artifact has been observed with Varian EPIDs in the presence of beam interrupts. This work determines the root cause and significance of this artifact. Integrated mode EPID images were acquired both with and without a manual beam interrupt for rectangular, sliding gap IMRT fields. Simultaneously, the individual frames were captured on a separate computer using a frame-grabber system. Synchronization of the individual frames with the integrated images allowed the determination of precisely how the EPID behaved during regular operation as well as when a beam interrupt was triggered. The ability of the EPID to reliably monitor a treatment in the presence of beam interrupts was tested by comparing the difference between the interrupt and non-interrupt images. The interrupted images acquired in integrated acquisition mode displayed unanticipated behaviour in the region of the image where the leaves were located when the beam interrupt was triggered. Differences greater than 5% were observed as a result of the interrupt in some cases, with the discrepancies occurring in a non-uniform manner across the imager. The differences measured were not repeatable from one measurement to another. Examination of the individual frames showed that the EPID was consistently losing a small amount of dose at the termination of every exposure. Inclusion of one additional frame in every image rectified the unexpected behaviour, reducing the differences to 1% or less. Although integrated EPID images nominally capture the entire dose delivered during an exposure, a small amount of dose is consistently being lost at the end of every exposure. The amount of missing dose is random, depending on the exact beam termination time within a frame. Inclusion of an extra frame at the end of each exposure effectively rectifies the problem, making the EPID more suitable for clinical dosimetry applications. The authors received support from Varian Medical Systems in the form of software and equipment loans as well as technical support. © 2012 American Association of Physicists in Medicine.

Tuning Linux to meet real time requirements

NASA Astrophysics Data System (ADS)

Herbel, Richard S.; Le, Dang N.

2007-04-01

There is a desire to use Linux in military systems. Customers are requesting contractors to use open source to the maximal possible extent in contracts. Linux is probably the best operating system of choice to meet this need. It is widely used. It is free. It is royalty free, and, best of all, it is completely open source. However, there is a problem. Linux was not originally built to be a real time operating system. There are many places where interrupts can and will be blocked for an indeterminate amount of time. There have been several attempts to bridge this gap. One of them is from RTLinux, which attempts to build a microkernel underneath Linux. The microkernel will handle all interrupts and then pass it up to the Linux operating system. This does insure good interrupt latency; however, it is not free [1]. Another is RTAI, which provides a similar typed interface; however, the PowerPC platform, which is used widely in real time embedded community, was stated as "recovering" [2]. Thus this is not suited for military usage. This paper provides a method for tuning a standard Linux kernel so it can meet the real time requirement of an embedded system.

Nursing implications: symptom presentation and quality of life in rectal cancer patients.

PubMed

O'Gorman, Claire; Barry, Amanda; Denieffe, Suzanne; Sasiadek, Wojciech; Gooney, Martina

2016-05-01

To determine the changes in symptoms experienced by rectal cancer patients during preoperative chemoradiotherapy, with a specific focus on fatigue and to explore how symptoms impact the quality of life. Rectal cancer continues to be a healthcare issue internationally, despite advances in management strategies, which includes the administration of preoperative chemoradiotherapy to improve locoregional control. It is known that this treatment may cause adverse effects; however, there is a paucity of literature that specifically examines fatigue, symptoms and quality of life in this patient cohort. A prospective, quantitative correlational design using purposive sampling was adopted. Symptoms and quality of life were measured with validated questionnaires in 35 patients at four time points. Symptoms that changed significantly over time as examined using rm-anova include fatigue, bowel function issues, nutritional issues, pain, dermatological issues and urinary function issues. Findings indicate that fatigue leads to poorer quality of life, with constipation, bloating, stool frequency, appetite loss, weight worry, nausea and vomiting, dry mouth and pain also identified as influencing factors on quality of life. Findings have highlighted the importance of thorough symptom assessment and management of patients receiving preoperative chemoradiotherapy, particularly midway through treatment, in order to optimise quality of life and minimise interruptions to treatment. Close monitoring of symptoms during preoperative chemoradiotherapy, particularly at week 4, will enable the implementation of timely interventions so that interruptions to treatment are prevented and the quality of life is optimised, which may hasten postoperative recovery times. © 2016 John Wiley & Sons Ltd.

Using an integrated information system to reduce interruptions and the number of non-relevant contacts in the inpatient pharmacy at tertiary hospital.

PubMed

Binobaid, Saleh; Almeziny, Mohammed; Fan, Ip-Shing

2017-07-01

Patient care is provided by a multidisciplinary team of healthcare professionals intended for high-quality and safe patient care. Accordingly, the team must work synergistically and communicate efficiently. In many hospitals, nursing and pharmacy communication relies mainly on telephone calls. In fact, numerous studies have reported telephone calls as a source of interruption for both pharmacy and nursing operations; therefore, the workload increases and the chance of errors raises. This report describes the implementation of an integrated information system that possibly can reduce telephone calls through providing real-time tracking capabilities and sorting prescriptions urgency, thus significantly improving traceability of all prescriptions inside pharmacy. The research design is based on a quasi-experiment using pre-post testing using the continuous improvement approach. The improvement project is performed using a six-step method. A survey was conducted in Prince Sultan Military Medical City (PSMMC) to measure the volume and types of telephone calls before and after implementation to evaluate the impact of the new system. Beforehand of the system implementation, during the two-week measurement period, all pharmacies received 4466 calls and the majority were follow-up calls. Subsequently of the integrated system rollout, there was a significant reduction ( p  > 0.001) in the volume of telephone calls to 2630 calls; besides, the calls nature turned out to be more professional inquiries ( p  > 0.001). As a result, avoidable interruptions and workload were decreased.

Application Study of a High Temperature Superconducting Fault Current Limiter for Electric Power System

NASA Astrophysics Data System (ADS)

Naito, Yuji; Shimizu, Iwao; Yamaguchi, Iwao; Kaiho, Katsuyuki; Yanabu, Satoru

Using high temperature superconductor, a Superconducting Fault Current Limiter (SFCL) was made and tested. Superconductor and vacuum interrupter as commutation switch are connected in parallel with bypass coil. When a fault occurs and the excessive current flows, superconductor is first quenched and the current is transferred to bypass coil because on voltage drop of superconductor. At the same time, since magnetic field is generated by current which flows in bypass coil, commutation switch is immediately driven by electromagnetic repulsion plate connected to driving rod of vacuum interrupter, and superconductor is separated from this circuit. Using the testing model, we could separate the superconductor from a circuit due to movement of vacuum interrupter within half-cycle current and transfer all current to bypass coil. Since operation of a commutation switch is included in current limiting operation of this testing model, it is one of helpful circuit of development of SFCL in the future. Moreover, since it can make the consumed energy of superconductor small during fault state due to realization of high-speed switch with simple composition, the burden of superconductor is reduced compared with conventional resistive type SFCL and it is considered that the flexibility of a SFCL design increases. Cooperation with a circuit breaker was also considered, the trial calculation of a parameter and energy of operation is conducted and discussion in the case of installing the SFCL to electric power system is made.

The Use of Interrupted Case Studies to Enhance Critical Thinking Skills in Biology

PubMed Central

White, Tracy K.; Whitaker, Paul; Gonya, Terri; Hein, Richard; Kroening, Dubear; Lee, Kevin; Lee, Laura; Lukowiak, Andrea; Hayes, Elizabeth

2009-01-01

There has been a dramatic increase in the availability of case studies for use in the biology classroom, and perceptions of the effectiveness of case-study-based learning are overwhelmingly positive. Here we report the results of a study in which we evaluated the ability of interrupted case studies to improve critical thinking in the context of experimental design and the conventions of data interpretation. Students were assessed using further case studies designed to evaluate their ability to recognize and articulate problematic approaches to these elements of experimentation. Our work reveals that case studies have broad utility in the classroom. In addition to demonstrating a small but statistically significant increase in the number of students capable of critically evaluating selected aspects of experimental design, we also observed increased student engagement and documented widespread misconceptions regarding the conventions of data acquisition and analysis. PMID:23653687

Development and testing of a 180-volt dc electronic circuit breaker with a 335-ampere carry and 1200-ampere interrupt rating

NASA Technical Reports Server (NTRS)

Brush, A. S.; Phillips, R. L.

1991-01-01

NASA Lewis Research Center and associated contractors have conducted a program to assess the potential requirements for a high-current switch to conceptually design a switch using the best existing technology, and to build and demonstrate a breadboard which meets the requirements. The result is the high current remote bus isolator (HRBI). The HRBI is rated at 180 V dc, 335 A continuous with a 1200 A interrupt rating. It also incorporates remote-control and protective features called for by the Space Station Freedom PMAD dc test bed design. Two breadboard 335 A circuit breakers were built and tested that demonstrate a promising concept of paralleled current-limiting modules. The units incorporated all control and protective features required by advanced aerospace power systems. Component stresses in each unit were determined by design, and are consistent with a life of many thousands of fault operations.

Smoke-free parks and beaches: an interrupted time-series study of behavioural impact in New York City.

PubMed

Johns, Michael; Farley, Shannon M; Rajulu, Deepa T; Kansagra, Susan M; Juster, Harlan R

2015-09-01

In 2011, New York City (NYC) parks and beaches became smoke-free. There is currently little research evaluating the impact of such laws on smoking behaviour at the population level. We used an interrupted time-series study design to analyse data from the New York State Adult Tobacco Survey to assess the law's impact using the rest of New York State as a comparison. Trends in how frequently respondents noticed people smoking in parks and beaches were analysed between the third quarter of 2009 and the fourth quarter of 2012, comparing NYC to the rest of the state. The trend in the frequency of NYC residents noticing people smoking in local parks and beaches decreased significantly over the six quarters after the law took effect. There was no comparable decline among residents in the rest of the state. An increase in the number of respondents who never noticed people smoking in NYC contributed to this decline. These results are consistent with previous studies and provide population-level evidence that suggest the law has reduced smoking in parks and on beaches. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Immune Escape Mutations Detected within HIV-1 Epitopes Associated with Viral Control During Treatment Interruption

PubMed Central

Schweighardt, Becky; Wrin, Terri; Meiklejohn, Duncan A.; Spotts, Gerald; Petropoulos, Christos J.; Nixon, Douglas F.; Hecht, Frederick M.

2010-01-01

We analyzed immune responses in chronically HIV-infected individuals who took part in a treatment interruption (TI) trial designed for patients who initiated anti-retroviral therapy within 6 months of seroconversion. In the two subjects that exhibited the best viral control, we detected CD8+ T cell responses against 1-2 Gag epitopes during the early weeks of TI and a subsequent increase in the number of epitopes recognized by the later time points. Each of these subjects developed mutations within the epitopes targeted by the highest magnitude responses. In the subject with the worst viral control, we detected responses against two Gag epitopes throughout the entire TI and no Gag mutations. The magnitude of these responses increased dramatically with time, greatly exceeding those detected in the virologic controllers. The highest levels of contemporaneous autologous neutralizing antibody activity were detected in the virologic controllers, and a subsequent escape mutation developed within the envelope gene of one controller that abrogated the response. These data suggest that immune escape mutations are a sign of viral control during TI, and that the absence of immune escape mutations in the presence of high-levels of viral replication indicates the lack of an effective host immune response. PMID:19910798

On the implementation of IP protection using biometrics based information hiding and firewall

NASA Astrophysics Data System (ADS)

Basu, Abhishek; Nandy, Kingshuk; Banerjee, Avishek; Giri, Supratick; Sarkar, Souvik; Sarkar, Subir Kumar

2016-02-01

System-on-chip-based design style creates a revolution in very large scale integration industry with design efficiency, operating speed and development time. To support this process, reuse and exchange of components are essential in electronic form called intellectual property (IP). This, however, increases the possibility of encroachment of IP of the design. So copyright protection of IP against piracy is the most important concern for IP vendors. The existing solutions for IP protection are still not secure enough with flexibility, cost, etc. This paper proposes an information-hiding-based solution for IP protection by embedding a biometric copyright information and firewall inside an IP in the form of a finite state machine with unique configuration. The scheme first introduces biometric signature-based copyright as ownership proof. Second, firewall interrupts the normal functionality of IP at the end of the user time period. The experimental outcomes of field-programmable-gate-array implementation illustrate the efficiency of the proposed method.

Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study.

PubMed

Westbrook, Johanna I; Raban, Magdalena Z; Walter, Scott R; Douglas, Heather

2018-01-09

Interruptions and multitasking have been demonstrated in experimental studies to reduce individuals' task performance. These behaviours are frequently used by clinicians in high-workload, dynamic clinical environments, yet their effects have rarely been studied. To assess the relative contributions of interruptions and multitasking by emergency physicians to prescribing errors. 36 emergency physicians were shadowed over 120 hours. All tasks, interruptions and instances of multitasking were recorded. Physicians' working memory capacity (WMC) and preference for multitasking were assessed using the Operation Span Task (OSPAN) and Inventory of Polychronic Values. Following observation, physicians were asked about their sleep in the previous 24 hours. Prescribing errors were used as a measure of task performance. We performed multivariate analysis of prescribing error rates to determine associations with interruptions and multitasking, also considering physician seniority, age, psychometric measures, workload and sleep. Physicians experienced 7.9 interruptions/hour. 28 clinicians were observed prescribing 239 medication orders which contained 208 prescribing errors. While prescribing, clinicians were interrupted 9.4 times/hour. Error rates increased significantly if physicians were interrupted (rate ratio (RR) 2.82; 95% CI 1.23 to 6.49) or multitasked (RR 1.86; 95% CI 1.35 to 2.56) while prescribing. Having below-average sleep showed a >15-fold increase in clinical error rate (RR 16.44; 95% CI 4.84 to 55.81). WMC was protective against errors; for every 10-point increase on the 75-point OSPAN, a 19% decrease in prescribing errors was observed. There was no effect of polychronicity, workload, physician gender or above-average sleep on error rates. Interruptions, multitasking and poor sleep were associated with significantly increased rates of prescribing errors among emergency physicians. WMC mitigated the negative influence of these factors to an extent. These results confirm experimental findings in other fields and raise questions about the acceptability of the high rates of multitasking and interruption in clinical environments. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Acceptance and barriers pertaining to a general practice decision support system for multiple clinical conditions: A mixed methods evaluation.

PubMed

Arts, Derk L; Medlock, Stephanie K; van Weert, Henk C P M; Wyatt, Jeremy C; Abu-Hanna, Ameen

2018-01-01

Many studies have investigated the use of clinical decision support systems as a means to improve care, but have thus far failed to show significant effects on patient-related outcomes. We developed a clinical decision support system that attempted to address issues that were identified in these studies. The system was implemented in Dutch general practice and was designed to be both unobtrusive and to respond in real time. Despite our efforts, usage of the system was low. In the current study we perform a mixed methods evaluation to identify remediable barriers which led to disappointing usage rates for our system. A mixed methods evaluation employing an online questionnaire and focus group. The focus group was organized to clarify free text comments and receive more detailed feedback from general practitioners. Topics consisted of items based on results from the survey and additional open questions. The response rate for the questionnaire was 94%. Results from the questionnaire and focus group can be summarized as follows: The system was perceived as interruptive, despite its design. Participants felt that there were too many recommendations and that the relevance of the recommendations varied. Demographic based recommendations (e.g. age) were often irrelevant, while specific risk-based recommendations (e.g. diagnosis) were more relevant. The other main barrier to use was lack of time during the patient visit. These results are likely to be useful to other researchers who are attempting to address the problems of interruption and alert fatigue in decision support.

Systems biology meets stress ecology: linking molecular and organismal stress responses in Daphnia magna

PubMed Central

Heckmann, Lars-Henrik; Sibly, Richard M; Connon, Richard; Hooper, Helen L; Hutchinson, Thomas H; Maund, Steve J; Hill, Christopher J; Bouetard, Anthony; Callaghan, Amanda

2008-01-01

Background Ibuprofen and other nonsteroidal anti-inflammatory drugs have been designed to interrupt eicosanoid metabolism in mammals, but little is known of how they affect nontarget organisms. Here we report a systems biology study that simultaneously describes the transcriptomic and phenotypic stress responses of the model crustacean Daphnia magna after exposure to ibuprofen. Results Our findings reveal intriguing similarities in the mode of action of ibuprofen between vertebrates and invertebrates, and they suggest that ibuprofen has a targeted impact on reproduction at the molecular, organismal, and population level in daphnids. Microarray expression and temporal real-time quantitative PCR profiles of key genes suggest early ibuprofen interruption of crustacean eicosanoid metabolism, which appears to disrupt signal transduction affecting juvenile hormone metabolism and oogenesis. Conclusion Combining molecular and organismal stress responses provides a guide to possible chronic consequences of environmental stress for population health. This could improve current environmental risk assessment by providing an early indication of the need for higher tier testing. Our study demonstrates the advantages of a systems approach to stress ecology, in which Daphnia will probably play a major role. PMID:18291039

Servicing a globally broadcast interrupt signal in a multi-threaded computer

DOEpatents

Attinella, John E.; Davis, Kristan D.; Musselman, Roy G.; Satterfield, David L.

2015-12-29

Methods, apparatuses, and computer program products for servicing a globally broadcast interrupt signal in a multi-threaded computer comprising a plurality of processor threads. Embodiments include an interrupt controller indicating in a plurality of local interrupt status locations that a globally broadcast interrupt signal has been received by the interrupt controller. Embodiments also include a thread determining that a local interrupt status location corresponding to the thread indicates that the globally broadcast interrupt signal has been received by the interrupt controller. Embodiments also include the thread processing one or more entries in a global interrupt status bit queue based on whether global interrupt status bits associated with the globally broadcast interrupt signal are locked. Each entry in the global interrupt status bit queue corresponds to a queued global interrupt.

Use of MV and kV imager correlation for maintaining continuous real-time 3D internal marker tracking during beam interruptions

NASA Astrophysics Data System (ADS)

Wiersma, R. D.; Riaz, N.; Dieterich, Sonja; Suh, Yelin; Xing, L.

2009-01-01

The integration of onboard kV imaging together with a MV electronic portal imaging device (EPID) on linear accelerators (LINAC) can provide an easy to implement real-time 3D organ position monitoring solution for treatment delivery. Currently, real-time MV-kV tracking has only been demonstrated by simultaneous imagining by both MV and kV imaging devices. However, modalities such as step-and-shoot IMRT (SS-IMRT), which inherently contain MV beam interruptions, can lead to loss of target information necessary for 3D localization. Additionally, continuous kV imaging throughout the treatment delivery can lead to high levels of imaging dose to the patient. This work demonstrates for the first time how full 3D target tracking can be maintained even in the presence of such beam interruption, or MV/kV beam interleave, by use of a relatively simple correlation model together with MV-kV tracking. A moving correlation model was constructed using both present and prior positions of the marker in the available MV or kV image to compute the position of the marker on the interrupted imager. A commercially available radiotherapy system, equipped with both MV and kV imaging devices, was used to deliver typical SS-IMRT lung treatment plans to a 4D phantom containing internally embedded metallic markers. To simulate actual lung tumor motion, previous recorded 4D lung patient motion data were used. Lung tumor motion data of five separate patients were inputted into the 4D phantom, and typical SS-IMRT lung plans were delivered to simulate actual clinical deliveries. Application of the correlation model to SS-IMRT lung treatment deliveries was found to be an effective solution for maintaining continuous 3D tracking during 'step' beam interruptions. For deliveries involving five or more gantry angles with 50 or more fields per plan, the positional errors were found to have <=1 mm root mean squared error (RMSE) in all three spatial directions. In addition to increasing the robustness of MV-kV tracking against beam interruption, it was also found that use of correlation can be an effective way of lowering kV dose to the patient and for increasing kV image quality by reduction of MV scatter interference.

41 CFR 301-70.506 - How do we define actual cost and constructive cost when an employee interrupts a travel...

Code of Federal Regulations, 2013 CFR

2013-07-01

... appropriate en route travel time. [FTR Amdt. 70, 63 FR 15971, Apr. 1, 1998. Redesignated by FTR Amdt. 108, 67... cost and constructive cost when an employee interrupts a travel assignment because of an incapacitating illness or injury? 301-70.506 Section 301-70.506 Public Contracts and Property Management Federal Travel...

41 CFR 301-70.506 - How do we define actual cost and constructive cost when an employee interrupts a travel...

Code of Federal Regulations, 2012 CFR

2012-07-01

... appropriate en route travel time. [FTR Amdt. 70, 63 FR 15971, Apr. 1, 1998. Redesignated by FTR Amdt. 108, 67... cost and constructive cost when an employee interrupts a travel assignment because of an incapacitating illness or injury? 301-70.506 Section 301-70.506 Public Contracts and Property Management Federal Travel...

41 CFR 301-70.506 - How do we define actual cost and constructive cost when an employee interrupts a travel...

Code of Federal Regulations, 2010 CFR

2010-07-01

... appropriate en route travel time. [FTR Amdt. 70, 63 FR 15971, Apr. 1, 1998. Redesignated by FTR Amdt. 108, 67... cost and constructive cost when an employee interrupts a travel assignment because of an incapacitating illness or injury? 301-70.506 Section 301-70.506 Public Contracts and Property Management Federal Travel...

41 CFR 301-70.506 - How do we define actual cost and constructive cost when an employee interrupts a travel...

Code of Federal Regulations, 2014 CFR

2014-07-01

... appropriate en route travel time. [FTR Amdt. 70, 63 FR 15971, Apr. 1, 1998. Redesignated by FTR Amdt. 108, 67... cost and constructive cost when an employee interrupts a travel assignment because of an incapacitating illness or injury? 301-70.506 Section 301-70.506 Public Contracts and Property Management Federal Travel...

41 CFR 301-70.506 - How do we define actual cost and constructive cost when an employee interrupts a travel...

Code of Federal Regulations, 2011 CFR

2011-07-01

... appropriate en route travel time. [FTR Amdt. 70, 63 FR 15971, Apr. 1, 1998. Redesignated by FTR Amdt. 108, 67... cost and constructive cost when an employee interrupts a travel assignment because of an incapacitating illness or injury? 301-70.506 Section 301-70.506 Public Contracts and Property Management Federal Travel...

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

Attinella, John E.; Davis, Kristan D.; Musselman, Roy G.

Methods, apparatuses, and computer program products for servicing a globally broadcast interrupt signal in a multi-threaded computer comprising a plurality of processor threads. Embodiments include an interrupt controller indicating in a plurality of local interrupt status locations that a globally broadcast interrupt signal has been received by the interrupt controller. Embodiments also include a thread determining that a local interrupt status location corresponding to the thread indicates that the globally broadcast interrupt signal has been received by the interrupt controller. Embodiments also include the thread processing one or more entries in a global interrupt status bit queue based on whethermore » global interrupt status bits associated with the globally broadcast interrupt signal are locked. Each entry in the global interrupt status bit queue corresponds to a queued global interrupt.« less

Study of Electromagnetic Repulsion Switch to High Speed Reclosing and Recover Time Characteristics of Superconductor

NASA Astrophysics Data System (ADS)

Koyama, Tomonori; Kaiho, Katsuyuki; Yamaguchi, Iwao; Yanabu, Satoru

Using a high-temperature superconductor, we constructed and tested a model superconducting fault current limiter (SFCL). The superconductor and vacuum interrupter as the commutation switch were connected in parallel using a bypass coil. When the fault current flows in this equipment, the superconductor is quenched and the current is then transferred to the parallel coil due to the voltage drop in the superconductor. This large current in the parallel coil actuates the magnetic repulsion mechanism of the vacuum interrupter and the current in the superconductor is broken. Using this equipment, the current flow time in the superconductor can be easily minimized. On the other hand, the fault current is also easily limited by large reactance of the parallel coil. This system has many merits. So, we introduced to electromagnetic repulsion switch. There is duty of high speed re-closing after interrupting fault current in the electrical power system. So the SFCL should be recovered to superconducting state before high speed re-closing. But, superconductor generated heat at the time of quench. It takes time to recover superconducting state. Therefore it is a matter of recovery time. In this paper, we studied recovery time of superconductor. Also, we proposed electromagnetic repulsion switch with reclosing system.

Structured intermittent interruption of chronic HIV infection treatment with highly active antiretroviral therapy: effects on leptin and TNF-alpha.

PubMed

Arjona, M Montes de Oca; Pérez-Cano, R; Garcia-Juárez, R; Martín-Aspas, A; del Alamo, C Fernández Gutiérrez; Girón-González, J A

2006-04-01

The changes in nutritional parameters and adipocytokines after structured intermittent interruption of highly active antiretroviral treatment of patients with chronic HIV infection are analyzed. Twenty-seven patients with chronic HIV infection (median CD4+ T cell count/microl: nadir, 394; at the beginning of structured interruptions, 1041; HIV viral load: nadir, 41,521 copies/ml; at the beginning of structured interruptions <50 copies/ml; median time of previous treatment: 60 months) were evaluated during three cycles of intermittent interruptions of therapy (8 weeks on/4 weeks off). CD4+ T cell count, HIV viral load, anthropometric measures, and serum concentrations of triglycerides, cholesterol, leptin, and tumor necrosis factor and its soluble receptors I and II were determined. After the three cycles of intermittent interruptions of therapy, no significant differences in CD4+ T cell count/microl, viral load, or serum concentrations of cholesterol or triglycerides with reference to baseline values were found. A near-significant higher fatty mass (skinfold thicknesses, at the end, 121 mm, at the beginning, 100 mm, p = 0.100), combined with a significant increase of concentration of leptin (1.5 vs. 4.7 ng/ml, p = 0,044), as well as a decrease in serum concentrations of soluble receptors of tumor necrosis factor (TNFRI, 104 vs. 73 pg/ml, p = 0.022; TNFRII 253 vs. 195 pg/ml, p = 0.098) were detected. Structured intermittent interruption of highly active antiretroviral treatment of patients with chronic HIV infection induces a valuable positive modification in markers of lipid turnover and adipose tissue mass.

Factors affecting medication-order processing time.

PubMed

Beaman, M A; Kotzan, J A

1982-11-01

The factors affecting medication-order processing time at one hospital were studied. The order processing time was determined by directly observing the time to process randomly selected new drug orders on all three work shifts during two one-week periods. An order could list more than one drug for an individual patient. The observer recorded the nature, location, and cost of the drugs ordered, as well as the time to process the order. The time and type of interruptions also were noted. The time to process a drug order was classified as six dependent variables: (1) total time, (2) work time, (3) check time, (4) waiting time I--time from arrival on the dumbwaiter until work was initiated, (5) waiting time II--time between completion of the work and initiation of checking, and (6) waiting time III--time after the check was completed until the order left on the dumbwaiter. The significant predictors of each of the six dependent variables were determined using stepwise multiple regression. The total time to process a prescription order was 58.33 +/- 48.72 minutes; the urgency status of the order was the only significant determinant of total time. Urgency status also significantly predicted the three waiting-time variables. Interruptions and the number of drugs on the order were significant determinants of work time and check time. Each telephone interruption increased the work time by 1.72 minutes. While the results of this study cannot be generalized to other institutions, pharmacy managers can use the method of determining factors that affect medication-order processing time to identify problem areas in their institutions.

Executing application function calls in response to an interrupt

DOEpatents

Almasi, Gheorghe; Archer, Charles J.; Giampapa, Mark E.; Gooding, Thomas M.; Heidelberger, Philip; Parker, Jeffrey J.

2010-05-11

Executing application function calls in response to an interrupt including creating a thread; receiving an interrupt having an interrupt type; determining whether a value of a semaphore represents that interrupts are disabled; if the value of the semaphore represents that interrupts are not disabled: calling, by the thread, one or more preconfigured functions in dependence upon the interrupt type of the interrupt; yielding the thread; and if the value of the semaphore represents that interrupts are disabled: setting the value of the semaphore to represent to a kernel that interrupts are hard-disabled; and hard-disabling interrupts at the kernel.

Using permutation tests to enhance causal inference in interrupted time series analysis.

PubMed

Linden, Ariel

2018-06-01

Interrupted time series analysis (ITSA) is an evaluation methodology in which a single treatment unit's outcome is studied serially over time and the intervention is expected to "interrupt" the level and/or trend of that outcome. The internal validity is strengthened considerably when the treated unit is contrasted with a comparable control group. In this paper, we introduce a robustness check based on permutation tests to further improve causal inference. We evaluate the effect of California's Proposition 99 for reducing cigarette sales by iteratively casting each nontreated state into the role of "treated," creating a comparable control group using the ITSAMATCH package in Stata, and then evaluating treatment effects using ITSA regression. If statistically significant "treatment effects" are estimated for pseudotreated states, then any significant changes in the outcome of the actual treatment unit (California) cannot be attributed to the intervention. We perform these analyses setting the cutpoint significance level to P > .40 for identifying balanced matches (the highest threshold possible for which controls could still be found for California) and use the difference in differences of trends as the treatment effect estimator. Only California attained a statistically significant treatment effect, strengthening confidence in the conclusion that Proposition 99 reduced cigarette sales. The proposed permutation testing framework provides an additional robustness check to either support or refute a treatment effect identified in for the true treated unit in ITSA. Given its value and ease of implementation, this framework should be considered as a standard robustness test in all multiple group interrupted time series analyses. © 2018 John Wiley & Sons, Ltd.

Safeguards by Design Challenge

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

Alwin, Jennifer Louise

The International Atomic Energy Agency (IAEA) defines Safeguards as a system of inspection and verification of the peaceful uses of nuclear materials as part of the Nuclear Nonproliferation Treaty. IAEA oversees safeguards worldwide. Safeguards by Design (SBD) involves incorporation of safeguards technologies, techniques, and instrumentation during the design phase of a facility, rather that after the fact. Design challenge goals are the following: Design a system of safeguards technologies, techniques, and instrumentation for inspection and verification of the peaceful uses of nuclear materials. Cost should be minimized to work with the IAEA’s limited budget. Dose to workers should always bemore » as low are reasonably achievable (ALARA). Time is of the essence in operating facilities and flow of material should not be interrupted significantly. Proprietary process information in facilities may need to be protected, thus the amount of information obtained by inspectors should be the minimum required to achieve the measurement goal. Then three different design challenges are detailed: Plutonium Waste Item Measurement System, Marine-based Modular Reactor, and Floating Nuclear Power Plant (FNPP).« less

Evaluation of a protocol-based intervention to promote timely switching from intravenous to oral paracetamol for post-operative pain management: an interrupted time series analysis.

PubMed

Sabry, Nirmeen; Dawoud, Dalia; Alansary, Adel; Hounsome, Natalia; Baines, Darrin

2015-12-01

Timely switching from intravenous to oral therapy ensures optimized treatment and efficient use of health care resources. Intravenous (IV) paracetamol is widely used for post-operative pain management but not always switched to the oral form in a timely manner, leading to unnecessary increase in expenditure. This study aims to evaluate the impact of a multifaceted intervention to promote timely switching from the IV to oral form in the post-operative setting. An evidence-based prescribing protocol was designed and implemented by the clinical pharmacy team in a single district general hospital in Egypt. The protocol specified the criteria for appropriate prescribing of IV paracetamol. Doctors were provided with information and educational sessions prior to implementation. A prospective, quasi-experimental study was undertaken to evaluate its impact on IV paracetamol utilization and costs. Data on monthly utilization and costs were recorded for 12 months before and after implementation (January 2012 to December 2013). Data were analysed using interrupted time series analysis. Prior to implementation, in 2012, total spending on IV paracetamol was 674 154.00 Egyptian Pounds (L.E.) ($23,668.00). There was a non-significant (P > 0.05) downward trend in utilization (-32 ampoules per month) and costs [reduction of 632 L.E. ($222) per month]. Following implementation, immediate decrease in utilization and costs (P < 0.05) and a trend change over the follow-up period were observed. Average monthly reduction was 26% (95% CI: 24% to 28%, P < 0.001). A multifaceted, protocol-based intervention to ensure timely switching from IV-to-oral paracetamol achieved significant reduction in utilization and cost of IV paracetamol in the first 5 months of its implementation. © 2015 John Wiley & Sons, Ltd.

Enhancing causal interpretations of quality improvement interventions.

PubMed

Cable, G

2001-09-01

In an era of chronic resource scarcity it is critical that quality improvement professionals have confidence that their project activities cause measured change. A commonly used research design, the single group pre-test/post-test design, provides little insight into whether quality improvement interventions cause measured outcomes. A re-evaluation of a quality improvement programme designed to reduce the percentage of bilateral cardiac catheterisations for the period from January 1991 to October 1996 in three catheterisation laboratories in a north eastern state in the USA was performed using an interrupted time series design with switching replications. The accuracy and causal interpretability of the findings were considerably improved compared with the original evaluation design. Moreover, the re-evaluation provided tangible evidence in support of the suggestion that more rigorous designs can and should be more widely employed to improve the causal interpretability of quality improvement efforts. Evaluation designs for quality improvement projects should be constructed to provide a reasonable opportunity, given available time and resources, for causal interpretation of the results. Evaluators of quality improvement initiatives may infrequently have access to randomised designs. Nonetheless, as shown here, other very rigorous research designs are available for improving causal interpretability. Unilateral methodological surrender need not be the only alternative to randomised experiments.

The Lethality Test System

NASA Astrophysics Data System (ADS)

Parsons, W. M.; Sims, J. R.; Parker, J. V.

1986-11-01

The Lethality Test System (LTS) under construction at Los Alamos is an electromagnetic launcher facility designed to perform impact experiments at velocities up to 15 km/sec. The launcher is a 25 mm round bore, plasma armature railgun 22 m in length. Preinjection is accomplished with a two-stage light gas gun capable of 7 km/sec. The railgun power supply utilizes traction motors, vacuum interrupters, and pulse transformers. An assembly of 28 traction motors, equipped with flywheels, stores approximately 80 MJ at 92 percent of full speed and energizes the primary windings of three pulse transformers at a current of 50 kA. At peak current an array of vacuum interrupters disconnects the transformer primary windings and forces the current to flow in the secondary windings. The secondary windings are connected to the railgun, and by staging the vacuum interrupter openings, a 1-1.3 MA ramped current waveform will be delivered to the railgun.

Interrupted Monosyllabic Words: The Effects of Ten Interruption Locations on Recognition Performance by Older Listeners with Sensorineural Hearing Loss.

PubMed

Wilson, Richard H; Sharrett, Kadie C

2017-01-01

Two previous experiments from our laboratory with 70 interrupted monosyllabic words demonstrated that recognition performance was influenced by the temporal location of the interruption pattern. The interruption pattern (10 interruptions/sec, 50% duty cycle) was always the same and referenced word onset; the only difference between the patterns was the temporal location of the on- and off-segments of the interruption cycle. In the first study, both young and older listeners obtained better recognition performances when the initial on-segment coincided with word onset than when the initial on-segment was delayed by 50 msec. The second experiment with 24 young listeners detailed recognition performance as the interruption pattern was incremented in 10-msec steps through the 0- to 90-msec onset range. Across the onset conditions, 95% of the functions were either flat or U-shaped. To define the effects that interruption pattern locations had on word recognition by older listeners with sensorineural hearing loss as the interruption pattern incremented, re: word onset, from 0 to 90 msec in 10-msec steps. A repeated-measures design with ten interruption patterns (onset conditions) and one uninterruption condition. Twenty-four older males (mean = 69.6 yr) with sensorineural hearing loss participated in two 1-hour sessions. The three-frequency pure-tone average was 24.0 dB HL and word recognition was ≥80% correct. Seventy consonant-vowel nucleus-consonant words formed the corpus of materials with 25 additional words used for practice. For each participant, the 700 interrupted stimuli (70 words by 10 onset conditions), the 70 words uninterrupted, and two practice lists each were randomized and recorded on compact disc in 33 tracks of 25 words each. The data were analyzed at the participant and word levels and compared to the results obtained earlier on 24 young listeners with normal hearing. The mean recognition performance on the 70 words uninterrupted was 91.0% with an overall mean performance on the ten interruption conditions of 63.2% (range: 57.9-69.3%), compared to 80.4% (range: 73.0-87.7%) obtained earlier on the young adults. The best performances were at the extremes of the onset conditions. Standard deviations ranged from 22.1% to 28.1% (24 participants) and from 9.2% to 12.8% (70 words). An arithmetic algorithm categorized the shapes of the psychometric functions across the ten onset conditions. With the older participants in the current study, 40% of the functions were flat, 41.4% were U-shaped, and 18.6% were inverted U-shaped, which compared favorably to the function shapes by the young listeners in the earlier study of 50.0%, 41.4%, and 8.6%, respectively. There were two words on which the older listeners had 40% better performances. Collectively, the data are orderly, but at the individual word or participant level, the data are somewhat volatile, which may reflect auditory processing differences between the participant groups. The diversity of recognition performances by the older listeners on the ten interruption conditions with each of the 70 words supports the notion that the term hearing loss is inclusive of processes well beyond the filtering produced by end-organ sensitivity deficits. American Academy of Audiology

Lithium Ion Battery Design and Safety

NASA Technical Reports Server (NTRS)

Au, George; Locke, Laura

2001-01-01

This viewgraph presentation makes several recommendations to ensure the safe and effective design of Lithium ion cell batteries. Large lithium ion cells require pressure switches and small cells require pressure disconnects and other safety devices with the ability to instantly interrupt flow. Other suggestions include specifications for batteries and battery chargers.

Design of capacity incentive and energy compensation for demand response programs

NASA Astrophysics Data System (ADS)

Liu, Zhoubin; Cui, Wenqi; Shen, Ran; Hu, Yishuang; Wu, Hui; Ye, Chengjin

2018-02-01

Variability and Uncertainties caused by renewable energy sources have called for large amount of balancing services. Demand side resources (DSRs) can be a good alternative of traditional generating units to provide balancing service. In the areas where the electricity market has not been fully established, e.g., China, DSRs can help balance the power system with incentive-based demand response programs. However, there is a lack of information about the interruption cost of consumers in these areas, making it hard to determine the rational amount of capacity incentive and energy compensation for the participants of demand response programs. This paper proposes an algorithm to calculate the amount of capacity incentive and energy compensation for demand response programs when there lacks the information about interruption cost. Available statistical information of interruption cost in referenced areas is selected as the referenced data. Interruption cost of the targeted area is converted from the referenced area by product per electricity consumption. On this basis, capacity incentive and energy compensation are obtained to minimize the payment to consumers. Moreover, the loss of consumers is guaranteed to be covered by the revenue they earned from load serving entities.

Microsurgical Performance After Sleep Interruption: A NeuroTouch Simulator Study.

PubMed

Micko, Alexander; Knopp, Karoline; Knosp, Engelbert; Wolfsberger, Stefan

2017-10-01

In times of the ubiquitous debate about doctors' working hour restrictions, it is still questionable if the physician's performance is impaired by high work load and long shifts. In this study, we evaluated the impact of sleep interruption on neurosurgical performance. Ten medical students and 10 neurosurgical residents were tested on the virtual-reality simulator NeuroTouch by performing an identical microsurgical task, well rested (baseline test), and after sleep interruption at night (stress test). Deviation of total score, timing, and excessive force on tissue were evaluated. In addition, vital parameters and self-assessment were analyzed. After sleep interruption, total performance score increased significantly (45.1 vs. 48.7, baseline vs. stress test, P = 0.048) while timing remained stable (10.1 vs. 10.4 minutes for baseline vs. stress test, P > 0.05) for both students and residents. Excessive force decreased in both groups during the stress test for the nondominant hand (P = 0.05). For the dominant hand, an increase of excessive force was encountered in the group of residents (P = 0.05). In contrast to their results, participants of both groups assessed their performance worse during the stress test. In our study, we found an increase of neurosurgical simulator performance in neurosurgical residents and medical students under simulated night shift conditions. Further, microsurgical dexterity remained unchanged. Based on our results and the data in the available literature, we cannot confirm that working hour restrictions will have a positive effect on neurosurgical performance. Copyright © 2017 Elsevier Inc. All rights reserved.

14 CFR 33.28 - Engine control systems.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Applicability. These requirements are applicable to any system or device that is part of engine type design...) Aircraft-supplied data. Single failures leading to loss, interruption or corruption of aircraft-supplied...

14 CFR 33.28 - Engine control systems.

Code of Federal Regulations, 2012 CFR

2012-01-01

...) Applicability. These requirements are applicable to any system or device that is part of engine type design...) Aircraft-supplied data. Single failures leading to loss, interruption or corruption of aircraft-supplied...

14 CFR 33.28 - Engine control systems.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) Applicability. These requirements are applicable to any system or device that is part of engine type design...) Aircraft-supplied data. Single failures leading to loss, interruption or corruption of aircraft-supplied...

14 CFR 33.28 - Engine control systems.

Code of Federal Regulations, 2013 CFR

2013-01-01

...) Applicability. These requirements are applicable to any system or device that is part of engine type design...) Aircraft-supplied data. Single failures leading to loss, interruption or corruption of aircraft-supplied...

14 CFR 33.28 - Engine control systems.

Code of Federal Regulations, 2014 CFR

2014-01-01

...) Applicability. These requirements are applicable to any system or device that is part of engine type design...) Aircraft-supplied data. Single failures leading to loss, interruption or corruption of aircraft-supplied...

Photolytic interruptions of the bacteriorhodopsin photocycle examined by time-resolved resonance raman spectroscopy.

PubMed

Grieger, I; Atkinson, G H

1985-09-24

An investigation of the photolytic conditions used to initiate and spectroscopically monitor the bacteriorhodopsin (BR) photocycle utilizing time-resolved resonance Raman (TR3) spectroscopy has revealed and characterized two photoinduced reactions that interrupt the thermal pathway. One reaction involves the photolytic interconversion of M-412 and M', and the other involves the direct photolytic conversion of the BR-570/K-590 photostationary mixture either to M-412 and M' or to M-like intermediates within 10 ns. The photolytic threshold conditions describing both reactions have been quantitatively measured and are discussed in terms of experimental parameters.

Active hold-down for heat treating

NASA Technical Reports Server (NTRS)

Collins, E. R., Jr. (Inventor)

1986-01-01

The object of the disclosure is to provide a vacuum hold-down for holding thin sheets to a support surface, which permits the thin sheet to change dimensions as it is held down. The hold-down includes numerous holes in the support surface, through which a vacuum is applied from a vacuum source. The holes are arranged in zones. The vacuum is repeatedly interrupted at only one or a few zones, while it continues to be applied to other zones, to allow the workpiece to creep along that interrupted zone. The vacuum to different zones is interrupted at different times, as by a slowly turning valve number, to allow each zone of the workpiece to creep. A positive pressure may be applied from a pressured air source to a zone when the vacuum is interrupted there, to help lift the corresponding workpiece zone off the surface to aid in creeping. The workpiece may undergo dimensional changes because of heating, cooling, drying, or other procedure.

Improving timeliness for acute asthma care for paediatric ED patients using a nurse driven intervention: an interrupted time series analysis.

PubMed

Brown, Kathleen; Iqbal, Sabah; Sun, Su-Lin; Fritzeen, Jennifer; Chamberlain, James; Mullan, Paul C

2016-01-01

Asthma is the most common chronic paediatric disease treated in the emergency department (ED). Rapid corticosteroid administration is associated with improved outcomes, but our busy ED setting has made it challenging to achieve this goal. Our primary aim was to decrease the time to corticosteroid administration in a large, academic paediatric ED. We conducted an interrupted time series analysis for moderate to severe asthma exacerbations of one to 18 year old patients. A multidisciplinary team designed the intervention of a bedside nurse initiated administration of oral dexamethasone, to replace the prior system of a physician initiated order for oral prednisone. Our baseline and intervention periods were 12 month intervals. Our primary process measure was the time to corticosteroid administration. Other process measures included ED length of stay, admission rate, and rate of emesis. The balance measures included rate of return visits to the ED or clinic within five days, as well as the proportion of discharged patients who were admitted within five days. No special cause variation occurred in the baseline period. The mean time to corticosteroid administration decreased significantly, from 98 minutes in the baseline period to 59 minutes in the intervention period (p < 0.01), and showed special cause variation improvement within two months after the intervention using statistical process control methodology. We sustained the improvement and demonstrated a stable process. The intervention period had a significantly lower admission rate (p<0.01) and emesis rate (p<0.01), with no unforeseen harm to patients found with any of our balance measures. In summary, the introduction of a nurse initiated, standardized protocol for corticosteroid therapy for asthma exacerbations in a paediatric ED was associated with decreased time to corticosteroid administration, admission rates, and post-corticosteroid emesis.

Numerical modeling of high-voltage circuit breaker arcs and their interraction with the power system

NASA Astrophysics Data System (ADS)

Orama, Lionel R.

In this work the interaction between series connected gas and vacuum circuit breaker arcs has been studied. The breakdown phenomena in vacuum interrupters during the post arc current period have been of special interest. Numerical models of gas and vacuum arcs were developed in the form of black box models. Especially, the vacuum post arc model was implemented by combining the existing transition model with an ion density function and expressions for the breakdown mechanisms. The test series studied reflect that for electric fields on the order of 10sp7V/m over the anode, the breakdown of the vacuum gap can result from a combination of both thermal and electrical stresses. For a particular vacuum device, the vacuum model helps to find the interruption limits of the electric field and power density over the anode. The series connection of gas and vacuum interrupters always performs better than the single gas device. Moreover, to take advantage of the good characteristics of both devices, the time between the current zero crossing in each interrupter can be changed. This current zero synchronization is controlled by changing the capacitance in parallel to the gas device. This gas/vacuum interrupter is suitable for interruption of very stressful short circuits in which the product of the dI/dt before current zero and the dV/dt after current zero is very high. Also, a single SF6 interrupter can be replaced by an air circuit breaker of the same voltage rating in series with a vacuum device without compromising the good performance of the SF6 device. Conceptually, a series connected vacuum device can be used for high voltage applications with equal distribution of electrical stresses between the individual interrupters. The equalization can be made by a sequential opening of the individual contact pairs, beginning with the interruptors that are closer to ground potential. This could eliminate the use of grading capacitors.

Early limited antiretroviral therapy is superior to deferred therapy in HIV-infected South African infants: results from the CHER (Children with HIV Early antiRetroviral) Randomized Trial

PubMed Central

Cotton, Mark F; Violari, Avy; Otwombe, Kennedy; Panchia, Ravindre; Dobbels, Els; Rabie, Helena; Josipovic, Deirdre; Liberty, Afaff; Lazarus, Erica; Innes, Steve; van Rensburg, Anita Janse; Pelser, Wilma; Truter, Handre; Madhi, Shabir A; Handelsman, Edward; Jean-Philippe, Patrick; McIntyre, James A; Gibb, Diana M; Babiker, Abdel G

2014-01-01

Background Interim results from the CHER trial showed that early antiretroviral therapy (ART) was life-saving for HIV-infected infants. Given limited options and potential for toxicity with life-long ART, CHER compared early limited ART with deferred ART. Methods CHER was an open 3-arm trial in HIV-infected asymptomatic infants aged <12 weeks with CD4% ≥25%. Infants were randomized to deferred (ART-Def) or immediate ART for 40weeks (ART-40W) or 96weeks (ART-96W), followed by interruption. Criteria for ART initiation in ART-Def and re-initiation after interruption were CD4% <25% in infancy; otherwise <20% or CDC severe stage B or stage C disease. Lopinavir-ritonavir, zidovudine, lamivudine was the first-line regimen at ART initiation and re-initiation. The primary endpoint was time-to-failure of first-line ART (immunological/clinical/virological) or death. Comparisons were by intent-to-treat, using time-to-event methods. Findings 377 infants were enrolled: median age 7.4weeks; CD4% 35% and HIV RNA log 5.7copies/ml. Median follow-up was 4.8 years; 34 (9%) were lost-to-follow-up. Median time to ART initiation in ART-Def was 20 (IQR 16–25) weeks. Time to restarting ART after interruption was 33 (26–45) weeks in ART-40W and 70 (35–109) weeks in ART-96W; at trial end 19% and 32% respectively, remained off ART. Proportions of follow-up time spent on ART were 81%, 70% and 69% in ART-Def, ART-40W and ART-96W arms. 48/125(38%), 32/126(25%) and 26/126(21%) children reached the primary endpoint; hazard ratio (95%CI), relative to ART-Def, was 0.59(0.38-0.93, p=0.02) for ART-40W and 0.47(0.27-0.76, p=0.002) for ART-96W. Seven children (3 ART-Def, 3 ART-40W, 1 ART-96W) switched to second-line ART. Interpretation Early limited ART had superior clinical/immunological outcome with no evidence of excess disease progression during subsequent interruption and less overall ART exposure than deferred ART. Longer time on primary ART permits longer subsequent interruption with marginally better outcomes. PMID:24209829

Astronaut Andrew S. W. Thomas, mission specialist, interrupts a Spacehab task to pose for an

NASA Technical Reports Server (NTRS)

1996-01-01

STS-77 ESC VIEW --- Astronaut Andrew S. W. Thomas, mission specialist, interrupts a Spacehab task to pose for an Electronic Still Camera (ESC) snapshot inside the Spacehab Module onboard the Earth-orbiting Space Shuttle Endeavour. In upper left is the view port which crew members had used for viewing and photographing operations with the Spartan 207/Inflatable Antenna Experiment (IAE). Thomas has his hand on an aft-bulkhead-mounted locker. The Space Experiment Facility (SEF), designed and managed by the University of Alabama, is just behind his left shoulder.

AIDS Therapies.

ERIC Educational Resources Information Center

Yarchoan, Robert; And Others

1988-01-01

Reports on one drug which is already in clinical use and the possibility of designing others that interrupt specific phases of the life cycle of the virus. Uses a chart, pictures, and diagrams to accompany explanations. (RT)

Dendritic cell immunotherapy followed by cART interruption during HIV-1 infection induces plasma protein markers of cellular immunity and neutrophil recruitment.

PubMed

van den Ham, Henk-Jan; Cooper, Jason D; Tomasik, Jakub; Bahn, Sabine; Aerts, Joeri L; Osterhaus, Albert D M E; Gruters, Rob A; Andeweg, Arno C

2018-01-01

To characterize the host response to dendritic cell-based immunotherapy and subsequent combined antiretroviral therapy (cART) interruption in HIV-1-infected individuals at the plasma protein level. An autologous dendritic cell (DC) therapeutic vaccine was administered to HIV-infected individuals, stable on cART. The effect of vaccination was evaluated at the plasma protein level during the period preceding cART interruption, during analytical therapy interruption and at viral reactivation. Healthy controls and post-exposure prophylactically treated healthy individuals were included as controls. Plasma marker ('analyte') levels including cytokines, chemokines, growth factors, and hormones were measured in trial participants and control plasma samples using a multiplex immunoassay. Analyte levels were analysed using principle component analysis, cluster analysis and limma. Blood neutrophil counts were analysed using linear regression. Plasma analyte levels of HIV-infected individuals are markedly different from those of healthy controls and HIV-negative individuals receiving post-exposure prophylaxis. Viral reactivation following cART interruption also affects multiple analytes, but cART interruption itself only has only a minor effect. We find that Thyroxine-Binding Globulin (TBG) levels and late-stage neutrophil numbers correlate with the time off cART after DC vaccination. Furthermore, analysis shows that cART alters several regulators of blood glucose levels, including C-peptide, chromogranin-A and leptin. HIV reactivation is associated with the upregulation of CXCR3 ligands. Chronic HIV infection leads to a change in multiple plasma analyte levels, as does virus reactivation after cART interruption. Furthermore, we find evidence for the involvement of TBG and neutrophils in the response to DC-vaccination in the setting of HIV-infection.

Recovery after Work: The Role of Work Beliefs in the Unwinding Process

PubMed Central

Zoupanou, Zoe; Cropley, Mark; Rydstedt, Leif W.

2013-01-01

According to the Effort-Recovery model, mental or physical detachment from work is an important mechanism of work related recovery, as delayed recovery has been associated with range of negative health symptoms. In this paper, we examine whether recovery from work (in the form of mentally disengagement from work) is affected by the concept of ‘work ethic’, which refers to beliefs workers hold about their work and leisure and the effects of experiencing interruptions at work. Two indices of post-work recovery were utilized: problem solving pondering and psychological detachment. The study was conducted with 310 participants employed from diverse occupational sectors. Main effects of positive and negative appraisal of work interruption and beliefs were analysed using mediated and moderated regression analysis on problem-solving pondering and detachment. Weakened belief in wasted time as a partial mediator, reduced problem-solving pondering post work when interruptions were appraised as positive, and a high evaluation of leisure partially mediated problem-solving pondering when interruptions were appraised as positive. The results also showed that a high evaluation of centrality of work and leisure moderated the effect of negative appraisal of work interruption on elevated problem-solving pondering. Positive appraisal of work interruption was related to problem-solving pondering, and the strength of this association was further moderated by a strong belief in delay of gratification. In addition, employees' positive appraisal of work interruption was related to work detachment, and the strength of this association was further moderated by strong beliefs in hard work and self-reliance. These findings are discussed in terms of their theoretical and practical implications for employees who are strongly influenced by such work beliefs. PMID:24349060

Recovery after work: the role of work beliefs in the unwinding process.

PubMed

Zoupanou, Zoe; Cropley, Mark; Rydstedt, Leif W

2013-01-01

According to the Effort-Recovery model, mental or physical detachment from work is an important mechanism of work related recovery, as delayed recovery has been associated with range of negative health symptoms. In this paper, we examine whether recovery from work (in the form of mentally disengagement from work) is affected by the concept of 'work ethic', which refers to beliefs workers hold about their work and leisure and the effects of experiencing interruptions at work. Two indices of post-work recovery were utilized: problem solving pondering and psychological detachment. The study was conducted with 310 participants employed from diverse occupational sectors. Main effects of positive and negative appraisal of work interruption and beliefs were analysed using mediated and moderated regression analysis on problem-solving pondering and detachment. Weakened belief in wasted time as a partial mediator, reduced problem-solving pondering post work when interruptions were appraised as positive, and a high evaluation of leisure partially mediated problem-solving pondering when interruptions were appraised as positive. The results also showed that a high evaluation of centrality of work and leisure moderated the effect of negative appraisal of work interruption on elevated problem-solving pondering. Positive appraisal of work interruption was related to problem-solving pondering, and the strength of this association was further moderated by a strong belief in delay of gratification. In addition, employees' positive appraisal of work interruption was related to work detachment, and the strength of this association was further moderated by strong beliefs in hard work and self-reliance. These findings are discussed in terms of their theoretical and practical implications for employees who are strongly influenced by such work beliefs.

Trends in the utilization of dental outpatient services affected by the expansion of health care benefits in South Korea to include scaling: a 6-year interrupted time-series study

PubMed Central

2018-01-01

Purpose This study utilized a strong quasi-experimental design to test the hypothesis that the implementation of a policy to expand dental care services resulted in an increase in the usage of dental outpatient services. Methods A total of 45,650,000 subjects with diagnoses of gingivitis or advanced periodontitis who received dental scaling were selected and examined, utilizing National Health Insurance claims data from July 2010 through November 2015. We performed a segmented regression analysis of the interrupted time-series to analyze the time-series trend in dental costs before and after the policy implementation, and assessed immediate changes in dental costs. Results After the policy change was implemented, a statistically significant 18% increase occurred in the observed total dental cost per patient, after adjustment for age, sex, and residence area. In addition, the dental costs of outpatient gingivitis treatment increased immediately by almost 47%, compared with a 15% increase in treatment costs for advanced periodontitis outpatients. This policy effect appears to be sustainable. Conclusions The introduction of the new policy positively impacted the immediate and long-term outpatient utilization of dental scaling treatment in South Korea. While the policy was intended to entice patients to prevent periodontal disease, thus benefiting the insurance system, our results showed that the policy also increased treatment accessibility for potential periodontal disease patients and may improve long-term periodontal health in the South Korean population. PMID:29535886

Trends in the utilization of dental outpatient services affected by the expansion of health care benefits in South Korea to include scaling: a 6-year interrupted time-series study.

PubMed

Park, Hee-Jung; Lee, Jun Hyup; Park, Sujin; Kim, Tae-Il

2018-02-01

This study utilized a strong quasi-experimental design to test the hypothesis that the implementation of a policy to expand dental care services resulted in an increase in the usage of dental outpatient services. A total of 45,650,000 subjects with diagnoses of gingivitis or advanced periodontitis who received dental scaling were selected and examined, utilizing National Health Insurance claims data from July 2010 through November 2015. We performed a segmented regression analysis of the interrupted time-series to analyze the time-series trend in dental costs before and after the policy implementation, and assessed immediate changes in dental costs. After the policy change was implemented, a statistically significant 18% increase occurred in the observed total dental cost per patient, after adjustment for age, sex, and residence area. In addition, the dental costs of outpatient gingivitis treatment increased immediately by almost 47%, compared with a 15% increase in treatment costs for advanced periodontitis outpatients. This policy effect appears to be sustainable. The introduction of the new policy positively impacted the immediate and long-term outpatient utilization of dental scaling treatment in South Korea. While the policy was intended to entice patients to prevent periodontal disease, thus benefiting the insurance system, our results showed that the policy also increased treatment accessibility for potential periodontal disease patients and may improve long-term periodontal health in the South Korean population.

A socio-technical systems approach to studying interruptions: understanding the interrupter's perspective.

PubMed

Rivera, A Joy

2014-05-01

The purpose of this study was to understand the cognitive processes underlying nurses' decision to interrupt other nurses. The Institute of Medicine (2000) reported that interruptions are likely contributors to medical errors. Unfortunately, the research to date has been quite homogenous, focusing only on the healthcare provider being interrupted, ignoring the true complexities of interruptions. This study took a socio-technical approach being the first to examine interruptions from the viewpoint of the interrupting nurse. Over 15 h of observations and 10 open-ended interviews with expert nurses in a Neuroscience Surgical Intensive Care Unit were conducted. It was found that nurses conduct a quick cost-benefit assessment to determine the interruptibility of other nurses and whether an interruption is value-added vs. non-value added. To complete the assessment, nurses consider several conditional factors related to the interruptee, the interrupter, and the nature of the interruption content, and different potential consequences of the interruption. Published by Elsevier Ltd.

A series on optimizing satellite systems. I - Restoring interruptions of communications sattelite service: Logistical and cost comparisons of mature and newly operational systems

NASA Astrophysics Data System (ADS)

Snow, Marcellus S.

1989-09-01

A mathematical model is presented of costs and operational factors involved in provision for service interruptions of both a mature and typically large incumbent satellite system and of a smaller, more recently operational system. The equation expresses the required launch frequency for the new system as a function of the launch spacing of the mature system; the time disparity between the inauguration of the two systems; and the rate of capacity depreciation. In addition, a technique is presented to compare the relative extent to which the discounted costs of the new system exceed those of the mature system in furnishing the same effective capacity in orbit, and thus the same service liability, at a given point in time. It is determined that a mature incumbent communications satellite system, having more capacity in orbit, will on balance have a lower probability of service interruption than a newer, smaller system.

Performance and Health Test Procedure for Grid Energy Storage Systems: Preprint

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

Baggu, Murali M; Smith, Kandler A; Friedl, Andrew

A test procedure to evaluate the performance and health of field installations of grid-connected battery energy storage systems (BESS) is described. Performance and health metrics captured in the procedures are: Round-trip efficiency, Standby losses, Response time/accuracy, and Useable Energy/ State of Charge at different discharge/charge rates over the system's lifetime. The procedures are divided into Reference Performance Tests, which require the system to be put in a test mode and are to be conducted in intervals, and Real-time Monitoring tests, which collect data during normal operation without interruption. The procedures can be applied on a wide array of BESS withmore » little modifications and can thus support BESS operators in the management of BESS field installations with minimal interruption and expenditures.can be applied on a wide array of BESS with little modifications and can thus support BESS operators in the management of BESS field installations with minimal interruption and expenditures.« less

Exploring the impact of an automated prescription-filling device on community pharmacy technician workflow.

PubMed

Walsh, Kristin E; Chui, Michelle Anne; Kieser, Mara A; Williams, Staci M; Sutter, Susan L; Sutter, John G

2011-01-01

To explore community pharmacy technician workflow change after implementation of an automated robotic prescription-filling device. At an independent community pharmacy in rural Mayville, WI, pharmacy technicians were observed before and 3 months after installation of an automated robotic prescription-filling device. The main outcome measures were sequences and timing of technician workflow steps, workflow interruptions, automation surprises, and workarounds. Of the 77 and 80 observations made before and 3 months after robot installation, respectively, 17 different workflow sequences were observed before installation and 38 after installation. Average prescription filling time was reduced by 40 seconds per prescription with use of the robot. Workflow interruptions per observation increased from 1.49 to 1.79 (P = 0.11), and workarounds increased from 10% to 36% after robot use. Although automated prescription-filling devices can increase efficiency, workflow interruptions and workarounds may negate that efficiency. Assessing changes in workflow and sequencing of tasks that may result from the use of automation can help uncover opportunities for workflow policy and procedure redesign.

Causal judgments about empirical information in an interrupted time series design.

PubMed

White, Peter A

2016-07-19

Empirical information available for causal judgment in everyday life tends to take the form of quasi-experimental designs, lacking control groups, more than the form of contingency information that is usually presented in experiments. Stimuli were presented in which values of an outcome variable for a single individual were recorded over six time periods, and an intervention was introduced between the fifth and sixth time periods. Participants judged whether and how much the intervention affected the outcome. With numerical stimulus information, judgments were higher for a pre-intervention profile in which all values were the same than for pre-intervention profiles with any other kind of trend. With graphical stimulus information, judgments were more sensitive to trends, tending to be higher when an increase after the intervention was preceded by a decreasing series than when it was preceded by an increasing series ending on the same value at the fifth time period. It is suggested that a feature-analytic model, in which the salience of different features of information varies between presentation formats, may provide the best prospect of explaining the results.

Building and Verifying a Predictive Model of Interruption Resumption

DTIC Science & Technology

2012-03-01

field, the vocal module speaks, the motor module moves the body, and the con- figural and manipulative modules perform spatial proces- sing [14]–[16...person cannot remember themselves. As described earlier, the model depends critically upon the basic properties of declarative memories. When a...success because the model’s ability to re- trieve an episodic code depends critically on the amount of time spent on the interruption. Also recall that

Reducing warfarin medication interactions: an interrupted time series evaluation.

PubMed

Feldstein, Adrianne C; Smith, David H; Perrin, Nancy; Yang, Xiuhai; Simon, Steven R; Krall, Michael; Sittig, Dean F; Ditmer, Diane; Platt, Richard; Soumerai, Stephen B

2006-05-08

Computerized decision support reduces medication errors in inpatients, but limited evidence supports its effectiveness in reducing the coprescribing of interacting medications, especially in the outpatient setting. The usefulness of academic detailing to enhance the effectiveness of medication interaction alerts also is uncertain. This study used an interrupted time series design. In a health maintenance organization with an electronic medical record, we evaluated the effectiveness of electronic medical record alerts and group academic detailing to reduce the coprescribing of warfarin and interacting medications. Participants were 239 primary care providers at 15 primary care clinics and 9910 patients taking warfarin. All 15 clinics received electronic medical record alerts for the coprescription of warfarin and 5 interacting medications: acetaminophen, nonsteroidal anti-inflammatory medications, fluconazole, metronidazole, and sulfamethoxazole. Seven clinics were randomly assigned to receive group academic detailing. The primary outcome, the interacting prescription rate (ie, the number of coprescriptions of warfarin-interacting medications per 10 000 warfarin users per month), was analyzed with segmented regression models, controlling for preintervention trends. At baseline, nearly a third of patients had an interacting prescription. Coinciding with the alerts, there was an immediate and continued reduction in the warfarin-interacting medication prescription rate (from 3294.0 to 2804.2), resulting in a 14.9% relative reduction (95% confidence interval, -19.5 to -10.2) at 12 months. Group academic detailing did not enhance alert effectiveness. This study, using a strong and quasi-experimental design in ambulatory care, found that medication interaction alerts modestly reduced the frequency of coprescribing of interacting medications. Additional efforts will be required to further reduce rates of inappropriate prescribing of warfarin with interacting drugs.

Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.

PubMed

Mann, Bikaramjit S; Barnieh, Lianne; Tang, Karen; Campbell, David J T; Clement, Fiona; Hemmelgarn, Brenda; Tonelli, Marcello; Lorenzetti, Diane; Manns, Braden J

2014-01-01

Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but the impact on health outcomes in these patients is unclear. To determine the association between drug insurance and patient cost sharing strategies on medication adherence, clinical and economic outcomes in those with chronic diseases (defined herein as diabetes, hypertension, hypercholesterolemia, coronary artery disease, and cerebrovascular disease). Studies were included if they examined various cost sharing strategies including copayments, coinsurance, fixed copayments, deductibles and maximum out-of-pocket expenditures. Value-based insurance design and reference based pricing studies were excluded. Two reviewers independently identified original intervention studies (randomized controlled trials, interrupted time series, and controlled before-after designs). MEDLINE, EMBASE, Cochrane Library, CINAHL, and relevant reference lists were searched until March 2013. Two reviewers independently assessed studies for inclusion, quality, and extracted data. Eleven studies, assessing the impact of seven policy changes, were included: 2 separate reports of one randomized controlled trial, 4 interrupted time series, and 5 controlled before-after studies. Outcomes included medication adherence, clinical events (myocardial infarction, stroke, death), quality of life, healthcare utilization, or cost. The heterogeneity among the studies precluded meta-analysis. Few studies reported the impact of cost sharing strategies on mortality, clinical and economic outcomes. The association between patient copayments and medication adherence varied across studies, ranging from no difference to significantly lower adherence, depending on the amount of the copayment. Lowering cost sharing in patients with chronic diseases may improve adherence, but the impact on clinical and economic outcomes is uncertain.

Evaluation of a clinical decision support tool for osteoporosis disease management: protocol for an interrupted time series design.

PubMed

Kastner, Monika; Sawka, Anna; Thorpe, Kevin; Chignel, Mark; Marquez, Christine; Newton, David; Straus, Sharon E

2011-07-22

Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines on assessing and managing osteoporosis are available, many patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions, a series of mixed-methods studies, and advice from experts in osteoporosis and human-factors engineering were used collectively to develop a multicomponent tool (targeted to family physicians and patients at risk for osteoporosis) that may support clinical decision making in osteoporosis disease management at the point of care. A three-phased approach will be used to evaluate the osteoporosis tool. In phase 1, the tool will be implemented in three family practices. It will involve ensuring optimal functioning of the tool while minimizing disruption to usual practice. In phase 2, the tool will be pilot tested in a quasi-experimental interrupted time series (ITS) design to determine if it can improve osteoporosis disease management at the point of care. Phase 3 will involve conducting a qualitative postintervention follow-up study to better understand participants' experiences and perceived utility of the tool and readiness to adopt the tool at the point of care. The osteoporosis tool has the potential to make several contributions to the development and evaluation of complex, chronic disease interventions, such as the inclusion of an implementation strategy prior to conducting an evaluation study. Anticipated benefits of the tool may be to increase awareness for patients about osteoporosis and its associated risks and provide an opportunity to discuss a management plan with their physician, which may all facilitate patient self-management.

Evaluation of a clinical decision support tool for osteoporosis disease management: protocol for an interrupted time series design

PubMed Central

2011-01-01

Background Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines on assessing and managing osteoporosis are available, many patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions, a series of mixed-methods studies, and advice from experts in osteoporosis and human-factors engineering were used collectively to develop a multicomponent tool (targeted to family physicians and patients at risk for osteoporosis) that may support clinical decision making in osteoporosis disease management at the point of care. Methods A three-phased approach will be used to evaluate the osteoporosis tool. In phase 1, the tool will be implemented in three family practices. It will involve ensuring optimal functioning of the tool while minimizing disruption to usual practice. In phase 2, the tool will be pilot tested in a quasi-experimental interrupted time series (ITS) design to determine if it can improve osteoporosis disease management at the point of care. Phase 3 will involve conducting a qualitative postintervention follow-up study to better understand participants' experiences and perceived utility of the tool and readiness to adopt the tool at the point of care. Discussion The osteoporosis tool has the potential to make several contributions to the development and evaluation of complex, chronic disease interventions, such as the inclusion of an implementation strategy prior to conducting an evaluation study. Anticipated benefits of the tool may be to increase awareness for patients about osteoporosis and its associated risks and provide an opportunity to discuss a management plan with their physician, which may all facilitate patient self-management. PMID:21781318

75 FR 6613 - Endangered and Threatened Wildlife and Plants; Listing with Designation of Critical Habitat for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-10

...-0104] [MO 92210-0-0009-B4] [RIN 1018-AU88] Endangered and Threatened Wildlife and Plants; Listing with Designation of Critical Habitat for the Georgia Pigtoe Mussel, Interrupted Rocksnail, and Rough Hornsnail AGENCY: Fish and Wildlife Service, Interior. ACTION: Proposed rule; reopening of comment period...

30 CFR 18.48 - Circuit-interrupting devices.

Code of Federal Regulations, 2011 CFR

2011-07-01

... two-pole switch of the “dead-man-control” type that must be held closed by hand and will open when hand pressure is released. (e) A machine designed to operate from both trolley wire and portable cable.... Such a switch shall be designed to prevent electrical connection to the machine frame when the cable is...

30 CFR 18.48 - Circuit-interrupting devices.

Code of Federal Regulations, 2013 CFR

2013-07-01

... two-pole switch of the “dead-man-control” type that must be held closed by hand and will open when hand pressure is released. (e) A machine designed to operate from both trolley wire and portable cable.... Such a switch shall be designed to prevent electrical connection to the machine frame when the cable is...

77 FR 16435 - Transmission Relay Loadability Reliability Standard

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-21

... are designed to read electrical measurements, such as current, voltage, and frequency, and can be set... an element of the system under its protection, it sends a signal to an interrupting device(s) (such... their relays according to one of thirteen specific settings (sub-parts R1.1 through R1.13) designed to...

40 CFR 86.146-96 - Fuel dispensing spitback procedure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... laboratory. (i) The fueling procedure consists of dispensing fuel through a nozzle, interrupted by a series... or methanol. The bag shall be designed and used so that liquid fuel does not spit back onto the... the orifice of the filler pipe. The bag must be designed to permit passage of the dispensing nozzle...

40 CFR 86.146-96 - Fuel dispensing spitback procedure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... laboratory. (i) The fueling procedure consists of dispensing fuel through a nozzle, interrupted by a series... or methanol. The bag shall be designed and used so that liquid fuel does not spit back onto the... the orifice of the filler pipe. The bag must be designed to permit passage of the dispensing nozzle...

40 CFR 86.1246-96 - Fuel dispensing spitback procedure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... laboratory. (i) The fueling procedure consists of dispensing fuel through a nozzle, interrupted by a series... or methanol. The bag shall be designed and used so that liquid fuel does not spit back onto the... the orifice of the filler pipe. The bag must be designed to permit passage of the dispensing nozzle...

40 CFR 86.1246-96 - Fuel dispensing spitback procedure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... laboratory. (i) The fueling procedure consists of dispensing fuel through a nozzle, interrupted by a series... or methanol. The bag shall be designed and used so that liquid fuel does not spit back onto the... the orifice of the filler pipe. The bag must be designed to permit passage of the dispensing nozzle...

The hidden effect of hearing acuity on speech recall, and compensatory effects of self-paced listening

PubMed Central

Piquado, Tepring; Benichov, Jonathan I.; Brownell, Hiram; Wingfield, Arthur

2013-01-01

Objective The purpose of this research was to determine whether negative effects of hearing loss on recall accuracy for spoken narratives can be mitigated by allowing listeners to control the rate of speech input. Design Paragraph-length narratives were presented for recall under two listening conditions in a within-participants design: presentation without interruption (continuous) at an average speech-rate of 150 words per minute; and presentation interrupted at periodic intervals at which participants were allowed to pause before initiating the next segment (self-paced). Study sample Participants were 24 adults ranging from 21 to 33 years of age. Half had age-normal hearing acuity and half had mild-to-moderate hearing loss. The two groups were comparable for age, years of formal education, and vocabulary. Results When narrative passages were presented continuously, without interruption, participants with hearing loss recalled significantly fewer story elements, both main ideas and narrative details, than those with age-normal hearing. The recall difference was eliminated when the two groups were allowed to self-pace the speech input. Conclusion Results support the hypothesis that the listening effort associated with reduced hearing acuity can slow processing operations and increase demands on working memory, with consequent negative effects on accuracy of narrative recall. PMID:22731919

Technological aspects of hospital communication challenges: an observational study.

PubMed

Popovici, Ilinca; Morita, Plinio P; Doran, Diane; Lapinsky, Stephen; Morra, Dante; Shier, Ashleigh; Wu, Robert; Cafazzo, Joseph A

2015-06-01

To gain insights into how technological communication tools impact effective communication among clinicians, which is critical for patient safety. This multi-site observational study analyzes inter-clinician communication and interaction with information technology, with a focus on the critical process of patient transfer from the Emergency Department to General Internal Medicine. Mount Sinai Hospital, Sunnybrook Health Sciences Centre and Toronto General Hospital. At least five ED and general internal medicine nurses and physicians directly involved in patient transfers were observed on separate occasions at each institution. N/A. N/A. The study provides insight into clinician workflow, evaluates current hospital communication systems and identifies key issues affecting communication: interruptions, issues with numeric pagers, lack of integrated communication tools, lack of awareness of consultation status, inefficiencies related to the paper chart, unintuitive user interfaces, mixed use of electronic and paper systems and lack of up-to-date contact information. It also identifies design trade-offs to be negotiated: synchronous communication vs. reducing interruptions, notification of patient status vs. reducing interruptions and speed vs. quality of handovers. The issues listed should be considered in the design of new technology for hospital communications. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Tidal disruption of stars in a supermassive black hole binary system: the influence of orbital properties on fallback and accretion rates

NASA Astrophysics Data System (ADS)

Vigneron, Quentin; Lodato, Giuseppe; Guidarelli, Alessio

2018-06-01

The disruption of a star by a supermassive black hole generates a sudden bright flare. Previous studies have focused on the disruption by single black holes, for which the fallback rate decays as ∝ t-5/3. In this paper, we generalize the study to the case of a supermassive black hole binary (SMBHB), using both analytical estimates and hydrodynamical simulations, looking for specific observable signatures. The range of binary separation for which it is possible to distinguish between the disruption created by a single or a binary black hole concerns typically separations of the order of a few milliparsecs for a primary of mass ˜106 M⊙. When the fallback rate is affected by the secondary, it undergoes two types interruptions, depending on the initial inclination θ of the orbit of the star relative to the plane of the SMBHB. For θ ≲ 70°, periodic sharp interruptions occur and the time of first interruption depends on the distance of the secondary black hole with the debris. If θ ≳ 70°, a first smooth interruption occurs, but not always followed by a further recovery of the fallback rate. This implies that most of the TDEs around a SMBHB will undergo periodic sharp interruptions of their light curve.

The Effect of a Clinical Decision Support System on Improving Adherence to Guideline in the Treatment of Atrial Fibrillation: An Interrupted Time Series Study.

PubMed

Sheibani, Reza; Sheibani, Mehdi; Heidari-Bakavoli, Alireza; Abu-Hanna, Ameen; Eslami, Saeid

2017-12-23

To evaluate the effect of a computerized Decision Support System (CDSS) on improving adherence to an anticoagulation guideline for the treatment of atrial fibrillation (AF). This study had an interrupted time series design. The adherence to the guideline was assessed at fortnightly (two weeks) intervals from January 2016 to January 2017, 6 months before and 6 months after intervention. Newly diagnosed patients with AF were included in the offices of ten cardiologists. Stroke and major bleeding risks were calculated by the CDSS which was implemented via a mobile application. Treatment recommendations based on the guideline were shown to cardiologists. The segmented regression model was used to evaluate the effect of CDSS on level and trend of guideline adherence for the treatment of AF. In our analysis, 373 patients were included. The trend of adherence to the anticoagulation guideline for the treatment of AF was stable in the pre-intervention phase. After the CDSS intervention, mean of the adherence to the guideline significantly increased from 48% to 65.5% (P-value < 0.0001). The trend of adherence to the guideline was stable in the post-intervention phase. Our results showed that the CDSS can improve adherence to the anticoagulation guideline for the treatment of AF. Registration ID: IRCT2016052528070N1.

Can the publication of guidelines change the management of early rheumatoid arthritis? An interrupted time series analysis from the United Kingdom.

PubMed

Judge, Andrew; Wallace, Gemma; Prieto-Alhambra, Dani; Arden, Nigel K; Edwards, Christopher J

2015-12-01

To assess whether publication of national treatment guidelines improved the management of early RA in the UK. Incident diagnoses of RA in persons aged over 18 years from 1995 to 2010 were identified from the Clinical Practice Research Datalink. Using a natural experimental study design, interrupted time series analysis was used to assess whether trends in the proportion of patients receiving DMARDs, within 3 and 12 months of diagnosis, changed following publication of British Society for Rheumatology guidelines in 2006. Between 1995 and 2010, 11 772 incident cases of RA were identified. There was a progressive increase in the proportion of patients prescribed any DMARD within 12 months from 43.3% in 1995 to 78.5% in 2010. After publication of the British Society for Rheumatology guidelines, the proportion of patients prescribed any DMARD within 12 months increased by 4.2% (P = 0.053). Prior to the guidance, prescribing was increasing by 1.64% per year, compared with 3.55% per year after publication (P < 0.001). Guidelines published by a national body can improve the proportion of patients receiving DMARD treatment in the first year after diagnosis of RA. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study.

PubMed

Abegaz, Teferi; Berhane, Yemane; Worku, Alemayehu; Assrat, Abebe

2014-05-31

In recent years, there has been an increasing interest in implementing road safety policy by different low income countries. However; the evidence is scarce on its success in the reduction of crashes, injuries and deaths. This study was conducted to assess whether road crashes, injuries and fatalities was reduced following the road safety regulation introduced as of September 2007 by Oromia Regional State Transport Bureau. Routine road traffic accident data for the year 2002-2011were collected from sixteen traffic police offices. Data on average daily vehicle flow was obtained from the Ethiopian Road Authority. Interrupted time series design using segmented linear regression model was applied to estimate the effect of an improved road safety policy. A total of 4,053 crashes occurred on Addis Ababa - Adama/Hawassa main road. Of these crashes, almost half 46.4% (1,880) were property damage, 29.4% (1,193) were fatal and 24.2% (980) injury crashes, resulting 1,392 fatalities and 1,749 injuries. There were statistically significant reductions in non-injury crashes and deaths. Non-injury crash was reduced by 19% and fatality by 12.4% in the first year of implementing the revised transport safety regulation. Although revised road safety policy helped in reducing motor vehicle crashes and associated fatalities, the overall incidence rate is still very high. Further action is required to avoid unnecessary loss of lives.

Effects of unplanned treatment interruptions on HIV treatment failure - results from TAHOD.

PubMed

Jiamsakul, Awachana; Kerr, Stephen J; Ng, Oon Tek; Lee, Man Po; Chaiwarith, Romanee; Yunihastuti, Evy; Van Nguyen, Kinh; Pham, Thuy Thanh; Kiertiburanakul, Sasisopin; Ditangco, Rossana; Saphonn, Vonthanak; Sim, Benedict L H; Merati, Tuti Parwati; Wong, Wingwai; Kantipong, Pacharee; Zhang, Fujie; Choi, Jun Yong; Pujari, Sanjay; Kamarulzaman, Adeeba; Oka, Shinichi; Mustafa, Mahiran; Ratanasuwan, Winai; Petersen, Boondarika; Law, Matthew; Kumarasamy, Nagalingeswaran

2016-05-01

Treatment interruptions (TIs) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia. Patients initiating cART between 2006 and 2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Covariables with P < 0.10 in univariable analyses were included in multivariable analyses, where P < 0.05 was considered statistically significant. Of 4549 patients from 13 countries in Asia, 3176 (69.8%) were male and the median age was 34 years. A total of 111 (2.4%) had TIs due to AEs and 135 (3.0%) had TIs for other reasons. Median interruption times were 22 days for AE and 148 days for non-AE TIs. In multivariable analyses, interruptions >30 days were associated with failure (31-180 days HR = 2.66, 95%CI (1.70-4.16); 181-365 days HR = 6.22, 95%CI (3.26-11.86); and >365 days HR = 9.10, 95% CI (4.27-19.38), all P < 0.001, compared to 0-14 days). Reasons for previous TI were not statistically significant (P = 0.158). Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption. © 2016 John Wiley & Sons Ltd.

Effects of unplanned treatment interruptions on HIV treatment failure– results from TAHOD

PubMed Central

Jiamsakul, Awachana; Kerr, Stephen J.; Ng, Oon Tek; Lee, Man Po; Chaiwarith, Romanee; Yunihastuti, Evy; Van Nguyen, Kinh; Pham, Thuy Thanh; Kiertiburanakul, Sasisopin; Ditangco, Rossana; Saphonn, Vonthanak; Sim, Benedict L. H.; Merati, Tuti Parwati; Wong, Wingwai; Kantipong, Pacharee; Zhang, Fujie; Choi, Jun Yong; Pujari, Sanjay; Kamarulzaman, Adeeba; Oka, Shinichi; Mustafa, Mahiran; Ratanasuwan, Winai; Petersen, Boondarika; Law, Matthew; Kumarasamy, Nagalingeswaran

2016-01-01

Objectives Treatment interruptions (TI) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia. Methods Patients initiating cART between 2006-2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Co-variables with p<0.10 in univariable analyses were included in multivariable analyses, where p<0.05 was considered statistically significant. Results Of 4549 patients from 13 countries in Asia, 3176 (69.8%) were male and the median age was 34 years. A total of 111 (2.4%) had TIs due to AEs and 135 (3.0%) had TIs for other reasons. Median interruption times were 22 days for AE and 148 days for non-AE TIs. In multivariable analyses, interruptions >30 days were associated with failure (31-180 days HR=2.66, 95%CI (1.70-4.16); 181-365 days HR=6.22, 95%CI (3.26-11.86); and >365 days HR=9.10, 95% CI (4.27-19.38), all p<0.001, compared to 0-14 days). Reasons for previous TI were not statistically significant (p=0.158). Conclusions Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption. PMID:26950901

Innovating patient care delivery: DSRIP's interrupted time series analysis paradigm.

PubMed

Shenoy, Amrita G; Begley, Charles E; Revere, Lee; Linder, Stephen H; Daiger, Stephen P

2017-12-08

Adoption of Medicaid Section 1115 waiver is one of the many ways of innovating healthcare delivery system. The Delivery System Reform Incentive Payment (DSRIP) pool, one of the two funding pools of the waiver has four categories viz. infrastructure development, program innovation and redesign, quality improvement reporting and lastly, bringing about population health improvement. A metric of the fourth category, preventable hospitalization (PH) rate was analyzed in the context of eight conditions for two time periods, pre-reporting years (2010-2012) and post-reporting years (2013-2015) for two hospital cohorts, DSRIP participating and non-participating hospitals. The study explains how DSRIP impacted Preventable Hospitalization (PH) rates of eight conditions for both hospital cohorts within two time periods. Eight PH rates were regressed as the dependent variable with time, intervention and post-DSRIP Intervention as independent variables. PH rates of eight conditions were then consolidated into one rate for regressing with the above independent variables to evaluate overall impact of DSRIP. An interrupted time series regression was performed after accounting for auto-correlation, stationarity and seasonality in the dataset. In the individual regression model, PH rates showed statistically significant coefficients for seven out of eight conditions in DSRIP participating hospitals. In the combined regression model, the coefficient of the PH rate showed a statistically significant decrease with negative p-values for regression coefficients in DSRIP participating hospitals compared to positive/increased p-values for regression coefficients in DSRIP non-participating hospitals. Several macro- and micro-level factors may have likely contributed DSRIP hospitals outperforming DSRIP non-participating hospitals. Healthcare organization/provider collaboration, support from healthcare professionals, DSRIP's design, state reimbursement and coordination in care delivery methods may have led to likely success of DSRIP. IV, a retrospective cohort study based on longitudinal data. Copyright © 2017 Elsevier Inc. All rights reserved.

Scottish Keep Well health check programme: an interrupted time series analysis.

PubMed

Geue, Claudia; Lewsey, James D; MacKay, Daniel F; Antony, Grace; Fischbacher, Colin M; Muirie, Jill; McCartney, Gerard

2016-09-01

Effective interventions are available to reduce cardiovascular risk. Recently, health check programmes have been implemented to target those at high risk of cardiovascular disease (CVD), but there is much debate whether these are likely to be effective at population level. This paper evaluates the impact of wave 1 of Keep Well, a Scottish health check programme, on cardiovascular outcomes. Interrupted time series analyses were employed, comparing trends in outcomes in participating and non-participating practices before and after the introduction of health checks. Health outcomes are defined as CVD mortality, incident hospitalisations and prescribing of cardiovascular drugs. After accounting for secular trends and seasonal variation, coronary heart disease mortality and hospitalisations changed by 0.4% (95% CI -5.2% to 6.3%) and -1.1% (-3.4% to 1.3%) in Keep Well practices and by -0.3% (-2.7% to 2.2%) and -0.1% (-1.8% to 1.7%) in non-Keep Well practices, respectively, following the intervention. Adjusted changes in prescribing in Keep Well and non-Keep Well practices were 0.4% (-10.4% to 12.5%) and -1.5% (-9.4% to 7.2%) for statins; -2.5% (-12.3% to 8.4%) and -1.6% (-7.1% to 4.3%) for antihypertensive drugs; and -0.9% (-6.5% to 5.0%) and -2.4% (-10.1% to 6.0%) for antiplatelet drugs. Any impact of the Keep Well health check intervention on CVD outcomes and prescribing in Scotland was very small. Findings do not support the use of the screening approach used by current health check programmes to address CVD. We used an interrupted time series method, but evaluation methods based on randomisation are feasible and preferable and would have allowed more reliable conclusions. These should be considered more often by policymakers at an early stage in programme design when there is uncertainty regarding programme effectiveness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Medication safety initiative in reducing medication errors.

PubMed

Nguyen, Elisa E; Connolly, Phyllis M; Wong, Vivian

2010-01-01

The purpose of the study was to evaluate whether a Medication Pass Time Out initiative was effective and sustainable in reducing medication administration errors. A retrospective descriptive method was used for this research, where a structured Medication Pass Time Out program was implemented following staff and physician education. As a result, the rate of interruptions during the medication administration process decreased from 81% to 0. From the observations at baseline, 6 months, and 1 year after implementation, the percent of doses of medication administered without interruption improved from 81% to 99%. Medication doses administered without errors at baseline, 6 months, and 1 year improved from 98% to 100%.

Improving the effectiveness of an interruption lag by inducing a memory-based strategy.

PubMed

Morgan, Phillip L; Patrick, John; Tiley, Leyanne

2013-01-01

The memory for goals model (Altmann & Trafton, 2002) posits the importance of a short delay (the 'interruption lag') before an interrupting task to encode suspended goals for retrieval post-interruption. Two experiments used the theory of soft constraints (Gray, Simms, Fu & Schoelles, 2006) to investigate whether the efficacy of an interruption lag could be improved by increasing goal-state access cost to induce a more memory-based encoding strategy. Both experiments used a copying task with three access cost conditions (Low, Medium, and High) and a 5-s interruption lag with a no lag control condition. Experiment 1 found that the participants in the High access cost condition resumed more interrupted trials and executed more actions correctly from memory when coupled with an interruption lag. Experiment 2 used a prospective memory test post-interruption and an eyetracker recorded gaze activity during the interruption lag. The participants in the High access cost condition with an interruption lag were best at encoding target information during the interruption lag, evidenced by higher scores on the prospective memory measure and more gaze activity on the goal-state during the interruption lag. Theoretical and practical issues regarding the use of goal-state access cost and an interruption lag are discussed. Copyright © 2012. Published by Elsevier B.V.

The effects of morphine on fixed-interval patterning and temporal discrimination.

PubMed Central

Odum, A L; Schaal, D W

2000-01-01

Changes produced by drugs in response patterns under fixed-interval schedules of reinforcement have been interpreted to result from changes in temporal discrimination. To examine this possibility, this experiment determined the effects of morphine on the response patterning of 4 pigeons during a fixed-interval 1-min schedule of food delivery with interpolated temporal discrimination trials. Twenty of the 50 total intervals were interrupted by choice trials. Pecks to one key color produced food if the interval was interrupted after a short time (after 2 or 4.64 s). Pecks to another key color produced food if the interval was interrupted after a long time (after 24.99 or 58 s). Morphine (1.0 to 10.0 mg/kg) decreased the index of curvature (a measure of response patterning) during fixed intervals and accuracy during temporal discrimination trials. Accuracy was equally disrupted following short and long sample durations. Although morphine disrupted temporal discrimination in the context of a fixed-interval schedule, these effects are inconsistent with interpretations of the disruption of response patterning as a selective overestimation of elapsed time. The effects of morphine may be related to the effects of more conventional external stimuli on response patterning. PMID:11029024

Evaluation of delivery of enteral nutrition in mechanically ventilated Malaysian ICU patients.

PubMed

Yip, Keng F; Rai, Vineya; Wong, Kang K

2014-01-01

There are numerous challenges in providing nutrition to the mechanically ventilated critically ill ICU patient. Understanding the level of nutritional support and the barriers to enteral feeding interruption in mechanically ventilated patients are important to maximise the nutritional benefits to the critically ill patients. Thus, this study aims to evaluate enteral nutrition delivery and identify the reasons for interruptions in mechanically ventilated Malaysian patients receiving enteral feeding. A cross sectional prospective study of 77 consecutive patients who required mechanical ventilation and were receiving enteral nutrition was done in an open 14-bed intensive care unit of a tertiary hospital. Data were collected prospectively over a 3 month period. Descriptive statistical analysis were made with respect to demographical data, time taken to initiate feeds, type of feeds, quantification of feeds attainment, and reasons for feed interruptions. There are no set feeding protocols in the ICU. The usual initial rate of enteral nutrition observed in ICU was 20 ml/hour, assessed every 6 hours and the decision was made thereafter to increase feeds. The target calorie for each patient was determined by the clinician alongside the dietitian. The use of prokinetic agents was also prescribed at the discretion of the attending clinician and is commonly IV metoclopramide 10 mg three times a day. About 66% of patients achieved 80% of caloric requirements within 3 days of which 46.8% achieved full feeds in less than 12 hours. The time to initiate feeds for patients admitted into the ICU ranged from 0 - 110 hours with a median time to start feeds of 15 hours and the interquartile range (IQR) of 6-59 hours. The mean time to achieve at least 80% of nutritional target was 1.8 days ± 1.5 days. About 79% of patients experienced multiple feeding interruptions. The most prevalent reason for interruption was for procedures (45.1%) followed by high gastric residual volume (38.0%), diarrhoea (8.4%), difficulty in nasogastric tube placement (5.6%) and vomiting (2.9%). Nutritional inadequacy in mechanically ventilated Malaysian patients receiving enteral nutrition was not as common as expected. However, there is still room for improvement with regards to decreasing the number of patients who did not achieve their caloric requirement throughout their stay in the ICU.

What do ICU doctors do? A multisite time and motion study of the clinical work patterns of registrars.

PubMed

Li, Ling; Hains, Isla; Hordern, Toni; Milliss, David; Raper, Ray; Westbrook, Johanna

2015-09-01

To quantify the time that intensive care unit registrars spend on different work tasks with other health professionals and patients and using information resources, and to compare them with those of clinicians in general wards and the emergency department (ED). A prospective, observational time-and-motion study of two ICUs with a total of 71 beds at two major teaching hospitals in Sydney. Twenty-six registrars were observed between 08:00 and 18:00 on weekdays for a total of 160.52 hours. Proportions of time spent on different tasks, using specific information resources, working with other health professionals and patients, and rates of multitasking and interruptions. A total of 12 043 distinct tasks were observed. Registrars spent 69.2% of time working at patients' bedsides, 49.6% in professional communication and 39.0% accessing information resources. Half of their time (53.8%) was spent with other ICU doctors and 29.2% with nurses. Compared with doctors and nurses on general wards, and doctors in the ED, ICU registrars were more likely to multitask (40.1 times/hour [24.4% of their time]). ICU registrars had a higher interruption rate than ward clinicians, (4.2 times/hour), but a lower rate than ED doctors. Face-to-face communication and information seeking consume a vast proportion of ICU registrars' time. Multitasking and handling frequent interruptions characterise their work, and such behaviours may create an increased risk of task errors. Electronic clinical information systems may be particularly beneficial in this information-rich environment.

Investigating Interruptions: Implications for Flightdeck Performance

NASA Technical Reports Server (NTRS)

Latorella, Kara A.

1999-01-01

A fundamental aspect of multiple task management is attending to new stimuli and integrating associated task requirements into an ongoing task set; this is "interruption management" (IM). Anecdotal evidence and field studies indicate the frequency and consequences of interruptions, however experimental investigations of mechanisms influencing IM are scarce. Interruptions on commercial flightdecks are numerous, of various forms, and have been cited as contributing factors in many aviation incident and accident reports. This research grounds an experimental investigation of flightdeck interruptions in a proposed IM stage model. This model organizes basic research, identifies influencing mechanisms, and suggests appropriate dependent measures for IM. Fourteen airline pilots participated in a flightdeck simulation experiment to investigate the general effects of performing an interrupting task and interrupted procedure, and the effects of specific task factors: (1) modality; (2) embeddedness, or goal-level, of an interruption; (3) strength of association, or coupling-strength, between interrupted tasks; (4) semantic similarity; and (5) environmental stress. General effects of interruptions were extremely robust. All individual task factors significantly affected interruption management, except "similarity." Results extend the Interruption Management model, and are interpreted for their implications for interrupted flightdeck performance and intervention strategies for mitigating their effects on the flightdeck.

Interrupting behaviour: Minimizing decision costs via temporal commitment and low-level interrupts.

PubMed

Lloyd, Kevin; Dayan, Peter

2018-01-01

Ideal decision-makers should constantly assess all sources of information about opportunities and threats, and be able to redetermine their choices promptly in the face of change. However, perpetual monitoring and reassessment impose inordinate sensing and computational costs, making them impractical for animals and machines alike. The obvious alternative of committing for extended periods of time to limited sensory strategies associated with particular courses of action can be dangerous and wasteful. Here, we explore the intermediate possibility of making provisional temporal commitments whilst admitting interruption based on limited broader observation. We simulate foraging under threat of predation to elucidate the benefits of such a scheme. We relate our results to diseases of distractibility and roving attention, and consider mechanistic substrates such as noradrenergic neuromodulation.

Phased array ghost elimination (PAGE) for segmented SSFP imaging with interrupted steady-state.

PubMed

Kellman, Peter; Guttman, Michael A; Herzka, Daniel A; McVeigh, Elliot R

2002-12-01

Steady-state free precession (SSFP) has recently proven to be valuable for cardiac imaging due to its high signal-to-noise ratio and blood-myocardium contrast. Data acquired using ECG-triggered, segmented sequences during the approach to steady-state, or return to steady-state after interruption, may have ghost artifacts due to periodic k-space distortion. Schemes involving several preparatory RF pulses have been proposed to restore steady-state, but these consume imaging time during early systole. Alternatively, the phased-array ghost elimination (PAGE) method may be used to remove ghost artifacts from the first several frames. PAGE was demonstrated for cardiac cine SSFP imaging with interrupted steady-state using a simple alpha/2 magnetization preparation and storage scheme and a spatial tagging preparation.

Interrupting behaviour: Minimizing decision costs via temporal commitment and low-level interrupts

PubMed Central

Dayan, Peter

2018-01-01

Ideal decision-makers should constantly assess all sources of information about opportunities and threats, and be able to redetermine their choices promptly in the face of change. However, perpetual monitoring and reassessment impose inordinate sensing and computational costs, making them impractical for animals and machines alike. The obvious alternative of committing for extended periods of time to limited sensory strategies associated with particular courses of action can be dangerous and wasteful. Here, we explore the intermediate possibility of making provisional temporal commitments whilst admitting interruption based on limited broader observation. We simulate foraging under threat of predation to elucidate the benefits of such a scheme. We relate our results to diseases of distractibility and roving attention, and consider mechanistic substrates such as noradrenergic neuromodulation. PMID:29338004

Changing use of surgical antibiotic prophylaxis in Thika Hospital, Kenya: a quality improvement intervention with an interrupted time series design.

PubMed

Aiken, Alexander M; Wanyoro, Anthony K; Mwangi, Jonah; Juma, Francis; Mugoya, Isaac K; Scott, J Anthony G

2013-01-01

In low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution.

Changing Use of Surgical Antibiotic Prophylaxis in Thika Hospital, Kenya: A Quality Improvement Intervention with an Interrupted Time Series Design

PubMed Central

Aiken, Alexander M.; Wanyoro, Anthony K.; Mwangi, Jonah; Juma, Francis; Mugoya, Isaac K.; Scott, J. Anthony G

2013-01-01

Introduction In low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. Methods We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. Results From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. Conclusion Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution. PMID:24244390

A Perioperative Systems Design to Improve Intraoperative Glucose Monitoring Is Associated with a Reduction in Surgical Site Infections in a Diabetic Patient Population.

PubMed

Ehrenfeld, Jesse M; Wanderer, Jonathan P; Terekhov, Maxim; Rothman, Brian S; Sandberg, Warren S

2017-03-01

Diabetic patients receiving insulin should have periodic intraoperative glucose measurement. The authors conducted a care redesign effort to improve intraoperative glucose monitoring. With approval from Vanderbilt University Human Research Protection Program (Nashville, Tennessee), the authors created an automatic system to identify diabetic patients, detect insulin administration, check for recent glucose measurement, and remind clinicians to check intraoperative glucose. Interrupted time series and propensity score matching were used to quantify pre- and postintervention impact on outcomes. Chi-square/likelihood ratio tests were used to compare surgical site infections at patient follow-up. The authors analyzed 15,895 cases (3,994 preintervention and 11,901 postintervention; similar patient characteristics between groups). Intraoperative glucose monitoring rose from 61.6 to 87.3% in cases after intervention (P = 0.0001). Recovery room entry hyperglycemia (fraction of initial postoperative glucose readings greater than 250) fell from 11.0 to 7.2% after intervention (P = 0.0019), while hypoglycemia (fraction of initial postoperative glucose readings less than 75) was unchanged (0.6 vs. 0.9%; P = 0.2155). Eighty-seven percent of patients had follow-up care. After intervention the unadjusted surgical site infection rate fell from 1.5 to 1.0% (P = 0.0061), a 55.4% relative risk reduction. Interrupted time series analysis confirmed a statistically significant surgical site infection rate reduction (P = 0.01). Propensity score matching to adjust for confounders generated a cohort of 7,604 well-matched patients and confirmed a statistically significant surgical site infection rate reduction (P = 0.02). Anesthesiologists add healthcare value by improving perioperative systems. The authors leveraged the one-time cost of programming to improve reliability of intraoperative glucose management and observed improved glucose monitoring, increased insulin administration, reduced recovery room hyperglycemia, and fewer surgical site infections. Their analysis is limited by its applied quasiexperimental design.

Evaluating RVUs as a measure of workload for use in assessing fatigue

NASA Astrophysics Data System (ADS)

Krupinski, Elizabeth A.; MacKinnon, Lea; Hasselbach, Karl; Taljanovic, Mihra

2015-03-01

Physician work is not well defined and does not take into account all of the activities and tasks involved in interpreting cases. We observed 3 MSK radiologists reading 100 cases. We recorded types of cases, whether residents/fellows were present, total time per case, time spent teaching, and time for interruptions. There were residents/fellows present for 65% of the cases. On average, when residents/fellows were present it took significantly longer to read a case. Overall, prior studies were accessed for 25% of the cases, with radiographs and CT accessing them more than MRI and US. Time per case was significantly longer when prior studies were included. In terms of interruptions, 9.24% of the time was taken up by calls to/from other clinicians, talking to technologists, discussing case protocols, and technical problems. All interruptions occurred during a case review. We downloaded RVU data for the 3 radiologists and correlated them with the actual times per case. The overall correlation was 0.215. For a given RVU, the actual amount of time spent on the case varies. Radiologists spend more time per case than assigned RVUs account for. This underestimation contributes to expectations of increased workloads, leading potentially to more and more cases being read in shorter amounts of time leading to increased fatigue and stress that could lead to increases in error rates. In order to better address fatigue and stress in the radiology department we need to better understand the pressures radiologists face and possibly reevaluate the RVU system.

Quasi-experimental study designs series-paper 6: risk of bias assessment.

PubMed

Waddington, Hugh; Aloe, Ariel M; Becker, Betsy Jane; Djimeu, Eric W; Hombrados, Jorge Garcia; Tugwell, Peter; Wells, George; Reeves, Barney

2017-09-01

Rigorous and transparent bias assessment is a core component of high-quality systematic reviews. We assess modifications to existing risk of bias approaches to incorporate rigorous quasi-experimental approaches with selection on unobservables. These are nonrandomized studies using design-based approaches to control for unobservable sources of confounding such as difference studies, instrumental variables, interrupted time series, natural experiments, and regression-discontinuity designs. We review existing risk of bias tools. Drawing on these tools, we present domains of bias and suggest directions for evaluation questions. The review suggests that existing risk of bias tools provide, to different degrees, incomplete transparent criteria to assess the validity of these designs. The paper then presents an approach to evaluating the internal validity of quasi-experiments with selection on unobservables. We conclude that tools for nonrandomized studies of interventions need to be further developed to incorporate evaluation questions for quasi-experiments with selection on unobservables. Copyright © 2017 Elsevier Inc. All rights reserved.

A Proposed Scalable Design and Simulation of Wireless Sensor Network-Based Long-Distance Water Pipeline Leakage Monitoring System

PubMed Central

Almazyad, Abdulaziz S.; Seddiq, Yasser M.; Alotaibi, Ahmed M.; Al-Nasheri, Ahmed Y.; BenSaleh, Mohammed S.; Obeid, Abdulfattah M.; Qasim, Syed Manzoor

2014-01-01

Anomalies such as leakage and bursts in water pipelines have severe consequences for the environment and the economy. To ensure the reliability of water pipelines, they must be monitored effectively. Wireless Sensor Networks (WSNs) have emerged as an effective technology for monitoring critical infrastructure such as water, oil and gas pipelines. In this paper, we present a scalable design and simulation of a water pipeline leakage monitoring system using Radio Frequency IDentification (RFID) and WSN technology. The proposed design targets long-distance aboveground water pipelines that have special considerations for maintenance, energy consumption and cost. The design is based on deploying a group of mobile wireless sensor nodes inside the pipeline and allowing them to work cooperatively according to a prescheduled order. Under this mechanism, only one node is active at a time, while the other nodes are sleeping. The node whose turn is next wakes up according to one of three wakeup techniques: location-based, time-based and interrupt-driven. In this paper, mathematical models are derived for each technique to estimate the corresponding energy consumption and memory size requirements. The proposed equations are analyzed and the results are validated using simulation. PMID:24561404

A proposed scalable design and simulation of wireless sensor network-based long-distance water pipeline leakage monitoring system.

PubMed

Almazyad, Abdulaziz S; Seddiq, Yasser M; Alotaibi, Ahmed M; Al-Nasheri, Ahmed Y; BenSaleh, Mohammed S; Obeid, Abdulfattah M; Qasim, Syed Manzoor

2014-02-20

Anomalies such as leakage and bursts in water pipelines have severe consequences for the environment and the economy. To ensure the reliability of water pipelines, they must be monitored effectively. Wireless Sensor Networks (WSNs) have emerged as an effective technology for monitoring critical infrastructure such as water, oil and gas pipelines. In this paper, we present a scalable design and simulation of a water pipeline leakage monitoring system using Radio Frequency IDentification (RFID) and WSN technology. The proposed design targets long-distance aboveground water pipelines that have special considerations for maintenance, energy consumption and cost. The design is based on deploying a group of mobile wireless sensor nodes inside the pipeline and allowing them to work cooperatively according to a prescheduled order. Under this mechanism, only one node is active at a time, while the other nodes are sleeping. The node whose turn is next wakes up according to one of three wakeup techniques: location-based, time-based and interrupt-driven. In this paper, mathematical models are derived for each technique to estimate the corresponding energy consumption and memory size requirements. The proposed equations are analyzed and the results are validated using simulation.

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

Larsen, Peter H.; LaCommare, Kristina H.; Eto, Joseph H.

Here, this study examines the relationship between annual changes in electricity reliability reported by a large cross-section of U.S. electricity distribution utilities over a period of 13 years and a broad set of potential explanatory variables, including weather and utility characteristics. We find statistically significant correlations between the average number of power interruptions experienced annually and above average wind speeds, precipitation, lightning strikes, and a measure of population density: customers per line mile. We also find significant relationships between the average number of minutes of power interruptions experienced and above average wind speeds, precipitation, cooling degree-days, and one strategy usedmore » to mitigate the impacts of severe weather: the amount of underground transmission and distribution line miles. Perhaps most importantly, we find a significant time trend of increasing annual average number of minutes of power interruptions over time—especially when interruptions associated with extreme weather are included. Lastly, the research method described in this analysis can provide a basis for future efforts to project long-term trends in reliability and the associated benefits of strategies to improve grid resiliency to severe weather—both in the U.S. and abroad.« less

Development of Electromagnetically Actuated Vacuum Circuit Breaker for 72kV Rated Switchgear

NASA Astrophysics Data System (ADS)

Kim, Tae-Hyun; Tsukima, Mitsuru; Maruyama, Akihiko; Takahara, Osamu; Haruna, Kazushi; Yano, Tomotaka; Matsunaga, Toshihiro; Imamura, Kazuaki; Arioka, Masahiro; Takeuchi, Toshie

A new electromagnetically actuated vacuum circuit breaker (VCB) has been developed for a 72kV rated switchgear. Each phase of this VCB has a plurality of compact electromagnetic actuators linked mechanically providing the required driving energy. The mechanical linkage working as a lever magnifies an actuator stroke to the required stroke of a 72kV rated vacuum interrupter. An electromagnetic analysis coupled with motion, which considers the mechanical linkage of the plural actuators, has been developed for designing the driving behavior of this VCB. Using this analytical method and a quality engineering method known as the Taguchi method, we have clarified effective parameters to reduce the time difference of the driving behavior for tolerance specifications. Moreover, analyzing the oscillatory behavior closing the contacts, a structure of this VCB has been designed to reduce the bounce duration. The developed new VCB has been confirmed that a time difference is short enough and bounce duration is reduced. This VCB is highly reliable against variations in manufacturing and environment.

Mechanical beam isolator for high-power laser systems

DOEpatents

Post, Richard F.; Vann, Charles S.

1998-01-01

A mechanical beam isolator uses rod-shaped elements having a Gaussian configuration to interrupt the path of a beam of photons or particles when the time-scale of the needed interruption is of the order of a microsecond or less. One or more of these rods is mounted transversely to, and penetrates through, a rotating shaft supported by bearings. Owing to the Gaussian geometry of the rods, they are able to withstand much higher rotation speeds, without tensile failure, than rods having any other geometrical shape.

Changes in second-line regimen durability and continuity of care in relation to national ART guideline changes in South Africa

PubMed Central

Onoya, Dorina; Brennan, Alana T; Berhanu, Rebecca; van der Berg, Liudmyla; Buthelezi, Thulasizwe; Fox, Matthew P

2016-01-01

Abstract Introduction: Little is known about the impact of antiretroviral therapy (ART) guideline changes on the durability of second-line ART and continuity of care. This study examines predictors of early drug substitutions and treatment interruptions using a cohort analysis of HIV positive adults switched to second-line ART between January 2004 and September 2013 in Johannesburg, South Africa. Methods: The main outcomes were having a drug substitution or treatment interruption in the first 24 months on second-line ART. Kaplan Meiers analyses and Cox proportional hazards regression were used to identify predictors of drug substitutions and treatment interruptions. Results: Of 3028 patients on second-line ART, 353 (11.7%) had a drug substitution (8.6 per 100PY, 95% CI: 7.8–9.6) and 260 (8.6%) had a treatment interruption (6.3 per 100PY, 95% CI: 5.6–7.1). While treatment interruptions decreased from 32.5 per 100PY for the 2004 cohort to 2.3 per 100PY for the 2013 cohort, the rates of drug substitutions steadily increased, peaking at an incidence of 26.7 per 100PY for the 2009 cohort and then decreased to 4.2 per 100PY in the 2011 cohort. Compared to the 2004 to 2008 cohorts, the hazard of early drug substitutions was highest among patients switched to AZT + ddI + LPVr in 2009 to 2010 (aHR 5.1, 95% CI: 3.4–7.1) but remained low over time among patients switched to TDF + 3TC/FTC + LPVr or AZT/ABC + 3TC + LPVr. The main common predictor of both treatment interruption and drug substitution was drug toxicity. Conclusions: Our results show a rapid transition between 2004 and 2010 ART guidelines and concurrent improvements in continuity of care among second-line ART patients. Drug toxicity reporting and monitoring systems need improvements to inform timely regimen changes and ensure that patients remain in care. However, reasons for drug substitutions should be closely monitored to ensure that patients do not run out of treatment options in the future. PMID:28364563

Are You Overworked . . . or Underorganized?

ERIC Educational Resources Information Center

Stegman, Wayne G.; Mackenzie, R. Alec

1985-01-01

Successful administrators practice time management by delegating effectively and scheduling blocks of time to work without interruption. In addition, they set clear goals for meetings, avoid unnecessary meetings, and use weekly and monthly calendars. (MLF)

How much time do nurses have for patients? a longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals

PubMed Central

2011-01-01

Background Time nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Few studies have measured how nurses distribute their time across tasks. We aimed to quantify how nurses distribute their time across tasks, with patients, in individual tasks, and engagement with other health care providers; and how work patterns changed over a two year period. Methods Prospective observational study of 57 nurses for 191.3 hours (109.8 hours in 2005/2006 and 81.5 in 2008), on two wards in a teaching hospital in Australia. The validated Work Observation Method by Activity Timing (WOMBAT) method was applied. Proportions of time in 10 categories of work, average time per task, time with patients and others, information tools used, and rates of interruptions and multi-tasking were calculated. Results Nurses spent 37.0%[95%CI: 34.5, 39.3] of their time with patients, which did not change in year 3 [35.7%; 95%CI: 33.3, 38.0]. Direct care, indirect care, medication tasks and professional communication together consumed 76.4% of nurses' time in year 1 and 81.0% in year 3. Time on direct and indirect care increased significantly (respectively 20.4% to 24.8%, P < 0.01;13.0% to 16.1%, P < 0.01). Proportion of time on medication tasks (19.0%) did not change. Time in professional communication declined (24.0% to 19.2%, P < 0.05). Nurses completed an average of 72.3 tasks per hour, with a mean task length of 55 seconds. Interruptions arose at an average rate of two per hour, but medication tasks incurred 27% of all interruptions. In 25% of medication tasks nurses multi-tasked. Between years 1 and 3 nurses spent more time alone, from 27.5%[95%CI 24.5, 30.6] to 39.4%[34.9, 43.9]. Time with health professionals other than nurses was low and did not change. Conclusions Nurses spent around 37% of their time with patients which did not change. Work patterns were increasingly fragmented with rapid changes between tasks of short length. Interruptions were modest but their substantial over-representation among medication tasks raises potential safety concerns. There was no evidence of an increase in team-based, multi-disciplinary care. Over time nurses spent significantly less time talking with colleagues and more time alone. PMID:22111656

Exploring the impact of an automated prescription-filling device on community pharmacy technician workflow

PubMed Central

Walsh, Kristin E.; Chui, Michelle Anne; Kieser, Mara A.; Williams, Staci M.; Sutter, Susan L.; Sutter, John G.

2012-01-01

Objective To explore community pharmacy technician workflow change after implementation of an automated robotic prescription-filling device. Methods At an independent community pharmacy in rural Mayville, WI, pharmacy technicians were observed before and 3 months after installation of an automated robotic prescription-filling device. The main outcome measures were sequences and timing of technician workflow steps, workflow interruptions, automation surprises, and workarounds. Results Of the 77 and 80 observations made before and 3 months after robot installation, respectively, 17 different workflow sequences were observed before installation and 38 after installation. Average prescription filling time was reduced by 40 seconds per prescription with use of the robot. Workflow interruptions per observation increased from 1.49 to 1.79 (P = 0.11), and workarounds increased from 10% to 36% after robot use. Conclusion Although automated prescription-filling devices can increase efficiency, workflow interruptions and workarounds may negate that efficiency. Assessing changes in workflow and sequencing of tasks that may result from the use of automation can help uncover opportunities for workflow policy and procedure redesign. PMID:21896459

All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time.

PubMed

Westbrook, Johanna I; Ampt, Amanda; Kearney, Leanne; Rob, Marilyn I

2008-05-05

To quantify time doctors in hospital wards spend on specific work tasks, and with health professionals and patients. Observational time and motion study. 400-bed teaching hospital in Sydney. 19 doctors (seven registrars, five residents, seven interns) in four wards were observed between 08:30 and 19:00 for a total of 151 hours between July and December 2006. Proportions of time in categories of work; proportions of tasks performed with health professionals and patients; proportions of tasks using specific information tools; rates of multitasking and interruptions. The greatest proportions of doctors' time were in professional communication (33%; 95% CI, 29%-38%); social activities, such as non-work communication and meal breaks (17%; 95% CI, 13%-21%), and indirect care, such as planning care (17%; 95% CI, 15%-19%). Multitasking involved 20% of time, and on average, doctors were interrupted every 21 minutes. Most tasks were completed with another doctor (56%; 95% CI, 55%-57%), while 24% (95% CI, 23%-25%) were undertaken alone and 15% (95% CI, 15%-16%) with a patient. Interns spent more time completing documentation and administrative tasks, and less time in direct care than residents and registrars. The time interns spent documenting (22%) was almost double the time they were engaged in direct patient care. Two-thirds of doctors' time was consumed by three work categories: professional communication, social activities and indirect care. Doctors on wards are interrupted at considerably lower rates than those in emergency and intensive care units. The results confirm interns' previously reported dissatisfaction with their level of administrative work and documentation.

Impact of pharmaceutical policy interventions on utilization of antipsychotic medicines in Finland and Portugal in times of economic recession: interrupted time series analyses

PubMed Central

2014-01-01

Objectives To analyze the impacts of pharmaceutical sector policies implemented to contain country spending during the economic recession – a reference price system in Finland and a mix of policies including changes in reimbursement rates, a generic promotion campaign and discounts granted to the public payer in Portugal – on utilization of, as a proxy for access to, antipsychotic medicines. Methodology We obtained monthly IMS Health sales data in standard units of antipsychotic medicines in Portugal and Finland for the period January 2007 to December 2011. We used an interrupted time series design to estimate changes in overall use and generic market shares by comparing pre-policy and post-policy levels and trends. Results Both countries’ policy approaches were associated with slight, likely unintended, decreases in overall use of antipsychotic medicines and with increases in generic market shares of major antipsychotic products. In Finland, quetiapine and risperidone generic market shares increased substantially (estimates one year post-policy compared to before, quetiapine: 6.80% [3.92%, 9.68%]; risperidone: 11.13% [6.79%, 15.48%]. The policy interventions in Portugal resulted in a substantially increased generic market share for amisulpride (estimate one year post-policy compared to before: 22.95% [21.01%, 24.90%]; generic risperidone already dominated the market prior to the policy interventions. Conclusions Different policy approaches to contain pharmaceutical expenditures in times of the economic recession in Finland and Portugal had intended – increased use of generics – and likely unintended – slightly decreased overall sales, possibly consistent with decreased access to needed medicines – impacts. These findings highlight the importance of monitoring and evaluating the effects of pharmaceutical policy interventions on use of medicines and health outcomes. PMID:25062657

Impact of pharmaceutical policy interventions on utilization of antipsychotic medicines in Finland and Portugal in times of economic recession: interrupted time series analyses.

PubMed

Leopold, Christine; Zhang, Fang; Mantel-Teeuwisse, Aukje K; Vogler, Sabine; Valkova, Silvia; Ross-Degnan, Dennis; Wagner, Anita K

2014-07-25

To analyze the impacts of pharmaceutical sector policies implemented to contain country spending during the economic recession--a reference price system in Finland and a mix of policies including changes in reimbursement rates, a generic promotion campaign and discounts granted to the public payer in Portugal - on utilization of, as a proxy for access to, antipsychotic medicines. We obtained monthly IMS Health sales data in standard units of antipsychotic medicines in Portugal and Finland for the period January 2007 to December 2011. We used an interrupted time series design to estimate changes in overall use and generic market shares by comparing pre-policy and post-policy levels and trends. Both countries' policy approaches were associated with slight, likely unintended, decreases in overall use of antipsychotic medicines and with increases in generic market shares of major antipsychotic products. In Finland, quetiapine and risperidone generic market shares increased substantially (estimates one year post-policy compared to before, quetiapine: 6.80% [3.92%, 9.68%]; risperidone: 11.13% [6.79%, 15.48%]. The policy interventions in Portugal resulted in a substantially increased generic market share for amisulpride (estimate one year post-policy compared to before: 22.95% [21.01%, 24.90%]; generic risperidone already dominated the market prior to the policy interventions. Different policy approaches to contain pharmaceutical expenditures in times of the economic recession in Finland and Portugal had intended--increased use of generics--and likely unintended--slightly decreased overall sales, possibly consistent with decreased access to needed medicines--impacts. These findings highlight the importance of monitoring and evaluating the effects of pharmaceutical policy interventions on use of medicines and health outcomes.

The new technological solution for the JT-60SA quench protection circuits

NASA Astrophysics Data System (ADS)

Gaio, E.; Maistrello, A.; Novello, L.; Matsukawa, M.; Perna, M.; Ferro, A.; Yamauchi, K.; Piovan, R.

2018-07-01

An advanced technology has been developed and employed for the main circuit breakers (CB) of the quench protection circuits (QPC) of the superconducting coils of JT-60SA: it consists in a Hybrid mechanical-static CB (HCB) composed of a mechanical Bypass switch (BPS) for conducting the continuous current, in parallel to a static circuit breaker (SCB) based on integrated gate commutated thyristor (IGCT) for current interruption. It was the result of a R&D program carried out since 2006 to identify innovative solutions for the interruption of high dc current, able to improve the maintainability and availability of the CB. The HCB developed for the JT-60SA QPC is the first realization of a dc circuit breaker based on this design approach for interrupting current of some tens of kA with reapplied voltage of some kV. It also represents the first application of hybrid technology with IGCT for protection of superconducting magnets in fusion experiments. The paper aims at giving a comprehensive overview of the main R&D activities devoted to the development of this new technological approach; then, the key aspects of the design, manufacturing and testing of the QPCs for JT-60SA, successfully completed in Naka Site in summer 2015 are presented. Finally, the significance of this research is discussed and the possible future developments, in particular in view of DEMO fusion reactor, are outlined.

An advanced BLT-humanized mouse model for extended HIV-1 cure studies.

PubMed

Lavender, Kerry J; Pace, Craig; Sutter, Kathrin; Messer, Ronald J; Pouncey, Dakota L; Cummins, Nathan W; Natesampillai, Sekar; Zheng, Jim; Goldsmith, Joshua; Widera, Marek; Van Dis, Erik S; Phillips, Katie; Race, Brent; Dittmer, Ulf; Kukolj, George; Hasenkrug, Kim J

2018-01-02

Although bone marrow, liver, thymus (BLT)-humanized mice provide a robust model for HIV-1 infection and enable evaluation of cure strategies dependent on endogenous immune responses, most mice develop graft versus host disease (GVHD), limiting their utility for extended HIV cure studies. This study aimed to: evaluate the GVHD-resistant C57 black 6 (C57BL/6) recombination activating gene 2 (Rag2)γcCD47 triple knockout (TKO)-BLT mouse as a model to establish HIV-1 latency. Determine whether TKO-BLT mice could be maintained on antiretroviral therapy (ART) for extended periods of time. Assess the rapidity of viral rebound following therapy interruption. TKO-BLT mice were HIV-1 infected, treated with various ART regimens over extended periods of time and assayed for viral rebound following therapy interruption. Daily subcutaneous injection and oral ART-mediated suppression of HIV-1 infection was tested at various doses in TKO-BLT mice. Mice were monitored for suppression of viremia and cellular HIV-1 RNA and DNA prior to and following therapy interruption. Mice remained healthy for 45 weeks posthumanization and could be treated with ART for up to 18 weeks. Viremia was suppressed to less than 200 copies/ml in the majority of mice with significant reductions in cellular HIV-1 RNA and DNA. Treatment interruption resulted in rapid viral recrudescence. HIV-1 latency can be maintained in TKO-BLT mice over extended periods on ART and rapid viral rebound occurs following therapy removal. The additional 15-18 weeks of healthy longevity compared with other BLT models provides sufficient time to examine the decay kinetics of the latent reservoir as well as observe delays in recrudescence in HIV-1 cure studies.

Evaluation and Impact of Workflow Interruptions During Robot-assisted Surgery.

PubMed

Allers, Jenna C; Hussein, Ahmed A; Ahmad, Nabeeha; Cavuoto, Lora; Wing, Joseph F; Hayes, Robin M; Hinata, Nobuyuki; Bisantz, Ann M; Guru, Khurshid A

2016-06-01

To analyze and categorize causes for interruptions during robot-assisted surgery. We analyzed 10 robot-assisted prostatectomies that were performed by 3 surgeons from October 2014 to June 2015. Interruptions to surgery were defined in terms of duration, stage of surgery, personnel involved, reasons, and impact of the interruption on the surgical workflow. The main reasons for interruptions included the following: console surgeons switching (29%); preparation of the surgical equipment, such as cleaning or changing the camera (29%) or an instrument (27%); or when a suture, stapler, or clip was needed (12%). The most common interruption duration was 10-29 seconds (47.6%), and the least common interruption duration was greater than 90 seconds (3.6%). Additionally, about 14% of the interruptions were considered avoidable, whereas the remaining 86% of interruptions were necessary for surgery. By identifying and analyzing interruptions, we can develop evidence-based strategies to improve operating room efficiency, lower costs, and advance patient safety. Copyright © 2016 Elsevier Inc. All rights reserved.

A systematic review on the use of time series data in the study of antimicrobial consumption and Pseudomonas aeruginosa resistance.

PubMed

Athanasiou, Christos I; Kopsini, Angeliki

2018-06-12

In the field of antimicrobial resistance, the number of studies that use time series data has increased recently. The purpose of this study is the systematic review of all studies on antibacterial consumption and on Pseudomonas aeruginosa resistance in healthcare settings, that have used time series data. A systematic review of the literature till June 2017 was conducted. All the studies that have used time series data and have examined the inhospital antibiotic consumption and Ps. aeruginosa resistance rates or incidence were eligible. No other exclusion criteria were applied. Data on the structure, terminology used, methods used and results of each article were recorded and analyzed as possible. A total of thirty six studies were retrieved, twenty three of which were in accordance with our criteria. Thirteen of them were quasi experimental studies and ten were ecological observational studies. Eighteen studies collected time series data of both parameters and the statistical methodology of "time series analysis" was applied in nine studies. Most of the studies were published in the last eight years. The Interrupted Time Series design was the most widespread. As expected, there was high heterogeneity in regard to the study design, terminology and statistical methods applied. Copyright © 2018. Published by Elsevier Ltd.

Assessment of teacher interruptions on learners during oral case presentations.

PubMed

Yang, Glen; Chin, Rachel

2007-06-01

Studies have only recently begun to investigate the effects of interruptions on physicians in the emergency department (ED). To determine the frequency and nature of interruptions by the training physician that occur when medical trainees do oral case presentations (OCPs) in the ED. This was an observational study. Learner OCPs to attending emergency physicians were observed in the ED of an urban Level 1 trauma center at a major teaching hospital. A single investigator followed attending physicians blinded to the study objective in a nonrandomized convenience sampling of all ED shifts, recording information regarding teacher interruptions during new patient presentations. Learners completed a brief questionnaire after each OCP. A total of 196 OCPs were observed. The mean (+/-SD) duration of OCPs was 3.30 (+/-1.85) minutes, and the mean (+/-SD) number of interruptions was 0.75 (+/-0.60) per minute and 2.49 (+/-1.95) per OCP. The number of interruptions (per OCP) and duration of OCP varied by learner level of training, with more experienced learners giving shorter presentations and being interrupted less often. Frequency (per minute) of interruptions did not vary by learner level. In 40.3% of OCPs, attending physicians interrupted to give an assessment and/or a plan before the learner had done so, but 8.3% of interrupted learners believed that teacher interruptions were "disruptive" to their OCP. Attending emergency physicians frequently interrupt learners during new patient OCPs, with the number of interruptions varying by learner level of training. Teacher interruptions appear to have minimal, if any, detrimental effect on the perceived effectiveness of OCPs as a learning experience.

Adaptation of superconducting fault current limiter to high-speed reclosing

NASA Astrophysics Data System (ADS)

Koyama, T.; Yanabu, S.

2009-10-01

Using a high temperature superconductor, we constructed and tested a model superconducting fault current limiter (SFCL). The superconductor might break in some cases because of its excessive generation of heat. Therefore, it is desirable to interrupt early the current that flows to superconductor. So, we proposed the SFCL using an electromagnetic repulsion switch which is composed of a superconductor, a vacuum interrupter and a by-pass coil, and its structure is simple. Duration that the current flow in the superconductor can be easily minimized to the level of less than 0.5 cycle using this equipment. On the other hand, the fault current is also easily limited by large reactance of the parallel coil. There is duty of high-speed reclosing after interrupting fault current in the electric power system. After the fault current is interrupted, the back-up breaker is re-closed within 350 ms. So, the electromagnetic repulsion switch should return to former state and the superconductor should be recovered to superconducting state before high-speed reclosing. Then, we proposed the SFCL using an electromagnetic repulsion switch which employs our new reclosing function. We also studied recovery time of the superconductor, because superconductor should be recovered to superconducting state within 350 ms. In this paper, the recovery time characteristics of the superconducting wire were investigated. Also, we combined the superconductor with the electromagnetic repulsion switch, and we did performance test. As a result, a high-speed reclosing within 350 ms was proven to be possible.

Effect of pre-procedural interrupted apixaban on heparin anticoagulation during catheter ablation for atrial fibrillation: a prospective observational study.

PubMed

Bin Abdulhak, Aref A; Kennedy, Kevin F; Gupta, Sanjaya; Giocondo, Michael; Ramza, Brian; Wimmer, Alan P

2015-11-01

Effective intraprocedural anticoagulation is considered essential to minimize the risk of thromboembolism in catheter ablation (CA) of atrial fibrillation (AF). The effect of interrupted apixaban on intraprocedural heparin dosing requirements and levels of achieved anticoagulation with heparin has not been well studied. The purpose of the present study was to compare heparin administration and activated clotted times (ACTs) for patients undergoing CA for AF treated with interrupted apixaban before the procedure with patients on uninterrupted warfarin. Consecutive patients undergoing CA for AF treated with interrupted apixaban or uninterrupted warfarin were prospectively enrolled. Heparin administration determined by a standard protocol and normalized to patient weight and procedure duration, as well as rapidity, and degree of anticoagulation with heparin (as measured by mean ACT, peak ACT, time to ACT ≥300 s, and time to ACT ≥350 s) were compared between the groups. Forty-eight patients were enrolled (25 apixaban and 23 warfarin). Heparin administered by bolus (51.3 ± 21.5 vs 27.8 ± 9.6 units/kg/h; p < 0.001) and mean heparin drip rate (25.3 ± 3.6 vs 20.7 ± 2.4 units/kg/h; p < 0.001) were significantly higher in the apixaban group compared to the warfarin group. Despite greater heparin administration, apixaban patients achieved a significantly lower mean ACT (332.3 ± 17.0 vs 384.5 ± 53.9; p < 0.001) and peak ACT (369.5 ± 22.6 vs 432.3 ± 75.8, p < 0.001) compared to the warfarin group. The time to ACT ≥350 s (66.7 ± 35.8 vs 26.9 ± 34.0; p < 0.001) was significantly longer for apixaban-treated patients. Outcome differences persisted after analysis using linear models and Cox proportional hazard regression with adjustment for propensity scores. A standard intraprocedural heparin protocol results in delayed and lower levels of anticoagulation as measured by the ACT for interrupted apixaban-treated patients in comparison to those on uninterrupted warfarin during CA of AF.

Distress among young adult cancer survivors: a cohort study.

PubMed

Yanez, Betina; Garcia, Sofia F; Victorson, David; Salsman, John M

2013-09-01

Being diagnosed with cancer as a young adult can lead to significant psychological distress and impaired quality of life. Compared to children and older adults diagnosed with cancer, fewer studies have addressed psychological distress among young adult cancer survivors. This study sought to identify the prevalence of, and factors associated with, distress among young adult cancer survivors (ages 18-39). Young adult cancer survivors (N = 335, mean age = 31.8, women = 68.4%) were recruited from an online research panel and stratified by cohort (time postactive treatment: 0-12, 13-24, and 25-60 months). Participants completed measures assessing demographic and clinical characteristics, global impact of cancer, cancer-related education and work interruption, and cancer-specific distress using the impact of event scale (IES). The mean score on the IES (M = 31.0, range = 0-75) was above the cut point of 20, suggesting clinically elevated distress. Analysis of covariance revealed significant main effects for cohort, global impact and cancer-related education/work interruption, and an interaction between cohort and cancer-related education/work interruption on distress. Although there was no significant effect of education/work interruption on distress for those in the 0-12 month cohort (p = .88), survivors in the 13-24 and 25-60 month cohorts reporting education/work interruption were significantly more distressed than those not reporting education/work interruption in the respective cohorts (p < .05). Young adult cancer survivors face unique challenges. These data underscore the importance of attending to cancer-related distress beyond the completion of treatment and may help inform targeted interventions to prevent or reduce significant distress and related sequelae in this population.

Testing Of Choiced Ceramics Cutting Tools At Irregular Interrupted Cut

NASA Astrophysics Data System (ADS)

Kyncl, Ladislav; Malotová, Šárka; Nováček, Pavel; Nicielnik, Henryk; Šoková, Dagmar; Hemžský, Pavel; Pitela, David; Holubjak, Jozef

2015-12-01

This article discusses the test of removable ceramic cutting inserts during machining irregular interrupted cut. Tests were performed on a lathe, with the preparation which simulated us the interrupted cut. By changing the number of plates mounted in a preparation it simulate us a regular or irregular interrupted cut. When with four plates it was regular interrupted cut, the remaining three variants were already irregular cut. It was examined whether it will have the irregular interrupted cutting effect on the insert and possibly how it will change life of inserts during irregular interrupted cut (variable delay between shocks).

The effect of load history on reinforced concrete bridge column behavior : [summary].

DOT National Transportation Integrated Search

2012-08-01

To satisfy the aims of performance based design, levels of damage which interrupt the serviceability of the : structure or require more invasive repair techniques must be related to engineering criteria. In this report, the : influence of displacemen...

The effect of load history on reinforced concrete bridge column behavior.

DOT National Transportation Integrated Search

2012-08-01

To satisfy the aims of performance based design, levels of damage which interrupt the serviceability of the : structure or require more invasive repair techniques must be related to engineering criteria. In this report, the : influence of displacemen...

Differentiating between adductor and abductor spasmodic dysphonia using airflow interruption

PubMed Central

Hoffman, Matthew R.; Jiang, Jack J.; Rieves, Adam L.; McElveen, Kelsey A.B.; Ford, Charles N.

2009-01-01

Objective To measure the laryngeal resistance (RL), subglottal pressure (Ps), and mean flow rate (MFR) of adductor (ADSD) and abductor (ABSD) spasmodic dysphonia patients using the airflow interrupter. Methods The RL of six ABSD and seven ADSD patients was measured using the airflow interrupter, a noninvasive device designed to measure MFR and Ps via mechanical balloon valve interruption. Subjects performed ten trials at each of two intensity levels, with each trial consisting of a sustained /a/ during which phonation was interrupted for 500 ms. Laryngeal resistance was calculated as subglottal pressure divided by airflow. Results Mean RL for the ADSD and ABSD subtypes at 65 dB were 24.78 cmH2O/l/s and 14.51 cmH2O/l/s, respectively (p = 0.04). Mean RL at 70 dB were 40.02 cmH2O/l/s and 15.84 cmH2O/l/s (p = 0.014). Ps for the ADSD and ABSD subtypes at 65 dB were 10.23 cmH2O and 8.32 cmH2O, respectively (p = 0.582). At the 70 dB level, Ps were 12.39 cmH2O and 11.78 cmH2O (p = 0.886). MFR for the ADSD and ABSD subtypes at 65 dB were 435 ml/s and 746 ml/s (p = 0.205). Mean MFR at 70 dB were 518 ml/s and 848 ml/s (p = 0.198). Conclusion Noninvasive measurements of RL may be useful for differentiating between ADSD and ABSD. This simple objective test which produces a quantitative output could be used to evaluate laryngeal function in patients with spasmodic dysphonia. PMID:19554636

A knowledge translation tool improved osteoporosis disease management in primary care: an interrupted time series analysis.

PubMed

Kastner, Monika; Sawka, Anna M; Hamid, Jemila; Chen, Maggie; Thorpe, Kevin; Chignell, Mark; Ewusie, Joycelyne; Marquez, Christine; Newton, David; Straus, Sharon E

2014-09-25

Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems, yet gaps in management still exist. In response, we developed a multi-component osteoporosis knowledge translation (Op-KT) tool involving a patient-initiated risk assessment questionnaire (RAQ), which generates individualized best practice recommendations for physicians and customized education for patients at the point of care. The objective of this study was to evaluate the effectiveness of the Op-KT tool for appropriate disease management by physicians. The Op-KT tool was evaluated using an interrupted time series design. This involved multiple assessments of the outcomes 12 months before (baseline) and 12 months after tool implementation (52 data points in total). Inclusion criteria were family physicians and their patients at risk for osteoporosis (women aged ≥ 50 years, men aged ≥ 65 years). Primary outcomes were the initiation of appropriate osteoporosis screening and treatment. Analyses included segmented linear regression modeling and analysis of variance. The Op-KT tool was implemented in three family practices in Ontario, Canada representing 5 family physicians with 2840 age eligible patients (mean age 67 years; 76% women). Time series regression models showed an overall increase from baseline in the initiation of screening (3.4%; P < 0.001), any osteoporosis medications (0.5%; P = 0.006), and calcium or vitamin D (1.2%; P = 0.001). Improvements were also observed at site level for all the three sites considered, but these results varied across the sites. Of 351 patients who completed the RAQ unprompted (mean age 64 years, 77% women), the mean time for completing the RAQ was 3.43 minutes, and 56% had any disease management addressed by their physician. Study limitations included the inherent susceptibility of our design compared with a randomized trial. The multicomponent Op-KT tool significantly increased osteoporosis investigations in three family practices, and highlights its potential to facilitate patient self-management. Next steps include wider implementation and evaluation of the tool in primary care.

The effect of the Swedish bicycle helmet law for children: an interrupted time series study.

PubMed

Bonander, Carl; Nilson, Finn; Andersson, Ragnar

2014-12-01

Previous population-based research has shown that bicycle helmet laws can reduce head injury rates among cyclists. According to deterrence theory, such laws are mainly effective if there is a high likelihood of being apprehended. In this study, we investigated the effect of the Swedish helmet law for children under the age of 15, a population that cannot be fined. An interrupted time series design was used. Monthly inpatient data on injured cyclists from 1998-2012, stratified by age (0-14, 15+), sex, and injury diagnosis, was obtained from the National Patient Register. The main outcome measure was the proportion of head injury admissions per month. Intervention effect estimates were obtained using generalized autoregressive moving average (GARMA) models. Pre-legislation trend and seasonality was adjusted for, and differences-in-differences estimation was obtained using adults as a non-equivalent control group. There was a statistically significant intervention effect among male children, where the proportion of head injuries dropped by 7.8 percentage points. There was no evidence of an intervention effect on the proportion of head injuries among female children. According to hospital admission data, the bicycle helmet law appears to have had an effect only on male children. This study, while quasi-experimental and thus not strictly generalizable, can contribute to increased knowledge regarding the effects of bicycle helmet laws. Copyright © 2014 National Safety Council and Elsevier Ltd. All rights reserved.

Using interrupted time series design to analyze changes in hand, foot, and mouth disease incidence during the declining incidence periods of 2008-2010 in China.

PubMed

Yu, Shi Cheng; Hao, Yuan Tao; Zhang, Jing; Xiao, Ge Xin; Liu, Zhuang; Zhu, Qi; Ma, Jia Qi; Wang, Yu

2012-12-01

To identify patterns of hand, foot and mouth disease (HFMD) incidence in China during declining incidence periods of 2008, 2009, and 2010. Reported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System (NDRS) and analyzed. An interrupted time series (ITS) technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years. Over 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level (P<0.0001) when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 (all P<0.005), but not 2009 to 2008. Incremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility. Copyright © 2012 The Editorial Board of Biomedical and Environmental Sciences. Published by Elsevier B.V. All rights reserved.

Improving outcomes for people with progressive cancer: interrupted time series trial of a needs assessment intervention.

PubMed

Waller, Amy; Girgis, Afaf; Johnson, Claire; Lecathelinais, Christophe; Sibbritt, David; Forstner, Dion; Liauw, Winston; Currow, David C

2012-03-01

Improving the effectiveness of cancer care delivery has become a major focus of research. This study assessed the uptake and impact of the Palliative Care Needs Assessment Guidelines and Needs Assessment Tool: Progressive Disease--Cancer (NAT: PD-C) on the outcomes of people with advanced cancer. Given widely varying survival in people with advanced cancer, an interrupted time series design was used, with data on unmet needs, depression, anxiety, and quality of life collected from 195 patients using telephone interviews every two months, for up to 18 months. Patients completed at least two baseline interviews before health professionals were academically detailed in the use of the Palliative Care Needs Assessment Guidelines and NAT: PD-C. Health professionals completed the NAT: PD-C with patients approximately monthly for the remainder of the study. Changes in patients' outcomes were compared prior to and following the introduction of the NAT: PD-C using general estimating equations. Moderate to high needs across all domains were frequently seen in the preintervention phase. The use of the NAT: PD-C was associated with a significant reduction in health system and information and patient care and support needs. These resources have the potential as an efficient and acceptable strategy for supporting needs-based cancer care. Further work is required to determine their unique contribution to improvements in patient outcomes. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Timing During Interruptions in Timing

ERIC Educational Resources Information Center

Fortin, Claudette; Bedard, Marie-Claude; Champagne, Julie

2005-01-01

Duration and location of breaks in time interval production were manipulated in various conditions of stimulus presentation (Experiments 1-4). Produced intervals shortened and then stabilized as break duration lengthened, suggesting that participants used the break as a preparatory period to restart timing as quickly as possible at the end of the…

Performance analysis of local area networks

NASA Technical Reports Server (NTRS)

Alkhatib, Hasan S.; Hall, Mary Grace

1990-01-01

A simulation of the TCP/IP protocol running on a CSMA/CD data link layer was described. The simulation was implemented using the simula language, and object oriented discrete event language. It allows the user to set the number of stations at run time, as well as some station parameters. Those parameters are the interrupt time and the dma transfer rate for each station. In addition, the user may configure the network at run time with stations of differing characteristics. Two types are available, and the parameters of both types are read from input files at run time. The parameters include the dma transfer rate, interrupt time, data rate, average message size, maximum frame size and the average interarrival time of messages per station. The information collected for the network is the throughput and the mean delay per packet. For each station, the number of messages attempted as well as the number of messages successfully transmitted is collected in addition to the throughput and mean packet delay per station.

Recent trends in power system reliability and implications for evaluating future investments in resiliency

DOE PAGES

Larsen, Peter H.; LaCommare, Kristina H.; Eto, Joseph H.; ...

2016-10-27

Here, this study examines the relationship between annual changes in electricity reliability reported by a large cross-section of U.S. electricity distribution utilities over a period of 13 years and a broad set of potential explanatory variables, including weather and utility characteristics. We find statistically significant correlations between the average number of power interruptions experienced annually and above average wind speeds, precipitation, lightning strikes, and a measure of population density: customers per line mile. We also find significant relationships between the average number of minutes of power interruptions experienced and above average wind speeds, precipitation, cooling degree-days, and one strategy usedmore » to mitigate the impacts of severe weather: the amount of underground transmission and distribution line miles. Perhaps most importantly, we find a significant time trend of increasing annual average number of minutes of power interruptions over time—especially when interruptions associated with extreme weather are included. Lastly, the research method described in this analysis can provide a basis for future efforts to project long-term trends in reliability and the associated benefits of strategies to improve grid resiliency to severe weather—both in the U.S. and abroad.« less

Improving the estimated cost of sustained power interruptions to electricity customers

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

LaCommare, Kristina Hamachi; Eto, Joseph H.; Dunn, Laurel N.

Electricity reliability and resiliency have become a topic of heightened interest in recent years in the United States. As utilities, regulators, and policymakers determine how to achieve optimal levels of electricity reliability while considering how best to prepare for future disruptions in power, the related issue of how much it costs when customers lose power remains a largely unanswered question. In 2006, Lawrence Berkeley National Laboratory developed an end-use based framework that estimates the cost of power interruptions in the U.S that has served as a foundational paper using the best available, yet far from perfect, information at that time.more » Since then, an abundance of work has been done to improve the quality and availability of information that now allow us to make a much more robust assessment of the cost of power interruptions to U.S. customers. In this paper, we find that the total U.S. cost of sustained power interruptions is 44 billion dollars per year (2015-) -25% more than the 26 billion dollars per year in 2002- (or 35 billion dollars per year in 2015-) estimated in our 2006 study.« less

Love-type seam-waves in washout models of coal seams

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

Breitzke, M.; Dresen, L.

The propagation of Love seam-waves across washouts of coal seams was studied by calculating synthetic seismograms with a finite-difference method. Seam interruption, seam end and seam thinning models ere investigated. The horizontal offset, the dip of the discontinuities and the degree of erosion served as variable parameters. Maximum displacement amplitudes, relative spectral amplitudes and phase and group slowness curves were extracted from the synthetic seismograms. Both seam interruption and seam thinning reduce the maximum displacement amplitudes of the transmitted Love seam-waves. The degree of amplitude reduction depends on the horizontal offset and the degree of erosion. It is four timesmore » greater for a total seam interruption than for an equivalent seam thinning with a horizontal offset of four times the seam thickness. In a seam cut vertically, the impedance contrast between the coal and the washout filling determines the maximum displacement amplitudes of the reflected Love seam-waves. They diminish by a maximum factor of four in oblique interruption zone discontinuities with a dip of maximum 27/sup 0/, and by a maximum factor of ten in a seam thinning with a degree of erosion of at least 22%.« less

Improving the estimated cost of sustained power interruptions to electricity customers

DOE PAGES

LaCommare, Kristina Hamachi; Eto, Joseph H.; Dunn, Laurel N.; ...

2018-04-18

Electricity reliability and resiliency have become a topic of heightened interest in recent years in the United States. As utilities, regulators, and policymakers determine how to achieve optimal levels of electricity reliability while considering how best to prepare for future disruptions in power, the related issue of how much it costs when customers lose power remains a largely unanswered question. In 2006, Lawrence Berkeley National Laboratory developed an end-use based framework that estimates the cost of power interruptions in the U.S that has served as a foundational paper using the best available, yet far from perfect, information at that time.more » Since then, an abundance of work has been done to improve the quality and availability of information that now allow us to make a much more robust assessment of the cost of power interruptions to U.S. customers. In this paper, we find that the total U.S. cost of sustained power interruptions is 44 billion dollars per year (2015-) -25% more than the 26 billion dollars per year in 2002- (or 35 billion dollars per year in 2015-) estimated in our 2006 study.« less

Mechanical beam isolator for high-power laser systems

DOEpatents

Post, R.F.; Vann, C.S.

1998-07-07

A mechanical beam isolator uses rod-shaped elements having a Gaussian configuration to interrupt the path of a beam of photons or particles when the time-scale of the needed interruption is of the order of a microsecond or less. One or more of these rods is mounted transversely to, and penetrates through, a rotating shaft supported by bearings. Owing to the Gaussian geometry of the rods, they are able to withstand much higher rotation speeds, without tensile failure, than rods having any other geometrical shape. 3 figs.

FPGA based control system for space instrumentation

NASA Astrophysics Data System (ADS)

Di Giorgio, Anna M.; Cerulli Irelli, Pasquale; Nuzzolo, Francesco; Orfei, Renato; Spinoglio, Luigi; Liu, Giovanni S.; Saraceno, Paolo

2008-07-01

The prototype for a general purpose FPGA based control system for space instrumentation is presented, with particular attention to the instrument control application software. The system HW is based on the LEON3FT processor, which gives the flexibility to configure the chip with only the necessary HW functionalities, from simple logic up to small dedicated processors. The instrument control SW is developed in ANSI C and for time critical (<10μs) commanding sequences implements an internal instructions sequencer, triggered via an interrupt service routine based on a HW high priority interrupt.

Optical diagnostics of the arc plasma using fast intensified CCD-spectrograph system

NASA Astrophysics Data System (ADS)

Pavelescu, Gabriela; Guillot, Stephane; Braic, Mariana T.; Hong, Dunpin; Pavelescu, D.; Fleurier, Claude; Braic, Viorel; Gherendi, F.; Dumitrescu, G.; Anghelita, P.; Bauchire, J. M.

2004-10-01

Spectroscopic diagnostics, using intensified high speed CCD camera, was applied to study the arc dynamics in low voltage circuit breakers, in vacuum and in air. Time-resolved emission spectroscopy of the vacuum arc plasma, generated during electrode separation, provided information about the interruption process. The investigations were focused on the partial unsuccessful interruption around current zero. Absorption spectroscopy, in a peculiar setup, was used in order to determine the metallic atoms densities in the interelectrode space of a low voltage circuit breaker, working in ambient air.

Designs for Evaluating the Community-Level Impact of Comprehensive Prevention Programs: Examples from the CDC Centers of Excellence in Youth Violence Prevention.

PubMed

Farrell, Albert D; Henry, David; Bradshaw, Catherine; Reischl, Thomas

2016-04-01

This article discusses the opportunities and challenges of developing research designs to evaluate the impact of community-level prevention efforts. To illustrate examples of evaluation designs, we describe six projects funded by the Centers for Disease Control and Prevention to evaluate multifaceted approaches to reduce youth violence in high-risk communities. Each of these projects was designed to evaluate the community-level impact of multiple intervention strategies to address individual and contextual factors that place youth at risk for violent behavior. Communities differed across projects in their setting, size, and how their boundaries were defined. Each project is using multiple approaches to compare outcomes in one or more intervention communities to those in comparison communities. Five of the projects are using comparative interrupted time-series designs to compare outcomes in an intervention community to matched comparison communities. A sixth project is using a multiple baseline design in which the order and timing of intervention activities is randomized across three communities. All six projects are also using regression point displacement designs to compare outcomes within intervention communities to those within broader sets of similar communities. Projects are using a variety of approaches to assess outcomes including archival records, surveys, and direct observations. We discuss the strengths and weaknesses of the designs of these projects and illustrate the challenges of designing high-quality evaluations of comprehensive prevention approaches implemented at the community level.

The Effects of Career Interruptions on Young Men and Women.

ERIC Educational Resources Information Center

Shorten, Brett; Lewis, Donald E.

1991-01-01

Data from a sample of 5,837 Australians showed that (1) women had longer career interruptions; (2) regardless of number of interruptions, men had higher wages; (3) longer interruptions had a negative effect on reentry wages; and (4) 1985-88 growth in wages for males was enhanced by increased numbers and length of interruptions, with the opposite…

Computer-mediated mobile messaging as collaboration support for nurses.

PubMed

Karpati, Peter; Toussaint, Pieter Jelle; Nytrø, Oystein

2009-01-01

Collaboration in hospitals is coordinated mainly by communication, which currently happens by face-to-face meetings, phone calls, pagers, notes and the electronic patient record. These habits raise problems e.g., delayed notifications and unnecessary interruptions. Dealing with these problems could save time and improve the care. Therefore we designed and prototyped a mobile messaging solution based on two specific scenarios coming from observations at a cardiology department of a Norwegian hospital. The main focus was on supporting the work of nurses. One prototype supported patient management while another one dealt with messages related to medication planning. The evaluation of the prototypes suggested that messaging-based collaboration support is worth to explore and also gave ideas for improvement.

Brain activity patterns induced by interrupting the cognitive processes with online advertising.

PubMed

Rejer, Izabela; Jankowski, Jarosław

2017-11-01

As a result of the increasing role of online advertising and strong competition among advertisers, intrusive techniques are commonly used to attract web users' attention. Moreover, since marketing content is usually delivered to the target audience when they are performing typical online tasks, like searching for information or reading online content, its delivery interrupts the web user's current cognitive process. The question posed by many researchers in the field of online advertising is: how should we measure the influence of interruption of cognitive processes on human behavior and emotional state? Much research has been conducted in this field; however, most of this research has focused on monitoring activity in the simulated environment, or processing declarative responses given by users in prepared questionnaires. In this paper, a more direct real-time approach is taken, and the effect of the interruption on a web user is analyzed directly by studying the activity of his brain. This paper presents the results of an experiment that was conducted to find the brain activity patterns associated with interruptions of the cognitive process by showing internet advertisements during a text-reading task. Three specific aspects were addressed in the experiment: individual patterns, the consistency of these patterns across trials, and the intra-subject correlation of the individual patterns. Two main effects were observed for most subjects: a drop in activity in the frontal and prefrontal cortical areas across all frequency bands, and significant changes in the frontal/prefrontal asymmetry index.

PAs reduce rounding interruptions in the pediatric intensive care unit.

PubMed

Hascall, Rebecca L; Perkins, R Serene; Kmiecik, Lauren; Gupta, Priya R; Shelak, Carolyn F; Demirel, Shaban; Buchholz, Mark T

2018-06-01

We investigated the proportion of encounters that were interrupted during family-centered rounds in the pediatric intensive care unit (PICU) to determine whether the use of a physician assistant (PA) significantly affected the proportion of interrupted encounters. We evaluated 2,657 rounding encounters in our 24-bed regional referral unit. The duration of each rounding encounter and total rounding duration were recorded. The presence or absence of a PA during each rounding encounter, the occurrence of an interruption, and other potential predictors of interruptions were recorded. The presence of a PA during PICU rounds was significantly associated (P < .001) with a 35.4% lower likelihood of an interruption. Family-centered rounds in the PICU are less likely to be interrupted when a PA is present. PAs help physicians and improve rounding efficiency by safely and effectively handling certain interruptions.

The effects of gated speech on the fluency of speakers who stutter

PubMed Central

Howell, Peter

2007-01-01

It is known that the speech of people who stutter improves when the speaker’s own vocalization is changed while the participant is speaking. One explanation of these effects is the disruptive rhythm hypothesis (DRH). DRH maintains that the manipulated sound only needs to disturb timing to affect speech control. The experiment investigated whether speech that was gated on and off (interrupted) affected the speech control of speakers who stutter. Eight children who stutter read a passage when they heard their voice normally and when the speech was gated. Fluency was enhanced (fewer errors were made and time to read a set passage was reduced) when speech was interrupted in this way. The results support the DRH. PMID:17726328

The effects of gated speech on the fluency of speakers who stutter.

PubMed

Howell, Peter

2007-01-01

It is known that the speech of people who stutter improves when the speaker's own vocalization is changed while the participant is speaking. One explanation of these effects is the disruptive rhythm hypothesis (DRH). The DRH maintains that the manipulated sound only needs to disturb timing to affect speech control. The experiment investigated whether speech that was gated on and off (interrupted) affected the speech control of speakers who stutter. Eight children who stutter read a passage when they heard their voice normally and when the speech was gated. Fluency was enhanced (fewer errors were made and time to read a set passage was reduced) when speech was interrupted in this way. The results support the DRH. Copyright 2007 S. Karger AG, Basel.

The Race against Time: Winning Strategies for Librarians.

ERIC Educational Resources Information Center

Lankford, Mary D.

1993-01-01

Discusses time management strategies that are particularly useful for school librarians. Highlights include setting realistic goals; active participation in learning and practicing time management skills; the use of day planners to help focus on goals and priorities; decision making for handling papers; controlling interruptions; and delegating…

Effects of smoke-free laws on alcohol-related car crashes in California and New York: time series analyses from 1982 to 2008.

PubMed

Bernat, Debra H; Maldonado-Molina, Mildred; Hyland, Andrew; Wagenaar, Alexander C

2013-02-01

We examined effects of New York and California's statewide smoke-free restaurant and bar policies on alcohol-related car crash fatalities. We used an interrupted time-series design from 1982 to 2008, with 312 monthly observations, to examine the effect of each state's law on single-vehicle-nighttime crashes and crashes involving a driver with a blood alcohol concentration of 0.08 grams per deciliter or greater. Implementation of New York and California's statewide smoke-free policies was not associated with alcohol-related car crash fatalities. Additionally, analyses showed no effect of New York's smoke-free policy on alcohol-related car crash fatalities in communities along the Pennsylvania-New York border. Statewide smoke-free restaurant and bar laws do not appear to affect rates of alcohol-related car crashes.

Use of an interrupted time-series design to evaluate a cancer screening program.

PubMed

Michielutte, R; Shelton, B; Paskett, E D; Tatum, C M; Velez, R

2000-10-01

An alternative approach to intervention-control designs to evaluate community health education studies is to use a quasi-experimental design in which the outcomes of interest are examined over time in the intervention unit. The Forsyth County Cancer Screening Project (FoCaS) was a comprehensive clinic- and community-based education program to increase screening for cervical cancer and breast cancer among low-income women. This paper reports the use of piecewise regression accounting for potential effects of auto-correlation in the data to evaluate the effectiveness of the project in increasing mammography screening. Data for the evaluation of trends in screening consisted of all mammograms performed during the period of May 1992 through June 1995 at the Reynolds Health Center in Forsyth County, North Carolina. The results suggested that the FoCaS project was effective in increasing mammography screening among women age 40 or older in the study population. Analysis of the trends by age indicated that the program had differential effects on women age 40-49 and 50 or older. The results demonstrate that analyses of the type presented here can either complement or serve as an alternative to more traditional intervention-control analyses.

Time-dependent rheological behavior of natural polysaccharide xanthan gum solutions in interrupted shear and step-incremental/reductional shear flow fields

NASA Astrophysics Data System (ADS)

Lee, Ji-Seok; Song, Ki-Won

2015-11-01

The objective of the present study is to systematically elucidate the time-dependent rheological behavior of concentrated xanthan gum systems in complicated step-shear flow fields. Using a strain-controlled rheometer (ARES), step-shear flow behaviors of a concentrated xanthan gum model solution have been experimentally investigated in interrupted shear flow fields with a various combination of different shear rates, shearing times and rest times, and step-incremental and step-reductional shear flow fields with various shearing times. The main findings obtained from this study are summarized as follows. (i) In interrupted shear flow fields, the shear stress is sharply increased until reaching the maximum stress at an initial stage of shearing times, and then a stress decay towards a steady state is observed as the shearing time is increased in both start-up shear flow fields. The shear stress is suddenly decreased immediately after the imposed shear rate is stopped, and then slowly decayed during the period of a rest time. (ii) As an increase in rest time, the difference in the maximum stress values between the two start-up shear flow fields is decreased whereas the shearing time exerts a slight influence on this behavior. (iii) In step-incremental shear flow fields, after passing through the maximum stress, structural destruction causes a stress decay behavior towards a steady state as an increase in shearing time in each step shear flow region. The time needed to reach the maximum stress value is shortened as an increase in step-increased shear rate. (iv) In step-reductional shear flow fields, after passing through the minimum stress, structural recovery induces a stress growth behavior towards an equilibrium state as an increase in shearing time in each step shear flow region. The time needed to reach the minimum stress value is lengthened as a decrease in step-decreased shear rate.

Interrupted breeding in a songbird migrant triggers development of nocturnal locomotor activity.

PubMed

Mukhin, Andrey; Kobylkov, Dmitry; Kishkinev, Dmitry; Grinkevich, Vitaly

2018-04-03

Long-distance avian migrants, e.g. Eurasian reed warblers (Acrocephalus scirpaceus), can precisely schedule events of their annual cycle. However, the proximate mechanisms controlling annual cycle and their interplay with environmental factors are poorly understood. We artificially interrupted breeding in reed warblers by bringing them into captivity and recording birds' locomotor activity for 5-7 days. Over this time, most of the captive birds gradually developed nocturnal locomotor activity not observed in breeding birds. When the birds were later released and radio-tracked, the individuals with highly developed caged activity performed nocturnal flights. We also found that reed warblers kept indoors without access to local cues developed a higher level of nocturnal activity compared to the birds kept outdoors with an access to the familiar environment. Also, birds translocated from a distant site (21 km) had a higher motivation to fly at night-time after release compared to the birds captured within 1 km of a study site. Our study suggests that an interrupted breeding triggers development of nocturnal locomotor activity in cages, and the level of activity is correlated with motivation to perform nocturnal flights in the wild, which can be restrained by familiar environment.

Neglect in human communication: quantifying the cost of cell-phone interruptions in face to face dialogs.

PubMed

Lopez-Rosenfeld, Matías; Calero, Cecilia I; Fernandez Slezak, Diego; Garbulsky, Gerry; Bergman, Mariano; Trevisan, Marcos; Sigman, Mariano

2015-01-01

There is a prevailing belief that interruptions using cellular phones during face to face interactions may affect severely how people relate and perceive each other. We set out to determine this cost quantitatively through an experiment performed in dyads, in a large audience in a TEDx event. One of the two participants (the speaker) narrates a story vividly. The listener is asked to deliberately ignore the speaker during part of the story (for instance, attending to their cell-phone). The speaker is not aware of this treatment. We show that total amount of attention is the major factor driving subjective beliefs about the story and the conversational partner. The effects are mostly independent on how attention is distributed in time. All social parameters of human communication are affected by attention time with a sole exception: the perceived emotion of the story. Interruptions during day-to-day communication between peers are extremely frequent. Our data should provide a note of caution, by indicating that they have a major effect on the perception people have about what they say (whether it is interesting or not . . .) and about the virtues of the people around them.

Neglect in Human Communication: Quantifying the Cost of Cell-Phone Interruptions in Face to Face Dialogs

PubMed Central

Lopez-Rosenfeld, Matías; Calero, Cecilia I.; Fernandez Slezak, Diego; Garbulsky, Gerry; Bergman, Mariano; Trevisan, Marcos; Sigman, Mariano

2015-01-01

There is a prevailing belief that interruptions using cellular phones during face to face interactions may affect severely how people relate and perceive each other. We set out to determine this cost quantitatively through an experiment performed in dyads, in a large audience in a TEDx event. One of the two participants (the speaker) narrates a story vividly. The listener is asked to deliberately ignore the speaker during part of the story (for instance, attending to their cell-phone). The speaker is not aware of this treatment. We show that total amount of attention is the major factor driving subjective beliefs about the story and the conversational partner. The effects are mostly independent on how attention is distributed in time. All social parameters of human communication are affected by attention time with a sole exception: the perceived emotion of the story. Interruptions during day-to-day communication between peers are extremely frequent. Our data should provide a note of caution, by indicating that they have a major effect on the perception people have about what they say (whether it is interesting or not . . .) and about the virtues of the people around them. PMID:26039326

Effectiveness of the California Tri-Pull Taping method for shoulder subluxation poststroke: a single-subject ABA design.

PubMed

Hayner, Kate A

2012-01-01

I evaluated the effectiveness of the California Tri-Pull Taping method for clients with poststroke inferior shoulder subluxation of the glenohumeral joint. Ten participants were followed for 9 wk using an interrupted time series quasi-experimental single-subject ABA design to examine shoulder pain, activities of daily living (ADL) function, active range of motion, tape comfort, and subluxation. The California Tri-Pull Taping method decreased inferior subluxation significantly from baseline to intervention but not at postintervention. Active range of motion was significantly increased in shoulder flexion and abduction between the baseline and intervention and the intervention and postintervention phases. Functional ADL scores were significant. The taping was reported to be comfortable. No significant difference in pain was found. This intervention is a promising adjunct to the management of the hemiplegic subluxed shoulder that warrants further research. Copyright © 2012 by the American Occupational Therapy Association, Inc.

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

None

This bibliography provides documentation for use by state public utility commissions and major nonregulated utilities in evaluating the applicability of a wide range of electric utility rate design and regulatory concepts in light of certain regulatory objectives. Part I, Utility Regulatory Objectives, contains 2084 citations on conservation of energy and capital; efficient use of facilities and resources; and equitable rates to electricity consumers. Part II, Rate Design Concepts, contains 1238 citations on time-of-day rates; seasonally-varying rates; cost-of-service rates; interruptible rates (including the accompanying use of load management techniques); declining block rates; and lifeline rates. Part III, Regulatory Concepts, contains 1282more » references on restrictions on master metering; procedures for review of automatic adjustment clauses; prohibitions of rate or regulatory discrimination against solar, wind, or other small energy systems; treatment of advertising expenses; and procedures to protect ratepayers from abrupt termination of service.« less

Design and Development of a Series Switch for High Voltage in RF Heating

NASA Astrophysics Data System (ADS)

Patel, Himanshu K.; Shah, Deep; Thacker, Mauli; Shah, Atman

2013-02-01

Plasma is the fourth state of matter. To sustain plasma in its ionic form very high temperature is essential. RF heating systems are used to provide the required temperature. Arching phenomenon in these systems can cause enormous damage to the RF tube. Heavy current flows across the anode-cathode junction, which need to be suppressed in minimal time for its protection. Fast-switching circuit breakers are used to cut-off the load from the supply in cases of arching. The crowbar interrupts the connection between the high voltage power supply (HVPS) and the RF tube for a temporary period between which the series switch has to open. The crowbar shunts the current across the load but in the process leads to short circuiting the HVPS. Thus, to protect the load as well as the HVPS a series switch is necessary. This paper presents the design and development of high voltage Series Switch for the high power switching applications. Fiber optic based Optimum triggering scheme is designed and tested to restrict the time delay well within the stipulated limits. The design is well supported with the experimental results for the whole set-up along with the series switch at various voltage level before its approval for operation at 5.2 kV.

Deformation of contact surfaces in a vacuum interrupter after high-current interruptions

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

Wang, Haoran; Wang, Zhenxing, E-mail: zxwang@xjtu.edu.cn; Zhou, Zhipeng

2016-08-07

In a high-current interruption, the contact surface in a vacuum interrupter might be severely damaged by constricted vacuum arcs causing a molten area on it. As a result, a protrusion will be initiated by a transient recovery voltage after current zero, enhancing the local electric field and making breakdowns occur easier. The objective of this paper is to simulate the deformation process on the molten area under a high electric field by adopting the finite element method. A time-dependent Electrohydrodynamic model was established, and the liquid-gas interface was tracked by the level-set method. From the results, the liquid metal canmore » be deformed to a Taylor cone if the applied electric field is above a critical value. This value is correlated to the initial geometry of the liquid metal, which increases as the size of the liquid metal decreases. Moreover, the buildup time of a Taylor cone obeys the power law t = k × E{sup −3}, where E is the initial electric field and k is a coefficient related to the material property, indicating a temporal self-similar characteristic. In addition, the influence of temperature has little impact on the deformation but has great impact on electron emission. Finally, the possible reason to initiate a delayed breakdown is associated with the deformation. The breakdown does not occur immediately when the voltage is just applied upon the gap but is postponed to several milliseconds later when the tip is formed on the liquid metal.« less

38 CFR 21.7020 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... considered a single period of continuous active duty. (vii) Time lost will not be considered to interrupt the.... 98-525) (b) Other definitions—(1) Active duty. (i) The term active duty means— (A) Full-time duty in the Armed Forces, other than active duty for training, (B) Full-time duty (other than for training...

38 CFR 21.7020 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... considered a single period of continuous active duty. (vii) Time lost will not be considered to interrupt the.... 98-525) (b) Other definitions—(1) Active duty. (i) The term active duty means— (A) Full-time duty in the Armed Forces, other than active duty for training, (B) Full-time duty (other than for training...

38 CFR 21.7020 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... considered a single period of continuous active duty. (vii) Time lost will not be considered to interrupt the.... 98-525) (b) Other definitions—(1) Active duty. (i) The term active duty means— (A) Full-time duty in the Armed Forces, other than active duty for training, (B) Full-time duty (other than for training...

38 CFR 21.7020 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... considered a single period of continuous active duty. (vii) Time lost will not be considered to interrupt the.... 98-525) (b) Other definitions—(1) Active duty. (i) The term active duty means— (A) Full-time duty in the Armed Forces, other than active duty for training, (B) Full-time duty (other than for training...

38 CFR 21.7020 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... considered a single period of continuous active duty. (vii) Time lost will not be considered to interrupt the.... 98-525) (b) Other definitions—(1) Active duty. (i) The term active duty means— (A) Full-time duty in the Armed Forces, other than active duty for training, (B) Full-time duty (other than for training...

29 CFR 552.102 - Live-in domestic service employees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... themselves, the amount of sleeping time, meal time and other periods of complete freedom from all duties when... periods of free time (other than those relating to meals and sleeping) to be excluded from hours worked.... If the sleeping time, meal periods or other periods of free time are interrupted by a call to duty...

29 CFR 552.102 - Live-in domestic service employees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... themselves, the amount of sleeping time, meal time and other periods of complete freedom from all duties when... periods of free time (other than those relating to meals and sleeping) to be excluded from hours worked.... If the sleeping time, meal periods or other periods of free time are interrupted by a call to duty...

Impact of routine surgical ward and intensive care unit admission surveillance cultures on hospital-wide nosocomial methicillin-resistant Staphylococcus aureus infections in a university hospital: an interrupted time-series analysis.

PubMed

Chaberny, Iris F; Schwab, Frank; Ziesing, Stefan; Suerbaum, Sebastian; Gastmeier, Petra

2008-12-01

To determine whether a routine admission screening in surgical wards and intensive care units (ICUs) was effective in reducing methicillin-resistant Staphylococcus aureus (MRSA) infections-particularly nosocomial MRSA infections-for the whole hospital. The study used a single-centre prospective quasi-experimental design to evaluate the effect of the MRSA screening policy on the incidence density of MRSA-infected/nosocomial MRSA-infected patients/1000 patient-days (pd) in the whole hospital. The effect on incidence density was calculated by a segmented regression analysis of interrupted time series with 30 months prior to and 24 months after a 6 month implementation period. The MRSA screening policy had a highly significant hospital-wide effect on the incidence density of MRSA infections. It showed a significant change in both level [-0.163 MRSA-infected patients/1000 pd, 95% confidence interval (CI): -0.276 to -0.050] and slope (-0.01 MRSA-infected patients/1000 pd per month, 95% CI: -0.018 to -0.003) after the implementation of the MRSA screening policy. A decrease in the MRSA infections by 57% is a conservative estimate of the reduction between the last month before (0.417 MRSA-infected patients/1000 pd) and month 24 after the implementation of the MRSA screening policy (0.18 MRSA-infected patients/1000 pd). Equivalent results were found in the analysis of nosocomial MRSA-infected patients/1000 pd. This is the first hospital-wide study that investigates the impact of introducing admission screening in ICUs and non-ICUs as a single intervention to prevent MRSA infections performed with a time-series regression analysis. Admission screening is a potent tool in controlling the spread of MRSA infections in hospitals.

Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit.

PubMed

Nzegwu, Nneka I; Rychalsky, Michelle R; Nallu, Loren A; Song, Xuemei; Deng, Yanhong; Natusch, Amber M; Baltimore, Robert S; Paci, George R; Bizzarro, Matthew J

2017-10-01

OBJECTIVE To evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP). DESIGN Quasi-experimental, interrupted time-series study. SETTING A 54-bed, level IV NICU in a regional academic and tertiary referral center. PATIENTS AND PARTICIPANTS All neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion. INTERVENTION Implementation of a NICU-specific ASP beginning July 2012. METHODS We convened a multidisciplinary team and developed guidelines for common infections, with a focus on prescriber audit and feedback. We conducted an interrupted time-series analysis to evaluate the effects of our ASP. Our primary outcome measure was days of antibiotic therapy (DOT) per 1,000 patient days for all and for select antimicrobials. Secondary outcomes included provider-specific antimicrobial prescription events for suspected late-onset sepsis (blood or cerebrospinal fluid infection at >72 hours of life) and guideline compliance. RESULTS Antibiotic utilization decreased by 14.7 DOT per 1,000 patient days during the stewardship period, although this decrease was not statistically significant (P=.669). Use of ampicillin, the most commonly antimicrobial prescribed in our NICU, decreased significantly, declining by 22.5 DOT per 1,000 patient days (P=.037). Late-onset sepsis evaluation and prescription events per 100 NICU days of clinical service decreased significantly (P<.0001), with an average reduction of 2.65 evaluations per year per provider. Clinical guidelines were adhered to 98.75% of the time. CONCLUSIONS Implementation of a NICU-specific antimicrobial stewardship program is feasible and can improve antibiotic prescribing practices. Infect Control Hosp Epidemiol 2017;38:1137-1143.

The impact of national-level interventions to improve hygiene on the incidence of irritant contact dermatitis in healthcare workers: changes in incidence from 1996 to 2012 and interrupted times series analysis.

PubMed

Stocks, S J; McNamee, R; Turner, S; Carder, M; Agius, R M

2015-07-01

Reducing healthcare-associated infections (HCAI) has been a priority in the U.K. over recent decades and this has been reflected in interventions focusing on improving hygiene procedures. To evaluate whether these interventions coincided with an increased incidence of work-related irritant contact dermatitis (ICD) attributed to hand hygiene or/and other hygiene measures in healthcare workers (HCWs). A quasi-experimental (interrupted time series) design was used to compare trends in incidence of ICD in HCWs attributed to hygiene before and after interventions to reduce HCAI with trends in the same periods in control groups (ICD in other workers). Cases of ICD reported to a U.K. surveillance scheme from 1996 to 2012 were analysed. The time periods compared were defined objectively based on the dates of the publication of national evidence-based guidelines, the U.K. Health Act 2006 and the Cleanyourhands campaign. The reported incidence of ICD in HCWs attributed to hygiene has increased steadily from 1996 to 2012 [annual incidence rate ratio (95% confidence interval): hand hygiene only 1.10 (1.07-1.12); all hygiene 1.05 (1.03-1.07)], whereas the incidence in other workers is declining. An increase in incidence of ICD in HCWs attributed to hand hygiene was observed at the beginning of the Cleanyourhands campaign. The increasing incidence of ICD in HCWs combined with the popularity of interventions to reduce HCAI warrants increased efforts towards identifying products and implementing practices posing the least risk of ICD. © 2015 British Association of Dermatologists.

Maternal and neonatal outcomes after implementation of a hospital policy to limit low-risk planned caesarean deliveries before 39 weeks of gestation: an interrupted time-series analysis.

PubMed

Hutcheon, J A; Strumpf, E C; Harper, S; Giesbrecht, E

2015-08-01

To evaluate the extent to which implementing a hospital policy to limit planned caesarean deliveries before 39 weeks of gestation improved neonatal health, maternal health, and healthcare costs. Retrospective cohort study. British Columbia Women's Hospital, Vancouver, Canada, in the period 2005-2012. Women with a low-risk planned repeat caesarean delivery. An interrupted time series design was used to evaluate the policy to limit planned caesarean deliveries before 39 weeks of gestation, introduced on 1 April 2008. Composite adverse neonatal health outcome (respiratory morbidity, 5-minute Apgar score of <7, neonatal intensive care unit admission, mortality), postpartum haemorrhage, obstetrical wound infection, out-of-hour deliveries, length of stay, and healthcare costs. Between 2005 and 2008, 60% (1204/2021) of low-risk planned caesarean deliveries were performed before 39 weeks of gestation. After the introduction of the policy, the proportion of planned caesareans dropped by 20 percentage points (adjusted risk difference of 20 fewer cases per 100 deliveries; 95% CI -25.8, -14.3) to 41% (1033/2518). The policy had no detectable impact on adverse neonatal outcomes (2.2 excess cases per 100; 95% CI -0.4, 4.8), maternal complications, or healthcare costs, but increased the risk of out-of-hours delivery from 16.2 to 21.1% (adjusted risk difference 6.3 per 100; 95% CI 1.6, 10.9). We found little evidence that a hospital policy to limit planned caesareans before 39 weeks of gestation reduced adverse neonatal outcomes. Hospital administrators intending to introduce such policies should anticipate, and plan for, modest increases in out-of-hours and emergency-timing. © 2015 Royal College of Obstetricians and Gynaecologists.

Multifaceted academic detailing program to increase pharmacotherapy for alcohol use disorder: interrupted time series evaluation of effectiveness.

PubMed

Harris, Alex H S; Bowe, Thomas; Hagedorn, Hildi; Nevedal, Andrea; Finlay, Andrea K; Gidwani, Risha; Rosen, Craig; Kay, Chad; Christopher, Melissa

2016-09-15

Active consideration of effective medications to treat alcohol use disorder (AUD) is a consensus standard of care, yet knowledge and use of these medications are very low across diverse settings. This study evaluated the overall effectiveness a multifaceted academic detailing program to address this persistent quality problem in the US Veterans Health Administration (VHA), as well as the context and process factors that explained variation in effectiveness across sites. An interrupted time series design, analyzed with mixed-effects segmented logistic regression, was used to evaluate changes in level and rate of change in the monthly percent of patients with a clinically documented AUD who received naltrexone, acamprosate, disulfiram, or topiramate. Using data from a 20 month post-implementation period, intervention sites (n = 37) were compared to their own 16 month pre-implementation performance and separately to the rest of VHA. From immediately pre-intervention to the end of the observation period, the percent of patients in the intervention sites with AUD who received medication increased over 3.4 % in absolute terms and 68 % in relative terms (i.e., 4.9-8.3 %). This change was significant compared to the pre-implementation period in the intervention sites and secular trends in control sites. Sites with lower pre-implementation adoption, more person hours of detailing, but fewer people detailed, had larger immediate increases in medication receipt after implementation. The average number of detailing encounters per person was associated with steeper increases in slope over time. This study found empirical support for a multifaceted quality improvement strategy aimed at increasing access to and utilization of pharmacotherapy for AUD. Future studies should focus on determining how to enhance the programs effects, especially in non-responsive locations.

Impact of bariatric surgery on clinical depression. Interrupted time series study with matched controls.

PubMed

Booth, Helen; Khan, Omar; Prevost, A Toby; Reddy, Marcus; Charlton, Judith; Gulliford, Martin C

2015-03-15

Obesity is associated with depression. This study aimed to evaluate whether clinical depression is reduced after bariatric surgery (BS). Obese adults who received BS procedures from 2002 to 2014 were sampled from the UK Clinical Practice Research Datalink. An interrupted time series design, with matched controls, was conducted from three years before, to a maximum of seven years after surgery. Controls were matched for body mass index (BMI), age, gender and year of procedure. Clinical depression was defined as a medical diagnosis recorded in year, or an antidepressant prescribed in year to a participant ever diagnosed with depression. Adjusted odds ratios (AOR) were estimated. There were 3045 participants (mean age 45.9; mean BMI 44.0kg/m(2)) who received BS, including laparoscopic gastric banding in 1297 (43%), gastric bypass in 1265 (42%), sleeve gastrectomy in 477 (16%) and six undefined. Before surgery, 36% of BS participants, and 21% of controls, had clinical depression; between-group AOR, 2.02, 95%CI 1.75-2.33, P<0.001. In the second post-operative year 32% had depression; AOR, compared to time without surgery, 0.83 (0.76-0.90, P<0.001). By the seventh year, the prevalence of depression increased to 37%; AOR 0.99 (0.76-1.29, P=0.959). Despite matching there were differences in depression between BS and control patients, representing the highly selective nature of BS. Depression is frequent among individuals selected to undergo bariatric surgery. Bariatric surgery may be associated with a modest reduction in clinical depression over the initial post-operative years but this is not maintained. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Description of real-time Ada software implementation of a power system monitor for the Space Station Freedom PMAD DC testbed

NASA Technical Reports Server (NTRS)

Ludwig, Kimberly; Mackin, Michael; Wright, Theodore

1991-01-01

The Ada language software development to perform the electrical system monitoring functions for the NASA Lewis Research Center's Power Management and Distribution (PMAD) DC testbed is described. The results of the effort to implement this monitor are presented. The PMAD DC testbed is a reduced-scale prototype of the electrical power system to be used in the Space Station Freedom. The power is controlled by smart switches known as power control components (or switchgear). The power control components are currently coordinated by five Compaq 382/20e computers connected through an 802.4 local area network. One of these computers is designated as the control node with the other four acting as subsidiary controllers. The subsidiary controllers are connected to the power control components with a Mil-Std-1553 network. An operator interface is supplied by adding a sixth computer. The power system monitor algorithm is comprised of several functions including: periodic data acquisition, data smoothing, system performance analysis, and status reporting. Data is collected from the switchgear sensors every 100 milliseconds, then passed through a 2 Hz digital filter. System performance analysis includes power interruption and overcurrent detection. The reporting mechanism notifies an operator of any abnormalities in the system. Once per second, the system monitor provides data to the control node for further processing, such as state estimation. The system monitor required a hardware time interrupt to activate the data acquisition function. The execution time of the code was optimized using an assembly language routine. The routine allows direct vectoring of the processor to Ada language procedures that perform periodic control activities. A summary of the advantages and side effects of this technique are discussed.

Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria.

PubMed

Swaminathan, Lakshmi; Flanders, Scott; Rogers, Mary; Calleja, Yvonne; Snyder, Ashley; Thyagarajan, Rama; Bercea, Priscila; Chopra, Vineet

2018-04-01

Although important in clinical care, reports of inappropriate peripherally inserted central catheter (PICC) use are growing. To test whether implementation of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) can improve PICC use and patient outcomes. Quasi-experimental, interrupted time series design at one study site with nine contemporaneous external controls. Ten hospitals participating in a state-wide quality collaborative from 1 August 2014 to 31 July 2016. 963 hospitalised patients who received a PICC at the study site vs 6613 patients at nine control sites. A multimodal intervention (tool, training, electronic changes, education) derived from MAGIC. Appropriateness of PICC use and rates of PICC-associated complications. Segmented Poisson regression was used for analyses. Absolute rates of inappropriate PICC use decreased substantially at the study site versus controls (91.3% to 65.3% (-26.0%) vs 72.2% to 69.6% (-2.6%); P<0.001). After adjusting for underlying trends and patient characteristics, however, a marginally significant 13.8% decrease in inappropriate PICC use occurred at the study site (incidence rate ratio 0.86 (95% CI 0.74 to 0.99; P=0.048)); no change was observed at control sites. While the incidence of all PICC complications decreased to a greater extent at the study site, the absolute difference between controls and intervention was small (33.9% to 26.7% (-7.2%) vs 22.4% to 20.8% (-1.6%); P=0.036). Non-randomised design limits inference; the most effective component of the multimodal intervention is unknown; effects following implementation were modest. In a multihospital quality improvement project, implementation of MAGIC improved PICC appropriateness and reduced complications to a modest extent. Given the size and resources required for this study, future work should consider cost-to-benefit ratio of similar approaches. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Impact of universal health insurance coverage in Thailand on sales and market share of medicines for non-communicable diseases: an interrupted time series study

PubMed Central

Garabedian, Laura Faden; Ross-Degnan, Dennis; Ratanawijitrasin, Sauwakon; Stephens, Peter; Wagner, Anita Katharina

2012-01-01

Objective In 2001, Thailand implemented the Universal Coverage Scheme (UCS), a public insurance system that aimed to achieve universal access to healthcare, including essential medicines, and to influence primary care centres and hospitals to use resources efficiently, via capitated payment for outpatient services and other payment policies for inpatient care. Our objective was to evaluate the impact of the UCS on utilisation of medicines in Thailand for three non-communicable diseases: cancer, cardiovascular disease and diabetes. Design Interrupted time-series design, with a non-equivalent comparison group. Setting Thailand, 1998–2006. Data Quarterly purchases of medicines from hospital and retail pharmacies collected by IMS Health between 1998 and 2006. Intervention UCS implementation, April–October 2001. Outcome measures Total pharmaceutical sales volume and percent market share by licensing status and National Essential Medicine List status. Results The UCS was associated with long-term increases in sales of medicines for conditions that are typically treated in outpatient primary care settings, such as diabetes, high cholesterol and high blood pressure, but not for medicines for diseases that are typically treated in secondary or tertiary care settings, such as heart failure, arrhythmias and cancer. Although the majority of increases in sales were for essential medicines, there were also postpolicy increases in sales of non-essential medicines. Immediately following the reform, there was a significant shift in hospital sector market share by licensing status for most classes of medicines. Government-produced products often replaced branded generic or generic competitors. Conclusions Our results suggest that expanding health insurance coverage with a medicine benefit to the entire Thai population increased access to medicines in primary care. However, our study also suggests that the UCS may have had potentially undesirable effects. Evaluations of the long-term impacts of universal health coverage on medicine utilisation are urgently needed. PMID:23192243

A combined intervention to reduce interruptions during medication preparation and double-checking: a pilot-study evaluating the impact of staff training and safety vests.

PubMed

Huckels-Baumgart, Saskia; Niederberger, Milena; Manser, Tanja; Meier, Christoph R; Meyer-Massetti, Carla

2017-10-01

The aim was to evaluate the impact of staff training and wearing safety vests as a combined intervention on interruptions during medication preparation and double-checking. Interruptions and errors during the medication process are common and an important issue for patient safety in the hospital setting. We performed a pre- and post-intervention pilot-study using direct structured observation of 26 nurses preparing and double-checking 431 medication doses (225 pre-intervention and 206 post-intervention) for 36 patients (21 pre-intervention and 15 post-intervention). With staff training and the introduction of safety vests, the interruption rate during medication preparation was reduced from 36.8 to 28.3 interruptions per hour and during double-checking from 27.5 to 15 interruptions per hour. This pilot-study showed that the frequency of interruptions decreased during the critical tasks of medication preparation and double-checking after the introduction of staff training and wearing safety vests as part of a quality improvement process. Nursing management should acknowledge interruptions as an important factor potentially influencing medication safety. Unnecessary interruptions can be successfully reduced by considering human and system factors and increasing both staff and nursing managers' awareness of 'interruptive communication practices' and implementing physical barriers. This is the first pilot-study specifically evaluating the impact of staff training and wearing safety vests on the reduction of interruptions during medication preparation and double-checking. © 2017 John Wiley & Sons Ltd.

Video Self-Modeling for English Language Learners

ERIC Educational Resources Information Center

Boisvert, Précille; Rao, Kavita

2015-01-01

Teachers of English language learners (ELLs), expected to address grade-level standards and prepare ELLs for standardized assessments, have the difficult task of designing instruction that meets the range of needs in their classrooms. When these learners have experienced limited or interrupted education, the challenges intensify. Whereas…

The behaviour of cow blastocyst in vitro: cinematographic and morphometric analysis.

PubMed Central

Massip, A; Mulnard, J; Vanderzwalmen, P; Hanzen, C; Ectors, F

1982-01-01

The behaviour of the cow blastocyst in vitro was studied by time-lapse cinematography and analysed by morphometry. Three types of behaviour were observed: continuous expansion followed by hatching; discontinuous expansion interrupted by few contractions and followed by hatching; discontinuous expansion interrupted by several rapid contractions without hatching. This demonstrated that the pulsatile activity of the blastocyst is not a necessary condition of hatching but also that only a moderate pulsatile activity is compatible with normal hatching. The time of hatching in vitro corresponded approximately with the time of zona loss in vivo (9-10 days). Rupture of the zona occurred at any point of the trophoblast layer. Hatching by herniation through a reduced opening of the zona was occasionally observed. The behavior of the embryos from a particular animal was very similar but differences were noted between embryos from different animals. Images Fig. 3 PMID:7076563

The culture contributing to interruptions in the nursing work environment: An ethnography.

PubMed

Hopkinson, Susan G; Wiegand, Debra L

2017-12-01

To understand the occurrence of interruptions within the culture of the medical nursing unit work environment. Interruptions may lead to errors in nursing work. Little is known about how the culture of the nursing work environment contributes to interruptions. A micro-focused ethnographic study was conducted. Data collection involved extensive observation of a nursing unit, 1:1 observations of nurses and follow-up interviews with the nurses. Data were analysed from unstructured field notes and interview transcripts. The definitions of interruption and culture guided coding, categorising and identification of themes. A framework was developed that describes the medical nursing unit as a complex culture full of unpredictable, nonlinear changes that affect the entire interconnected system, often in the form of an interruption. The cultural elements contributing to interruptions included (i) the value placed on excellence in patient care and meeting personal needs, (ii) the beliefs that the nurses had to do everything by themselves and that every phone call was important, (iii) the patterns of changing patients, patient transport and coordination of resources and (iv) the normative practices of communicating and adapting. Interruptions are an integral part of the culture of a medical nursing unit. Uniformly decreasing interruptions may disrupt current practices, such as communication to coordinate care, that are central to nursing work. In future research, the nursing work environment must be looked at through the lens of a complex system. Interventions to minimise the negative impact of interruptions must take into account the culture of the nursing as a complex adaptive system. Nurses should be educated on their own contribution to interruptions and issues addressed at a system level, rather than isolating the interruption as the central issue. © 2017 John Wiley & Sons Ltd.

Clinical events after interruption of anticoagulation in patients with atrial fibrillation: An analysis from the ENGAGE AF-TIMI 48 trial.

PubMed

Cavallari, Ilaria; Ruff, Christian T; Nordio, Francesco; Deenadayalu, Naveen; Shi, Minggao; Lanz, Hans; Rutman, Howard; Mercuri, Michele F; Antman, Elliott M; Braunwald, Eugene; Giugliano, Robert P

2018-04-15

Patients with atrial fibrillation (AF) who interrupt anticoagulation are at high risk of thromboembolism and death. Patients enrolled in the ENGAGE AF-TIMI 48 trial (randomized comparison of edoxaban vs. warfarin) who interrupted study anticoagulant for >3 days were identified. Clinical events (ischemic stroke/systemic embolism, major cardiac and cerebrovascular events [MACCE]) were analyzed from day 4 after interruption until day 34 or study drug resumption. During 2.8 years median follow-up, 13,311 (63%) patients interrupted study drug for >3 days. After excluding those who received open-label anticoagulation during the at-risk window, the population for analysis included 9148 patients. The rates of ischemic stroke/systemic embolism and MACCE post interruption were substantially greater than in patients who never interrupted (15.42 vs. 0.26 and 60.82 vs. 0.36 per 100 patient-years, respectively, p adj  < .001). Patients who interrupted study drug for an adverse event (44.1% of the cohort), compared to those who interrupted for other reasons, had an increased risk of MACCE (HR adj 2.75; 95% CI 2.02-3.74, p < .0001), but similar rates of ischemic stroke/systemic embolism. Rates of clinical events after interruption of warfarin and edoxaban were similar. Interruption of study drug was frequent in patients with AF and was associated with a substantial risk of major cardiac and cerebrovascular events over the ensuing 30 days. This risk was particularly high in patients who interrupted as a result of an adverse event; these patients deserve close monitoring and resumption of anticoagulation as soon as it is safe to do so. Copyright © 2018 Elsevier B.V. All rights reserved.

Evaluating a community-based exercise intervention with adults living with HIV: protocol for an interrupted time series study

PubMed Central

O'Brien, Kelly K; Bayoumi, Ahmed M; Solomon, Patricia; Tang, Ada; Murzin, Kate; Chan Carusone, Soo; Zobeiry, Mehdi; Nayar, Ayesha; Davis, Aileen M

2016-01-01

Introduction Our aim was to evaluate a community-based exercise (CBE) intervention with the goal of reducing disability and enhancing health for community-dwelling people living with HIV (PLWH). Methods and analysis We will use a mixed-methods implementation science study design, including a prospective longitudinal interrupted time series study, to evaluate a CBE intervention with PLWH in Toronto, Canada. We will recruit PLWH who consider themselves medically stable and safe to participate in exercise. In the baseline phase (0–8 months), participants will be monitored bimonthly. In the intervention phase (8–14 months), participants will take part in a 24-week CBE intervention that includes aerobic, resistance, balance and flexibility exercise at the YMCA 3 times per week, with weekly supervision by a fitness instructor, and monthly educational sessions. In the follow-up phase (14–22 months), participants will be encouraged to continue to engage in unsupervised exercise 3 times per week. Quantitative assessment: We will assess cardiopulmonary fitness, strength, weight, body composition and flexibility outcomes followed by the administration of self-reported questionnaires to assess disability and contextual factor outcomes (coping, mastery, stigma, social support) bimonthly. We will use time series regression analysis to determine the level and trend of outcomes across each phase in relation to the intervention. Qualitative assessment: We will conduct a series of face-to-face interviews with a subsample of participants and recreation providers at initiation, midpoint and completion of the 24-week CBE intervention. We will explore experiences and anticipated benefits with exercise, perceived impact of CBE for PLWH and the strengths and challenges of implementing a CBE intervention. Interviews will be audio recorded and analysed thematically. Ethics and dissemination Protocol approved by the University of Toronto HIV/AIDS Research Ethics Board. Knowledge translation will occur with stakeholders in the form of presentations and publications in open access peer-reviewed journals. Trial registration number NCT02794415; Pre-results. PMID:27798038

A case report of evaluating a large-scale health systems improvement project in an uncontrolled setting: a quality improvement initiative in KwaZulu-Natal, South Africa.

PubMed

Mate, Kedar S; Ngidi, Wilbroda Hlolisile; Reddy, Jennifer; Mphatswe, Wendy; Rollins, Nigel; Barker, Pierre

2013-11-01

New approaches are needed to evaluate quality improvement (QI) within large-scale public health efforts. This case report details challenges to large-scale QI evaluation, and proposes solutions relying on adaptive study design. We used two sequential evaluative methods to study a QI effort to improve delivery of HIV preventive care in public health facilities in three districts in KwaZulu-Natal, South Africa, over a 3-year period. We initially used a cluster randomised controlled trial (RCT) design. During the RCT study period, tensions arose between intervention implementation and evaluation design due to loss of integrity of the randomisation unit over time, pressure to implement changes across the randomisation unit boundaries, and use of administrative rather than functional structures for the randomisation. In response to this loss of design integrity, we switched to a more flexible intervention design and a mixed-methods quasiexperimental evaluation relying on both a qualitative analysis and an interrupted time series quantitative analysis. Cluster RCT designs may not be optimal for evaluating complex interventions to improve implementation in uncontrolled 'real world' settings. More flexible, context-sensitive evaluation designs offer a better balance of the need to adjust the intervention during the evaluation to meet implementation challenges while providing the data required to evaluate effectiveness. Our case study involved HIV care in a resource-limited setting, but these issues likely apply to complex improvement interventions in other settings.

Randomized, Controlled Trial of Therapy Interruption in Chronic HIV-1 Infection

PubMed Central

Papasavvas, Emmanouil; Kostman, Jay R; Mounzer, Karam; Grant, Robert M; Gross, Robert; Gallo, Cele; Azzoni, Livio; Foulkes, Andrea; Thiel, Brian; Pistilli, Maxwell; Mackiewicz, Agnieszka; Shull, Jane; Montaner, Luis J

2004-01-01

Background Approaches to limiting exposure to antiretroviral therapy (ART) drugs are an active area of HIV therapy research. Here we present longitudinal follow-up of a randomized, open-label, single-center study of the immune, viral, and safety outcomes of structured therapy interruptions (TIs) in patients with chronically suppressed HIV-1 infection as compared to equal follow-up of patients on continuous therapy and including a final therapy interruption in both arms. Methods and Findings Forty-two chronically HIV-infected patients on suppressive ART with CD4 counts higher than 400 were randomized 1:1 to either (1) three successive fixed TIs of 2, 4, and 6 wk, with intervening resumption of therapy with resuppression for 4 wk before subsequent interruption, or (2) 40 wk of continuous therapy, with a final open-ended TI in both treatment groups. Main outcome was analysis of the time to viral rebound (>5,000 copies/ml) during the open-ended TI. Secondary outcomes included study-defined safety criteria, viral resistance, therapy failure, and retention of immune reconstitution. There was no difference between the groups in time to viral rebound during the open-ended TI (continuous therapy/single TI, median [interquartile range] = 4 [1–8] wk, n = 21; repeated TI, median [interquartile range] = 5 [4–8] wk, n = 21; p = 0.36). No differences in study-related adverse events, viral set point at 12 or 20 wk of open-ended interruption, viral resistance or therapy failure, retention of CD4 T cell numbers on ART, or retention of lymphoproliferative recall antigen responses were noted between groups. Importantly, resistance detected shortly after initial viremia following the open-ended TI did not result in a lack of resuppression to less than 50 copies/ml after reinitiation of the same drug regimen. Conclusion Cycles of 2- to 6-wk time-fixed TIs in patients with suppressed HIV infection failed to confer a clinically significant benefit with regard to viral suppression off ART. Also, secondary analysis showed no difference between the two strategies in terms of safety, retention of immune reconstitution, and clinical therapy failure. Based on these findings, we suggest that further clinical research on the long-term consequences of TI strategies to decrease drug exposure is warranted. PMID:15630469

Optical Analysis Of The Vacuum Arc Plasma Generated In Cup-Shape Contacts

NASA Astrophysics Data System (ADS)

Pavelescu, G.; Pavelescu, D.; Dumitrescu, G.; Anghelita, P.; Gherendi, F.

2007-04-01

In this paper are presented the results of the optical analysis on the rotating arc plasma, generated in the vacuum low voltage circuit breaker with cup-shaped contacts. An adequate experimental setup was used for single shot time and spatial resolved spectroscopy in order to analyze the evolution of the vacuum arc plasma. Different current interruption situations are correlated with plasma spectral diagnosis. The study is aimed to contribute to a better understanding of the complex phenomena that take place in the interruption process of high currents that appears in the short-circuit regime of electrical networks.

Mass media interventions for preventing smoking in young people.

PubMed

Carson, Kristin V; Ameer, Faisal; Sayehmiri, Kourosh; Hnin, Khin; van Agteren, Joseph Em; Sayehmiri, Fatemeh; Brinn, Malcolm P; Esterman, Adrian J; Chang, Anne B; Smith, Brian J

2017-06-02

Mass media interventions can be used as a way of delivering preventive health messages. They have the potential to reach and modify the knowledge, attitudes and behaviour of a large proportion of the community. To assess the effects of mass media interventions on preventing smoking in young people, and whether it can reduce smoking uptake among youth (under 25 years), improve smoking attitudes, intentions and knowledge, improve self-efficacy/self-esteem, and improve perceptions about smoking, including the choice to follow positive role models. We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE and Embase in June 2016. This is an update of a review first published in 1998. Randomized trials, controlled trials without randomization and interrupted time-series studies that assessed the effect of mass media campaigns (defined as channels of communication such as television, radio, newspapers, social media, billboards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person-to-person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years. We define smoking behaviour as the presence or absence of tobacco smoking or other tobacco use, or both, and the frequency of tobacco use. Eligible comparators included education or no intervention. Two review authors independently extracted information relating to the characteristics and the content of media interventions, participants, outcomes, methods of the study and risks of bias. We combined studies using qualitative narrative synthesis. We assessed the risks of bias for each study using the Cochrane 'Risk of bias' tool, alongside additional domains to account for the nature of the intervention. We assessed the quality of evidence contributing to outcomes using GRADE. We identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time-series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.Three studies (n = 17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school-based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n = 72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school-based intervention, and one interrupted time-series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school-based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school-based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns. Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review. Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed.

The effects of EMR deployment on doctors' work practices: a qualitative study in the emergency department of a teaching hospital.

PubMed

Park, Sun Young; Lee, So Young; Chen, Yunan

2012-03-01

The goal of this study was to examine the effects of medical notes (MD) in an electronic medical records (EMR) system on doctors' work practices at an Emergency Department (ED). We conducted a six-month qualitative study, including in situ field observations and semi-structured interviews, in an ED affiliated with a large teaching hospital during the time periods of before, after, and during the paper-to-electronic transition of the rollout of an EMR system. Data were analyzed using open coding method and various visual representations of workflow diagrams. The use of the EMR in the ED resulted in both direct and indirect effects on ED doctors' work practices. It directly influenced the ED doctors' documentation process: (i) increasing documentation time four to five fold, which in turn significantly increased the number of incomplete charts, (ii) obscuring the distinction between residents' charting inputs and those of attendings, shifting more documentation responsibilities to the residents, and (iii) leading to the use of paper notes as documentation aids to transfer information from the patient bedside to the charting room. EMR use also had indirect consequences: it increased the cognitive burden of doctors, since they had to remember multiple patients' data; it aggravated doctors' multi-tasking due to flexibility in the system use allowing more interruptions; and it caused ED doctors' work to become largely stationary in the charting room, which further contributed to reducing doctors' time with patients and their interaction with nurses. We suggest three guidelines for designing future EMR systems to be used in teaching hospitals. First, the design of documentation tools in EMR needs to take into account what we called "note-intensive tasks" to support the collaborative nature of medical work. Second, it should clearly define roles and responsibilities. Lastly, the system should provide a balance between flexibility and interruption to better manage the complex nature of medical work and to facilitate necessary interactions among ED staff and patients in the work environment. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

46 CFR 154.1365 - Audible and visual alarms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment... it to be turned off after sounding. For remote group alarms this arrangement must not interrupt the..., except for remote group alarms, the location of each fault that actuates it. (d) Each vessel must have...

30 CFR 75.825 - Power centers.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., and be designed and installed as follows: (1) Rated for the maximum phase-to-phase voltage of the circuit; (2) Rated for the full-load current of the circuit that is supplied power through the device. (3... current of the circuit or causes the current to be interrupted automatically before the disconnecting...

30 CFR 18.48 - Circuit-interrupting devices.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., AND APPROVAL OF MINING PRODUCTS ELECTRIC MOTOR-DRIVEN MINE EQUIPMENT AND ACCESSORIES Construction and.... Such a switch shall be designed to prevent electrical connection to the machine frame when the cable is... motor in the event the belt is stopped, or abnormally slowed down. Note: Short transfer-type conveyors...

The 512-channel correlator controller

NASA Technical Reports Server (NTRS)

Brokl, S. S.

1976-01-01

A high-speed correlator for radio and radar observations was developed and a controller was designed so that the correlator could run automatically without computer intervention. The correlator controller assumes the role of bus master and keeps track of data and properly interrupts the computer at the end of the observation.

Learning on Hold: Cell Phones Sidetrack Parent-Child Interactions

ERIC Educational Resources Information Center

Reed, Jessa; Hirsh-Pasek, Kathy; Golinkoff, Roberta Michnick

2017-01-01

Although research suggests that responsive interactions are imperative for language development, the advent of mobile technology means that parent-child exchanges are often fraught with unpredictable interruptions. Less clear is how these momentary breaks in responsiveness affect word learning. In this within-subjects design, 38 mothers taught…

General bulk service queueing system with N-policy, multiplevacations, setup time and server breakdown without interruption

NASA Astrophysics Data System (ADS)

Sasikala, S.; Indhira, K.; Chandrasekaran, V. M.

2017-11-01

In this paper, we have considered an MX / (a,b) / 1 queueing system with server breakdown without interruption, multiple vacations, setup times and N-policy. After a batch of service, if the size of the queue is ξ (< a), then the server immediately takes a vacation. Upon returns from a vacation, if the queue is less than N, then the server takes another vacation. This process continues until the server finds atleast N customers in the queue. After a vacation, if the server finds at least N customers waiting for service, then the server needs a setup time to start the service. After a batch of service, if the amount of waiting customers in the queue is ξ (≥ a) then the server serves a batch of min(ξ,b) customers, where b ≥ a. We derived the probability generating function of queue length at arbitrary time epoch. Further, we obtained some important performance measures.

Evaluation of Interruption Behavior by Naive Encoders.

ERIC Educational Resources Information Center

Coon, Christine A.; Schwanenflugel, Paula J.

1996-01-01

Determines the characteristics of interactions that influence judgments of interruption behavior in naive observers. Asks subjects to decide whether an example of an interruption was an interruption and then rate it in terms of how "good" or "bad" it was. Finds that naive observers use some of the same features described in…

A Study of the Quantity of Time for Teaching Reading.

ERIC Educational Resources Information Center

Florida Reading Association.

A study was conducted to provide descriptive information about the quantity of classroom time used for teaching reading and the interruptive events that occur during the scheduled reading time. Data were gathered from 148 public and private school teachers representing all grade levels and a wide range of teaching experience. The subjects each…

Reduction in outpatient antibiotic sales for pre-school children: interrupted time series analysis of weekly antibiotic sales data in Sweden 1992-2002.

PubMed

Högberg, Liselotte; Oke, Thimothy; Geli, Patricia; Lundborg, Cecilia Stålsby; Cars, Otto; Ekdahl, Karl

2005-07-01

The aim of this study was to use detailed weekly data on outpatient antibiotic sales for pre-school children in Sweden to test for the significance of trends during 1992-2002. We also report on the special features found in weekly antibiotic data, and how the interrupted time series (ITS) design can adjust for this. Weekly data on the total number of dispensed outpatient antibiotic prescriptions to pre-school children were studied, as well as the individual subgroups commonly used to treat respiratory tract infections in children: narrow-spectrum penicillins, broad-spectrum penicillins and macrolides. In parallel, monthly data of paracetamol sales of paediatric dosages were analysed to reflect trends in symptomatic treatment. An ITS model controlling for seasonality and autocorrelation was used to examine the datasets for significant level and trend shifts. A significant increase in mean and change in level could be found in the total antibiotic data in 1997, also reflected in broad-spectrum penicillin data where a similar trend break occurred in 1996. For macrolides, a trend break with a decrease in mean was noted in 1996, but no trend breaks were found in narrow-spectrum penicillin data. In contrast to the general decreasing trends in antibiotic sales, the yearly over-the-counter sales of paracetamol in paediatric preparations increased during the same period, with no identified trend breaks. The overall decrease in antibiotic sales and increase in paediatric paracetamol sales might suggest that symptomatic treatment in the home has increased, as antibiotics are less commonly prescribed.

Fuel Cell Power Plant Initiative. Volume 1; Solid Oxide Fuel Cell/Logistics Fuel Processor 27 kWe Power System Demonstration for ARPA

NASA Technical Reports Server (NTRS)

Veyo, S.E.

1997-01-01

This report describes the successful testing of a 27 kWe Solid Oxide Fuel Cell (SOFC) generator fueled by natural gas and/or a fuel gas produced by a brassboard logistics fuel preprocessor (LFP). The test period began on May 24, 1995 and ended on February 26, 1996 with the successful completion of all program requirements and objectives. During this time period, this power system produced 118.2 MWh of electric power. No degradation of the generator's performance was measured after 5582 accumulated hours of operation on these fuels: local natural gas - 3261 hours, jet fuel reformate gas - 766 hours, and diesel fuel reformate gas - 1555 hours. This SOFC generator was thermally cycled from full operating temperature to room temperature and back to operating temperature six times, because of failures of support system components and the occasional loss of test site power, without measurable cell degradation. Numerous outages of the LFP did not interrupt the generator's operation because the fuel control system quickly switched to local natural gas when an alarm indicated that the LFP reformate fuel supply had been interrupted. The report presents the measured electrical performance of the generator on all three fuel types and notes the small differences due to fuel type. Operational difficulties due to component failures are well documented even though they did not affect the overall excellent performance of this SOFC power generator. The final two appendices describe in detail the LFP design and the operating history of the tested brassboard LFP.

Methodological Considerations for Use of Routine Health Information System Data to Evaluate Malaria Program Impact in an Era of Declining Malaria Transmission

PubMed Central

Ashton, Ruth A.; Bennett, Adam; Yukich, Joshua; Bhattarai, Achuyt; Keating, Joseph; Eisele, Thomas P.

2017-01-01

Abstract. Coverage of malaria control interventions is increasing dramatically across endemic countries. Evaluating the impact of malaria control programs and specific interventions on health indicators is essential to enable countries to select the most effective and appropriate combination of tools to accelerate progress or proceed toward malaria elimination. When key malaria interventions have been proven effective under controlled settings, further evaluations of the impact of the intervention using randomized approaches may not be appropriate or ethical. Alternatives to randomized controlled trials are therefore required for rigorous evaluation under conditions of routine program delivery. Routine health management information system (HMIS) data are a potentially rich source of data for impact evaluation, but have been underused in impact evaluation due to concerns over internal validity, completeness, and potential bias in estimates of program or intervention impact. A range of methodologies were identified that have been used for impact evaluations with malaria outcome indicators generated from HMIS data. Methods used to maximize internal validity of HMIS data are presented, together with recommendations on reducing bias in impact estimates. Interrupted time series and dose-response analyses are proposed as the strongest quasi-experimental impact evaluation designs for analysis of malaria outcome indicators from routine HMIS data. Interrupted time series analysis compares the outcome trend and level before and after the introduction of an intervention, set of interventions or program. The dose-response national platform approach explores associations between intervention coverage or program intensity and the outcome at a subnational (district or health facility catchment) level. PMID:28990915

Effectiveness of employer financial incentives in reducing time to report worker injury: an interrupted time series study of two Australian workers' compensation jurisdictions.

PubMed

Lane, Tyler J; Gray, Shannon; Hassani-Mahmooei, Behrooz; Collie, Alex

2018-01-05

Early intervention following occupational injury can improve health outcomes and reduce the duration and cost of workers' compensation claims. Financial early reporting incentives (ERIs) for employers may shorten the time between injury and access to compensation benefits and services. We examined ERI effect on time spent in the claim lodgement process in two Australian states: South Australia (SA), which introduced them in January 2009, and Tasmania (TAS), which introduced them in July 2010. Using administrative records of 1.47 million claims lodged between July 2006 and June 2012, we conducted an interrupted time series study of ERI impact on monthly median days in the claim lodgement process. Time periods included claim reporting, insurer decision, and total time. The 18-month gap in implementation between the states allowed for a multiple baseline design. In SA, we analysed periods within claim reporting: worker and employer reporting times (similar data were not available in TAS). To account for external threats to validity, we examined impact in reference to a comparator of other Australian workers' compensation jurisdictions. Total time in the process did not immediately change, though trend significantly decreased in both jurisdictions (SA: -0.36 days per month, 95% CI -0.63 to -0.09; TAS: 0.35, -0.50 to -0.20). Claim reporting time also decreased in both (SA: -1.6 days, -2.4 to -0.8; TAS: -5.4, -7.4 to -3.3). In TAS, there was a significant increase in insurer decision time (4.6, 3.9 to 5.4) and a similar but non-significant pattern in SA. In SA, worker reporting time significantly decreased (-4.7, -5.8 to -3.5), but employer reporting time did not (-0.3, -0.8 to 0.2). The results suggest that ERIs reduced claim lodgement time and, in the long-term, reduced total time in the claim lodgement process. However, only worker reporting time significantly decreased in SA, indicating that ERIs may not have shortened the process through the intended target of employer reporting time. Lack of similar data in Tasmania limited our ability to determine whether this was a result of ERIs or another component of the legislative changes. Further, increases in insurer decision time highlight possible unintended negative effects.

In Search of a Pony: Sources, Methods, Outcomes, and Motivated Reasoning.

PubMed

Stone, Marc B

2018-05-01

It is highly desirable to be able to evaluate the effect of policy interventions. Such evaluations should have expected outcomes based upon sound theory and be carefully planned, objectively evaluated and prospectively executed. In many cases, however, assessments originate with investigators' poorly substantiated beliefs about the effects of a policy. Instead of designing studies that test falsifiable hypotheses, these investigators adopt methods and data sources that serve as little more than descriptions of these beliefs in the guise of analysis. Interrupted time series analysis is one of the most popular forms of analysis used to present these beliefs. It is intuitively appealing but, in most cases, it is based upon false analogies, fallacious assumptions and analytical errors.

Spaceborne centrifugal relays for spacecraft propulsion

NASA Technical Reports Server (NTRS)

Ouzidane, Malika

1991-01-01

Acceleration using centrifugal relays is a recently discovered method for the acceleration of spaceborne payloads to high velocity at high thrust. Centrifugal relays are moving rotors which progressively accelerate reaction mass to higher velocities. One important engineering problem consists of accurately tracking the position of the projectiles and rotors and guiding each projectile exactly onto the appropriate guide tracks on each rotor. The topics of this research are the system kinematics and dynamics and the computerized guidance system which will allow the projectile to approach each rotor with exact timing with respect to the rotor rotation period and with very small errors in lateral positions. Kinematics studies include analysis of rotor and projectile positions versus time and projectile/rotor interactions. Guidance studies include a detailed description of the tracking mechanism (interrupt of optical beams) and the aiming mechanism (electromagnetic focusing) including the design of electromagnetic deflection coils and the switching circuitry.

Effects of Smoke-Free Laws on Alcohol-Related Car Crashes in California and New York: Time Series Analyses From 1982 to 2008

PubMed Central

Maldonado-Molina, Mildred; Hyland, Andrew; Wagenaar, Alexander C.

2013-01-01

We examined effects of New York and California’s statewide smoke-free restaurant and bar polices on alcohol-related car crash fatalities. We used an interrupted time-series design from 1982 to 2008, with 312 monthly observations, to examine the effect of each state’s law on single-vehicle-nighttime crashes and crashes involving a driver with a blood alcohol concentration of 0.08 grams per deciliter or greater. Implementation of New York and California’s statewide smoke-free policies was not associated with alcohol-related car crash fatalities. Additionally, analyses showed no effect of New York’s smoke-free policy on alcohol-related car crash fatalities in communities along the Pennsylvania-New York border. Statewide smoke-free restaurant and bar laws do not appear to affect rates of alcohol-related car crashes. PMID:23237160

Advanced information processing system: Local system services

NASA Technical Reports Server (NTRS)

Burkhardt, Laura; Alger, Linda; Whittredge, Roy; Stasiowski, Peter

1989-01-01

The Advanced Information Processing System (AIPS) is a multi-computer architecture composed of hardware and software building blocks that can be configured to meet a broad range of application requirements. The hardware building blocks are fault-tolerant, general-purpose computers, fault-and damage-tolerant networks (both computer and input/output), and interfaces between the networks and the computers. The software building blocks are the major software functions: local system services, input/output, system services, inter-computer system services, and the system manager. The foundation of the local system services is an operating system with the functions required for a traditional real-time multi-tasking computer, such as task scheduling, inter-task communication, memory management, interrupt handling, and time maintenance. Resting on this foundation are the redundancy management functions necessary in a redundant computer and the status reporting functions required for an operator interface. The functional requirements, functional design and detailed specifications for all the local system services are documented.

An astronomer's guide to period searching

NASA Astrophysics Data System (ADS)

Schwarzenberg-Czerny, A.

2003-03-01

We concentrate on analysis of unevenly sampled time series, interrupted by periodic gaps, as often encountered in astronomy. While some of our conclusions may appear surprising, all are based on classical statistical principles of Fisher & successors. Except for discussion of the resolution issues, it is best for the reader to forget temporarily about Fourier transforms and to concentrate on problems of fitting of a time series with a model curve. According to their statistical content we divide the issues into several sections, consisting of: (ii) statistical numerical aspects of model fitting, (iii) evaluation of fitted models as hypotheses testing, (iv) the role of the orthogonal models in signal detection (v) conditions for equivalence of periodograms (vi) rating sensitivity by test power. An experienced observer working with individual objects would benefit little from formalized statistical approach. However, we demonstrate the usefulness of this approach in evaluation of performance of periodograms and in quantitative design of large variability surveys.

Two-dimensional electron density characterisation of arc interruption phenomenon in current-zero phase

NASA Astrophysics Data System (ADS)

Inada, Yuki; Kamiya, Tomoki; Matsuoka, Shigeyasu; Kumada, Akiko; Ikeda, Hisatoshi; Hidaka, Kunihiko

2018-01-01

Two-dimensional electron density imaging over free burning SF6 arcs and SF6 gas-blast arcs was conducted at current zero using highly sensitive Shack-Hartmann type laser wavefront sensors in order to experimentally characterise electron density distributions for the success and failure of arc interruption in the thermal reignition phase. The experimental results under an interruption probability of 50% showed that free burning SF6 arcs with axially asymmetric electron density profiles were interrupted with a success rate of 88%. On the other hand, the current interruption of SF6 gas-blast arcs was reproducibly achieved under locally reduced electron densities and the interruption success rate was 100%.

Process Management and Exception Handling in Multiprocessor Operating Systems Using Object-Oriented Design Techniques. Revised Sep. 1988

NASA Technical Reports Server (NTRS)

Russo, Vincent; Johnston, Gary; Campbell, Roy

1988-01-01

The programming of the interrupt handling mechanisms, process switching primitives, scheduling mechanism, and synchronization primitives of an operating system for a multiprocessor require both efficient code in order to support the needs of high- performance or real-time applications and careful organization to facilitate maintenance. Although many advantages have been claimed for object-oriented class hierarchical languages and their corresponding design methodologies, the application of these techniques to the design of the primitives within an operating system has not been widely demonstrated. To investigate the role of class hierarchical design in systems programming, the authors have constructed the Choices multiprocessor operating system architecture the C++ programming language. During the implementation, it was found that many operating system design concerns can be represented advantageously using a class hierarchical approach, including: the separation of mechanism and policy; the organization of an operating system into layers, each of which represents an abstract machine; and the notions of process and exception management. In this paper, we discuss an implementation of the low-level primitives of this system and outline the strategy by which we developed our solution.

HIV-1 DNA predicts disease progression and post-treatment virological control

PubMed Central

Williams, James P; Hurst, Jacob; Stöhr, Wolfgang; Robinson, Nicola; Brown, Helen; Fisher, Martin; Kinloch, Sabine; Cooper, David; Schechter, Mauro; Tambussi, Giuseppe; Fidler, Sarah; Carrington, Mary; Babiker, Abdel; Weber, Jonathan

2014-01-01

In HIV-1 infection, a population of latently infected cells facilitates viral persistence despite antiretroviral therapy (ART). With the aim of identifying individuals in whom ART might induce a period of viraemic control on stopping therapy, we hypothesised that quantification of the pool of latently infected cells in primary HIV-1 infection (PHI) would predict clinical progression and viral replication following ART. We measured HIV-1 DNA in a highly characterised randomised population of individuals with PHI. We explored associations between HIV-1 DNA and immunological and virological markers of clinical progression, including viral rebound in those interrupting therapy. In multivariable analyses, HIV-1 DNA was more predictive of disease progression than plasma viral load and, at treatment interruption, predicted time to plasma virus rebound. HIV-1 DNA may help identify individuals who could safely interrupt ART in future HIV-1 eradication trials. Clinical trial registration: ISRCTN76742797 and EudraCT2004-000446-20 DOI: http://dx.doi.org/10.7554/eLife.03821.001 PMID:25217531

Transmission of Onchocerca volvulus by Simulium neavei in Mount Elgon Focus of Eastern Uganda Has Been Interrupted

PubMed Central

Katabarwa, Moses; Lakwo, Tom; Habomugisha, Peace; Agunyo, Stella; Byamukama, Edson; Oguttu, David; Ndyomugyenyi, Richard; Tukesiga, Ephraim; Ochieng, Galex Orukan; Abwaimo, Francis; Onapa, Ambrose; Lwamafa, Dennis W. K.; Walsh, Frank; Unnasch, Thomas R.; Richards, Frank O.

2014-01-01

The study determined that Simulium neavei-transmitted onchocerciasis in Mount Elgon onchocerciasis focus had been interrupted. Annual mass treatment with ivermectin changed to two times per year along with vector elimination in 2007. Then, baseline microfilaria (mf) prevalence data of 1994 in five sentinel communities were compared with follow-up data in 2005 and 2011. Blood spots from 3,051 children obtained in 2009 were analyzed for Onchocerca volvulus immunoglobulin G4 antibodies. Fresh water crab host captures and blackflies collected indicated their infestation with larval stages of S. neavei and presence or absence of the vector, respectively. Mf rates dropped from 62.2% to 0.5%, and 1 (0.03%) of 3,051 children was positive for O. volvulus antibodies. Crab infestation dropped from 41.9% in 2007 to 0%, and S. neavei biting reduced to zero. Both remained zero for the next 3 years, confirming interruption of onchocerciasis transmission, and interventions were halted. PMID:24686740

Determining the Overall Impact of Interruptions during Online Testing

ERIC Educational Resources Information Center

Sinharay, Sandip; Wan, Ping; Whitaker, Mike; Kim, Dong-In; Zhang, Litong; Choi, Seung W.

2014-01-01

With an increase in the number of online tests, interruptions during testing due to unexpected technical issues seem unavoidable. For example, interruptions occurred during several recent state tests. When interruptions occur, it is important to determine the extent of their impact on the examinees' scores. There is a lack of research on this…