Comparison of the university hospital and county hospitals in western Sweden to identify potential weak links in the early chain of care for acute stroke: results of an observational study

PubMed Central

Wireklint Sundström, Birgitta; Herlitz, Johan; Hansson, Per Olof; Brink, Peter

2015-01-01

Objective To identify weak links in the early chain of care for acute stroke. Setting 9 emergency hospitals in western Sweden, each with a stroke unit, and the emergency medical services (EMS). Participants All patients hospitalised with a first and a final diagnosis of stroke−between 15 December 2010 and 15 April 2011. The university hospital in the city of Gothenburg was compared with 6 county hospitals. Primary and secondary measures (1) The system delay, that is, median delay time from call to the EMS until diagnosis was designated as the primary end point. Secondary end points were: (2) the system delay time from call to the EMS until arrival in a hospital ward, (3) the use of the EMS, (4) priority at the dispatch centre and (5) suspicion of stroke by the EMS nurse. Results In all, 1376 acute patients with stroke (median age 79 years; 49% women) were included. The median system delay from call to the EMS until (1) diagnosis (CT scan) and (2) arrival in a hospital ward was 3 h and 52 min and 4 h and 22 min, respectively. The system delay (1) was significantly shorter in county hospitals. (3) The study showed that 76% used the EMS (Gothenburg 71%; the county 79%; p<0.0001). (4) Priority 1 was given at the dispatch centre in 54% of cases. (5) Stroke was suspected in 65% of cases. A prenotification was sent in 32% (Gothenburg 52%; the county 20%; p<0.0001). Conclusions System delay is still long and only a small fraction of patients received thrombolysis. Three of four used the EMS (more frequent in the county). They were given the highest priority at the dispatch centre in half of the cases. Stroke was suspected in two-thirds of the cases, but a prenotification was seldom sent to the hospital. PMID:26351184

Hospital referral patterns: how emergency medical care is accessed in a disaster.

PubMed

Reilly, Michael J; Markenson, David

2010-10-01

A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning. We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data. Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care. Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for

[Hospitals and other philanthropic foundations in early Byzantine period].

PubMed

Yildirim, R Vedat; Ataç, Adnan

Early Byzantine Period includes between A.D. 330 when Constantinople was established and A.D. 518 when Justinus I became emperor. In this time period, a lot of philanthropic foundations such as hospitals, hospices, orphanages, rest homes and soup kitchens are established. Many of patriarchs and religious men opened them. In some of them, it refers to there was patients' care. The oldest hospital in Constantinople was established by Hasios Marcianos, and was next to Saint Irene Church. In addition to this Empress Flacilla wife of Theodosius the Great made hospitals restored and visited patients regularly. Hospitals were not limited in the center of Empire. Hospitals and other philanthropic foundations were established in Antiochia, Alexandria, Nikea, Adrianopolis, Castoria and Jerusalem. The concept of the modern hospital (the actual care, 'hospitality' and treatment of visitors) for the civilian masses in Europe didn't come to fruition until post Constantine and the rise of Christianity. While these early Christian hospitals were grossly over their heads regarding medical capability (they essentially served as last stops for the dying or quarantine centers), the concept of providing care to the public was the actual intent. In this regard, the first civilian hospitals were developed.

Paramedic-Initiated CMS Sepsis Core Measure Bundle Prior to Hospital Arrival: A Stepwise Approach.

PubMed

Walchok, Jason G; Pirrallo, Ronald G; Furmanek, Douglas; Lutz, Martin; Shope, Colt; Giles, Brandi; Gue, Greta; Dix, Aaron

2017-01-01

To improve patient outcomes, the Center for Medicare and Medicaid Services (CMS) implemented core measures that outline the initial treatment of the septic patient. These measures include initial blood culture collection prior to antibiotics, adequate intravenous fluid resuscitation, and early administration of broad spectrum antibiotics. We sought to determine if Paramedics can initiate the CMS sepsis core measure bundle in the prehospital field reliably. This is a retrospective, case series from a 3rd service EMS system model in Greenville, South Carolina between November 17, 2014 and February 20, 2016. An adult Prehospital Sepsis Assessment Tool was created using the 2012 Surviving Sepsis guidelines: 2 of 3 signs of systemic inflammatory response (heart rate, respiratory rate, oral temperature) and a known or suspected source of infection. A "Sepsis Alert" was called by paramedics and upon IV access a set of blood cultures and blood for lactate analysis was collected prior to field antibiotic administration. The Sepsis Alert was compared to serum lactate levels and ICD 9 or 10 admitting diagnosis of Sepsis, Severe Sepsis, or Septic Shock. Blood culture contamination, serum lactate, and antibiotic match were determined by in-hospital laboratory analysis. A total of 120 trained paramedics called 1,185 "Sepsis Alerts" on 56,643 patients (50.3% Male, mean age 70). Patients with missing discharge diagnosis were eliminated (n = 31). The admitting diagnosis of sepsis overall was 73.5% (848/1154): Sepsis 50% (578/1154), Severe Sepsis 14.6% (169/1154), Septic Shock 8.9% (101/1154). A total of 946 blood cultures were collected in the prehospital setting, with a 95.04% (899/946) no contamination rate. Contamination was found in 4.96% (47/946). A total of 179 (18.9%) of the uncontaminated blood cultures were found to have positive growth with 720 (76.1%) having no growth. EMS administered antibiotics matched blood culture positive growth in 72% of patients. The lactate

Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care

PubMed Central

Richards, Suzanne H; Coast, Joanna; Gunnell, David J; Peters, Tim J; Pounsford, John; Darlow, Mary-Anne

1998-01-01

Objective: To compare effectiveness and acceptability of early discharge to a hospital at home scheme with that of routine discharge from acute hospital. Design: Pragmatic randomised controlled trial. Setting: Acute hospital wards and community in north of Bristol, with a catchment population of about 224 000 people. Subjects: 241 hospitalised but medically stable elderly patients who fulfilled criteria for early discharge to hospital at home scheme and who consented to participate. Interventions: Patients’ received hospital at home care or routine hospital care. Main outcome measures: Patients’ quality of life, satisfaction, and physical functioning assessed at 4 weeks and 3 months after randomisation to treatment; length of stay in hospital and in hospital at home scheme after randomisation; mortality at 3 months. Results: There were no significant differences in patient mortality, quality of life, and physical functioning between the two arms of the trial at 4 weeks or 3 months. Only one of 11 measures of patient satisfaction was significantly different: hospital at home patients perceived higher levels of involvement in decisions. Length of stay for those receiving routine hospital care was 62% (95% confidence interval 51% to 75%) of length of stay in hospital at home scheme. Conclusions: The early discharge hospital at home scheme was similar to routine hospital discharge in terms of effectiveness and acceptability. Increased length of stay associated with the scheme must be interpreted with caution because of different organisational characteristics of the services. Key messages Pressure on hospital beds, the increasing age of the population, and high costs associated with acute hospital care have fuelled the search for alternatives to inpatient hospital care There were no significant differences between early discharge to hospital at home scheme and routine hospital care in terms of patient quality of life, physical functioning, and most measures of

Day hospital for early intervention for individuals with psychotic disorders.

PubMed

Šago, Daniela; Filipčić, Igor; Lovretić, Vanja; Mayer, Nina

2018-06-01

In long-term outcome studies on individuals with first-episode psychosis, improved remission and recovery rates perhaps reflect the improved treatment in dedicated early intervention program. The first episode is a critical period in which individuals with psychosis, as well as members of their families, are confronted with the illness for the first time. Until nowadays, treatment of first psychotic episodes in Croatia has usually been provided in hospital setting. The day hospital provides comprehensive therapeutic approach that refers to early systematic application of all available and effective therapeutic methods in the initial phases of psychotic disorders, and aims to attain and maintain remission and recovery, as well as insight and adherence to treatment. The day hospital is a time-limited structured program that comprises diagnostic procedures, treatment and rehabilitation based on various group psychotherapy and socio-therapy approaches. It is cheaper than hospital treatment and preferred by patients and their families. The importance of involving family members along with patients in the therapeutic process is recognized. The aim of this paper is to present the first day hospital for early intervention and treatment of individuals with psychotic disorder, established within Psychiatric hospital "Sveti Ivan", Zagreb, Croatia.

Climate and the complexity of migratory phenology: sexes, migratory distance, and arrival distributions

NASA Astrophysics Data System (ADS)

Macmynowski, Dena P.; Root, Terry L.

2007-05-01

The intra- and inter-season complexity of bird migration has received limited attention in climatic change research. Our phenological analysis of 22 species collected in Chicago, USA, (1979 2002) evaluates the relationship between multi-scalar climate variables and differences (1) in arrival timing between sexes, (2) in arrival distributions among species, and (3) between spring and fall migration. The early migratory period for earliest arriving species (i.e., short-distance migrants) and earliest arriving individuals of a species (i.e., males) most frequently correlate with climate variables. Compared to long-distance migrant species, four times as many short-distance migrants correlate with spring temperature, while 8 of 11 (73%) of long-distance migrant species’ arrival is correlated with the North Atlantic Oscillation (NAO). While migratory phenology has been correlated with NAO in Europe, we believe that this is the first documentation of a significant association in North America. Geographically proximate conditions apparently influence migratory timing for short-distance migrants while continental-scale climate (e.g., NAO) seemingly influences the phenology of Neotropical migrants. The preponderance of climate correlations is with the early migratory period, not the median of arrival, suggesting that early spring conditions constrain the onset or rate of migration for some species. The seasonal arrival distribution provides considerable information about migratory passage beyond what is apparent from statistical analyses of phenology. A relationship between climate and fall phenology is not detected at this location. Analysis of the within-season complexity of migration, including multiple metrics of arrival, is essential to detect species’ responses to changing climate as well as evaluate the underlying biological mechanisms.

A balancing act in an unknown territory: a metasynthesis of first-time mothers' experiences in early labour.

PubMed

Eri, Tine S; Bondas, Terese; Gross, Mechthild M; Janssen, Patricia; Green, Josephine M

2015-03-01

to integrate findings of individual studies in order to broaden the understanding of first-time mothers' experiences of early labour. the methodology was metasynthesis which is based on the interpretive meta-ethnography described by Noblit and Hare (1988). Metasynthesis is research on research which synthesises the findings of previous qualitative studies, and the focus is on interpretation and the creation of new knowledge. all included studies originated from high resource countries (USA 2, UK 4, and Scandinavia 5) and all were carried out in a context of hospital based maternity care. a total of 231 women participated in the studies. 11 articles were included. The main results are presented with the metaphor a balancing act in an unknown territory. The 'unknown territory' has a double meaning: as the personal experience of going into labour for the first time and as encountering the maternity care system. On both levels women have to make significant decisions: whether labour really has started and subsequently when to go to the hospital. A key challenge is to balance the arrival on the labour ward at the 'right' time, not too early and not too late. Arriving at the 'right' time leads to a positive path, while arriving 'too soon' might lead to a cascade of negative experiences. The results are further presented with five central themes: 'Finding out if labour has started is absorbing'; 'Dealing with labour at home'; 'Trying to arrive at the labour ward at the right time'; 'There is always a risk of being sent home'; 'Encountering health professionals arouses strong emotions'. the metasynthesis broadens the understanding of first-time mothers' experiences of early labour, and suggests that women's needs when planning a hospital birth are not being adequately met at this stage in the labour process. Three areas of future research are suggested: how to support and strengthen women during pregnancy in order to cope with early labour; women's experiences of early

Early Cardiac Arrest in Patients Hospitalized With Pneumonia

PubMed Central

Yuen, Trevor C.; McConville, John F.; Kress, John P.; VandenHoek, Terry L.; Hall, Jesse B.; Edelson, Dana P.

2012-01-01

Background: Pneumonia is the leading infectious cause of death. Early deterioration and death commonly result from progressive sepsis, shock, respiratory failure, and cardiac complications. Recent data suggest that cardiac arrest may also be common, yet few previous studies have addressed this. Accordingly, we sought to characterize early cardiac arrest in patients who are hospitalized with coexisting pneumonia. Methods: We performed a retrospective analysis of a multicenter cardiac arrest database, with data from > 500 North American hospitals. We included in-hospital cardiac arrest events that occurred in community-dwelling adults with pneumonia within the first 72 h after hospital admission. We compared patient and event characteristics for patients with and without pneumonia. For patients with pneumonia, we also compared events according to event location. Results: We identified 4,453 episodes of early cardiac arrest in patients who were hospitalized with pneumonia. Among patients with preexisting pneumonia, only 36.5% were receiving mechanical ventilation and only 33.3% were receiving infusions of vasoactive drugs prior to cardiac arrest. Only 52.3% of patients on the ward were receiving ECG monitoring prior to cardiac arrest. Shockable rhythms were uncommon in all patients with pneumonia (ventricular tachycardia or fibrillation, 14.8%). Patients on the ward were significantly older than patients in the ICU. Conclusions: In patients with preexisting pneumonia, cardiac arrest may occur in the absence of preceding shock or respiratory failure. Physicians should be alert to the possibility of abrupt cardiopulmonary collapse, and future studies should address this possibility. The mechanism may involve myocardial ischemia, a maladaptive response to hypoxia, sepsis-related cardiomyopathy, or other phenomena. PMID:22194592

Pre-hospital and early in-hospital management of severe injuries: changes and trends.

PubMed

Hussmann, Bjoern; Lendemans, Sven

2014-10-01

The pre-hospital and early in-hospital management of most severely injured patients has dramatically changed over the last 20 years. In this context, the factor time has gained more and more attention, particularly in German-speaking countries. While the management in the early 1990s aimed at comprehensive and complete therapy at the accident site, the premise today is to stabilise trauma patients at the accident site and transfer them into the hospital rapidly. In addition, the introduction of training and education programmes such as Pre-hospital Trauma Life Support (PHTLS(®)), Advanced Trauma Life Support (ATLS(®)) concept or the TEAM(®) concept has increased the quality of treatment of most severely injured trauma patients both in the preclinical field and in the emergency trauma room. Today, all emergency surgical procedures in severely injured patients are generally performed in accordance with the Damage Control Orthopaedics (DCO) principle. The advancements described in this article provide examples for the improved quality of the management of severely injured patients in the preclinical field and during the initial in-hospital treatment phase. The implementation of trauma networks, the release of the S3 polytrauma guidelines, and the DGU "Weißbuch" have contributed to a more structured management of most severely injured patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

Early warning system for financially distressed hospitals via data mining application.

PubMed

Koyuncugil, Ali Serhan; Ozgulbas, Nermin

2012-08-01

The aim of this study is to develop a Financial Early Warning System (FEWS) for hospitals by using data mining. A data mining method, Chi-Square Automatic Interaction Detector (CHAID) decision tree algorithm, was used in the study for financial profiling and developing FEWS. The study was conducted in Turkish Ministry of Health's public hospitals which were in financial distress and in need of urgent solutions for financial issues. 839 hospitals were covered and financial data of the year 2008 was obtained from Ministry of Health. As a result of the study, it was determined that 28 hospitals (3.34%) had good financial performance, and 811 hospitals (96.66%) had poor financial performance. According to FEWS, the covered hospitals were categorized into 11 different financial risk profiles, and it was found that 6 variables affected financial risk of hospitals. According to the profiles of hospitals in financial distress, one early warning signal was detected and financial road map was developed for risk mitigation.

Investigations of acoustic-seismic effects at long range - Early-arriving seismic waves from Apollo 16

NASA Technical Reports Server (NTRS)

Dalins, I.; Mccarty, V. M.; Kaschak, G.; Donn, W. L.

1974-01-01

A reasonably comprehensive technical effort is described dealing with the investigations of acoustically generated seismic waves of Apollo 16 and Apollo 17 origin along the eastern seabord of the United States. This expanded effort is a continuation of earlier, rather successful detections of rocket-generated seismic disturbances on Skidaway Island, Georgia. The more recent effort has yielded few positive results other than a recording of an early-arriving seismic wave from Apollo 16 that was detected in Jacksonville. Evaluation of the negative results obtained in the Fort Monmouth area, with earlier studies of infrasound, local weather conditions, and geology, could be advantageous in the process of trying to gain a better insight into the acoustic-seismic resonance mechanism requiring phase-velocity matching at the atmosphere-ground interface.

APOLLO XI - CREW ARRIVAL - ELLINGTON AFB (EAFB), TX

NASA Image and Video Library

1969-07-27

S69-40217 (27 July 1969) --- Neil A. Armstrong, commander of the Apollo 11 flight, greets his son Mark, on telephone intercom system, while his wife Jan and another son Eric look on. Armstrong had just arrived in early morning with the Mobile Quarantine Facility (MQF) at Ellington Air Force Base. Armstrong and fellow astronauts will remain in the MQF until arrival and confinement in the Crew Reception Area (CRA) of the Lunar Receiving Laboratory (LRL) at the Manned Spacecraft Center (MSC). Quarantine period will end on Aug. 11, 1969.

Predictive Ability of an Emergency Medical Dispatch Stroke Diagnostic Tool in Identifying Hospital-Confirmed Strokes.

PubMed

Clawson, Jeff J; Scott, Greg; Gardett, Isabel; Youngquist, Scott; Taillac, Peter; Fivaz, Conrad; Olola, Christopher

2016-08-01

Early hospital notification of a possible stroke arriving via emergency medical services (EMS) can prepare stroke center personnel for timely treatment, especially timely administration of tissue plasminogen activator. Stroke center notification from the emergency dispatch center-before responders reach the scene-may promote even earlier and faster system activation, meaning that stroke center teams may be ready to receive patients as soon as the ambulance arrives. This study evaluates the use of a Medical Priority Dispatch System (MPDS; Priority Dispatch Corp., Salt Lake City, UT) Stroke Diagnostic Tool (SDxT) to identify possible strokes early by comparing the tools' results to on-scene and hospital findings. The retrospective descriptive study utilized stroke data from 3 sources: emergency medical dispatch, EMS, and emergency department/hospital. A total of 830 cases were collected between June 2012 and December 2013, of which 603 (72.7%) had matching dispatch records. Of the 603 cases, 304 (50.4%) were handled using MPDS Stroke Protocol 28. The SDxT had an 86.4% ability (OR [95% CI]: 2.3 [1.5, 3.5]) to effectively identify strokes among all the hospital-confirmed stroke cases (sensitivity), and a 26.6% ability to effectively identify nonstrokes among all the hospital-confirmed nonstroke cases (specificity). The SDxT demonstrated a very high sensitivity, compared to similar tools used in the field and at dispatch. The specificity was somewhat low, but this was expected-and is intended in the creation of protocols to be used over the phone in emergency situations. The tool is a valuable method for identifying strokes early and may allow early hospital notification. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Age at Arrival and Life Chances Among Childhood Immigrants.

PubMed

Hermansen, Are Skeie

2017-02-01

This study examines the causal relationship between childhood immigrants' age at arrival and their life chances as adults. I analyze panel data on siblings from Norwegian administrative registries, which enables me to disentangle the effect of age at arrival on adult socioeconomic outcomes from all fixed family-level conditions and endowments shared by siblings. Results from sibling fixed-effects models reveal a progressively stronger adverse influence of immigration at later stages of childhood on completed education, employment, adult earnings, occupational attainment, and social welfare assistance. The persistence of these relationships within families indicates that experiences related to the timing of childhood immigration have causal effects on later-life outcomes. These age-at-arrival effects are considerably stronger among children who arrive from geographically distant and economically less-developed origin regions than among children originating from developed countries. The age-at-arrival effects vary less by parental education and child gender. On the whole, the findings indicate that childhood immigration after an early-life formative period tends to constrain later human capital formation and economic opportunities over the life course.

Early disaster response in Haiti: the Israeli field hospital experience.

PubMed

Kreiss, Yitshak; Merin, Ofer; Peleg, Kobi; Levy, Gad; Vinker, Shlomo; Sagi, Ram; Abargel, Avi; Bartal, Carmi; Lin, Guy; Bar, Ariel; Bar-On, Elhanan; Schwaber, Mitchell J; Ash, Nachman

2010-07-06

The earthquake that struck Haiti in January 2010 caused an estimated 230,000 deaths and injured approximately 250,000 people. The Israel Defense Forces Medical Corps Field Hospital was fully operational on site only 89 hours after the earthquake struck and was capable of providing sophisticated medical care. During the 10 days the hospital was operational, its staff treated 1111 patients, hospitalized 737 patients, and performed 244 operations on 203 patients. The field hospital also served as a referral center for medical teams from other countries that were deployed in the surrounding areas. The key factor that enabled rapid response during the early phase of the disaster from a distance of 6000 miles was a well-prepared and trained medical unit maintained on continuous alert. The prompt deployment of advanced-capability field hospitals is essential in disaster relief, especially in countries with minimal medical infrastructure. The changing medical requirements of people in an earthquake zone dictate that field hospitals be designed to operate with maximum flexibility and versatility regarding triage, staff positioning, treatment priorities, and hospitalization policies. Early coordination with local administrative bodies is indispensable.

Improving Hospital-Wide Early Resource Allocation through Machine Learning.

PubMed

Gartner, Daniel; Padman, Rema

2015-01-01

The objective of this paper is to evaluate the extent to which early determination of diagnosis-related groups (DRGs) can be used for better allocation of scarce hospital resources. When elective patients seek admission, the true DRG, currently determined only at discharge, is unknown. We approach the problem of early DRG determination in three stages: (1) test how much a Naïve Bayes classifier can improve classification accuracy as compared to a hospital's current approach; (2) develop a statistical program that makes admission and scheduling decisions based on the patients' clincial pathways and scarce hospital resources; and (3) feed the DRG as classified by the Naïve Bayes classifier and the hospitals' baseline approach into the model (which we evaluate in simulation). Our results reveal that the DRG grouper performs poorly in classifying the DRG correctly before admission while the Naïve Bayes approach substantially improves the classification task. The results from the connection of the classification method with the mathematical program also reveal that resource allocation decisions can be more effective and efficient with the hybrid approach.

Call for research: detecting early vulnerability for psychiatric hospitalization.

PubMed

Prince, Jonathan D

2013-01-01

This study delineated the extent to which a broad set of risk factors in youth, a period well suited to primary prevention strategies, influences the likelihood and timing of first lifetime psychiatric hospitalizations. Logistic regression was used to delineate early risk factors for psychiatric hospitalization among Americans in a nationally representative survey (NCS-R, Part II, 2001-2003: N = 5,692). Results suggest that inpatient stay is more common and happens at earlier ages among Americans who report growing up with versus without: (1) depressed parents or caregivers, (2) family members who victimized them, or (3) one of three child mental illnesses (conduct, oppositional defiant, or separation anxiety disorder). In order to prevent inpatient stay, findings call for longitudinal research on early vulnerability for psychiatric hospitalization among families with: (1) depressed parents of children or adolescents, (2) violence against children, and (3) children that have externalizing or separation anxiety disorders.

Early appendectomy shortens antibiotic course and hospital stay in children with early perforated appendicitis.

PubMed

Tsai, Hsin-Yu; Chao, Hsun-Chin; Yu, Wan-Ju

2017-10-01

The optimal management of perforated appendicitis in the pediatric population has been controversial. This study aimed to compare the therapeutic efficacy between conservative treatment (CS) and early appendectomy (EA) in pediatric perforated appendicitis, and to determine whether surgical intervention is an optimal treatment modality for early perforated appendicitis in children. Patients treated between January 2012 and April 2014, aged 0-18 years, with an imaging-based diagnosis of perforated appendicitis were retrospectively reviewed. Patients were classified into nonabscess and abscess groups by image findings, and were further categorized into CS and EA groups by treatment modality. Early perforated appendicitis was defined as having duration of symptoms≤7 days, C-reactive protein level≤200 mg/L, maximum abscess diameter≤5 cm, and absence of general peritonitis, and unstable vital signs. The clinical features and therapeutic outcomes were compared between CS and EA in each group. A total of 326 patients had confirmed appendicitis, including 116 patients with an image diagnosis of perforation. The CS group had a significantly longer duration of symptoms, larger abscesses, and higher serum C-reactive protein levels at presentation (all p<0.05). Patients in the EA group had a shorter antibiotic course and length of hospitalization, and a lower rate of antibiotic escalation than those in the CS group (p<0.001, p<0.001, and p<0.05, respectively). In patients with early perforated appendicitis, the CS and EA groups showed no difference in baseline disease severity. Patients in the EA group also had a shorter antibiotic course and length of hospitalization than those in the CS group (p<0.001 and p<0.001, respectively). Compared with CS, EA shortens the antibiotic course and hospital stay in pediatric early perforated appendicitis, even in the presence of small abscesses. Copyright © 2017. Published by Elsevier B.V.

Early Intervention Services for Early-Phase Psychosis - Centre for integrative psychiatry in Psychiatric Hospital "Sveti Ivan", Croatia.

PubMed

Matić, Katarina; Gereš, Natko; Gerlach, Josefina; Prskalo-Čule, Diana; Zadravec Vrbanc, Tihana; Lovretić, Vanja; Librenjak, Dina; Vuk Pisk, Sandra; Ivezić, Ena; Šimunović Filipčić, Ivona; Jeleč, Vjekoslav; Filipčić, Igor

2018-06-01

There is a growing body of evidence suggesting that early and effective management in the critical early years of schizophrenia can improve long-term outcomes. The objective of this study was to evaluate time to relapse of the patients with early-phase psychosis treated in the Centre for integrative psychiatry (CIP). We performed a retrospective cohort study on the sample of 373 early-phase psychosis patients admitted to Psychiatric Hospital "Sveti Ivan", Zagreb Croatia: from January 1, 2015 to December 31, 2017. The primary outcome was time to relapse. Patients who were admitted to group psychotherapeutic program after the end of acute treatment had 70% lower hazard for relapse (HR=0.30; 95% CI 0.16-0.58). Patients who were included first in the psychotherapeutic program and then treated and controlled in the daily hospital had 74% lower hazard for relapse (HR=0.26; 95% CI 0.10-0.67). In early-phase psychosis, integrative early intervention service has relevant beneficial effects compare to treatment as usual. These results justified the implementation of multimodal early intervention services in treatment of patients with early-phase psychosis.

Pre-hospital National Early Warning Score (NEWS) is associated with in-hospital mortality and critical care unit admission: A cohort study.

PubMed

Abbott, Tom E F; Cron, Nicholas; Vaid, Nidhi; Ip, Dorothy; Torrance, Hew D T; Emmanuel, Julian

2018-03-01

National Early Warning Score (NEWS) is increasingly used in UK hospitals. However, there is only limited evidence to support the use of pre-hospital early warning scores. We hypothesised that pre-hospital NEWS was associated with death or critical care escalation within the first 48 h of hospital stay. Planned secondary analysis of a prospective cohort study at a single UK teaching hospital. Consecutive medical ward admissions over a 20-day period were included in the study. Data were collected from ambulance report forms, medical notes and electronic patient records. Pre-hospital NEWS was calculated retrospectively. The primary outcome was a composite of death or critical care unit escalation within 48 h of hospital admission. The secondary outcome was length of hospital stay. 189 patients were included in the analysis. The median pre-hospital NEWS was 3 (IQR 1-5). 13 patients (6.9%) died or were escalated to the critical care unit within 48 h of hospital admission. Pre-hospital NEWS was associated with death or critical care unit escalation (OR, 1.25; 95% CI, 1.04-1.51; p = 0.02), but NEWS on admission to hospital was more strongly associated with this outcome (OR, 1.52; 95% CI, 1.18-1.97, p < 0.01). Neither was associated with hospital length of stay. Pre-hospital NEWS was associated with death or critical care unit escalation within 48 h of hospital admission. NEWS could be used by ambulance crews to assist in the early triage of patients requiring hospital treatment or rapid transport. Further cohort studies or trials in large samples are required before implementation.

Factors associated with hospital arrival time after the onset of stroke symptoms: A cross-sectional study at two teaching hospitals in Harare, Zimbabwe.

PubMed

Seremwe, Farayi; Kaseke, Farayi; Chikwanha, Theodora M; Chikwasha, Vasco

2017-06-01

Late presentation to hospital after onset of stroke affects management and outcomes of the patients. This study aimed to determine the factors associated with time taken to present to hospital after the onset of acute stroke symptoms. A descriptive cross sectional study was conducted at two teaching hospitals in Zimbabwe. Participants included patients admitted with stroke and their relatives. A self-administered questionnaire was used to collect information on history of stroke occurrence and time taken to present to hospital. Data was analysed for means, frequencies, percentages and Odds ratios. Less than half (33%) of the participants were able to recognize symptoms of stroke. Not having money to pay for hospital bills was a predictor of late hospital presentation (OR =6.64; 95% CI, (2.05-21.53); p=0.002). The other factors, though not statistically significant included not perceiving stroke as a serious illness (OR = 2.43; 95% CI (0.78-5.51); p=0.083) and unavailability of transport (OR=2.33; 95% CI (0.71-7.56); p=0.161). Predictors for early presentation included receiving knowledge about stroke from the community (OR=0.46; 95% CI (0.15-1.39); p=0.170); seeking help at the hospital (OR=0.50; 95% CI (0.18-1.37); p=0.177) and having a stroke while at the workplace (OR =0.46; 95% CI (0.08-2.72); p=0.389). Regarding stroke as an emergency that does not require prerequisite payment for services at hospitals and improved community awareness on stroke may improve time taken to present to hospital after the onset of stroke symptoms.

Hospitals of Rome in the Early Nineteenth Century: The Apostolic Visit of 1825.

PubMed

Duffin, Jacalyn

2016-01-01

Pope Leo XII marked the 1825 Jubilee by visiting the hospitals of Rome. Italy was recovering from the French invasion that had disrupted social and religious structures. The Visitors investigated conditions, and recommended changes. By 1826, eight large hospitals were ordered to unite, but, three years later, the order was rescinded. Based on the Visit's mostly unexamined records in the Vatican Secret Archives, hospital registers, and minutes of the governing council held in the Archivio di Stato di Roma, this paper reconstructs the network of Rome's hospitals in the early 19 th century. It also compares Roman hospitals to its Parisian counterparts, especially with respect to governance and education. Finally, it examines the merger as an early example of a practice that remains vibrant (if controversial) today.

[The early medical textbooks in Korea: medical textbooks published at Je Joong Won-Severance Hospital Medical School].

PubMed

Park, H W

1998-01-01

Kwang Hye Won(Je Joong Won), the first western hospital in Korea, was founded in 1885. The first western Medical School in Korea was open in 1886 under the hospital management. Dr. O. R. Avison, who came to Korea in 1893, resumed the medical education there, which was interrupted for some time before his arrival in Korea. He inaugurated translating and publishing medical textbooks with the help of Kim Pil Soon who later became one of the first seven graduates in Severance Hospital Medical School. The first western medical textbook translated into Korean was Henry Gray's Anatomy. However, these twice-translated manuscripts were never to be published on account of being lost and burnt down. The existing early anatomy textbooks, the editions of 1906 and 1909, are not the translation of Gray's Anatomy, but that of Japanese anatomy textbook of Gonda. The remaining oldest medical textbook in Korean is Inorganic Materia Medica published in 1905. This book is unique among its kind that O. R. Avison is the only translator of the book and it contains the prefaces of O. R. Avison and Kim Pil Soon. The publication of medical textbook was animated by the participation of other medical students, such as Hong Suk Hoo and Hong Jong Eun. The list of medical textbooks published includes almost all the field of medicine. The medical textbooks in actual existence are as follows: Inorganic Materia Medica (1905), Inorganic Chemistry (1906), Anatomy I (1906), Physiology (1906), Diagnostics I (1906), Diagnostics II (1907), Obstetrics (1908), Organic Chemistry (1909), Anatomy (1909), and Surgery (1910).

Age and date for early arrival of the Acheulian in Europe (Barranc de la Boella, la Canonja, Spain).

PubMed

Vallverdú, Josep; Saladié, Palmira; Rosas, Antonio; Huguet, Rosa; Cáceres, Isabel; Mosquera, Marina; Garcia-Tabernero, Antonio; Estalrrich, Almudena; Lozano-Fernández, Iván; Pineda-Alcalá, Antonio; Carrancho, Ángel; Villalaín, Juan José; Bourlès, Didier; Braucher, Régis; Lebatard, Anne; Vilalta, Jaume; Esteban-Nadal, Montserrat; Bennàsar, Maria Lluc; Bastir, Marcus; López-Polín, Lucía; Ollé, Andreu; Vergés, Josep Maria; Ros-Montoya, Sergio; Martínez-Navarro, Bienvenido; García, Ana; Martinell, Jordi; Expósito, Isabel; Burjachs, Francesc; Agustí, Jordi; Carbonell, Eudald

2014-01-01

The first arrivals of hominin populations into Eurasia during the Early Pleistocene are currently considered to have occurred as short and poorly dated biological dispersions. Questions as to the tempo and mode of these early prehistoric settlements have given rise to debates concerning the taxonomic significance of the lithic assemblages, as trace fossils, and the geographical distribution of the technological traditions found in the Lower Palaeolithic record. Here, we report on the Barranc de la Boella site which has yielded a lithic assemblage dating to ∼1 million years ago that includes large cutting tools (LCT). We argue that distinct technological traditions coexisted in the Iberian archaeological repertoires of the late Early Pleistocene age in a similar way to the earliest sub-Saharan African artefact assemblages. These differences between stone tool assemblages may be attributed to the different chronologies of hominin dispersal events. The archaeological record of Barranc de la Boella completes the geographical distribution of LCT assemblages across southern Eurasia during the EMPT (Early-Middle Pleistocene Transition, circa 942 to 641 kyr). Up to now, chronology of the earliest European LCT assemblages is based on the abundant Palaeolithic record found in terrace river sequences which have been dated to the end of the EMPT and later. However, the findings at Barranc de la Boella suggest that early LCT lithic assemblages appeared in the SW of Europe during earlier hominin dispersal episodes before the definitive colonization of temperate Eurasia took place.

Age and Date for Early Arrival of the Acheulian in Europe (Barranc de la Boella, la Canonja, Spain)

PubMed Central

Vallverdú, Josep; Saladié, Palmira; Rosas, Antonio; Huguet, Rosa; Cáceres, Isabel; Mosquera, Marina; Garcia-Tabernero, Antonio; Estalrrich, Almudena; Lozano-Fernández, Iván; Pineda-Alcalá, Antonio; Carrancho, Ángel; Villalaín, Juan José; Bourlès, Didier; Braucher, Régis; Lebatard, Anne; Vilalta, Jaume; Esteban-Nadal, Montserrat; Bennàsar, Maria Lluc; Bastir, Marcus; López-Polín, Lucía; Ollé, Andreu; Vergés, Josep Maria; Ros-Montoya, Sergio; Martínez-Navarro, Bienvenido; García, Ana; Martinell, Jordi; Expósito, Isabel; Burjachs, Francesc; Agustí, Jordi; Carbonell, Eudald

2014-01-01

The first arrivals of hominin populations into Eurasia during the Early Pleistocene are currently considered to have occurred as short and poorly dated biological dispersions. Questions as to the tempo and mode of these early prehistoric settlements have given rise to debates concerning the taxonomic significance of the lithic assemblages, as trace fossils, and the geographical distribution of the technological traditions found in the Lower Palaeolithic record. Here, we report on the Barranc de la Boella site which has yielded a lithic assemblage dating to ∼1 million years ago that includes large cutting tools (LCT). We argue that distinct technological traditions coexisted in the Iberian archaeological repertoires of the late Early Pleistocene age in a similar way to the earliest sub-Saharan African artefact assemblages. These differences between stone tool assemblages may be attributed to the different chronologies of hominin dispersal events. The archaeological record of Barranc de la Boella completes the geographical distribution of LCT assemblages across southern Eurasia during the EMPT (Early-Middle Pleistocene Transition, circa 942 to 641 kyr). Up to now, chronology of the earliest European LCT assemblages is based on the abundant Palaeolithic record found in terrace river sequences which have been dated to the end of the EMPT and later. However, the findings at Barranc de la Boella suggest that early LCT lithic assemblages appeared in the SW of Europe during earlier hominin dispersal episodes before the definitive colonization of temperate Eurasia took place. PMID:25076416

Early hospital discharge in maternal and newborn care.

PubMed

Fink, Anne M

2011-01-01

This article highlights the historic precedence of early discharge practices and the debate regarding length of stay for new mothers and newborns in the United States. Although the documented effects of early discharge on maternal and newborn health are inconsistent, research findings universally support follow-up care for mothers and infants within 1 week of hospital discharge. Research is needed to identify the components and timing of follow-up care to optimize maternal and newborn outcomes. © 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

An ESS treatment of the pattern of female arrival at the mating site in the yellow dung fly scathophaga stercoraria (L.)

PubMed

Reuter; Ward; Blanckenhorn

1998-12-07

In most previous work on the yellow dung fly Scathophaga stercoraria (L.), as on other species, adaptive explanations have been sought for male behaviour whereas female behaviour has not been examined in similar detail. Here, the arrival of females at the mating site, fresh cattle droppings, is investigated. While almost all males are present shortly after pat deposition females arrive at a low, decreasing rate over an interval of about 5 hours. We propose that the distribution of female arrival times represents a mixed Evolutionarily Stable Strategy (ESS), formed by different trade-offs between costs and benefits of early and late arrival. Early arrival could be favoured by advantages due to better conditions for oviposition, faster egg development of reduced larval competition. Late arrival could be favoured by negative effects on females of male-male competition being weaker later after deposition. Computer simulations with distributions of arrival times deviating from the natural one were performed to "measure" the costs for females arriving at different times. These costs were compared with estimated benefits corresponding to the females' arrival times. This procedure revealed that females coming to the pat later in a population of females arriving shortly after deposition would be favoured. In a population arriving according to a uniform distribution, early females would have fitness advantages. Thus, evolution should lead to an intermediate distribution of arrival times, as in nature, i.e. female arrival behaviour is probably adaptive. The simulations also revealed that the intensity of sexual selection though male-male competition is highest with the natural pattern of female arrival. Therefore, natural selection generating this pattern amplifies the intensity of male-male interaction as a by-product. Copyright 1998 Academic Press

Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review

PubMed Central

2013-01-01

Background Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical rehabilitation programs on physical functioning among geriatric patients acutely admitted to the hospital. The second aim was to evaluate the feasibility of early physical rehabilitation programs. Methods Two searches, one for physical functioning and one for feasibility, were conducted in PubMed, CINAHL, and EMBASE. Additional studies were identified through reference and citation tracking. To be included articles had to report on in-hospital early physical rehabilitation of patients aged 65 years and older with an outcome measure of physical functioning. Studies were excluded when the treatment was performed on specialized units other than geriatric units. Randomized controlled trials were included to examine the effect of early physical rehabilitation on physical functioning, length of stay and discharge destination. To investigate feasibility also non randomized controlled trials were added. Results Fifteen articles, reporting on 13 studies, described the effect on physical functioning. The early physical rehabilitation programs were classified in multidisciplinary programs with an exercise component and usual care with an exercise component. Multidisciplinary programs focussed more on facilitating discharge home and independent ADL, whereas exercise programs aimed at improving functional outcomes. At time of discharge patients who had participated in a multidisciplinary program or exercise program improved more on physical functional tests and were less likely to be discharged to a nursing home compared to patients receiving only usual care. In addition, multidisciplinary programs reduced the length of hospital stay significantly. Follow-up interventions improved

Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review.

PubMed

Kosse, Nienke M; Dutmer, Alisa L; Dasenbrock, Lena; Bauer, Jürgen M; Lamoth, Claudine J C

2013-10-10

Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical rehabilitation programs on physical functioning among geriatric patients acutely admitted to the hospital. The second aim was to evaluate the feasibility of early physical rehabilitation programs. Two searches, one for physical functioning and one for feasibility, were conducted in PubMed, CINAHL, and EMBASE. Additional studies were identified through reference and citation tracking. To be included articles had to report on in-hospital early physical rehabilitation of patients aged 65 years and older with an outcome measure of physical functioning. Studies were excluded when the treatment was performed on specialized units other than geriatric units. Randomized controlled trials were included to examine the effect of early physical rehabilitation on physical functioning, length of stay and discharge destination. To investigate feasibility also non randomized controlled trials were added. Fifteen articles, reporting on 13 studies, described the effect on physical functioning. The early physical rehabilitation programs were classified in multidisciplinary programs with an exercise component and usual care with an exercise component. Multidisciplinary programs focussed more on facilitating discharge home and independent ADL, whereas exercise programs aimed at improving functional outcomes. At time of discharge patients who had participated in a multidisciplinary program or exercise program improved more on physical functional tests and were less likely to be discharged to a nursing home compared to patients receiving only usual care. In addition, multidisciplinary programs reduced the length of hospital stay significantly. Follow-up interventions improved physical functioning after

Pre-hospital Delay as Determinant of Ischemic Stroke Outcome in an Italian Cohort of Patients Not Receiving Thrombolysis.

PubMed

Denti, Licia; Artoni, Andrea; Scoditti, Umberto; Gatti, Elisa; Bussolati, Chiara; Ceda, Gian Paolo

2016-06-01

Pre-hospital delay in acute stroke is critical to the administration of thrombolysis and affects patients' clinical outcome. In this study, the impact of pre-hospital delay on the outcome of ischemic stroke was investigated in an Italian cohort of patients who did not receive thrombolysis. Data from a cohort of 1847 patients, suffering from first-ever ischemic stroke and referred to an in-hospital clinical pathway were analyzed retrospectively. The relationship between pre-hospital delay and 1-month mortality was assessed with adjustment for demographics, premorbid disability, and stroke severity, which was graded according to the Scandinavian Stroke Scale, with higher scores indicating less severity. Five hundred and twelve patients (27.7%) arrived at hospital within 2 hours of symptom onset. A significant correlation was found between early arrival and a reduced risk of 1-month mortality (hazard ratio .65; 95% confidence interval .48-.89; P = .02). There was a significant interaction (P = .01) between pre-hospital delay and the neurological score on mortality in the multivariate model, and the survival advantage of early admission was significant only for patients with scores on the Scandinavian Stroke Scale less than 18 (hazard ratio .54; 95% confidence interval .34-.85; P = .008). Our study suggests that reducing pre-hospital delay can increase the probability of survival in patients with ischemic stroke, especially those who are most severely affected. Even if the patients cannot benefit from thrombolysis, survival rates can be increased provided that they are managed according to standardized care processes. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Highly Automated Arrival Management and Control System Suitable for Early NextGen

NASA Technical Reports Server (NTRS)

Swenson, Harry N.; Jung, Jaewoo

2013-01-01

This is a presentation of previously published work conducted in the development of the Terminal Area Precision Scheduling and Spacing (TAPSS) system. Included are concept and technical descriptions of the TAPSS system and results from human in the loop simulations conducted at Ames Research Center. The Terminal Area Precision Scheduling and Spacing system has demonstrated through research and extensive high-fidelity simulation studies to have benefits in airport arrival throughput, supporting efficient arrival descents, and enabling mixed aircraft navigation capability operations during periods of high congestion. NASA is currently porting the TAPSS system into the FAA TBFM and STARS system prototypes to ensure its ability to operate in the FAA automation Infrastructure. NASA ATM Demonstration Project is using the the TAPSS technologies to provide the ground-based automation tools to enable airborne Interval Management (IM) capabilities. NASA and the FAA have initiated a Research Transition Team to enable potential TAPSS and IM Technology Transfer.

Early mortality and complications in hospitalized adult Californians with acute myeloid leukaemia.

PubMed

Ho, Gwendolyn; Jonas, Brian A; Li, Qian; Brunson, Ann; Wun, Ted; Keegan, Theresa H M

2017-06-01

Few studies have evaluated the impact of complications, sociodemographic and clinical factors on early mortality (death ≤60 days from diagnosis) in acute myeloid leukaemia (AML) patients. Using data from the California Cancer Registry linked to hospital discharge records from 1999 to 2012, we identified patients aged ≥15 years with AML who received inpatient treatment (N = 6359). Multivariate logistic regression analyses were used to assess the association of complications with early mortality, adjusting for sociodemographic factors, comorbidities and hospital type. Early mortality decreased over time (25·3%, 1999-2000; 16·8%, 2011-2012) across all age groups, but was higher in older patients (6·9%, 15-39, 11·4%, 40-54, 18·6% 55-65, and 35·8%, >65 years). Major bleeding [Odds ratio (OR) 1·5, 95% confidence interval (CI) 1·3-1·9], liver failure (OR 1·9, 95% CI 1·1-3·1), renal failure (OR 2·4, 95% CI 2·0-2·9), respiratory failure (OR 7·6, 95% CI 6·2-9·3) and cardiac arrest (OR 15·8, 95% CI 8·7-28·6) were associated with early mortality. Higher early mortality was also associated with single marital status, low neighbourhood socioeconomic status, lack of health insurance and comorbidities. Treatment at National Cancer Institute-designated cancer centres was associated with lower early mortality (OR 0·5, 95% CI 0·4-0·6). In conclusion, organ dysfunction, hospital type and sociodemographic factors impact early mortality. Further studies should investigate how differences in healthcare delivery affect early mortality. © 2017 John Wiley & Sons Ltd.

Early Childhood Special Educators and the Hospital Ethics Committee.

ERIC Educational Resources Information Center

Lowenthal, Barbara

1989-01-01

The paper discusses issues of concern to early childhood special educators serving on hospital ethics committees to assist families with seriously ill and handicapped infants in neonatal intensive care units. Issues include infant euthanasia and the right to life, child abuse legislation, and possible effects on families. (Author/JDD)

Does earlier arrival of the retrieval team improve short-term outcomes in outborn extremely premature infants?

PubMed

Sharpe, Janet B; Davies, Mark W

2018-05-31

The risk of mortality and morbidity is increased in outborn, extremely premature infants. We aim to determine whether earlier arrival of the retrieval team after the birth of infants less than 29 weeks gestation improves short-term mortality and morbidity. This is a retrospective analysis of a cohort of infants less than 29 weeks gestation who were retrieved to the Royal Brisbane and Women's Hospital (RBWH) over a 5-year period. Demographic information regarding the infant and mother, retrieval team arrival time and outcome data was collected. Primary outcomes investigated were mortality prior to discharge from hospital or a composite of mortality or severe intraventricular haemorrhage (IVH). Data on 105 infants were analysed; 88 infants (83.8%) survived to discharge home, and 79 (75.2%) survived to discharge without severe IVH. On univariate analysis, there was no significant association between age at arrival of the retrieval team and death prior to discharge (P = 0.94) or death prior to discharge or severe IVH (P = 0.83). On logistic regression analysis, age at arrival of retrieval team remained non-significant for a reduction in death prior to discharge and composite of death or severe IVH (P = 0.70 and P = 0.99, respectively). The earlier arrival of the retrieval team is not associated with improved short-term outcomes in outborn, extremely preterm infants who are retrieved and admitted to a tertiary neonatal intensive care unit - for infants where the retrieval team arrived within about 8 h of birth. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Hospital at home for chronic obstructive pulmonary disease: an integrated hospital and community based generic intermediate care service for prevention and early discharge.

PubMed

Davison, A G; Monaghan, M; Brown, D; Eraut, C D; O'Brien, A; Paul, K; Townsend, J; Elston, C; Ward, L; Steeples, S; Cubitt, L

2006-01-01

Recent randomized controlled studies have reported success for hospital at home for prevention and early discharge of chronic obstructive pulmonary disease (COPD) patients using hospital based respiratory nurse specialists. This observational study reports results using an integrated hospital and community based generic intermediate care service. The length of care, readmission within 60 days and death within 60 days in the early discharge (9.37 days, 21.1%, 7%) and the prevention of admission (five to six days, 34.1%, 3.8%) are similar to previous studies. We suggest that this generic community model of service may allow hospital at home services for COPD to be introduced in more areas.

Mobile phone technology identifies and recruits trained citizens to perform CPR on out-of-hospital cardiac arrest victims prior to ambulance arrival.

PubMed

Ringh, Mattias; Fredman, David; Nordberg, Per; Stark, Tomas; Hollenberg, Jacob

2011-12-01

In a two-parted study, evaluate a new concept were mobile phone technology is used to dispatch lay responders to nearby out-of-hospital cardiac arrests (OHCAs). Mobile phone positioning systems (MPS) can geographically locate selected mobile phone users at any given moment. A mobile phone service using MPS was developed and named Mobile Life Saver (MLS). Simulation study: 25 volunteers named mobile responders (MRs) were connected to MLS. Ambulance time intervals from 22 consecutive OHCAs in 2005 were used as controls. The MRs randomly moved in Stockholm city centre and were dispatched to simulated OHCAs (identical to controls) if they were within a 350 m distance. Real life study: during 25 weeks 1271-1801 MRs trained in CPR were connected to MLS. MLS was activated at the dispatch centre in parallel with ambulance dispatch when an OHCA was suspected. The MRs were dispatched if they were within 500 m from the suspected OHCA. Simulation study: mean response time for the MRs compared to historical ambulance time intervals was reduced by 2 min 20s (44%), p<0.001, (95% CI, 1 min 5s - 3 min 35s). The MRs reached the simulated OHCA prior to the historical control in 72% of cases. Real life study: the MLS was triggered 92 times. In 45% of all suspected and in 56% of all true OHCAs the MRs arrived prior to ambulance. CPR was performed by MRs in 17% of all true OHCAs and in 30% of all true OHCAs if MRs arrived prior to ambulance. Mobile phone technology can be used to identify and recruit nearby CPR-trained citizens to OHCAs for bystander CPR prior to ambulance arrival. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Emergency department arrival times after acute ischemic stroke during the 1990s.

PubMed

Kleindorfer, Dawn O; Broderick, Joseph P; Khoury, Jane; Flaherty, Matthew L; Woo, Daniel; Alwell, Kathleen; Moomaw, Charles J; Pancioli, Arthur; Jauch, Edward; Miller, Rosie; Kissela, Brett M

2007-01-01

Only 8% of ischemic stroke (IS) patients are eligible for rt-PA, and the largest exclusion criterion is delayed time of presentation to the ED. We sought to investigate whether patients are arriving to the ED more quickly in 1999 than in 1993/94 within our large biracial population of 1.3 million. Using ICD-9 codes 430-436, we ascertained all stroke events that presented to a local ED within our population in 7/93-6/94 and again in 1999. Times were recorded as documented in the medical record. There were 1,792 IS patients that presented to an ED in 1993/94 and 1,973 in 1999. The percentage of patients with documented times arriving in under 3 h improved slightly in 1999 (26% vs. 23% in 93/94, P = 0.03), however, the percentage arriving in under 2 h did not. Blacks significantly improved in arrivals under 3 h: 26% in 1999 compared to 17% in 1993/94 (P = 0.01), while whites did not (26% vs. 25%, P = 0.29). In 1999, only 9% of patients arrived from 3-8 h after symptom onset, the large majority of times were either estimated, unknown, or >8 h. We found only marginal improvement in arrival times during the 1990s. In our population, blacks improved in early arrival after symptom onset, while whites did not. Very few patients arrive 3-8 h after onset; therefore expansion of the acute treatment time window to 8 h is unlikely to dramatically affect acute treatment of ischemic stroke.

Deep seafloor arrivals: an unexplained set of arrivals in long-range ocean acoustic propagation.

PubMed

Stephen, Ralph A; Bolmer, S Thompson; Dzieciuch, Matthew A; Worcester, Peter F; Andrew, Rex K; Buck, Linda J; Mercer, James A; Colosi, John A; Howe, Bruce M

2009-08-01

Receptions, from a ship-suspended source (in the band 50-100 Hz) to an ocean bottom seismometer (about 5000 m depth) and the deepest element on a vertical hydrophone array (about 750 m above the seafloor) that were acquired on the 2004 Long-Range Ocean Acoustic Propagation Experiment in the North Pacific Ocean, are described. The ranges varied from 50 to 3200 km. In addition to predicted ocean acoustic arrivals and deep shadow zone arrivals (leaking below turning points), "deep seafloor arrivals," that are dominant on the seafloor geophone but are absent or very weak on the hydrophone array, are observed. These deep seafloor arrivals are an unexplained set of arrivals in ocean acoustics possibly associated with seafloor interface waves.

Finding the signal in the noise: Could social media be utilized for early hospital notification of multiple casualty events?

PubMed Central

Moore, Sara; Wakam, Glenn; Hubbard, Alan E.; Cohen, Mitchell J.

2017-01-01

Introduction Delayed notification and lack of early information hinder timely hospital based activations in large scale multiple casualty events. We hypothesized that Twitter real-time data would produce a unique and reproducible signal within minutes of multiple casualty events and we investigated the timing of the signal compared with other hospital disaster notification mechanisms. Methods Using disaster specific search terms, all relevant tweets from the event to 7 days post-event were analyzed for 5 recent US based multiple casualty events (Boston Bombing [BB], SF Plane Crash [SF], Napa Earthquake [NE], Sandy Hook [SH], and Marysville Shooting [MV]). Quantitative and qualitative analysis of tweet utilization were compared across events. Results Over 3.8 million tweets were analyzed (SH 1.8 m, BB 1.1m, SF 430k, MV 250k, NE 205k). Peak tweets per min ranged from 209–3326. The mean followers per tweeter ranged from 3382–9992 across events. Retweets were tweeted a mean of 82–564 times per event. Tweets occurred very rapidly for all events (<2 mins) and represented 1% of the total event specific tweets in a median of 13 minutes of the first 911 calls. A 200 tweets/min threshold was reached fastest with NE (2 min), BB (7 min), and SF (18 mins). If this threshold was utilized as a signaling mechanism to place local hospitals on standby for possible large scale events, in all case studies, this signal would have preceded patient arrival. Importantly, this threshold for signaling would also have preceded traditional disaster notification mechanisms in SF, NE, and simultaneous with BB and MV. Conclusions Social media data has demonstrated that this mechanism is a powerful, predictable, and potentially important resource for optimizing disaster response. Further investigated is warranted to assess the utility of prospective signally thresholds for hospital based activation. PMID:28982201

Effects of comprehensive education protocol in decreasing pre-hospital stroke delay among Chinese urban community population.

PubMed

Chen, Shengyun; Sun, Haixin; Zhao, Xingquan; Fu, Paul; Yan, Wang; Yilong, Wang; Hongyan, Jia; Yan, Zhang; Wenzhi, Wang

2013-06-01

Studies have shown that awareness of early stroke symptoms and the use of ambulances are two important factors in decreasing pre-hospital stroke delay. The purpose of this study is to evaluate a comprehensive educational stroke protocol in improving stroke response times. Two urban communities in Beijing (population ≍50 000), matched in economic status and geography, were enrolled in this study. A comprehensive educational protocol, which included public lectures and distribution of instructive material for the community and its medical staff, was implemented from August 2008 to December 2010. Surveillance of new onset stroke in both communities was carried out during the same period. Pre-hospital delay time and percentage of patients using emergency medical services (EMS) were compared between the two communities. After comprehensive educational protocol, we found that: (i) pre-hospital delay (time from stroke symptom onset to hospital arrival) decreased from 180 to 79 minutes, (ii) the proportion of patients arriving within three hours of stroke onset increased from 55·8% to 80·4%, (iii) pre-hospital delay of stroke patients with symptoms of paralysis, numbness, and speech impediments was decreased, and (iv) the proportion of stroke patients calling for EMS increased from 50·4% to 60·7%. The comprehensive educational stroke protocol was significantly effective in decreasing pre-hospital stroke delay.

In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis.

PubMed

Lalani, Tahaniyat; Chu, Vivian H; Park, Lawrence P; Cecchi, Enrico; Corey, G Ralph; Durante-Mangoni, Emanuele; Fowler, Vance G; Gordon, David; Grossi, Paolo; Hannan, Margaret; Hoen, Bruno; Muñoz, Patricia; Rizk, Hussien; Kanj, Souha S; Selton-Suty, Christine; Sexton, Daniel J; Spelman, Denis; Ravasio, Veronica; Tripodi, Marie Françoise; Wang, Andrew

2013-09-09

There are limited prospective, controlled data evaluating survival in patients receiving early surgery vs medical therapy for prosthetic valve endocarditis (PVE). To determine the in-hospital and 1-year mortality in patients with PVE who undergo valve replacement during index hospitalization compared with patients who receive medical therapy alone, after controlling for survival and treatment selection bias. Participants were enrolled between June 2000 and December 2006 in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a prospective, multinational, observational cohort of patients with infective endocarditis. Patients hospitalized with definite right- or left-sided PVE were included in the analysis. We evaluated the effect of treatment assignment on mortality, after adjusting for biases using a Cox proportional hazards model that included inverse probability of treatment weighting and surgery as a time-dependent covariate. The cohort was stratified by probability (propensity) for surgery, and outcomes were compared between the treatment groups within each stratum. Valve replacement during index hospitalization (early surgery) vs medical therapy. In-hospital and 1-year mortality. Of the 1025 patients with PVE, 490 patients (47.8%) underwent early surgery and 535 individuals (52.2%) received medical therapy alone. Compared with medical therapy, early surgery was associated with lower in-hospital mortality in the unadjusted analysis and after controlling for treatment selection bias (in-hospital mortality: hazard ratio [HR], 0.44 [95% CI, 0.38-0.52] and lower 1-year mortality: HR, 0.57 [95% CI, 0.49-0.67]). The lower mortality associated with surgery did not persist after adjustment for survivor bias (in-hospital mortality: HR, 0.90 [95% CI, 0.76-1.07] and 1-year mortality: HR, 1.04 [95% CI, 0.89-1.23]). Subgroup analysis indicated a lower in-hospital mortality with early surgery in the highest surgical propensity quintile (21

Survival After Application of Automatic External Defibrillators Before Arrival of the Emergency Medical System

PubMed Central

Weisfeldt, Myron L.; Sitlani, Colleen M.; Ornato, Joseph P.; Rea, Thomas; Aufderheide, Tom P.; Davis, Daniel; Dreyer, Jonathan; Hess, Erik P.; Jui, Jonathan; Maloney, Justin; Sopko, George; Powell, Judy; Nichol, Graham; Morrison, Laurie J.

2010-01-01

Objectives The purpose of this study was to assess the effectiveness of contemporary automatic external defibrillator (AED) use. Background In the PAD (Public Access Defibrillation) trial, survival was doubled by focused training of lay volunteers to use an AED in high-risk public settings. Methods We performed a population-based cohort study of persons with nontraumatic out-of-hospital cardiac arrest before emergency medical system (EMS) arrival at Resuscitation Outcomes Consortium (ROC) sites between December 2005 and May 2007. Multiple logistic regression was used to assess the independent association between AED application and survival to hospital discharge. Results Of 13,769 out-of-hospital cardiac arrests, 4,403 (32.0%) received bystander cardiopulmonary resuscitation but had no AED applied before EMS arrival, and 289 (2.1%) had an AED applied before EMS arrival. The AED was applied by health care workers (32%), lay volunteers (35%), police (26%), or unknown (7%). Overall survival to hospital discharge was 7%. Survival was 9% (382 of 4,403) with bystander cardiopulmonary resuscitation but no AED, 24% (69 of 289) with AED application, and 38% (64 of 170) with AED shock delivered. In multivariable analyses adjusting for: 1) age and sex; 2) bystander cardiopulmonary resuscitation performed; 3) location of arrest (public or private); 4) EMS response interval; 5) arrest witnessed; 6) initial shockable or not shockable rhythm; and 7) study site, AED application was associated with greater likelihood of survival (odds ratio: 1.75; 95% confidence interval: 1.23 to 2.50; p < 0.002). Extrapolating this greater survival from the ROC EMS population base (21 million) to the population of the U.S. and Canada (330 million), AED application by bystanders seems to save 474 lives/year. Conclusions Application of an AED in communities is associated with nearly a doubling of survival after out-of-hospital cardiac arrest. These results reinforce the importance of strategically

Care Transitions After Acute Myocardial Infarction for Transferred-In Versus Direct-Arrival Patients.

PubMed

Vora, Amit N; Peterson, Eric D; Hellkamp, Anne S; Sutton, Nadia R; Panacek, Edward; Thomas, Laine; de Lemos, James A; Wang, Tracy Y

2016-03-01

Many patients in the United States require transfer from one hospital to another for acute myocardial infarction (MI) care. How well these transferred-in patients are transitioned back to their local community is unknown. We used linked Medicare claims data to examine postdischarge outcomes of 39 136 patients with acute MI aged ≥65 years discharged alive from 451 US hospitals in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines. Multivariable Cox modeling was used to compare the likelihood of outpatient clinic follow-up and risks of all-cause mortality and all-cause or cardiovascular readmission at 30 days post MI between transferred-in and direct-arrival patients. From 2007 to 2010, 14 060 of 39 136 patients (36%) required interhospital transfer for acute MI care, traveling a median of 43 miles (interquartile range, 27-68 miles; 77.6 km [interquartile range, 48.2-122.6 km]). Compared with those arriving directly, transferred-in patients with MI were slightly younger (median age, 73 versus 74; P<0.01) but less likely to have previous MI, heart failure, and previous revascularization than direct-arrival patients. Relative to direct-arrival patients, those transferred-in had a lower likelihood of outpatient follow-up within 30 days post discharge (risk-adjusted incidence, 69.9% versus 78.2%; hazard ratio [HR], 0.90; 95% confidence interval, 0.87-0.92) and higher adjusted 30-day all-cause and cardiovascular readmission risks (14.5% versus 14.0%; HRall-cause, 1.08; 95% confidence interval, 1.01-1.15 and 9.5% versus 9.1%; HRcardiovascular, 1.13; 95% confidence interval, 1.04-1.22). In contrast, risk-adjusted 30-day mortality was similar between transferred-in and direct arrivals (1.6% versus 1.6%; HR, 1.05; 95% confidence interval, 0.86-1.27). Transferred-in patients with acute MI are less likely to have outpatient clinic follow-up within 30 days and more likely to be readmitted within the first 30 days post discharge compared

[The arrival of the plague in São Paulo in 1899].

PubMed

do Nascimento, Dilene Raimundo

2011-01-01

In October 1899, the bubonic plague arrived in Brazil through the port of Santos. A city of intensive port activity, Santos was the gateway for a plague epidemic that devastated several cities in Brazil in the early 20th century and prompted joint action by several states to fight it. More importantly, given the difficulties and delays in importing anti-plague serum from Europe, it led to the creation of the Butantan Institute in Sao Paulo (in 1899) and the Municipal Serotherapeutic Institute in Rio de Janeiro (in 1900), which developed and standardized anti-plague serum and vaccines according to the particular conditions of the country. Until then, public health efforts had been isolated and had not reached the whole country. Oswaldo Cruz, newly arrived after three years of specialization at the Pasteur Institute in Paris, worked with scientists Adolfo Lutz and Vital Brazil on identifying the plague in Santos. This article analyzes the arrival of the bubonic plague epidemic in the state of Sao Paulo and the public health measures taken to combat the disease and provide patient care in the early part of the 20th century. The primary sources for this analysis were the São Paulo newspapers, especially O Estado de Sao Paulo, and reports from the Ministry of Justice and the President of the State of Sao Paulo.

Validation of a Pediatric Early Warning Score in Hospitalized Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients.

PubMed

Agulnik, Asya; Forbes, Peter W; Stenquist, Nicole; Rodriguez-Galindo, Carlos; Kleinman, Monica

2016-04-01

To evaluate the correlation of a Pediatric Early Warning Score with unplanned transfer to the PICU in hospitalized oncology and hematopoietic stem cell transplant patients. We performed a retrospective matched case-control study, comparing the highest documented Pediatric Early Warning Score within 24 hours prior to unplanned PICU transfers in hospitalized pediatric oncology and hematopoietic stem cell transplant patients between September 2011 and December 2013. Controls were patients who remained on the inpatient unit and were matched 2:1 using age, condition (oncology vs hematopoietic stem cell transplant), and length of hospital stay. Pediatric Early Warning Scores were documented by nursing staff at least every 4 hours as part of routine care. Need for transfer was determined by a PICU physician called to evaluate the patient. A large tertiary/quaternary free-standing academic children's hospital. One hundred ten hospitalized pediatric oncology patients (42 oncology, 68 hematopoietic stem cell transplant) requiring unplanned PICU transfer and 220 matched controls. None. Using the highest score in the 24 hours prior to transfer for cases and a matched time period for controls, the Pediatric Early Warning Score was highly correlated with the need for PICU transfer overall (area under the receiver operating characteristic = 0.96), and in the oncology and hematopoietic stem cell transplant groups individually (area under the receiver operating characteristic = 0.95 and 0.96, respectively). The difference in Pediatric Early Warning Score results between the cases and controls was noted as early as 24 hours prior to PICU admission. Seventeen patients died (15.4%). Patients with higher Pediatric Early Warning Scores prior to transfer had increased PICU mortality (p = 0.028) and length of stay (p = 0.004). We demonstrate that our institution's Pediatric Early Warning Score is highly correlated with the need for unplanned PICU transfer in hospitalized oncology and

Early deep sedation is associated with decreased in-hospital and two-year follow-up survival.

PubMed

Balzer, Felix; Weiß, Björn; Kumpf, Oliver; Treskatsch, Sascha; Spies, Claudia; Wernecke, Klaus-Dieter; Krannich, Alexander; Kastrup, Marc

2015-04-28

There is increasing evidence that deep sedation is detrimental to critically ill patients. The aim of this study was to examine effects of deep sedation during the early period after ICU admission on short- and long-term survival. In this observational, matched-pair analysis, patients receiving mechanical ventilation that were admitted to ICUs of a tertiary university hospital in six consecutive years were grouped as either lightly or deeply sedated within the first 48 hours after ICU admission. The Richmond Agitation-Sedation Score (RASS) was used to assess sedation depth (light sedation: -2 to 0; deep: -3 or below). Multivariate Cox regression was conducted to investigate the impact of early deep sedation within the first 48 hours of admission on in-hospital and two-year follow-up survival. In total, 1,884 patients met inclusion criteria out of which 27.2% (n = 513) were deeply sedated. Deeply sedated patients had longer ventilation times, increased length of stay and higher rates of mortality. Early deep sedation was associated with a hazard ratio of 1.661 (95% CI: 1.074 to 2.567; P = 0.022) for in-hospital survival and 1.866 (95% CI: 1.351 to 2.576; P < 0.001) for two-year follow-up survival. Early deep sedation during the first 48 hours of intensive care treatment was associated with decreased in-hospital and two-year follow-up survival. Since early deep sedation is a modifiable risk factor, this data shows an urgent need for prospective clinical trials focusing on light sedation in the early phase of ICU treatment.

Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

PubMed

Noyez, L; Biemans, I; Verkroost, M; van Swieten, H

2013-10-01

This study evaluates whether a sedentary lifestyle is an independent predictor for increased mortality after elective cardiac surgery. Three thousand one hundred fifty patients undergoing elective cardiac surgery between January 2007 and June 2012 completed preoperatively the Corpus Christi Heart Project questionnaire concerning physical activity (PA). Based on this questionnaire, 1815 patients were classified as active and 1335 patients were classified as sedentary. The endpoints of the study were hospital mortality and early mortality. The study population had a mean age of 69.7 ± 10.1 (19-95) years and a mean logistic EuroSCORE risk of 5.1 ± 5.6 (0.88-73.8). Sedentary patients were significantly older (p = 0.001), obese (p = 0.001), had a higher EuroSCORE risk (p = 0.001), and a higher percentage of complications. Hospital mortality (1.1 % versus 0.4 % (p = 0.014)) and early mortality (1.5 % versus 0.6 % (p = 0.006)) were significantly higher in the sedentary group compared with the active group. However, a sedentary lifestyle was not identified as an independent predictor for hospital mortality (p = 0.61) or early mortality (p = 0.70). Sedentary patients were older, obese and had a higher EuroSCORE risk. They had significantly more postoperative complications, higher hospital mortality and early mortality. Despite these results, sedentary behaviour could not be identified as an independent predictor for hospital or early mortality.

The Birth of Hospital, Asclepius cult and Early Christianity.

PubMed

Yeo, In-Sok

2017-04-01

History of hospital is one of main fields of researches in medical history. Besides writing a history of an individual hospital, considerable efforts have been made to trace the origin of hospital. Those who quest for the origin of hospital are faced with an inevitable problem of defining hospital. As the different definition can lead to a different outcome, it is important to make a clear definition. In this article, the hospital was defined as an institution in which patients are housed and given medical treatments. According to the definition, the Great Basilius is regarded to have created the first hospital in 369 CE. The creation of hospital is considered to be closely related with Christian philantrophy. However, the question is raised against this explanation. As the religious philantrophy does not exclusively belong to the Christianity alone, more comprehensive and persuasive theory should be proposed to explain why the first hospital was created in the Christian World, not in the Buddhistic or other religious world. Furthermore, in spite of sharing the same Christian background, why the first hospital appeared in Byzantine Empire, not in Western Roman Empire, also should be explained. My argument is that Asclepius cult and the favorable attitude toward medicine in Greek world are responsible to the appearance of the first hospital in Byzantine Empire. The evangelic work of Jesus was heavily depended on healing activities. The healing activities of Jesus and his disciples were rivalled by Asclepius cult which had been widely spread and practiced in the Hellenistic world. The temples of Asclepius served as a model for hospital, for the temples were the institution exclusively reserved for the patients. The exclusive housing of patients alone in the temples of Asclepius is clearly contrasted with the other early forms of hospitals in which not only patients but also the poor, foreigners and pilgrims were housed altogether. Toward the healing god Asclepius

Diagnoses of Early and Late Readmissions after Hospitalization for Pneumonia. A Systematic Review

PubMed Central

Sjoding, Michael W.; Iwashyna, Theodore J.

2014-01-01

Rationale: Pneumonia is a frequent cause of hospitalization, yet drivers of post-pneumonia morbidity remain poorly characterized. Causes of hospital readmissions may elucidate important sources of morbidity and are of particular interest given the U.S. Hospital Readmission Reductions Program. Objectives: To review the primary diagnoses of early (≤30 d) and late (≥31 d) readmissions after pneumonia hospitalization. Methods: Systematic review of MEDLINE, Embase, and CINAHL databases. We identified original research studies of adults aged 18 years or older, hospitalized for pneumonia, and for whom cause-specific readmission rates were reported. Two authors abstracted study results and assessed study quality. Measurements and Main Results: Of the 1,243 citations identified, 12 met eligibility criteria. Included studies were conducted in the United States, Spain, Canada, Croatia, and Sweden. All-cause 30-day readmission rates ranged from 16.8 to 20.1% across administrative studies; the weighted average for the studies using chart review was 11.6% (15.6% in United States–based studies). Pneumonia, heart failure/cardiovascular causes, and chronic obstructive pulmonary disease/pulmonary causes are the most common reasons for early readmission after pneumonia hospitalization. Although it was the single most common cause for readmission, pneumonia accounted for only 17.9 to 29.4% of all 30-day readmissions in administrative studies and a weighted average of 23.0% in chart review studies. After accounting for study population, there was no clear difference in findings between claims-based versus chart-review studies. Few studies assessed readmissions beyond 30 days, although the limited available data suggest similar primary diagnoses for early and late readmissions. No studies assessed whether reasons for readmission were similar to patients’ reasons for healthcare use before hospitalization. Conclusions: Pneumonia, heart failure/cardiovascular disease, and chronic

Access block in NSW hospitals, 1999-2001: does the definition matter?

PubMed

Forero, Roberto; Mohsin, Mohammed; Bauman, Adrian E; Ieraci, Sue; Young, Lis; Phung, Hai N; Hillman, Kenneth M; McCarthy, Sally M; Hugelmeyer, C David

2004-01-19

To estimate the magnitude of access block and its trend over time in New South Wales hospitals, using different definitions of access block, and to explore its association with clinical and non-clinical factors. An epidemiological study using the Emergency Department Information System datasets (1 January 1999 to 31 December 2001) from a sample of 55 NSW hospitals. Prevalence of access block measured by four different definitions; strength of association between access block, type of hospital, year of presentation, mode and time of arrival, triage category (an indicator of urgency), age and sex. Rates of access block (for all four definitions) increased between 1999 and 2001 by 1%-2% per year. There were increases across all regions of NSW, but urban regions in particular. Patients presenting to Principal Referral hospitals and those who arrived at night were more likely to experience access block. After adjusting for triage category and year of presentation, the mode of arrival, time of arrival, type of hospital, age and sex were significantly associated with access block. Access block continues to increase across NSW, whatever the definition used. We recommend that hospitals in NSW and Australia move to the use of one standard definition of access block, as our study suggests there is no significant additional information emerging from the use of multiple definitions.

Revisiting the “Golden Hour”: An Evaluation of Out-of-Hospital Time in Shock and Traumatic Brain Injury

PubMed Central

Newgard, Craig D.; Meier, Eric N.; Bulger, Eileen M.; Buick, Jason; Sheehan, Kellie; Lin, Steve; Minei, Joseph P.; Barnes-Mackey, Roxy A.; Brasel, Karen

2015-01-01

Study Objective We evaluated shock and traumatic brain injury (TBI) patients previously enrolled in an out-of-hospital clinical trial to test the association between out-of-hospital time and outcome. Methods This was a secondary analysis of shock and TBI patients ≥ 15 years enrolled in a Resuscitation Outcomes Consortium out-of-hospital clinical trial by 81 EMS agencies transporting to 46 Level I and II trauma centers in 11 sites (May 2006 through May 2009). Inclusion criteria were: SBP ≤ 70 mmHg or SBP 71 - 90 mmHg with heart rate ≥ 108 beats per minute (shock cohort) and Glasgow Coma Scale score ≤ 8 (TBI cohort); patients meeting both criteria were placed in the shock cohort. Primary outcomes were 28-day mortality (shock cohort) and 6-month Glasgow Outcome Scale - Extended (GOSE) ≤ 4 (TBI cohort). Results There were 778 patients in the shock cohort (26% 28-day mortality) and 1,239 patients in the TBI cohort (53% 6-month GOSE ≤ 4). Out-of-hospital time > 60 minutes was not associated with worse outcomes after accounting for important confounders in the shock cohort (adjusted odds ratio [aOR] 1.42, 95% CI 0.77-2.62) or TBI cohort (aOR 0.80, 95% CI 0.52-1.21). However, shock patients requiring early critical hospital resources and arriving > 60 minutes had higher 28-day mortality (aOR 2.37, 95% CI 1.05-5.37); this finding was not observed among a similar TBI subgroup. Conclusions Among out-of-hospital trauma patients meeting physiologic criteria for shock and TBI, there was no association between time and outcome. However, the subgroup of shock patients requiring early critical resources arriving after 60 minutes had higher mortality. PMID:25596960

19 CFR 122.31 - Notice of arrival.

Code of Federal Regulations, 2010 CFR

2010-04-01

... advance notice of arrival in accordance with § 122.22 of this part. (ii) Aircraft arriving from Cuba. Aircraft arriving from Cuba must follow the advance notice of arrival procedures set forth in § 122.154 in... aircraft arriving from areas south of the United States (other than Cuba) must follow the advance notice of...

Scandinavian exceptionalism? Civic integration and labour market activation for newly arrived immigrants.

PubMed

Breidahl, Karen N

2017-01-01

Since the late 1990s, a wide range of so-called new civic integration policies aimed at civilizing or disciplining newcomers have been introduced. Consequently, migration scholars have discussed whether a converging restrictive 'civic turn' has taken place in Western Europe or whether national models have been resilient: Based on an in-depth historical and comparative analysis of labour market activation policies targeting newly arrived immigrants in Sweden, Norway, and Denmark since the early 1990s, the article contributes to the overall question: To what extent do the institutional pathways of the Scandinavian welfare states prevail when confronted with newcomers? Activation policies targeting newly arrived immigrants exemplifies how the ambition of states to promote functional, individual autonomy is also an important, ongoing process in diverse policy areas of the welfare state and not restricted to early integration instruments. While the Scandinavian welfare states differ on a number of counts with respect to immigration control, national integration philosophies and citizenship policies, the article outlines how activation policies aimed at newly arrived immigrants share several features. One of the key factors in this turn involves path dependency from, among others, a lengthy tradition for strong state involvement and norms about employment. Another factor in this turn involves transnational policy learning. On some points, national versions of these policies are also found due to country-specific citizenship traditions, integration philosophies and party political constellations.

Transient ischaemic attacks clinics provide equivalent and more efficient care than early in-hospital assessment.

PubMed

Martínez-Martínez, M M; Martínez-Sánchez, P; Fuentes, B; Cazorla-García, R; Ruiz-Ares, G; Correas-Callero, E; Lara-Lara, M; Díez-Tejedor, E

2013-02-01

Clinics for early management of transient ischaemic attacks (TIAs) have been developed in some stroke centres, resulting in reduced recurrence rates compared to appointment-based outpatient management, thus saving on hospitalization. We analysed the care process, recurrence rates and economic impact of the first year of work in our early-management TIA clinic and compared these with our previous in-hospital study protocols for low- and moderate-risk TIA patients. This was a prospective evaluation of the management of low- to moderate-risk TIA patients, comparing a new TIA clinic model (2010) with a previous hospitalization model (2009). Demographic data, vascular risk factor profiles, diagnostic test performance, secondary prevention measures, final aetiological diagnoses and cerebrovascular recurrences at 7 and 90 days were compared between in-hospital and TIA clinic assessed patients. We also carried out an economic comparison of the costs of each model's process. Two hundred and eleven low- to moderate-risk TIA patients were included, of whom 40.8% were hospitalized. There were no differences between the TIA clinic assessed and in-hospital assessed patients in terms of risk factor diagnosis and secondary prevention measures. The stroke recurrence rate (2.4% vs. 1.2%; P = 0.65) was low and similar for both groups (CI 95%, 0.214-20.436; P = 0.52). Cost per patient was €393.28 for clinic versus €1931.18 for in-hospital management. Outpatient management resulted in a 77.8% reduction in hospitalizations. Transient ischaemic attacks clinics are efficient for the early management of low- to moderate-risk TIA patients compared to in-hospital assessment, with no higher recurrence rates and at almost one-fifth the cost. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

African departure rather than migration speed determines variation in spring arrival in pied flycatchers.

PubMed

Ouwehand, Janne; Both, Christiaan

2017-01-01

Properly timed spring migration enhances reproduction and survival. Climate change requires organisms to respond to changes such as advanced spring phenology. Pied flycatchers Ficedula hypoleuca have become a model species to study such phenological adaptations of long-distance migratory songbirds to climate change, but data on individuals' time schedules outside the breeding season are still lacking. Using light-level geolocators, we studied variation in migration schedules across the year in a pied flycatcher population in the Netherlands, which sheds light on the ability for individual adjustments in spring arrival timing to track environmental changes at their breeding grounds. We show that variation in arrival dates to breeding sites in 2014 was caused by variation in departure date from sub-Saharan Africa and not by environmental conditions encountered en route. Spring migration duration was short for all individuals, on average 2 weeks. Males migrated ahead of females in spring, while migration schedules in autumn were flexibly adjusted according to breeding duties. Individuals were therefore not consistently early or late throughout the year. In fast migrants like our Dutch pied flycatchers, advancement of arrival to climate change likely requires changes in spring departure dates. Adaptation for earlier arrival may be slowed down by harsh circumstances in winter, or years with high costs associated with early migration. © 2016 The Authors. Journal of Animal Ecology published by John Wiley & Sons Ltd on behalf of British Ecological Society.

Hospital cost analysis of a prospective, randomized trial of early vs interval appendectomy for perforated appendicitis in children.

PubMed

Myers, Adrianne L; Williams, Regan F; Giles, Kim; Waters, Teresa M; Eubanks, James W; Hixson, S Douglas; Huang, Eunice Y; Langham, Max R; Blakely, Martin L

2012-04-01

The methods of surgical care for children with perforated appendicitis are controversial. Some surgeons prefer early appendectomy; others prefer initial nonoperative management followed by interval appendectomy. Determining which of these two therapies is most cost-effective was the goal of this study. We conducted a prospective, randomized trial in children with a preoperative diagnosis of perforated appendicitis. Patients were randomized to early or interval appendectomy. Overall hospital costs were extracted from the hospital's internal cost accounting system and the two treatment groups were compared using an intention-to-treat analysis. Nonparametric data were reported as median ± standard deviation (or range) and compared using a Wilcoxon rank sum test. One hundred thirty-one patients were randomized to either early (n = 64) or interval (n = 67) appendectomy. Hospital charges and costs were significantly lower in patients randomized to early appendectomy. Total median hospital costs were $17,450 (range $7,020 to $55,993) for patients treated with early appendectomy vs $22,518 (range $4,722 to $135,338) for those in the interval appendectomy group. Median hospital costs more than doubled in patients who experienced an adverse event ($15,245 vs $35,391, p < 0.0001). Unplanned readmissions also increased costs significantly and were more frequent in patients randomized to interval appendectomy. In a prospective randomized trial, hospital charges and costs were significantly lower for early appendectomy when compared with interval appendectomy. The increased costs were related primarily to the significant increase in adverse events, including unplanned readmissions, seen in the interval appendectomy group. Copyright © 2012. Published by Elsevier Inc.

Early Medicaid Expansion In Connecticut Stemmed The Growth In Hospital Uncompensated Care.

PubMed

Nikpay, Sayeh; Buchmueller, Thomas; Levy, Helen

2015-07-01

As states continue to debate whether or not to expand Medicaid under the Affordable Care Act (ACA), a key consideration is the impact of expansion on the financial position of hospitals, including their burden of uncompensated care. Conclusive evidence from coverage expansions that occurred in 2014 is several years away. In the meantime, we analyzed the experience of hospitals in Connecticut, which expanded Medicaid coverage to a large number of childless adults in April 2010 under the ACA. Using hospital-level panel data from Medicare cost reports, we performed difference-in-differences analyses to compare the change in Medicaid volume and uncompensated care in the period 2007-13 in Connecticut to changes in other Northeastern states. We found that early Medicaid expansion in Connecticut was associated with an increase in Medicaid discharges of 7-9 percentage points, relative to a baseline rate of 11 percent, and an increase of 7-8 percentage points in Medicaid revenue as a share of total revenue, relative to a baseline share of 10 percent. Also, in contrast to the national and regional trends of increasing uncompensated care during this period, hospitals in Connecticut experienced no increase in uncompensated care. We conclude that uncompensated care in Connecticut was roughly one-third lower than what it would have been without early Medicaid expansion. The results suggest that ACA Medicaid expansions could reduce hospitals' uncompensated care burden. Project HOPE—The People-to-People Health Foundation, Inc.

Analysis of the equilibrium trip cost accounting for the fuel cost in a single-lane traffic system without late arrival

NASA Astrophysics Data System (ADS)

Tang, Tie-Qiao; Wang, Tao; Chen, Liang; Huang, Hai-Jun

2018-01-01

In this paper, we introduce the fuel cost into each commuter's trip cost, define a new trip cost without late arrival and its corresponding equilibrium state, and use a car-following model to explore the impacts of the fuel cost on each commuter's departure time, departure interval, arrival time, arrival interval, traveling time, early arrival time and trip cost at the above equilibrium state. The numerical results show that considering the fuel cost in each commuter's trip cost has positive impacts on his trip cost and fuel cost, and the traffic situation in the system without late arrival, i.e., each commuter should explicitly consider the fuel cost in his trip cost.

Risk factors for early miscarriage among Chinese: a hospital-based case-control study.

PubMed

Xu, Guangli; Wu, Yiming; Yang, Liming; Yuan, Lu; Guo, Huafeng; Zhang, Fuqing; Guan, Yichun; Yao, Wu

2014-06-01

To investigate the risk factors for early miscarriage among Chinese women. Hospital-based matched case-control study. Academic medical center and maternal health hospital. 620 women with early miscarriage (less than 13 weeks of gestation) and 1,240 normal pregnant women. Face-to-face questionnaire. Multivariable conditional odds ratio (OR) and 95% confidence interval (CI) to measure risk factors. After adjustment for confounding factors, the following were independently associated with increased risk: history of miscarriage, repeated induced abortion, working night shifts, and frequent staying up late. Vitamin supplementation and regular physical activity reduced the risk of miscarriage. We did not find paternal age, alcohol consumption, or smoking status to be linked with early miscarriage. Our findings suggest that a healthy diet, regular physical activity, and planned pregnancy may be advantageous for women in pre-pregnancy or early pregnancy. Induced abortion, working night shifts, and frequent staying up late were associated with an increased risk of miscarriage. Further work in larger populations is warranted. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Short Hospitalization after Early Intervention in Managing Grade III Pancreatic Injuries in Children: A Possible New Trend

PubMed Central

Al-Jazaeri, Ayman H.

2011-01-01

The presence of ductal disruption in pancreatic trauma is a major indicator of severity leading to higher morbidities and prolonged hospital stay. However, the adoption of early interventional approach in selected cases of documented grade III pancreatic trauma could result in shorter hospitalization and early recovery. We are describing our approach of early presentation-tailored interventions in managing two consecutive children diagnosed with grade III pancreatic injuries, which constitute the two main ends of the presentations’ spectrum. For the early presenter a spleen preserving distal pancreatectomy was performed, while for the late presenter with large symptomatic pseudocyst endoscopic drainage was attempted. Both early and late presenting children had quick and uneventful recoveries leading to 5 and 6 days of hospitalization, respectively. Both cases continued to be asymptomatic at 4 and 12 months post procedure. In the pseudocyst case, the gastro-cystostomy stents were removed after 10 weeks, and 2.5 months later a completely healed pancreas was demonstrated by magnetic resonance cholangio-pancreatography. Unlike other abdominal solid organ injuries in children, adopting early presentation-tailored intervention can be associated with quicker recovery and short hospitalization for grade III pancreatic injuries. While the series is still small, achieving such remarkable outcomes in two consecutive cases is possible and could set a new trend in managing these injuries in children. PMID:21912067

Early hospital discharge versus continued hospitalization in febrile pediatric cancer patients with prolonged neutropenia: A randomized, prospective study.

PubMed

Ahmed, Nabil; El-Mahallawy, Hadir A; Ahmed, Ibrahim A; Nassif, Shimaa; El-Beshlawy, Aamal; El-Haddad, Alaa

2007-11-01

Hospitalization with single or multi-agent antibiotic therapy has been the standard of care for treatment of febrile neutropenia in cancer patients. We hypothesized that an empiric antibiotic regimen that is effective and that can be administered once-daily will allow for improved hospital utilization by early transition to outpatient care. Febrile pediatric cancer patients with anticipated prolonged neutropenia were randomized between a regimen of once-daily ceftriaxone plus amikacin (C + A) and imipenem monotherapy (control). Afebrile patients on C + A satisfying "Early Discharge Criteria" at 72 hr continued treatment as outpatients. We compared the outcome, adverse events, duration of hospitalization, and cost between both groups. A prospective randomized controlled clinical trial was conducted on 129 febrile episodes in pediatric cancer patients with prolonged neutropenia. No adverse events were seen in 32 children (84% of study arm) treated on an outpatient basis. We found a statistically significant difference between the duration of hospitalization of the C + A group [median 5 days] and control [median 9 days](P < 0.001), per episode antibiotic cost (P < 0.001) and total episode cost (P < 0.001). There was no statistically significant difference in the response to treatment at 72 hr or after necessary antimicrobial modifications. We conclude that pediatric febrile cancer patients initially considered at risk for sepsis due to prolonged neutropenia can be re-evaluated at 72 hr for outpatient therapy. The convenience, low incidence of adverse effects, and cost benefit of the once-daily regimen of C + A may be particularly useful to reduce the overall treatment costs and duration of hospitalization. (c) 2007 Wiley-Liss, Inc.

Early endocrine attending surgeon presence increases operating room efficiency.

PubMed

Clark, Audra; Dackiw, Alan P; White, Wendy D; Nwariaku, Fiemu E; Holt, Shelby A; Rabaglia, Jennifer L; Oltmann, Sarah C

2016-10-01

Preincision operating room (OR) preparation varies greatly. Cases requiring exacting preoperative setup may be more sensitive to inconsistent team members and trainees. Leadership and oversight by the surgeon may facilitate a timely start. The study hypothesized that early attending presence in the OR expedites surgery start time, improving efficiency, and decreasing cost. Prospective data collection of endocrine surgery cases at an urban teaching hospital was performed. Time points recorded in minutes. Cost/min of OR time was $54. Patients classified as in the OR ≤10 min before attending arrival or >10 min before attending arrival. A total of 227 cases (166 thyroid, 54 parathyroid, 10 adrenal) were performed over 14 mo. Of the patients, 128 were in the OR ≤10 min before attending arrival, and 99 patients were >10 min (3 ± 3 min versus 35 ± 14 min, P < 0.01). The ≤10 min procedures started sooner after patient arrival in OR (40 ± 11 versus 63 ± 19, P < 0.01) which equated to $1202 of savings before incision. Although attending time in the OR before incision was equivalent between groups for adrenal and parathyroid, time to incision was shorter in the ≤10 min groups, saving $2416 ± 477 and $1458 ± 244, respectively (P < 0.01). Attending time in OR before thyroidectomy was 13 min longer in ≤10 min than >10 min (P < 0.01), but incisions were made 20 min sooner (P < 0.01) equating to $1076 ± 120 in savings. Early attending presence in the OR shortens time to incision. For parathyroid and adrenal cases, this does not require additional surgeon time. In ORs without consistent teams, early attending presence in the OR improves efficiency and yields significant cost savings. Copyright © 2016 Elsevier Inc. All rights reserved.

Early Posttherapy Hospitalizations Among Survivors of Childhood Leukemia and Lymphoma.

PubMed

Smitherman, Andrew B; Wilkins, Tania M; Blatt, Julie; Dusetzina, Stacie B

2016-08-01

Long-term survivors of childhood cancers are at increased risk for hospitalization. To test the hypothesis that many treatment-related morbidities are identifiable in the early posttherapy period, we determined the rates and causes for hospitalization among survivors of leukemia and lymphoma during the first 3 years posttherapy. Using a health plan claims database, we identified patients aged 0 to 21 years old treated for leukemia or lymphoma from 2000 to 2010. Survivors were matched 10:1 with similar children without a history of cancer. Hospitalization rates over 3 years were compared using Cox proportional hazards regression and risks of cause-specific hospitalization were compared using log-binomial models. Nineteen percent of childhood leukemia and lymphoma survivors were hospitalized in the first 3 years off therapy. Leukemia survivors (N=529) experienced over 6 times (hazard ratio=6.3; 95% confidence interval [CI], 4.9-8.0) and lymphoma survivors (N=454) over 3 times the hospitalization rate of controls (hazard ratio=3.2; 95% CI, 2.5-4.2). Compared with children without a cancer history, survivors were at increased risk for hospitalization due to infectious causes (leukemia: relative risk [RR], 60.0; 95% CI, 23.4-154.0; lymphoma: RR, 10.0; 95% CI, 4.4-22.9). In addition, lymphoma survivors were at increased risk for cardiovascular-related (RR, 15.0; 95% CI, 5.4-42.0) and pulmonary-related (RR, 8.1; 95% CI, 3.9-16.8) hospitalizations. These findings highlight the morbidity experienced by survivors and suggest that treatment-associated complications may be emerging soon after therapy completion.

The Stardust spacecraft arrives at KSC

NASA Technical Reports Server (NTRS)

1998-01-01

After arrival at the Shuttle Landing Facility in the early morning hours, the crated Stardust spacecraft waits to be unloaded from the aircraft. Built by Lockheed Martin Astronautics near Denver, Colo., for the Jet Propulsion Laboratory (JPL) NASA, the spacecraft Stardust will use a unique medium called aerogel to capture comet particles flying off the nucleus of comet Wild 2 in January 2004, plus collect interstellar dust for later analysis. Stardust will be launched aboard a Boeing Delta 7426 rocket from Complex 17, Cape Canaveral Air Station, targeted for Feb. 6, 1999. The collected samples will return to Earth in a re- entry capsule to be jettisoned from Stardust as it swings by in January 2006.

Ultra-Wideband Angle-of-Arrival Tracking Systems

NASA Technical Reports Server (NTRS)

Arndt, G. Dickey; Ngo, Phong H.; Phan, Chau T.; Gross, Julia; Ni, Jianjun; Dusl, John

2010-01-01

Systems that measure the angles of arrival of ultra-wideband (UWB) radio signals and perform triangulation by use of those angles in order to locate the sources of those signals are undergoing development. These systems were originally intended for use in tracking UWB-transmitter-equipped astronauts and mobile robots on the surfaces of remote planets during early stages of exploration, before satellite-based navigation systems become operational. On Earth, these systems could be adapted to such uses as tracking UWB-transmitter-equipped firefighters inside buildings or in outdoor wildfire areas obscured by smoke. The same characteristics that have made UWB radio advantageous for fine resolution ranging, covert communication, and ground-penetrating radar applications in military and law-enforcement settings also contribute to its attractiveness for the present tracking applications. In particular, the waveform shape and the short duration of UWB pulses make it possible to attain the high temporal resolution (of the order of picoseconds) needed to measure angles of arrival with sufficient precision, and the low power spectral density of UWB pulses enables UWB radio communication systems to operate in proximity to other radio communication systems with little or no perceptible mutual interference.

Is the Australian hospital system adequately prepared for terrorism?

PubMed

Rosenfeld, Jeffrey V; Fitzgerald, Mark; Kossmann, Thomas; Pearce, Andrew; Joseph, Anthony; Joseph, Andrew; Tan, Gim; Gardner, Michele; Shapira, Shmuel

Australian hospitals need to be prepared to deal with mass casualties from terrorist strikes, including bomb blasts and chemical, biological and radiation injury. Injuries from bomb explosions are more severe than those commonly seen in Australian hospitals. In disasters involving mass casualties in urban areas, many of the injured make their own way to hospital, often arriving before the more seriously injured casualties. Major hospitals in Australia should plan for large numbers of undifferentiated and potentially contaminated casualties arriving with minimal warning. It is critical that experienced and trained senior medical officers perform the triage of casualties in emergency departments, with frequent reassessment to detect missed injuries (especially pulmonary blast injury). Hospitals require well developed standard operating procedures for mass casualty events, reinforced by regular drills. Preparing for a major event includes training staff in major incident management, setting up an operational/control unit, nominating key personnel, ensuring there is an efficient intra-hospital communication system, and enhancing links with other emergency services and hospitals.

Does winter region affect spring arrival time and body mass of king eiders in northern Alaska?

USGS Publications Warehouse

Oppel, Steffen; Powell, Abby N.

2009-01-01

Events during the non-breeding season may affect the body condition of migratory birds and influence performance during the following breeding season. Migratory birds nesting in the Arctic often rely on endogenous nutrients for reproductive efforts, and are thus potentially subject to such carry-over effects. We tested whether king eider (Somateria spectabilis) arrival time and body mass upon arrival at breeding grounds in northern Alaska were affected by their choice of a winter region in the Bering Sea. We captured birds shortly after arrival on breeding grounds in early June 2002–2006 at two sites in northern Alaska and determined the region in which individuals wintered using satellite telemetry or stable isotope ratios of head feathers. We used generalized linear models to assess whether winter region explained variation in arrival body mass among individuals by accounting for sex, site, annual variation, and the date a bird was captured. We found no support for our hypothesis that either arrival time or arrival body mass of king eiders differed among winter regions. We conclude that wintering in different regions in the Bering Sea is unlikely to have reproductive consequences for king eiders in our study areas.

The Mars Climate Orbiter arrives at KSC to begin final preparations for launch

NASA Technical Reports Server (NTRS)

1998-01-01

The Mars Climate Orbiter spacecraft arrives at KSC's Shuttle Landing Facility aboard an Air Force C-17 cargo plane early this morning following its flight from the Lockheed Martin Astronautics plant in Denver, Colo. When the spacecraft arrives at the red planet, it will primarily support its companion Mars Polar Lander spacecraft, planned for launch on Jan. 3, 1999. After that, the Mars Climate Orbiter's instruments will monitor the Martian atmosphere and image the planet's surface on a daily basis for one Martian year (1.8 Earth years). It will observe the appearance and movement of atmospheric dust and water vapor, as well as characterize seasonal changes on the surface. The detailed images of the surface features will provide important clues to the planet's early climate history and give scientists more information about possible liquid water reserves beneath the surface. The scheduled launch date for the Mars Climate Orbiter is Dec. 10, 1998, on a Delta II 7425 rocket.

Early Infectious Diseases Specialty Intervention Is Associated with Shorter Hospital Stays and Lower Readmission Rates: A Retrospective Cohort Study.

PubMed

Schmitt, Steven; MacIntyre, Ann T; Bleasdale, Susan C; Ritter, J Trees; Nelson, Sandra B; Berbari, Elie F; Burdette, Steven D; Hewlett, Angela; Miles, Matthew; Robinson, Philip A; Siddiqui, Javeed; Trotman, Robin; Martinelli, Lawrence; Zeitlin, Gary; Rodriguez, Andrés; Smith, Mark W; McQuillen, Daniel P

2018-06-13

Intervention by infectious diseases (ID) physicians improves outcomes for inpatients in Medicare, but patients with other insurance types could fare differently. We assessed whether ID involvement leads to better outcomes among privately insured patients under age 65 hospitalized with common infections. We performed a retrospective analysis of administrative claims data from community hospital and post-discharge ambulatory care. Patients were privately insured individuals under 65 years old with an acute-care stay in 2014 for selected infections, classed as having early (by day 3) or late (after day 3) ID intervention, or none. Key outcomes were mortality, cost, length of the index stay; readmission rate, mortality and total cost of care over the first 30 days after discharge. Patients managed with early ID involvement had shorter length of stay, lower spending, and lower mortality in the index stay than those patients managed without ID involvement. Relative to late, early ID involvement was associated with shorter length of stay and lower cost. Individuals with early ID intervention during hospitalization had fewer readmissions and lower healthcare payments after discharge. Relative to late, those with early ID intervention experienced lower readmission, lower spending, and lower mortality. Among privately insured patients under 65 years old, treated in a hospital, early intervention with an ID physician was associated with lower mortality rate and shorter length of stay. Patients who received early ID intervention during their hospital stay were less likely to be readmitted after discharge and had lower total healthcare spending.

Syphilis and psychiatry at the Mysore Government Mental Hospital (NIMHANS) in the early 20th century

PubMed Central

Ghani, Sarah; Murthy, Pratima; Jain, Sanjeev; Sarin, Alok

2018-01-01

Prior to the advent of the Wasserman Test as a diagnostic tool for Syphilis, the identification rate for Syphilis at the Mysore Government Mental Hospital in Southern India was 1%. With the introduction of the test, there was a dramatic increase in the diagnosis of Syphilis, with 17% of the patients testing positive. This paper throws light on the early notions of Syphilis and GPI, societal responses to the disease, early misdiagnosis, the advent of the Wasserman test and treatment management as reflected in the records of the early 20th century at the Mysore Government Mental Hospital (currently known as NIMHANS). PMID:29527060

Arrival metering fuel consumption analysis

DOT National Transportation Integrated Search

2011-01-01

Arrival metering is a method of time-based traffic management that is used by the Federal Aviation Administration to plan and manage streams of arrival traffic during periods of : high demand at busy airports. The Traffic Management Advisor is an aut...

The impact of early hyperglycaemia on children with traumatic brain injury.

PubMed

Fu, Yue-Qiang; Chong, Shu-Ling; Lee, Jan Hau; Liu, Cheng-Jun; Fu, Sheng; Loh, Tsee Foong; Ng, Kee Chong; Xu, Feng

2017-01-01

Hyperglycaemia is common amongst children with traumatic brain injury (TBI). We aim to investigate the association between early hyperglycaemia and poor clinical outcomes in children with moderate to severe TBI. We performed a retrospective study in a tertiary paediatric hospital between May 2012 and October 2014 of all patients with TBI who were aged <16 years with a Glasgow Coma Scale (GCS) of ≤13. The primary outcome was death. Secondary outcomes were 14 ventilation-free, 14 paediatric intensive care unit (PICU)-free and 28 hospital-free days. We defined hyperglycaemia as glucose >11.1 mmol/L (200 mg/dL). There were 109 patients with a median age of 54 months [inter-quartile range (IQR): 17-82]. Median glucose on arrival was 6.1 mmol/L (IQR: 5.2-9.8). Median GCS in our cohort was 8 (IQR: 6-12). Multivariate logistic regression demonstrated that initial hyperglycaemia [odds ratio (OR): 15.23; 95% confidence interval (CI): 3.74-62.00; P < 0.001], and GCS <8 (OR: 13.02; 95% CI: 2.31-73.33; P = 0.004) were risk factors for mortality. Multivariate linear regression showed that initial hyperglycaemia was a risk factor for reduced ventilation-free, PICU-free and hospital-free days. Early hyperglycaemia predicts for in-hospital mortality, reduced ventilation-free, PICU-free and hospital-free days in children with moderate to severe TBI.

Weather Impact on Airport Arrival Meter Fix Throughput

NASA Technical Reports Server (NTRS)

Wang, Yao

2017-01-01

Time-based flow management provides arrival aircraft schedules based on arrival airport conditions, airport capacity, required spacing, and weather conditions. In order to meet a scheduled time at which arrival aircraft can cross an airport arrival meter fix prior to entering the airport terminal airspace, air traffic controllers make regulations on air traffic. Severe weather may create an airport arrival bottleneck if one or more of airport arrival meter fixes are partially or completely blocked by the weather and the arrival demand has not been reduced accordingly. Under these conditions, aircraft are frequently being put in holding patterns until they can be rerouted. A model that predicts the weather impacted meter fix throughput may help air traffic controllers direct arrival flows into the airport more efficiently, minimizing arrival meter fix congestion. This paper presents an analysis of air traffic flows across arrival meter fixes at the Newark Liberty International Airport (EWR). Several scenarios of weather impacted EWR arrival fix flows are described. Furthermore, multiple linear regression and regression tree ensemble learning approaches for translating multiple sector Weather Impacted Traffic Indexes (WITI) to EWR arrival meter fix throughputs are examined. These weather translation models are developed and validated using the EWR arrival flight and weather data for the period of April-September in 2014. This study also compares the performance of the regression tree ensemble with traditional multiple linear regression models for estimating the weather impacted throughputs at each of the EWR arrival meter fixes. For all meter fixes investigated, the results from the regression tree ensemble weather translation models show a stronger correlation between model outputs and observed meter fix throughputs than that produced from multiple linear regression method.

Direct hospital marketing: an idea whose time has come.

PubMed

Dodson, D C; Dotson, M J; Cussimanio, L

1990-01-01

Health care marketing has arrived swiftly and with significant impact upon the hospital scene. From the early days of rejection and suspicion of only a few years ago, it has now taken its place with other hospital management functions. Still, however, hospitals have not yet reached the degree of expertise that exists in other sectors. One of the reasons why hospitals have not fully emerged to the level of marketing expertise as many of their traditional business counterparts is that many of the areas of both the science and art of marketing have not been fully developed. One such area is direct mail marketing. Presented here is an overview of the advantages and functions of hospital direct mail marketing. A variety of examples are given with a more thorough case example being provided by Lee's Summit Community Hospital in Lee's Summit, Missouri. The successful direct mail marketing campaign there should be both an inspiration and a model for success for other hospitals. Space limitations prevent the authors from some of the more exacting details of mail marketing and, of course, successful campaigns do not happen by magic. They take careful planning, strategy, and execution. They also require a coordinated organizational and human effort to be successful. But direct mail marketing does offer a potentially new arena of marketing for most hospitals. The expertise, skill, knowledge, and technology are in place. All that is really needed is the commitment on the part of the hospital leadership.

An Exploratory Study of Runway Arrival Procedures: Time Based Arrival and Self-Spacing

NASA Technical Reports Server (NTRS)

Houston, Vincent E.; Barmore, Bryan

2009-01-01

The ability of a flight crew to deliver their aircraft to its arrival runway on time is important to the overall efficiency of the National Airspace System (NAS). Over the past several years, the NAS has been stressed almost to its limits resulting in problems such as airport congestion, flight delay, and flight cancellation to reach levels that have never been seen before in the NAS. It is predicted that this situation will worsen by the year 2025, due to an anticipated increase in air traffic operations to one-and-a-half to three times its current level. Improved arrival efficiency, in terms of both capacity and environmental impact, is an important part of improving NAS operations. One way to improve the arrival performance of an aircraft is to enable the flight crew to precisely deliver their aircraft to a specified point at either a specified time or specified interval relative to another aircraft. This gives the flight crew more control to make the necessary adjustments to their aircraft s performance with less tactical control from the controller; it may also decrease the controller s workload. Two approaches to precise time navigation have been proposed: Time-Based Arrivals (e.g., required times of arrival) and Self-Spacing. Time-Based Arrivals make use of an aircraft s Flight Management System (FMS) to deliver the aircraft to the runway threshold at a given time. Self-Spacing enables the flight crew to achieve an ATC assigned spacing goals at the runway threshold relative to another aircraft. The Joint Planning and Development Office (JPDO), a multi-agency initiative established to plan and coordinate the development of the Next Generation Air Transportation System (NextGen), has asked for data for both of these concepts to facilitate future research and development. This paper provides a first look at the delivery performance of these two concepts under various initial and environmental conditions in an air traffic simulation environment.

Early Medicaid Expansion in Connecticut Stemmed the Growth in Hospital Uncompensated Care

PubMed Central

Nikpay, Sayeh; Buchmueller, Thomas; Levy, Helen

2015-01-01

As states continue to debate whether or not to expand Medicaid under the Affordable Care Act (ACA), a key consideration is the impact of expansion on the financial position of hospitals, including their burden of uncompensated care. Conclusive evidence from coverage expansions that occurred in 2014 is several years away. In the meantime, we analyzed the experience of hospitals in Connecticut, which expanded Medicaid coverage to a large number of childless adults in April 2010 under the ACA. With hospital-level panel data from Medicare cost reports, we used difference-in-differences analyses to compare the change in Medicaid volume and uncompensated care in the period 2007–13 in Connecticut to changes in other Northeastern states. We found that early Medicaid expansion in Connecticut was associated with an increase in Medicaid discharges of 7 to 9 percentage points, relative to a baseline rate of 11 percent, and 7 to 8 percentage point increase in Medicaid revenue as a share of total revenue, relative to baseline share of 9.5 percent.. Also, in contrast to the national and regional trends of increasing uncompensated care during this period, hospitals in Connecticut experienced no increase in uncompensated care. We conclude that uncompensated care in Connecticut was roughly one-third lower than what it would have been without early Medicaid expansion. The results suggest that ACA Medicaid expansions could reduce hospitals’ uncompensated care burden. PMID:26153312

Exploring the performance of the National Early Warning Score (NEWS) in a European emergency department.

PubMed

Alam, N; Vegting, I L; Houben, E; van Berkel, B; Vaughan, L; Kramer, M H H; Nanayakkara, P W B

2015-05-01

Several triage systems have been developed for use in the emergency department (ED), however they are not designed to detect deterioration in patients. Deteriorating patients may be at risk of going undetected during their ED stay and are therefore vulnerable to develop serious adverse events (SAEs). The national early warning score (NEWS) has a good ability to discriminate ward patients at risk of SAEs. The utility of NEWS had not yet been studied in an ED. To explore the performance of the NEWS in an ED with regard to predicting adverse outcomes. A prospective observational study. Patients Eligible patients were those presenting to the ED during the 6 week study period with an Emergency Severity Index (ESI) of 2 and 3 not triaged to the resuscitation room. NEWS was documented at three time points: on arrival (T0), hour after arrival (T1) and at transfer to the general ward/ICU (T2). The outcomes of interest were: hospital admission, ICU admission, length of stay and 30 day mortality. A total of 300 patients were assessed for eligibility. Complete data was able to be collected for 274 patients on arrival at the ED. NEWS was significantly correlated with patient outcomes, including 30 day mortality, hospital admission, and length of stay at all-time points. The NEWS measured at different time points was a good predictor of patient outcomes and can be of additional value in the ED to longitudinally monitor patients throughout their stay in the ED and in the hospital. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A comprehensive review of prehospital and in-hospital delay times in acute stroke care.

PubMed

Evenson, K R; Foraker, R E; Morris, D L; Rosamond, W D

2009-06-01

The purpose of this study was to systematically review and summarize prehospital and in-hospital stroke evaluation and treatment delay times. We identified 123 unique peer-reviewed studies published from 1981 to 2007 of prehospital and in-hospital delay time for evaluation and treatment of patients with stroke, transient ischemic attack, or stroke-like symptoms. Based on studies of 65 different population groups, the weighted Poisson regression indicated a 6.0% annual decline (P<0.001) in hours/year for prehospital delay, defined from symptom onset to emergency department arrival. For in-hospital delay, the weighted Poisson regression models indicated no meaningful changes in delay time from emergency department arrival to emergency department evaluation (3.1%, P=0.49 based on 12 population groups). There was a 10.2% annual decline in hours/year from emergency department arrival to neurology evaluation or notification (P=0.23 based on 16 population groups) and a 10.7% annual decline in hours/year for delay time from emergency department arrival to initiation of computed tomography (P=0.11 based on 23 population groups). Only one study reported on times from arrival to computed tomography scan interpretation, two studies on arrival to drug administration, and no studies on arrival to transfer to an in-patient setting, precluding generalizations. Prehospital delay continues to contribute the largest proportion of delay time. The next decade provides opportunities to establish more effective community-based interventions worldwide. It will be crucial to have effective stroke surveillance systems in place to better understand and improve both prehospital and in-hospital delays for acute stroke care.

Hospitalization for early bonding of the genetic mother after a surrogate pregnancy: report of two cases.

PubMed

Sharan, H; Yahav, J; Peleg, D; Ben-Rafael, Z; Merlob, P

2001-12-01

In surrogate pregnancies the genetic parents have little opportunity for early bonding to their infant, either prenatally (in utero) or in the immediate postnatal period. The purpose of this article is to describe a new method for encouraging early parent-infant bonding after surrogate pregnancy by hospitalizing the genetic mother in the maternity ward immediately after the delivery. Two genetic mothers were hospitalized in the maternity ward (rooming-in system) at the Rabin Medical Center in Israel immediately after delivery of their infants by surrogate arrangement. The first birth was a singleton pregnancy with vaginal delivery and the second, a twin pregnancy with delivery by cesarean section. The genetic parents were counseled by a social worker from the adoption agency, starting 3 months before the estimated date of delivery. The parents were referred to the hospital social worker before the delivery. To assess attachment, we observed the parents' behavior toward their children during two daily 15-minute periods of free, unstructured interaction. The parents showed good primary caregiving functions and established affective verbal and physical contact with the infants. They began to recognize the infants' needs and temperament, and exhibited an aura of self-confidence during their interactions. All expressed satisfaction with the method at discharge and reported on reduction of their fears about returning home with the infants. We believe that early hospitalization of the genetic mother in a surrogate delivery may be desirable to establish good and safe early mother-infant bonding, and that it should be considered for adoption as regular hospital policy. Further randomized studies with larger samples over the long term are warranted.

Arrival in the labour ward in second stage of labour--any prognostic significance?

PubMed

Nkyekyer, K

1998-05-01

A comparative descriptive study was carried out to determine whether, in uncomplicated term pregnancies with the foetus in vertex presentation, there were any differences in maternal or foetal outcome between women who arrived in the labour ward in second stage of labour and those who arrived in early active phase. There were two hundred and seventeen women each in the study and comparison groups. There were no significant differences between the two groups as regards age, parity, marital status and level of education. Women in the comparison group were better antenatal clinic attendants. Those in the study group were more likely to have indicated that they had problems with transportation. They also had considerably shorter labours and all achieved spontaneous vaginal deliveries; a significant proportion (10.6%) of the comparison group had interventional deliveries. The incidence of episiotomies, lower genital tract injuries, manual removal of placenta and postpartum haemorrhage after vaginal delivery were not different between the two groups. Babies born to mothers in the study group were significantly lighter, by about 170 gms, and had a lower incidence of low one-minute Apgar scores. There were no significant differences in the rates of admission to the neonatal intensive care unit or in early neonatal deaths. Arrival in the labour ward in second stage of labour prognosticates non-interventional delivery without any increased risk of adverse outcome to the mother or her baby.

Telecommunications in Israeli field hospitals deployed to three crisis zones.

PubMed

Finestone, Aharon S; Levy, Gadi; Bar-Dayan, Yaron

2014-10-01

A field hospital overseas requires various types of communication equipment. This study presents the communications equipment used by three Israeli field hospital delegations to earthquake sites at Adapazari, Turkey, in 1999, Port-au-Prince, Haiti, in 2010 and Minamisanriku, Japan, in 2011. The delegations to Turkey and Haiti were relatively large (105-230 personnel) and were on the site early (three to four days after each event). The 55-person delegation to Japan arrived later and was established as an outpatient community hospital. Standard military VHF radios were the only effective tool up to 5 km, until cellular coverage was regained (1-2 weeks after each event). International communication was good. While short-wave communication (telephone and Internet) was used in Turkey, a direct satellite channel was set up in Haiti. In Japan, BGAN Inmarsat provided efficient Wi-Fi for all needs. Motorola walkie talkies were not efficient beyond the immediate vicinity. This paper recommends continued use of military-specification equipment alongside newer modalities, particularly in situations where infrastructure is damaged. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

The Mars Climate Orbiter arrives at KSC to begin final preparations for launch

NASA Technical Reports Server (NTRS)

1998-01-01

The Mars Climate Orbiter spacecraft is moved into the Spacecraft Assembly and Encapsulation Facility-2 (SAEF-2) in KSC's industrial area. It arrived at the Shuttle Landing Facility aboard an Air Force C-17 cargo plane early this morning following its flight from the Lockheed Martin Astronautics plant in Denver, Colo. When it arrives at the red planet, the Mars Climate Orbiter will primarily support its companion Mars Polar Lander spacecraft, planned for launch on Jan. 3, 1999. After that, the Mars Climate Orbiter's instruments will monitor the Martian atmosphere and image the planet's surface on a daily basis for one Martian year (1.8 Earth years). It will observe the appearance and movement of atmospheric dust and water vapor, as well as characterize seasonal changes on the surface. The detailed images of the surface features will provide important clues to the planet's early climate history and give scientists more information about possible liquid water reserves beneath the surface. The scheduled launch date for the Mars Climate Orbiter is Dec. 10, 1998, on a Delta II 7425 rocket.

The Mars Climate Orbiter arrives at KSC to begin final preparations for launch

NASA Technical Reports Server (NTRS)

1998-01-01

The Mars Climate Orbiter spacecraft is moved onto a flatbed for transport to the Spacecraft Assembly and Encapsulation Facility-2 (SAEF-2). It arrived at KSC's Shuttle Landing Facility aboard an Air Force C-17 cargo plane early this morning following its flight from the Lockheed Martin Astronautics plant in Denver, Colo. When it arrives at the red planet, the Mars Climate Orbiter will primarily support its companion Mars Polar Lander spacecraft, planned for launch on Jan. 3, 1999. After that, the Mars Climate Orbiter's instruments will monitor the Martian atmosphere and image the planet's surface on a daily basis for one Martian year (1.8 Earth years). It will observe the appearance and movement of atmospheric dust and water vapor, as well as characterize seasonal changes on the surface. The detailed images of the surface features will provide important clues to the planet's early climate history and give scientists more information about possible liquid water reserves beneath the surface. The scheduled launch date for the Mars Climate Orbiter is Dec. 10, 1998, on a Delta II 7425 rocket.

Wavelet-based automatic determination of the P- and S-wave arrivals

NASA Astrophysics Data System (ADS)

Bogiatzis, P.; Ishii, M.

2013-12-01

The detection of P- and S-wave arrivals is important for a variety of seismological applications including earthquake detection and characterization, and seismic tomography problems such as imaging of hydrocarbon reservoirs. For many years, dedicated human-analysts manually selected the arrival times of P and S waves. However, with the rapid expansion of seismic instrumentation, automatic techniques that can process a large number of seismic traces are becoming essential in tomographic applications, and for earthquake early-warning systems. In this work, we present a pair of algorithms for efficient picking of P and S onset times. The algorithms are based on the continuous wavelet transform of the seismic waveform that allows examination of a signal in both time and frequency domains. Unlike Fourier transform, the basis functions are localized in time and frequency, therefore, wavelet decomposition is suitable for analysis of non-stationary signals. For detecting the P-wave arrival, the wavelet coefficients are calculated using the vertical component of the seismogram, and the onset time of the wave is identified. In the case of the S-wave arrival, we take advantage of the polarization of the shear waves, and cross-examine the wavelet coefficients from the two horizontal components. In addition to the onset times, the automatic picking program provides estimates of uncertainty, which are important for subsequent applications. The algorithms are tested with synthetic data that are generated to include sudden changes in amplitude, frequency, and phase. The performance of the wavelet approach is further evaluated using real data by comparing the automatic picks with manual picks. Our results suggest that the proposed algorithms provide robust measurements that are comparable to manual picks for both P- and S-wave arrivals.

An Analysis of the Relationship Between the Heat Index and Arrivals in the Emergency Department

PubMed Central

Levy, Matthew; Broccoli, Morgan; Cole, Gai; Jenkins, J Lee; Klein, Eili Y.

2015-01-01

Background: Heatwaves are one of the most deadly weather-related events in the United States and account for more deaths annually than hurricanes, tornadoes, floods, and earthquakes combined. However, there are few statistically rigorous studies of the effect of heatwaves on emergency department (ED) arrivals. A better understanding of this relationship can help hospitals plan better and provide better care for patients during these types of events. Methods: A retrospective review of all ED patient arrivals that occurred from April 15 through August 15 for the years 2008 through 2013 was performed. Daily patient arrival data were combined with weather data (temperature and humidity) to examine the potential relationships between the heat index and ED arrivals as well as the length of time patients spend in the ED using generalized additive models. In particular the effect the 2012 heat wave that swept across the United States, and which was hypothesized to increase arrivals was examined. Results: While there was no relationship found between the heat index and arrivals on a single day, a non-linear relationship was found between the mean three-day heat index and the number of daily arrivals. As the mean three-day heat index initially increased, the number of arrivals significantly declined. However, as the heat index continued to increase, the number of arrivals increased. It was estimated that there was approximately a 2% increase in arrivals when the mean heat index for three days approached 100°F. This relationship was strongest for adults aged 18-64, as well as for patients arriving with lower acuity. Additionally, a positive relationship was noted between the mean three-day heat index and the length of stay (LOS) for patients in the ED, but no relationship was found for the time from which a patient was first seen to when a disposition decision was made. No significant relationship was found for the effect of the 2012 heat wave on ED arrivals, though it

Early-career registered nurses' participation in hospital quality improvement activities.

PubMed

Djukic, Maja; Kovner, Christine T; Brewer, Carol S; Fatehi, Farida K; Bernstein, Ilya

2013-01-01

We surveyed 2 cohorts of early-career registered nurses from 15 states in the US, 2 years apart, to compare their reported participation in hospital quality improvement (QI) activities. We anticipated differences between the 2 cohorts because of the growth of several initiatives for engaging nurses in QI. There were no differences between the 2 cohorts across 14 measured activities, except for their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates.

The effect of early postnatal discharge from hospital for women and infants: a systematic review protocol.

PubMed

Jones, Eleanor; Taylor, Beck; MacArthur, Christine; Pritchett, Ruth; Cummins, Carole

2016-02-08

The length of postnatal hospital stay has declined over the last 40 years. There is little evidence to support a policy of early discharge following birth, and there is some concern about whether early discharge of mothers and babies is safe. The Cochrane review on the effects of early discharge from hospital only included randomised controlled trials (RCTs) which are problematic in this area, and a systematic review including other study designs is required. The aim of this broader systematic review is to determine possible effects of a policy of early postnatal discharge on important maternal and infant health-related outcomes. A systematic search of published literature will be conducted for randomised controlled trials, non-randomised controlled trials (NRCTs), controlled before-after studies (CBA), and interrupted time series studies (ITS) that report on the effect of a policy of early postnatal discharge from hospital. Databases including Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and Science Citation Index will be searched for relevant material. Reference lists of articles will also be searched in addition to searches to identify grey literature. Screening of identified articles and data extraction will be conducted in duplicate and independently. Methodological quality of the included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria for risk of bias tool. Discrepancies will be resolved by consensus or by consulting a third author. Meta-analysis using a random effects model will be used to combine data. Where significant heterogeneity is present, data will be combined in a narrative synthesis. The findings will be reported according to the preferred reporting items for systematic reviews (PRISMA) statement. Information on the effects of early postnatal discharge from hospital will be important for policy makers and clinicians providing maternity care. This review will also identify any gaps in the current

Pointing to Shaun Tan's The Arrival and Re-Imagining Visual Poetics in Research

ERIC Educational Resources Information Center

Bjartveit, Carolyn J.; Panayotidis, E. Lisa

2014-01-01

In this article, the authors discuss how Shaun Tan's graphic novel "The Arrival" (2006) opened a polyphonic dialogue with culturally diverse early childhood educators. Using visual, graphic and symbolic languages provided alternative ways for the research participants to express their experiences and understandings of being recent…

Integrated Specialized Early-Course Psychosis Treatment Services - University Psychiatric Hospital Vrapce Model.

PubMed

Ostojić, DraŽenka; Čulo, Ilaria; Silić, Ante; Kos, Suzana; Savić, Aleksandar

2018-06-01

First episode of psychosis presents a critical period in terms of numerous associated risks, but also possibilities for effective therapeutic interventions. There is a continued focus on early interventions in prodromal states and early course of frank psychosis, aimed at ensuring faster remission, reducing relapses, achieving better long-term functioning, and preventing adverse outcomes linked to untreated psychosis and chronic psychotic disorders. A number of different specialized treatment models and services exist trying to close knowledge gaps and provide clinical interventions to first-episode psychosis (FEP) patients, but there is still no generally accepted standard of care informing our every-day practice. FEP and early-course psychosis specialized treatment model developed in 2004 in University Psychiatric Hospital Vrapce rests on integration of care across different organization units and clinical presentation acuity levels and patient needs (intensive care, FEP inpatient unit, FEP outpatient services including day hospital). Such integration of FEP services allows for flexible entry point on multiple levels, earlier structuring of therapeutic alliance for those requiring inpatient care, reduction of risks associated with FEP, quicker formation of long-term treatment plans, reduction of delay in accessing specialized services, and a more coordinated diagnostic process and recruitment of FEP patient population. Detailed evaluations of outcomes and comparisons with different treatment models are necessary in order to assess strengths and weaknesses of each specific model and inform modifications to current practice models.

Current approaches for assessment and treatment of women with early miscarriage or ectopic pregnancy in Nigeria: a case for dedicated early pregnancy services.

PubMed

Iyoke, C A; Ugwu, O G; Ezugwu, F O; Onah, H E; Agbata, A T; Ajah, L C

2014-01-01

It has been suggested that women with early miscarriage or ectopic pregnancy are best cared for in dedicated units which offer rapid and definitive ultrasonographic and biochemical assessment at the initial review of the patient. To describe the current protocols for the assessment and treatment of women with early miscarriage or ectopic pregnancy as reported by Nigerian Gynecologists, and determine if dedicated early pregnancy services such as Early Pregnancy Assessment Units could be introduced to improve care. A cross-sectional survey of Nigerian Gynecologists attending the 46 th Annual Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria. This was a questionnaire-based study. Data analysis was by descriptive statistics using Statistical Package for the Social Sciences software, version 17.0 for Windows (IBM Corporation, Armonk, NY, USA). A total of 232 gynecologists working in 52 different secondary and tertiary health facilities participated in the survey. The mean age of the respondents was 42.6 ± 9.1 years (range 28-70 years). The proportion of gynecologists reporting that women with early miscarriage or ectopic pregnancy were first managed within the hospital general emergency room was 92%. The mean reported interval between arrival in hospital and first ultrasound scan was 4.9 ± 1.4 hours (range ½-8 hours). Transvaginal scan was stated as the routine initial imaging investigation by only 17.2% of respondents. Approximately 94.8% of respondents felt that dedicated early pregnancy services were feasible and should be introduced to improve the care of women with early miscarriage and ectopic pregnancy. Reported protocols for managing early miscarriage or ectopic pregnancy in many health facilities in Nigeria appear to engender unnecessary delays and avoidable costs, and dedicated early pregnancy services could be both useful and feasible in addressing these shortcomings in the way women with such conditions are currently managed.

Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis.

PubMed

Henriksen, Hanne H; Rahbar, Elaheh; Baer, Lisa A; Holcomb, John B; Cotton, Bryan A; Steinmetz, Jacob; Ostrowski, Sisse R; Stensballe, Jakob; Johansson, Pär I; Wade, Charles E

2016-12-09

The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in-hospital within 6 hours of admission. Clinical data on patient demographics, blood biochemistry, injury severity score and mortality were collected. Admission rTEG was conducted to characterize the coagulation profile and hemostatic function. 75 patients received pre-hospital plasma and/or RBCs (PH group; nearly half received both RBCs and plasma) whereas 182 patients only received in-hospital blood products (RBCs, Plasma and Platelets) within 6 hours of admission (IH group). PH patients had lower Glasgow coma scale (GCS) scores, more penetrating injuries, lower systolic blood pressures, lower hemoglobin levels, lower platelet counts and greater acidosis upon ED admission than the IH group (all p < 0.05). Despite differences in type of injury and admission vitals indicating that the PH group had more signs of bleeding than the IH group, there were no significant differences in in-hospital mortality (PH 26.7% vs. IH 20.9% p = 0.31). When comparing rTEG variables between PH patients transfused with 0, 1 or 2 units of plasma, more pre-hospital plasma transfusion was tendency towards improved rTEG variables. When adjusting for pre-hospital RBC, pre-hospital plasma was associated with significantly higher rTEG MA (p = 0.012) at hospital admission. After adjusting for pre-hospital RBCs, pre-hospital plasma transfusion was independently associated with increased rTEG MA, as well as arrival indices of

What prevents phenological adjustment to climate change in migrant bird species? Evidence against the ``arrival constraint'' hypothesis

NASA Astrophysics Data System (ADS)

Goodenough, Anne E.; Hart, Adam G.; Elliot, Simon L.

2011-01-01

Phenological studies have demonstrated changes in the timing of seasonal events across multiple taxonomic groups as the climate warms. Some northern European migrant bird populations, however, show little or no significant change in breeding phenology, resulting in synchrony with key food sources becoming mismatched. This phenological inertia has often been ascribed to migration constraints (i.e. arrival date at breeding grounds preventing earlier laying). This has been based primarily on research in The Netherlands and Germany where time between arrival and breeding is short (often as few as 9 days). Here, we test the arrival constraint hypothesis over a 15-year period for a U.K. pied flycatcher ( Ficedula hypoleuca) population where laying date is not constrained by arrival as the period between arrival and breeding is substantial and consistent (average 27 ± 4.57 days SD). Despite increasing spring temperatures and quantifiably stronger selection for early laying on the basis of number of offspring to fledge, we found no significant change in breeding phenology, in contrast with co-occurring resident blue tits ( Cyanistes caeruleus). We discuss possible non-migratory constraints on phenological adjustment, including limitations on plasticity, genetic constraints and competition, as well as the possibility of counter-selection pressures relating to adult survival, longevity or future reproductive success. We propose that such factors need to be considered in conjunction with the arrival constraint hypothesis.

What prevents phenological adjustment to climate change in migrant bird species? Evidence against the "arrival constraint" hypothesis.

PubMed

Goodenough, Anne E; Hart, Adam G; Elliot, Simon L

2011-01-01

Phenological studies have demonstrated changes in the timing of seasonal events across multiple taxonomic groups as the climate warms. Some northern European migrant bird populations, however, show little or no significant change in breeding phenology, resulting in synchrony with key food sources becoming mismatched. This phenological inertia has often been ascribed to migration constraints (i.e. arrival date at breeding grounds preventing earlier laying). This has been based primarily on research in The Netherlands and Germany where time between arrival and breeding is short (often as few as 9 days). Here, we test the arrival constraint hypothesis over a 15-year period for a U.K. pied flycatcher (Ficedula hypoleuca) population where laying date is not constrained by arrival as the period between arrival and breeding is substantial and consistent (average 27 ± 4.57 days SD). Despite increasing spring temperatures and quantifiably stronger selection for early laying on the basis of number of offspring to fledge, we found no significant change in breeding phenology, in contrast with co-occurring resident blue tits (Cyanistes caeruleus). We discuss possible non-migratory constraints on phenological adjustment, including limitations on plasticity, genetic constraints and competition, as well as the possibility of counter-selection pressures relating to adult survival, longevity or future reproductive success. We propose that such factors need to be considered in conjunction with the arrival constraint hypothesis.

The impact of early specialist management on outcomes of patients with in-hospital stroke.

PubMed

Manawadu, Dulka; Choyi, Jithesh; Kalra, Lalit

2014-01-01

Delays in treatment of in-hospital stroke (IHS) adversely affect patient outcomes. We hypothesised that early referral and specialist management of IHS patients will improve outcomes at 90 days. Baseline characteristics, assessment delays, thrombolysis eligibility, 90-day functional outcomes and all-cause mortality were compared between IHS patients referred for specialist stroke management within 3 hours of symptom onset (early referrals) and later referrals. Patients were identified from a prospective stroke registry between January 2009 and December 2010. Inclusion criteria were primary admission with a non-stroke diagnosis, onset of new neurological deficits after admission and early ischaemic changes on CT or MR imaging. Eighty four (4.6%) of 1836 stroke patients had IHS (mean age 74 year; 51% male, median NIHSS score 10). There were no significant differences in baseline characteristics between 53 (63%) early and 31 (37%) late referrals. Thrombolysis was performed in 29 (76%) of the 37/78 (47%) potentially eligible patients; 7 patients were excluded because specialist referral was delayed beyond 4.5 hours despite symptom recognition within 3 hours of onset. Early referral improved functional outcomes (modified Rankin Scale 0-2 at 90 days 40% v 7%, p = 0.001) and was an independent predictor of mRS 0-2 at 90 days after adjusting for age, pre-morbid function, primary cause for hospital admission and stroke severity [OR 1.13 (95% C.I.  = 1.10-1.27), p = 0.002]. Early referral and specialist management of IHS patients that includes thrombolysis is associated with better functional outcomes at 90 days.

Improving arrival time identification in transient elastography

NASA Astrophysics Data System (ADS)

Klein, Jens; McLaughlin, Joyce; Renzi, Daniel

2012-04-01

In this paper, we improve the first step in the arrival time algorithm used for shear wave speed recovery in transient elastography. In transient elastography, a shear wave is initiated at the boundary and the interior displacement of the propagating shear wave is imaged with an ultrasound ultra-fast imaging system. The first step in the arrival time algorithm finds the arrival times of the shear wave by cross correlating displacement time traces (the time history of the displacement at a single point) with a reference time trace located near the shear wave source. The second step finds the shear wave speed from the arrival times. In performing the first step, we observe that the wave pulse decorrelates as it travels through the medium, which leads to inaccurate estimates of the arrival times and ultimately to blurring and artifacts in the shear wave speed image. In particular, wave ‘spreading’ accounts for much of this decorrelation. Here we remove most of the decorrelation by allowing the reference wave pulse to spread during the cross correlation. This dramatically improves the images obtained from arrival time identification. We illustrate the improvement of this method on phantom and in vivo data obtained from the laboratory of Mathias Fink at ESPCI, Paris.

8 CFR 232.3 - Arriving aliens.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Arriving aliens. 232.3 Section 232.3 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS DETENTION OF ALIENS FOR PHYSICAL AND MENTAL EXAMINATION § 232.3 Arriving aliens. When a district director has reasonable grounds...

8 CFR 232.3 - Arriving aliens.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Arriving aliens. 232.3 Section 232.3 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS DETENTION OF ALIENS FOR PHYSICAL AND MENTAL EXAMINATION § 232.3 Arriving aliens. When a district director has reasonable grounds...

8 CFR 232.3 - Arriving aliens.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Arriving aliens. 232.3 Section 232.3 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS DETENTION OF ALIENS FOR PHYSICAL AND MENTAL EXAMINATION § 232.3 Arriving aliens. When a district director has reasonable grounds...

8 CFR 232.3 - Arriving aliens.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Arriving aliens. 232.3 Section 232.3 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS DETENTION OF ALIENS FOR PHYSICAL AND MENTAL EXAMINATION § 232.3 Arriving aliens. When a district director has reasonable grounds...

8 CFR 232.3 - Arriving aliens.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Arriving aliens. 232.3 Section 232.3 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS DETENTION OF ALIENS FOR PHYSICAL AND MENTAL EXAMINATION § 232.3 Arriving aliens. When a district director has reasonable grounds...

Clinical Features of Non-clostridial Gas Gangrene and Risk Factors for In-hospital Mortality.

PubMed

Takazawa, Kensuke; Otsuka, Hiroyuki; Nakagawa, Yoshihide; Inokuchi, Sadaki

2015-09-20

To examine the clinical features of patients with non-clostridial gas gangrene (NCGG) at our hospital and identify risk factors for in-hospital mortality. This study included 24 patients with NCGG who were hospitalized in our medical facility from April 2005 to March 2015. The clinical features of NCGG were reviewed, and the characteristics of 6 patients who died in hospital and 18 who survived were compared to investigate risk factors. The median time from symptom onset to hospital arrival was 168 h. The causative agent was Klebsiella pneumoniae in 8.3% and mixed infection in 91.7%; 83.3% of patients had diabetes, and one patient had no obvious underlying disease. The site of infection was the neck in 4.2%, the thoracoabdominal wall and retroperitoneum in 12.5% each, the back in 33.3%, the buttocks in 25.0%, the perineum in 20.8%, and the extremities in 45.8%. Retroperitoneal infection, blood lactate ≥ 4.0 mmol/L, and Japanese Association for Acute Medicine disseminated intravascular coagulation (DIC) score ≥ 4 on emergency department (ED) arrival were significantly higher in non-survivors than in survivors. NCGG tends to develop in patients with diabetes, and in-hospital mortality rates are still high. Retroperitoneal infection, hyperlactatemia, and DIC on ED arrival are risk factors for in-hospital mortality.

Early Versus Delayed Colonoscopy in Hospitalized Patients With Lower Gastrointestinal Bleeding: A Meta-Analysis.

PubMed

Sengupta, Neil; Tapper, Elliot B; Feuerstein, Joseph D

2017-04-01

Early colonoscopy is recommended for patients with severe lower gastrointestinal bleeding (LGIB). There is limited data as to whether this is associated with improved outcomes. We performed a meta-analysis of studies comparing early (<24 h) versus delayed colonoscopy (>24 h). PubMed, Embase, and Web of Science were searched for manuscripts using colonoscopy as a diagnostic/treatment modality for patients hospitalized with LGIB. Studies were included if data were available on outcomes comparing early and delayed colonoscopy. Articles were reviewed for time to colonoscopy, rebleeding, mortality, length of stay (LOS), surgery, interventions, localization of LGIB, and number of packed red blood cells. Pooled measures were reported using the Mantel-Haenszel method. A total of 8491 studies were assessed of which 6 were included. There were 422 patients in the early arm and 479 in the delayed arm. There were no differences in age (64.2 vs. 65.7, P=0.85), admission hemoglobin (10.3 vs. 10.3 g/dL, P=0.96), LOS (5.21 vs. 6.09, P=0.52), and packed red blood cells transfusion (2.37 vs. 2.35, P=0.92) between the groups. In hospital mortality [odds ratio (OR), 1.64; 95% confidence interval (CI), 0.51-5.32], rebleeding (OR, 1.38; 95% CI, 0.85-2.23) and need for surgery (OR, 0.89; 95% CI, 0.42-1.89) were not different in delayed versus early colonoscopy. Early colonoscopy was associated with a higher detection of bleeding source (OR, 2.97; 95% CI, 2.11-4.19) and endoscopic intervention (OR, 3.99; 95% CI, 2.59-6.13). Early colonoscopy is not associated with reduced rebleeding, LOS, or surgery but is associated with a higher rate of source localization and endoscopic intervention.

Text mining approach to predict hospital admissions using early medical records from the emergency department.

PubMed

Lucini, Filipe R; S Fogliatto, Flavio; C da Silveira, Giovani J; L Neyeloff, Jeruza; Anzanello, Michel J; de S Kuchenbecker, Ricardo; D Schaan, Beatriz

2017-04-01

Emergency department (ED) overcrowding is a serious issue for hospitals. Early information on short-term inward bed demand from patients receiving care at the ED may reduce the overcrowding problem, and optimize the use of hospital resources. In this study, we use text mining methods to process data from early ED patient records using the SOAP framework, and predict future hospitalizations and discharges. We try different approaches for pre-processing of text records and to predict hospitalization. Sets-of-words are obtained via binary representation, term frequency, and term frequency-inverse document frequency. Unigrams, bigrams and trigrams are tested for feature formation. Feature selection is based on χ 2 and F-score metrics. In the prediction module, eight text mining methods are tested: Decision Tree, Random Forest, Extremely Randomized Tree, AdaBoost, Logistic Regression, Multinomial Naïve Bayes, Support Vector Machine (Kernel linear) and Nu-Support Vector Machine (Kernel linear). Prediction performance is evaluated by F1-scores. Precision and Recall values are also informed for all text mining methods tested. Nu-Support Vector Machine was the text mining method with the best overall performance. Its average F1-score in predicting hospitalization was 77.70%, with a standard deviation (SD) of 0.66%. The method could be used to manage daily routines in EDs such as capacity planning and resource allocation. Text mining could provide valuable information and facilitate decision-making by inward bed management teams. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Deployment and early experience with remote-presence patient care in a community hospital.

PubMed

Petelin, J B; Nelson, M E; Goodman, J

2007-01-01

The introduction of the RP6 (InTouch Health, Santa Barbara, CA, USA) remote-presence "robot" appears to offer a useful telemedicine device. The authors describe the deployment and early experience with the RP6 in a community hospital and provided a live demonstration of the system on April 16, 2005 during the Emerging Technologies Session of the 2005 SAGES Meeting in Fort Lauderdale, Florida. The RP6 is a 5-ft 4-in. tall, 215-pound robot that can be remotely controlled from an appropriately configured computer located anywhere on the Internet (i.e., on this planet). The system is composed of a control station (a computer at the central station), a mechanical robot, a wireless network (at the remote facility: the hospital), and a high-speed Internet connection at both the remote (hospital) and central locations. The robot itself houses a rechargeable power supply. Its hardware and software allows communication over the Internet with the central station, interpretation of commands from the central station, and conversion of the commands into mechanical and nonmechanical actions at the remote location, which are communicated back to the central station over the Internet. The RP6 system allows the central party (e.g., physician) to control the movements of the robot itself, see and hear at the remote location (hospital), and be seen and heard at the remote location (hospital) while not physically there. Deployment of the RP6 system at the hospital was accomplished in less than a day. The wireless network at the institution was already in place. The control station setup time ranged from 1 to 4 h and was dependent primarily on the quality of the Internet connection (bandwidth) at the remote locations. Patients who visited with the RP6 on their discharge day could be discharged more than 4 h earlier than with conventional visits, thereby freeing up hospital beds on a busy med-surg floor. Patient visits during "off hours" (nights and weekends) were three times more

Coping with the challenges of early disaster response: 24 years of field hospital experience after earthquakes.

PubMed

Bar-On, Elhanan; Abargel, Avi; Peleg, Kobi; Kreiss, Yitshak

2013-10-01

To propose strategies and recommendations for future planning and deployment of field hospitals after earthquakes by comparing the experience of 4 field hospitals deployed by The Israel Defense Forces (IDF) Medical Corps in Armenia, Turkey, India and Haiti. Quantitative data regarding the earthquakes were collected from published sources; data regarding hospital activity were collected from IDF records; and qualitative information was obtained from structured interviews with key figures involved in the missions. The hospitals started operating between 89 and 262 hours after the earthquakes. Their sizes ranged from 25 to 72 beds, and their personnel numbered between 34 and 100. The number of patients treated varied from 1111 to 2400. The proportion of earthquake-related diagnoses ranged from 28% to 67% (P < .001), with hospitalization rates between 3% and 66% (P < .001) and surgical rates from 1% to 24% (P < .001). In spite of characteristic scenarios and injury patterns after earthquakes, patient caseload and treatment requirements varied widely. The variables affecting the patient profile most significantly were time until deployment, total number of injured, availability of adjacent medical facilities, and possibility of evacuation from the disaster area. When deploying a field hospital in the early phase after an earthquake, a wide variability in patient caseload should be anticipated. Customization is difficult due to the paucity of information. Therefore, early deployment necessitates full logistic self-sufficiency and operational versatility. Also, collaboration with local and international medical teams can greatly enhance treatment capabilities.

19 CFR 122.154 - Notice of arrival.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AIR COMMERCE REGULATIONS Flights to and From Cuba § 122.154 Notice of arrival. (a) Application. All aircraft entering the U.S. from Cuba must give advance notice of arrival, unless it is an Office of Foreign...

Early Invasive Strategy and In-Hospital Survival Among Diabetics With Non-ST-Elevation Acute Coronary Syndromes: A Contemporary National Insight.

PubMed

Mahmoud, Ahmed N; Elgendy, Islam Y; Mansoor, Hend; Wen, Xuerong; Mojadidi, Mohammad K; Bavry, Anthony A; Anderson, R David

2017-03-18

There are limited data on the merits of an early invasive strategy in diabetics with non-ST-elevation acute coronary syndrome, with unclear influence of this strategy on survival. The aim of this study was to evaluate the in-hospital survival of diabetics with non-ST-elevation acute coronary syndrome treated with an early invasive strategy compared with an initial conservative strategy. The National Inpatient Sample database, years 2012-2013, was queried for diabetics with a primary diagnosis of non-ST-elevation acute coronary syndrome defined as either non-ST-elevation myocardial infarction or unstable angina (unstable angina). An early invasive strategy was defined as coronary angiography±revascularization within 48 hours of admission. Propensity scores were used to assemble a cohort managed with either an early invasive or initial conservative strategy balanced on >50 baseline characteristics and hospital presentations. Incidence of in-hospital mortality was compared in both groups. In a cohort of 363 500 diabetics with non-ST-elevation acute coronary syndrome, 164 740 (45.3%) were treated with an early invasive strategy. Propensity scoring matched 21 681 diabetics in both arms. Incidence of in-hospital mortality was lower with an early invasive strategy in both the unadjusted (2.0% vs 4.8%; odds ratio [OR], 0.41; 95% CI, 0.39-0.42; P <0.0001) and propensity-matched models (2.2% vs 3.8%; OR, 0.57; 95% CI, 0.50-0.63; P <0.0001). The benefit was observed across various subgroups, except for patients with unstable angina ( P interaction =0.02). An early invasive strategy may be associated with a lower incidence of in-hospital mortality in patients with diabetes. The benefit of this strategy appears to be superior in patients presenting with non-ST-elevation myocardial infarction compared with unstable angina. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

[Hospital at home: assessment of early discharge in terms of patients mortality and satisfaction].

PubMed

Damiani, G; Pinnarelli, L; Ricciardi, G

2006-01-01

New organizational models are essentials for European Hospitals because of restraining budget and ageing of population. Hospital at home is an alternative to inpatient care, effective both in clinical and economic ground. The aim of our study was to evaluate the impact of Hospital at Home in terms of decreased mortality and patient satisfaction. We carried out a meta-analysis of the literature about hospital at home interventions. We searched Medline (to December 2002), the Cochrane Controlled Trials Register (to October 2002) and other bibliographical databases, with a supplementary handsearching of literature. We used the following keywords: hospital at home, home hospitalization, mortality, patient satisfaction, cost, acute hospital care, conventional hospitalization. We included studies respecting the following criteria: analytical or experimental studies aimed at compare early discharge to hospital at home and continued care in an acute hospital. Review Manager 4.2 software was used to collect data and perform statistical analysis. We found 2420 articles searching for the chosen keywords. Twelve studies (2048 patients) were included for death outcome and six studies (1382 patients) were included for satisfaction outcome. The selected studies indicated a greater effect size of patient satisfaction in home patients than hospitalized ones (Odds Ratio: 1.58 95% CI: 1.25, 2.00) and showed no difference in terms of mortality (Risk Difference: -0.01 95% CI: -0.03, 0.02). Our results underline the effectiveness of this organizational model, as an alternative to continued care in an acute hospital. Further useful considerations could be drawn by economic evaluation studies carried out on field.

Costs and Consequences of Early Hospital Discharge After Major Inpatient Surgery in Older Adults

PubMed Central

Regenbogen, Scott E.; Cain-Nielsen, Anne H.; Norton, Edward C.; Chen, Lena M.; Birkmeyer, John D.; Skinner, Jonathan S.

2017-01-01

IMPORTANCE As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. OBJECTIVE To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions. DESIGN, SETTING, AND PARTICIPANTS This investigation was a cross-sectional cohort study of Medicare beneficiaries undergoing colectomy (189 229 patients at 1876 hospitals), coronary artery bypass grafting (CABG) (218 940 patients at 1056 hospitals), or total hip replacement (THR) (231774 patients at 1831 hospitals) between January 1, 2009, and June 30, 2012. The dates of the analysis were September 1, 2015, to May 31, 2016. Associations between surgical episode payments and hospitals’ length of stay (LOS) mode were evaluated among a risk and postoperative complication-matched cohort of patients without major postoperative complications. To further control for potential differences between hospitals, a within-hospital comparison was also performed evaluating the change in hospitals’ mean surgical episode payments according to their change in LOS mode during the study period. EXPOSURE Undergoing surgery in a hospital with short vs long postoperative hospitalization practices, characterized according to LOS mode, a measure least sensitive to postoperative outliers. MAIN OUTCOMES AND MEASURES Risk-adjusted, price-standardized, 90-day overall surgical episode payments and their components, including index, outlier, readmission, physician services, and postdischarge care. RESULTS A total of 639 943 Medicare beneficiaries were included in the study. Total surgical episode payments for risk and postoperative complication-matched patients were significantly lower

The U.S. Laboratory module arrives at KSC

NASA Technical Reports Server (NTRS)

1998-01-01

NASA's 'Super Guppy' aircraft arrives in KSC air space escorted by two T-38 aircraft after leaving Marshall Space Flight Center in Huntsville, Ala. The whale-like airplane carries the U.S. Laboratory module, considered the centerpiece of the International Space Station. The module will undergo final pre- launch preparations at KSC's Space Station Processing Facility. Scheduled for launch aboard the Shuttle Endeavour on mission STS- 98, the laboratory comprises three cylindrical sections with two end cones. Each end-cone contains a hatch opening for entering and exiting the lab. The lab will provide a shirtsleeve environment for research in such areas as life science, microgravity science, Earth science and space science. Designated Flight 5A, this mission is targeted for launch in early 2000.

A model of seismic coda arrivals to suppress spurious events.

NASA Astrophysics Data System (ADS)

Arora, N.; Russell, S.

2012-04-01

We describe a model of coda arrivals which has been added to NET-VISA (Network processing Vertically Integrated Seismic Analysis) our probabilistic generative model of seismic events, their transmission, and detection on a global seismic network. The scattered energy that follows a seismic phase arrival tends to deceive typical STA/LTA based arrival picking software into believing that a real seismic phase has been detected. These coda arrivals which tend to follow all seismic phases cause most network processing software including NET-VISA to believe that multiple events have taken place. It is not a simple matter of ignoring closely spaced arrivals since arrivals from multiple events can indeed overlap. The current practice in NET-VISA of pruning events within a small space-time neighborhood of a larger event works reasonably well, but it may mask real events produced in an after-shock sequence. Our new model allows any seismic arrival, even coda arrivals, to trigger a subsequent coda arrival. The probability of such a triggered arrival depends on the amplitude of the triggering arrival. Although real seismic phases are more likely to generate such coda arrivals. Real seismic phases also tend to generate coda arrivals with more strongly correlated parameters, for example azimuth and slowness. However, the SNR (Signal to Noise Ratio) of a coda arrival immediately following a phase arrival tends to be lower because of the nature of the SNR calculation. We have calibrated our model on historical statistics of such triggered arrivals and our inference accounts for them while searching for the best explanation of seismic events their association to the arrivals and the coda arrivals. We have tested our new model on one week of global seismic data spanning March 22, 2009 to March 29, 2009. Our model was trained on two and half months of data from April 5, 2009 to June 20, 2009. We use the LEB bulletin produced by the IDC (International Data Center) as the ground truth

Pressure Ulcer Preventive Device Use Among Elderly Patients Early in the Hospital Stay

PubMed Central

Rich, Shayna E.; Shardell, Michelle; Margolis, David; Baumgarten, Mona

2010-01-01

Background Clinical guidelines for the prevention of pressure ulcers advise that pressure-reducing devices should be used for all patients at risk of or with pressure ulcers and that all pressure ulcers should be documented in the patient record. Adherence to these guidelines among elderly hospital patients early in the hospital stay has not been examined in prior studies. Objective The objective of this study was to examine adherence to guidelines by determining the frequency and correlates of use of preventive devices early in the hospital stay of elderly patients and by determining the frequency and correlates of recording pressure ulcers in the patient record. Methods This was a cross-sectional study of 792 patients aged 65 years or older admitted through the emergency department to the inpatient medical service at two teaching hospitals in Philadelphia, Pennsylvania, between 1998 and 2001. Patients were examined by a research nurse on Hospital Day 3 (median of 48 hours after admission) to determine the use of preventive devices, presence of pressure ulcers, and risk of pressure ulcers (by Norton scale). Data on additional risk factors were obtained from the admission nursing assessment in the patient record. Data on documentation of pressure ulcers were obtained by chart abstraction. Results Only 15% of patients had any preventive devices in use at the time of the examination. Among patients considered at risk of pressure ulcers (Norton score ≤14), only 51% had a preventive device. In multivariable analyses, high risk of pressure ulcers was associated with use of preventive devices (odds ratio = 41.8, 95% confidence interval = 14.0–124.6), whereas the type and stage of pressure ulcer were not. Documentation of a pressure ulcer was present for only 68% of patients who had a pressure ulcer according to the research examination. Discussion Use of preventive devices and documentation of pressure ulcers are suboptimal even among patients at high risk. PMID

Changes in spring arrival dates and temperature sensitivity of migratory birds over two centuries

NASA Astrophysics Data System (ADS)

Kolářová, Eva; Matiu, Michael; Menzel, Annette; Nekovář, Jiří; Lumpe, Petr; Adamík, Peter

2017-07-01

Long-term phenological data have been crucial at documenting the effects of climate change in organisms. However, in most animal taxa, time series length seldom exceeds 35 years. Therefore, we have limited evidence on animal responses to climate prior to the recent warm period. To fill in this gap, we present time series of mean first arrival dates to Central Europe for 13 bird species spanning 183 years (1828-2010). We found a uniform trend of arrival dates advancing in the most recent decades (since the late 1970s). Interestingly, birds were arriving earlier during the cooler early part of the nineteenth century than in the recent warm period. Temperature sensitivity was slightly stronger in the warmest 30-year period (-1.70 ± SD 0.47 day °C-1) than in the coldest period (-1.42 ± SD 0.89 day °C-1); however, the difference was not statistically significant. In the most recent decades, the temperature sensitivity of both short- and long-distance migrants significantly increased. Our results demonstrate how centennial time series can provide a much more comprehensive perspective on avian responses to climate change.

ARRIVE has not ARRIVEd: Support for the ARRIVE (Animal Research: Reporting of in vivo Experiments) guidelines does not improve the reporting quality of papers in animal welfare, analgesia or anesthesia.

PubMed

Leung, Vivian; Rousseau-Blass, Frédérik; Beauchamp, Guy; Pang, Daniel S J

2018-01-01

Poor research reporting is a major contributing factor to low study reproducibility, financial and animal waste. The ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines were developed to improve reporting quality and many journals support these guidelines. The influence of this support is unknown. We hypothesized that papers published in journals supporting the ARRIVE guidelines would show improved reporting compared with those in non-supporting journals. In a retrospective, observational cohort study, papers from 5 ARRIVE supporting (SUPP) and 2 non-supporting (nonSUPP) journals, published before (2009) and 5 years after (2015) the ARRIVE guidelines, were selected. Adherence to the ARRIVE checklist of 20 items was independently evaluated by two reviewers and items assessed as fully, partially or not reported. Mean percentages of items reported were compared between journal types and years with an unequal variance t-test. Individual items and sub-items were compared with a chi-square test. From an initial cohort of 956, 236 papers were included: 120 from 2009 (SUPP; n = 52, nonSUPP; n = 68), 116 from 2015 (SUPP; n = 61, nonSUPP; n = 55). The percentage of fully reported items was similar between journal types in 2009 (SUPP: 55.3 ± 11.5% [SD]; nonSUPP: 51.8 ± 9.0%; p = 0.07, 95% CI of mean difference -0.3-7.3%) and 2015 (SUPP: 60.5 ± 11.2%; nonSUPP; 60.2 ± 10.0%; p = 0.89, 95%CI -3.6-4.2%). The small increase in fully reported items between years was similar for both journal types (p = 0.09, 95% CI -0.5-4.3%). No paper fully reported 100% of items on the ARRIVE checklist and measures associated with bias were poorly reported. These results suggest that journal support for the ARRIVE guidelines has not resulted in a meaningful improvement in reporting quality, contributing to ongoing waste in animal research.

Arrival and expansion of the invasive foraminifera Trochammina hadai Uchio in Padilla Bay, Washington

USGS Publications Warehouse

McGann, Mary; Grossman, Eric E.; Takesue, Renee K.; Penttila, Dan; Walsh, John P.; Corbett, Reide

2012-01-01

Trochammina hadai Uchio, a benthic foraminifera native to Japanese estuaries, was first identified as an invasive in 1995 in San Francisco Bay and later in 16 other west coast estuaries. To investigate the timing of the arrival and expansion of this invasive species in Padilla Bay, Washington, we analyzed the distribution of foraminifera in two surface samples collected in 1971, in nine surface samples collected by Scott in 1972–1973, as well as in two cores (Padilla Flats 3 and Padilla V1/V2) obtained in 2004. Trochanimina hadai, originally identified as the native Trochammina pacifica Cushman in several early foraminiferal studies, dominates the assemblage of most of the surface samples. In the Padilla V1/V2 and Padilla Flats 3 cores, the species' abundance follows a pattern of absence, first appearance, rapid expansion commonly seen shortly after the arrival of a successful biological invasion, setback, and second expansion. Using Q-mode cluster analysis, pre-expansion and expansion assemblages were identified. Pb-210 dating of these cores proved unsuccessful. However, based on T. hadai's first appearance occurring stratigraphically well above sedimentological changes in the cores that reflect deposition of sediments in the bay due to previous diversions of the Skagit River, and its dominance in the early 1970s surface samples, we conclude that the species arrived in Padilla Bay somewhere between the late 1800s and 1971. Trochammina hadai may have been introduced into the bay in the 1930s when oyster culturing began there or, at a minimum, ten years prior to its appearance in San Francisco Bay.

The incorporation of fault zone head wave and direct wave secondary arrival times and arrival polarizations into seismic tomography: Application to the Parkfield, California area

NASA Astrophysics Data System (ADS)

Bennington, N. L.; Thurber, C. H.; Peng, Z.; Zhao, P.

2012-12-01

We present a 3D P-wave velocity (Vp) model of the Parkfield region that utilizes existing P-wave arrival time data, including fault zone head waves (FZHW), plus new data from direct wave secondary arrivals (DWSA). The first-arrival and DWSA travel times are obtained as the global and local minimum travel time paths, respectively. The inclusion of DWSA results in as much as a 10% increase in the across-fault velocity contrast for the Vp model at Parkfield relative to Thurber et al. (2006). Viewed along strike, three pronounced velocity contrast regions are observed: a pair of strong positive velocity contrasts (SW fast), one NW of the 1966 Parkfield hypocenter and the other SE of the 2004 Parkfield hypocenter, and a strong negative velocity contrast (NE fast) between the two hypocenters. The negative velocity contrast partially to entirely encompasses peak coseismic slip estimated in several slip models for the 2004 earthquake, suggesting that the negative velocity contrast played a part in defining the rupture patch of the 2004 Parkfield earthquake. We expand on this work by modifying our seismic tomography algorithm to incorporate arrival polarizations (azimuths). Synthetic tests will be presented to demonstrate the improvements in velocity structure when arrival polarizations are incorporated. These tests will compare the synthetic model recovered when FZHW/DWSA arrivals as well as existing P-wave arrival time data are inverted to that recovered with the same dataset with the inclusion of arrival polarizations. We plan to extend this work to carry out a full scale seismic tomography/relocation inversion at Parkfield, CA utilizing arrival polarizations from all first-P arrivals, and FZHW/DWSA arrivals as well as existing P-wave arrival time data. This effort requires the determination of polarization data for all P-waves and FZHW's at Parkfield. To this end, we use changes in the arrival azimuth from fault normal to source-receiver direction to identify FZHW and

Early administration of systemic corticosteroids reduces hospital admission rates for children with moderate and severe asthma exacerbation.

PubMed

Bhogal, Sanjit K; McGillivray, David; Bourbeau, Jean; Benedetti, Andrea; Bartlett, Susan; Ducharme, Francine M

2012-07-01

The variable effectiveness of clinical asthma pathways to reduce hospital admissions may be explained in part by the timing of systemic corticosteroid administration. We examine the effect of early (within 60 minutes [SD 15 minutes] of triage) versus delayed (>75 minutes) administration of systemic corticosteroids on health outcomes. We conducted a prospective observational cohort of children aged 2 to 17 years presenting to the emergency department with moderate or severe asthma, defined as a Pediatric Respiratory Assessment Measure (PRAM) score of 5 to 12. The outcomes were hospital admission, relapse, and length of active treatment; they were analyzed with multivariate logistic and linear regressions adjusted for covariates and potential confounders. Among the 406 eligible children, 88% had moderate asthma; 22%, severe asthma. The median age was 4 years (interquartile range 3 to 8 years); 64% were male patients. Fifty percent of patients received systemic corticosteroids early; in 33%, it was delayed; 17% of children failed to receive any. Overall, 36% of patients were admitted to the hospital. Compared with delayed administration, early administration reduced the odds of admission by 0.4 (95% confidence interval 0.2 to 0.7) and the length of active treatment by 0.7 hours (95% confidence interval -1.3 to -0.8 hours), with no significant effect on relapse. Delayed administration was positively associated with triage priority and negatively with PRAM score. In this study of children with moderate or severe asthma, administration of systemic corticosteroids within 75 minutes of triage decreased hospital admission rate and length of active treatment, suggesting that early administration of systemic corticosteroids may allow for optimal effectiveness. Copyright © 2012 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

A Novel early pregnancy assessment unit/Gynaecology assessment unit dashboard: An experience from a UK district general hospital.

PubMed

Wahba, K; Shah, A; Hill, K; Hosni, M M

2015-01-01

The establishment of early pregnancy assessment units (EPAUs)/Gynaecology assessment units (GAUs) started more than 20 years ago in the UK to decrease hospital admissions of patients with early pregnancy problems. However, there are still wide variations in the quality of services provided by these units. The objective of this study was to create a method that can be used for continuous assessment of these units on a regular basis. We designed a dashboard covering all aspects of EPAU/GAU activities depending upon the early pregnancy unit association guidelines, and the department of health data and statistics. The EPAU/GAU dashboard has been used successfully in the early assessment pregnancy unit of Yeovil District hospital for few years and is still implemented until now. It is an excellent tool for continuous audit. It is a simple method that should be adopted by different EPAUs/GAUs for their objective assessment in order to improve the services provided by these units.

Time to hospitalization for suicide attempt by the timing of parental suicide during offspring early development

PubMed Central

Kuramoto, S. Janet; Runeson, Bo; Stuart, Elizabeth A.; Lichtenstein, Paul; Wilcox, Holly C.

2013-01-01

Context Previous studies have suggested that children who experience parental suicide at earlier ages are at higher risk of future hospitalization for suicide attempt. However, how the trajectories of risk differ by offspring age at the time of parental suicide is currently unknown. Objective To study time at risk to hospitalization for suicide attempt among offspring after experiencing parental suicide or accidental death by offspring developmental period at the time of parental death. Design Population-based retrospective cohort study Setting Sweden Participants 26,096 offspring who experienced parental suicide and 32,395 offspring of accident decedents prior to age 25 from 1973-2003. Main Outcome Measures Hospitalization for suicide attempt. Parametric survival analysis was used to model the time to hospitalization for suicide attempt across offspring who lost a parent during early childhood (0-5 years old), later childhood (6-12), adolescence (13-17) and young adulthood (18-24). Results The risk in offspring who lost a parent during early or late childhood surpassed the other two age groups’ hazards approximately 5 years after the origin and, for the youngest group, continued to rise over the course of decades. Offspring who lost a parent during adolescence or young adulthood were at greatest risk within 1 to 2 years after parental suicide, and risk declined over time. The shape of hospitalization risk was similar among those who experienced parental fatal accident. When the shape of hospitalization for suicide attempt at each developmental period was fixed to be the same between the two groups, offspring who lost a parent to suicide had earlier risk to hospitalization for suicide attempt hospitalization than offspring who lost a parent to an accident. Conclusion The hospitalization risk for suicide attempt in offspring who lost a parent during their childhood is different from those who lost a parent during adolescence or young adulthood. The results suggest

National Early Warning Score (NEWS) as an emergency department predictor of disease severity and 90-day survival in the acutely dyspneic patient - a prospective observational study.

PubMed

Bilben, Bente; Grandal, Linda; Søvik, Signe

2016-06-02

National Early Warning Score (NEWS) was designed to detect deteriorating patients in hospital wards, specifically those at increased risk of ICU admission, cardiac arrest, or death within 24 h. NEWS is not validated for use in Emergency Departments (ED), but emerging data suggest it may be useful. A criticism of NEWS is that patients with chronic poor oxygenation, e.g. severe chronic obstructive pulmonary disease (COPD), will have elevated NEWS also in the absence of acute deterioration, possibly reducing the predictive power of NEWS in this subgroup. We wanted to prospectively evaluate the usefulness of NEWS in unselected adult patients emergently presenting in a Norwegian ED with respiratory distress as main symptom. In respiratory distressed patients, NEWS was calculated on ED arrival, after 2-4 h, and the next day. Manchester Triage Scale (MTS) category, age, gender, comorbidity (ASA score), ICU-admission, ventilatory support, and discharge diagnoses were noted. Survival status was tracked for >90 days through the Population Registry. Data are medians (25-75th percentiles). Factors predicting 90-day survival were analysed with multiple logistic regression. We included 246 patients; 71 years old (60-80), 89 % home-dwelling, 74 % ASA 3-4, 72 % MTS 1-2, 88 % admitted to hospital. NEWS on arrival was 5 (3-7). NEWS correlated closely with MTS category and maximum in-hospital level of care (ED, ward, high-dependency unit, ICU). Sixteen patients died in-hospital, 26 died after discharge within 90 days. Controlled for age, ASA score, and COPD, a higher NEWS on ED arrival predicted poorer 90-day survival. Increased NEWS also correlated with decreased 30-day- and in-hospital survival and a decreased probability for home-dwelling patients to be discharged directly home. In respiratory distressed patients, NEWS on ED arrival correlated closely with triage category and need of ICU admission and predicted long-term out-of-hospital survival controlled for age

9 CFR 93.804 - Declaration upon arrival.

Code of Federal Regulations, 2010 CFR

2010-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.804 Declaration upon arrival. Upon arrival of an elephant, hippopotamus, rhinoceros, or tapir at a... importer; (f) The name and address of the broker; (g) The region from which the elephant, hippopotamus...

9 CFR 93.804 - Declaration upon arrival.

Code of Federal Regulations, 2012 CFR

2012-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.804 Declaration upon arrival. Upon arrival of an elephant, hippopotamus, rhinoceros, or tapir at a... importer; (f) The name and address of the broker; (g) The region from which the elephant, hippopotamus...

9 CFR 93.804 - Declaration upon arrival.

Code of Federal Regulations, 2014 CFR

2014-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.804 Declaration upon arrival. Upon arrival of an elephant, hippopotamus, rhinoceros, or tapir at a... importer; (f) The name and address of the broker; (g) The region from which the elephant, hippopotamus...

9 CFR 93.804 - Declaration upon arrival.

Code of Federal Regulations, 2013 CFR

2013-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.804 Declaration upon arrival. Upon arrival of an elephant, hippopotamus, rhinoceros, or tapir at a... importer; (f) The name and address of the broker; (g) The region from which the elephant, hippopotamus...

9 CFR 93.804 - Declaration upon arrival.

Code of Federal Regulations, 2011 CFR

2011-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.804 Declaration upon arrival. Upon arrival of an elephant, hippopotamus, rhinoceros, or tapir at a... importer; (f) The name and address of the broker; (g) The region from which the elephant, hippopotamus...

7 CFR 319.75-6 - Arrival notification.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 5 2011-01-01 2011-01-01 false Arrival notification. 319.75-6 Section 319.75-6 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FOREIGN QUARANTINE NOTICES Khapra Beetle § 319.75-6 Arrival...

7 CFR 319.75-6 - Arrival notification.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 5 2014-01-01 2014-01-01 false Arrival notification. 319.75-6 Section 319.75-6 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FOREIGN QUARANTINE NOTICES Khapra Beetle § 319.75-6 Arrival...

7 CFR 319.75-6 - Arrival notification.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 5 2013-01-01 2013-01-01 false Arrival notification. 319.75-6 Section 319.75-6 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FOREIGN QUARANTINE NOTICES Khapra Beetle § 319.75-6 Arrival...

7 CFR 319.75-6 - Arrival notification.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 5 2012-01-01 2012-01-01 false Arrival notification. 319.75-6 Section 319.75-6 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FOREIGN QUARANTINE NOTICES Khapra Beetle § 319.75-6 Arrival...

14 CFR 93.29 - International Arrival Authorizations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false International Arrival Authorizations. 93.29... at Chicago O'Hare International Airport § 93.29 International Arrival Authorizations. (a) Except as... marketing arrangement unless the flight was predominately marketed, by contract, under the control of...

Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium.

PubMed

Kurz, Michael Christopher; Schmicker, Robert H; Leroux, Brian; Nichol, Graham; Aufderheide, Tom P; Cheskes, Sheldon; Grunau, Brian; Jasti, Jamie; Kudenchuk, Peter; Vilke, Gary M; Buick, Jason; Wittwer, Lynn; Sahni, Ritu; Straight, Ronald; Wang, Henry E

2018-04-30

Prior observational studies suggest no additional benefit from advanced life support (ALS) when compared with providing basic life support (BLS) for patients with out-of-hospital cardiac arrest (OHCA). We compared the association of ALS care with OHCA outcomes using prospective clinical data from the Resuscitation Outcomes Consortium (ROC). Included were consecutive adults OHCA treated by participating emergency medical services (EMS) agencies between June 1, 2011, and June 30, 2015. We defined BLS as receipt of cardiopulmonary resuscitation (CPR) and/or automated defibrillation and ALS as receipt of an advanced airway, manual defibrillation, or intravenous drug therapy. We compared outcomes among patients receiving: 1) BLS-only; 2) BLS + late ALS; 3) BLS + early ALS; and 4) ALS-first care. Using multivariable logistic regression, we evaluated the associations between level of care and return of spontaneous circulation (ROSC), survival to hospital discharge, and survival with good functional status, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, EMS response time, CPR quality, and ROC site. Among 35,065 patients with OHCA, characteristics were median age 68 years (IQR 56-80), male 63.9%, witnessed arrest 43.8%, bystander CPR 50.6%, and shockable initial rhythm 24.2%. Care delivered was: 4.0% BLS-only, 31.5% BLS + late ALS, 17.2% BLS + early ALS, and 47.3% ALS-first. ALS care with or without initial BLS care was independently associated with increased adjusted ROSC and survival to hospital discharge unless delivered greater than 6 min after BLS arrival (BLS + late ALS). Regardless of when it was delivered, ALS care was not associated with significantly greater functional outcome. ALS care was associated with survival to hospital discharge when provided initially or within six minutes of BLS arrival. ALS care, with or without initial BLS care, was associated with increased ROSC, however it was

Using Quality Improvement to Introduce and Standardize the National Early Warning Score (NEWS) for Adult Inpatients at a Children's Hospital.

PubMed

Conway-Habes, Erin E; Herbst, Brian F; Herbst, Lori A; Kinnear, Benjamin; Timmons, Kristen; Horewitz, Deborah; Falgout, Rachel; O'Toole, Jennifer K; Vossmeyer, Michael

2017-03-01

The population of adults with childhood-onset chronic illness is growing across children's hospitals and constitutes a high risk population. National Early Warning Score (NEWS) is among the most recently validated adult early warning scores (EWSs) for early recognition of and response to clinical deterioration. Our aim was to implement and standardize NEWS scoring in 80% of patients age 21 and older admitted to a children's hospital. Our intervention was tested on a single unit of our children's hospital. The primary process measure was the percentage of NEWS documented within 1 hour of routine nursing assessments, and was tracked using a run chart. Improvement activities focused on effective training, key stakeholder buy-in, increased awareness, real-time mitigation of failures, accountability for adherence, and action-oriented response. We also tracked the distribution of NEWS values and medical emergency team calls. The percentage of NEWS documented with routine nursing assessments for patients age 21 and over increased from 0% to 90% within 15 weeks and remained at 77% or greater for 17 weeks. Our distribution of NEWS values was similar to previously reported NEWS distribution. A nurse-driven adult early warning system for inpatients age 21 and older at a children's hospital can be achieved through a standardized EWS assessment process, incorporation into the electronic health record, and charge nurse and key stakeholder oversight. Furthermore, implementation of an adult EWS being used at a pediatric institution and our distribution of NEWS values were comparable to distribution published from adult hospitals. Copyright © 2017 by the American Academy of Pediatrics.

7 CFR 322.7 - Notice of arrival.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation of Adult Honeybees, Honeybee Germ Plasm, and Bees Other Than Honeybees From Approved Regions § 322.7 Notice of arrival. (a) At least 10 business days prior to the arrival in the United States of any shipment of bees...

7 CFR 322.7 - Notice of arrival.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation of Adult Honeybees, Honeybee Germ Plasm, and Bees Other Than Honeybees From Approved Regions § 322.7 Notice of arrival. (a) At least 10 business days prior to the arrival in the United States of any shipment of bees...

7 CFR 322.7 - Notice of arrival.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation of Adult Honeybees, Honeybee Germ Plasm, and Bees Other Than Honeybees From Approved Regions § 322.7 Notice of arrival. (a) At least 10 business days prior to the arrival in the United States of any shipment of bees...

7 CFR 322.7 - Notice of arrival.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation of Adult Honeybees, Honeybee Germ Plasm, and Bees Other Than Honeybees From Approved Regions § 322.7 Notice of arrival. (a) At least 10 business days prior to the arrival in the United States of any shipment of bees...

7 CFR 322.7 - Notice of arrival.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation of Adult Honeybees, Honeybee Germ Plasm, and Bees Other Than Honeybees From Approved Regions § 322.7 Notice of arrival. (a) At least 10 business days prior to the arrival in the United States of any shipment of bees...

Evaluation of Post-Arrival Programs and Services.

ERIC Educational Resources Information Center

Australian Inst. of Multicultural Affairs, Melbourne (Australia).

This book assesses the effectiveness of recommendations implemented after the release of the Australian government's "Report of the Review of Post-Arrival Programs and Services for Migrants" in 1977. In general, the implementation of the Report's proposals has been of substantial benefit to migrants (both newly arrived and longer…

7 CFR 319.75-6 - Arrival notification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Plant Protection and Quarantine of the arrival by such means as a manifest, Customs entry document... 7 Agriculture 5 2010-01-01 2010-01-01 false Arrival notification. 319.75-6 Section 319.75-6 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION...

Collaborative Arrival Planning: Data Sharing and User Preference Tools

NASA Technical Reports Server (NTRS)

Zelenka, Richard E.; Edwards, Thomas A. (Technical Monitor)

1998-01-01

Air traffic growth and air carrier economic pressures have motivated efforts to increase the flexibility of the air traffic management process and change the relationship between the air traffic control service provider and the system user. One of the most visible of these efforts is the U.S. government/industry "free flight" initiative, in which the service provider concentrates on safety and cross-airline fairness, and the user on their business objectives and operating preferences, including selecting their own path and speed in real-time. In the terminal arrival phase of flight, severe restrictions and rigid control are currently placed on system users, typically without regard for individual user operational preferences. Airborne delays applied to arriving aircraft into capacity constrained airports are imposed on a first-come, first-serve basis, and thus do not allow the system user to plan for or prioritize late arrivals, or to economically optimize their arrival sequence. A central tenant of the free-flight operating paradigm is collaboration between service providers and users in reaching air traffic management decisions. Such collaboration would be particularly beneficial to an airline's "hub" operation, where off-schedule arrival aircraft are a consistent problem, as they cause serious air-port ramp difficulties, rippling airline scheduling effects, and result in large economic inefficiencies. Greater collaboration can also lead to increased airport capacity and decrease the severity of over-capacity rush periods. In the NASA Collaborative Arrival Planning (CAP) project, both independent exchange of real-time data between the service provider and system user and collaborative decision support tools are addressed. Data exchange of real-time arrival scheduling, airspace management, and air carrier fleet data between the FAA service provider and an air carrier is being conducted and evaluated. Collaborative arrival decision support tools to allow intra

Early diagnosis and multidisciplinary care reduce the hospitalization time and duration of tube feeding and prevent early obesity in PWS infants.

PubMed

Bacheré, N; Diene, G; Delagnes, V; Molinas, C; Moulin, P; Tauber, M

2008-01-01

To describe and evaluate the impact of very early diagnosis and multidisciplinary care on the evolution and care of infants presenting with Prader-Willi syndrome (PWS). 19 infants diagnosed with PWS before the second month of life were followed by a multidisciplinary team. Median age at the time of analysis was 3.1 years [range 0.4-6.5]. The data were compared with data collected in 1997 from 113 questionnaires filled out by members of the French PWS Association. The patients from this latter data set were 12.0 years [range 4 months to 41 years] at the time of analysis, with a median age of 36 months at diagnosis. The duration of their hospitalization time was significantly reduced from 30.0 [range 0-670] to 21 [range 0-90] days (p = 0.043). The duration of gastric tube feeding was significantly reduced from 30.5 [range 0-427] to 15 [range 0-60] days (p = 0.017). Growth hormone treatment was started at a mean age of 1.9 +/- 0.5 years in 10 infants and L-thyroxine in 6 infants. Only 1 infant became obese at 2.5 years. Early diagnosis combined with multidisciplinary care decreases the hospitalization time, duration of gastric tube feeding and prevents early obesity in PWS infants. (c) 2007 S. Karger AG, Basel.

Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves Mental Health, and Physical Performance

DTIC Science & Technology

2016-10-01

AD______________ AWARD NUMBER: W81XWH-14-2-0160 TITLE: Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves... designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of... Care Unit Decreases Hospital Stay, Improves Mental Health, and Physical Performance 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Oscar E

Early Discharge in Low-Risk Patients Hospitalized for Acute Coronary Syndromes: Feasibility, Safety and Reasons for Prolonged Length of Stay.

PubMed

Laurencet, Marie-Eva; Girardin, François; Rigamonti, Fabio; Bevand, Anne; Meyer, Philippe; Carballo, David; Roffi, Marco; Noble, Stéphane; Mach, François; Gencer, Baris

2016-01-01

Length of hospital stay (LHS) is an indicator of clinical effectiveness. Early hospital discharge (≤72 hours) is recommended in patients with acute coronary syndromes (ACS) at low risk of complications, but reasons for prolonged LHS poorly reported. We collected data of ACS patients hospitalized at the Geneva University Hospitals from 1st July 2013 to 30th June 2015 and used the Zwolle index score to identify patients at low risk (≤ 3 points). We assessed the proportion of eligible patients who were successfully discharged within 72 hours and the reasons for prolonged LHS. Outcomes were defined as adherence to recommended therapies, major adverse events at 30 days and patients' satisfaction using a Likert-scale patient-reported questionnaire. Among 370 patients with ACS, 255 (68.9%) were at low-risk of complications but only 128 (50.2%)were eligible for early discharge, because of other clinical reasons for prolonged LHS (e.g. staged coronary revascularization, cardiac monitoring) in 127 patients (49.8%). Of the latter, only 45 (35.2%) benefitted from an early discharge. Reasons for delay in discharge in the remaining 83 patients (51.2%) were mainly due to delays in additional investigations, titration of medical therapy, admission or discharge during weekends. In the early discharge group, at 30 days, only one patient (2.2%) had an adverse event (minor bleeding), 97% of patients were satisfied by the medical care. Early discharge was successfully achieved in one third of eligible ACS patients at low risk of complications and appeared sufficiently safe while being overall appreciated by the patients.

Computing angle of arrival of radio signals

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

Borchardt, John J.; Steele, David K.

Various technologies pertaining to computing angle of arrival of radio signals are described. A system that is configured for computing the angle of arrival of a radio signal includes a cylindrical sheath wrapped around a cylindrical object, where the cylindrical sheath acts as a ground plane. The system further includes a plurality of antennas that are positioned about an exterior surface of the cylindrical sheath, and receivers respectively coupled to the antennas. The receivers output measurements pertaining to the radio signal. A processing circuit receives the measurements and computes the angle of arrival of the radio signal based upon themore » measurements.« less

Out-of-Hospital Fluid in Severe Sepsis: Effect on Early Resuscitation in the Emergency Department

PubMed Central

Seymour, Christopher W.; Cooke, Colin R.; Mikkelsen, Mark E.; Hylton, Julie; Rea, Tom D.; Goss, Christopher H.; Gaieski, David F.; Band, Roger A.

2014-01-01

Background Early identification and treatment of patients with severe sepsis improves outcome, yet the role of out-of-hospital intravenous (IV) fluid is unknown. Objective To determine if the delivery of out-of-hospital fluid in patients with severe sepsis is associated with reduced time to achievement of goal-oriented resuscitation in the emergency department (ED). Methods We performed a secondary data analysis of a retrospective cohort study in a metropolitan, tertiary care, university-based medical center supported by a two-tiered system of out-of-hospital emergency medical services (EMS) providers. We studied the association between delivery of out-of-hospital fluid by advanced life support (ALS) providers and the achievement of resuscitation endpoints (central venous pressure [CVP] ≥8 mmHg, mean arterial pressure [MAP] ≥65 mmHg, and central venous oxygen saturation [ScvO2] ≥70%) within six hours after triage during early goal-directed therapy (EGDT) in the ED. Results Twenty five (48%) of 52 patients transported by ALS with severe sepsis received out-of-hospital fluid. Data for age, gender, source of sepsis, and presence of comorbidities were similar between patients who did and did not receive out-of-hospital fluid. Patients receiving out-of-hospital fluid had lower out-of-hospital mean (± standard deviation) systolic blood pressure (95 ± 40 mmHg vs. 117 ± 29 mmHg; p = 0.03) and higher median (interquartile range) Sequential Organ Failure Assessment (SOFA) scores in the ED (7 [5–8] vs. 4 [4–6]; p = 0.01) than patients not receiving out-of-hospital fluid. Despite greater severity of illness, patients receiving out-of-hospital fluid approached but did not attain a statistically significant increase in the likelihood of achieving MAP ≥65 mmHg within six hours after ED triage (70% vs. 44%, p = 0.09). On average, patients receiving out-of-hospital fluid received twice the fluid volume within one hour after ED triage (1.1 L [1.0–2.0 L] vs. 0.6 L [0

19 CFR 12.113 - Arrival of shipment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... to the director of the port of entry the Notice of Arrival completed by the Administrator and indicating the Customs action to be taken with respect to the shipment. The port director shall compare entry... risk and expense until the completed Notice of Arrival is presented or until other disposition is...

19 CFR 122.154 - Notice of arrival.

Code of Federal Regulations, 2014 CFR

2014-04-01

... notice of arrival shall state: (1) Type of aircraft and registration number; (2) Name of aircraft... aircraft entering the U.S. from Cuba must give advance notice of arrival, unless it is an Office of Foreign Assets Control (OFAC) approved scheduled commercial aircraft of a scheduled airline. (b) Procedure for...

19 CFR 122.154 - Notice of arrival.

Code of Federal Regulations, 2012 CFR

2012-04-01

... notice of arrival shall state: (1) Type of aircraft and registration number; (2) Name of aircraft... aircraft entering the U.S. from Cuba must give advance notice of arrival, unless it is an Office of Foreign Assets Control (OFAC) approved scheduled commercial aircraft of a scheduled airline. (b) Procedure for...

19 CFR 122.154 - Notice of arrival.

Code of Federal Regulations, 2011 CFR

2011-04-01

... notice of arrival shall state: (1) Type of aircraft and registration number; (2) Name of aircraft... aircraft entering the U.S. from Cuba must give advance notice of arrival, unless it is an Office of Foreign Assets Control (OFAC) approved scheduled commercial aircraft of a scheduled airline. (b) Procedure for...

19 CFR 122.154 - Notice of arrival.

Code of Federal Regulations, 2013 CFR

2013-04-01

... notice of arrival shall state: (1) Type of aircraft and registration number; (2) Name of aircraft... aircraft entering the U.S. from Cuba must give advance notice of arrival, unless it is an Office of Foreign Assets Control (OFAC) approved scheduled commercial aircraft of a scheduled airline. (b) Procedure for...

Effect of early oral feeding on length of hospital stay following gastrectomy for gastric cancer: a Japanese multicenter, randomized controlled trial.

PubMed

Shimizu, Nobuyuki; Oki, Eiji; Tanizawa, Yutaka; Suzuki, Yutaka; Aikou, Susumu; Kunisaki, Chikara; Tsuchiya, Takashi; Fukushima, Ryoji; Doki, Yuichiro; Natsugoe, Shoji; Nishida, Yasunori; Morita, Masaru; Hirabayashi, Naoki; Hatao, Fumihiko; Takahashi, Ikuo; Choda, Yasuhiro; Iwasaki, Yoshiaki; Seto, Yasuyuki

2018-05-02

This multicenter, randomized controlled study evaluates the safety of early oral feeding following gastrectomy, and its effect on the length of postoperative hospital stay. The subjects of this study were patients who underwent distal gastrectomy (DG) or total gastrectomy (TG) for gastric cancer between January 2014 and December 2015. Patients were randomly assigned to the early oral feeding group (intervention group) or the conventional postoperative management group (control group) for each procedure. We evaluated the length of postoperative hospital stay and the incidence of postoperative complications in each group. No significant differences in length of postoperative stay were found between the intervention and control groups of the patients who underwent DG. The incidence of postoperative complications was significantly greater in the DG intervention group. In contrast, the length of postoperative stay was significantly shorter in the TG intervention group, although the TG group did not attain the established target sample size. Early oral feeding did not shorten the postoperative hospital stay after DG. The higher incidence of postoperative complications precluded the unselected adoption of early oral feeding for DG patients. Further confirmative studies are required to definitively establish the potential benefits of early oral feeding for TG patients.

If Time Is Brain Where Is the Improvement in Prehospital Time after Stroke?

PubMed Central

Pulvers, Jeremy N.; Watson, John D. G.

2017-01-01

Despite the availability of thrombolytic and endovascular therapy for acute ischemic stroke, many patients are ineligible due to delayed hospital arrival. The identification of factors related to either early or delayed hospital arrival may reveal potential targets of intervention to reduce prehospital delay and improve access to time-critical thrombolysis and clot retrieval therapy. Here, we have reviewed studies reporting on factors associated with either early or delayed hospital arrival after stroke, together with an analysis of stroke onset to hospital arrival times. Much effort in the stroke treatment community has been devoted to reducing door-to-needle times with encouraging improvements. However, this review has revealed that the median onset-to-door times and the percentage of stroke patients arriving before the logistically critical 3 h have shown little improvement in the past two decades. Major factors affecting prehospital time were related to emergency medical pathways, stroke symptomatology, patient and bystander behavior, patient health characteristics, and stroke treatment awareness. Interventions addressing these factors may prove effective in reducing prehospital delay, allowing prompt diagnosis, which in turn may increase the rates and/or efficacy of acute treatments such as thrombolysis and clot retrieval therapy and thereby improve stroke outcomes. PMID:29209269

Deep seafloor arrivals in long range ocean acoustic propagation.

PubMed

Stephen, Ralph A; Bolmer, S Thompson; Udovydchenkov, Ilya A; Worcester, Peter F; Dzieciuch, Matthew A; Andrew, Rex K; Mercer, James A; Colosi, John A; Howe, Bruce M

2013-10-01

Ocean bottom seismometer observations at 5000 m depth during the long-range ocean acoustic propagation experiment in the North Pacific in 2004 show robust, coherent, late arrivals that are not readily explained by ocean acoustic propagation models. These "deep seafloor" arrivals are the largest amplitude arrivals on the vertical particle velocity channel for ranges from 500 to 3200 km. The travel times for six (of 16 observed) deep seafloor arrivals correspond to the sea surface reflection of an out-of-plane diffraction from a seamount that protrudes to about 4100 m depth and is about 18 km from the receivers. This out-of-plane bottom-diffracted surface-reflected energy is observed on the deep vertical line array about 35 dB below the peak amplitude arrivals and was previously misinterpreted as in-plane bottom-reflected surface-reflected energy. The structure of these arrivals from 500 to 3200 km range is remarkably robust. The bottom-diffracted surface-reflected mechanism provides a means for acoustic signals and noise from distant sources to appear with significant strength on the deep seafloor.

9 CFR 98.7 - Declaration upon arrival.

Code of Federal Regulations, 2011 CFR

2011-01-01

... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.7 Declaration upon arrival. Upon arrival of an embryo at a port of entry, the importer or the importer's agent shall notify APHIS of the...

9 CFR 98.7 - Declaration upon arrival.

Code of Federal Regulations, 2014 CFR

2014-01-01

... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.7 Declaration upon arrival. Upon arrival of an embryo at a port of entry, the importer or the importer's agent shall notify APHIS of the...

9 CFR 98.7 - Declaration upon arrival.

Code of Federal Regulations, 2013 CFR

2013-01-01

... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.7 Declaration upon arrival. Upon arrival of an embryo at a port of entry, the importer or the importer's agent shall notify APHIS of the...

9 CFR 98.7 - Declaration upon arrival.

Code of Federal Regulations, 2012 CFR

2012-01-01

... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.7 Declaration upon arrival. Upon arrival of an embryo at a port of entry, the importer or the importer's agent shall notify APHIS of the...

9 CFR 98.7 - Declaration upon arrival.

Code of Federal Regulations, 2010 CFR

2010-01-01

... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.7 Declaration upon arrival. Upon arrival of an embryo at a port of entry, the importer or the importer's agent shall notify APHIS of the...

NOSE laparoscopic gastrectomies for early gastric cancer may reduce morbidity and hospital stay: early results from a prospective nonrandomized study.

PubMed

Hüscher, Cristiano G S; Lirici, Marco Maria; Ponzano, Cecilia

2017-04-01

Natural orifice specimen extraction - NOSE laparoscopy is a promising technique that avoids mini-laparotomy, possibly reducing postoperative pain, wound infections and hospital stay. Recent systematic reviews have shown that postoperative morbidity associated with laparoscopically assisted gastrectomies is similar to that after open gastrectomies. More specifically, there is no difference in wound infection rate. The study objective was to evaluate whether postoperative morbidity and hospital stay may be reduced by transoral specimen extraction after laparoscopically assisted gastrectomy for early gastric cancer (EGC). A prospective, nonrandomized study was carried out starting in August 2012. Data from all patients operated on during the first year, with minimum 18 months follow-up, were collected to assess feasibility, oncologic results, postoperative morbidity, hospital stay and functional results. Overall, 14 patients were included and followed-up. After gastric resection, a 3 cm opening was created on the gastric stump, and the specimen, divided into three segments stitched one to each other, was sutured to the gastric tube and retrieved through the mouth. Postoperative morbidity was 7.14% (1/14): one case of pneumonia. No wound infection occurred. The mean postoperative hospital stay was 4.7 ± 1.0 days. NOSE laparoscopic subtotal gastrectomy is feasible and safe, with similar oncologic results as LAG, but decreased morbidity and hospital stay.

Out-of-hospital characteristics and care of patients with severe sepsis: a cohort study

PubMed Central

Seymour, Christopher W.; Band, Roger A.; Cooke, Colin R.; Mikkelsen, Mark E.; Hylton, Julie; Rea, Tom D.; Goss, Christopher H.; Gaieski, David F.

2010-01-01

Purpose Early recognition and treatment in severe sepsis improves outcomes. Yet, out-of-hospital patient characteristics and emergency medical services (EMS) care in severe sepsis is understudied. Our goal was to describe out-of-hospital characteristics and EMS care in patients with severe sepsis, and evaluate associations between out-of-hospital characteristics and severity of organ dysfunction in the emergency department (ED). Materials & Methods We performed a secondary data analysis of existing data from patients with severe sepsis transported by EMS to an academic medical center. We constructed multivariable linear regression models to determine if out-of-hospital factors are associated with serum lactate and SOFA in the ED. Results Two hundred sixteen patients with severe sepsis arrived by EMS. Median serum lactate in the ED was 3.0 mmol/L (IQR:2.0-5.0) and median SOFA score was 4 (IQR:2-6). Sixty-three percent (135) of patients were transported by advanced life support providers and 30% (62) received IV fluid. Lower out-of-hospital Glasgow coma scale (GCS) was independently associated with elevated serum lactate (p<0.01). Out-of-hospital hypotension, greater respiratory rate, and lower GCS were associated with greater SOFA (p<0.01). Conclusions Out-of-hospital fluid resuscitation occurred in less than one-third of patients with severe sepsis, and routinely measured out-of-hospital variables were associated with greater serum lactate and SOFA in the ED. PMID:20381301

Direction of Arrival Estimation Using a Reconfigurable Array

DTIC Science & Technology

2005-05-06

civilian world. Keywords: Direction-of-arrival Estimation MUSIC algorithm Reconfigurable Array Experimental Created by Neevia Personal...14. SUBJECT TERMS: Direction-of-arrival ; Estimation ; MUSIC algorithm ; Reconfigurable ; Array ; Experimental 16. PRICE CODE 17...9 1.5 MuSiC Algorithm

8 CFR 251.5 - Paper arrival and departure manifests for crew.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Paper arrival and departure manifests for... REGULATIONS ARRIVAL AND DEPARTURE MANIFESTS AND LISTS: SUPPORTING DOCUMENTS § 251.5 Paper arrival and... from the United States must submit arrival and departure manifests in a paper format in accordance with...

Early hospital mortality prediction of intensive care unit patients using an ensemble learning approach.

PubMed

Awad, Aya; Bader-El-Den, Mohamed; McNicholas, James; Briggs, Jim

2017-12-01

Mortality prediction of hospitalized patients is an important problem. Over the past few decades, several severity scoring systems and machine learning mortality prediction models have been developed for predicting hospital mortality. By contrast, early mortality prediction for intensive care unit patients remains an open challenge. Most research has focused on severity of illness scoring systems or data mining (DM) models designed for risk estimation at least 24 or 48h after ICU admission. This study highlights the main data challenges in early mortality prediction in ICU patients and introduces a new machine learning based framework for Early Mortality Prediction for Intensive Care Unit patients (EMPICU). The proposed method is evaluated on the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database. Mortality prediction models are developed for patients at the age of 16 or above in Medical ICU (MICU), Surgical ICU (SICU) or Cardiac Surgery Recovery Unit (CSRU). We employ the ensemble learning Random Forest (RF), the predictive Decision Trees (DT), the probabilistic Naive Bayes (NB) and the rule-based Projective Adaptive Resonance Theory (PART) models. The primary outcome was hospital mortality. The explanatory variables included demographic, physiological, vital signs and laboratory test variables. Performance measures were calculated using cross-validated area under the receiver operating characteristic curve (AUROC) to minimize bias. 11,722 patients with single ICU stays are considered. Only patients at the age of 16 years old and above in Medical ICU (MICU), Surgical ICU (SICU) or Cardiac Surgery Recovery Unit (CSRU) are considered in this study. The proposed EMPICU framework outperformed standard scoring systems (SOFA, SAPS-I, APACHE-II, NEWS and qSOFA) in terms of AUROC and time (i.e. at 6h compared to 48h or more after admission). The results show that although there are many values missing in the first few hour of ICU admission

Weak Links in the Early Chain of Care of Acute Lower Limb Ischaemia in Terms of Recognition and Emergency Management.

PubMed

Langenskiöld, M; Smidfelt, K; Karlsson, A; Bohm, C; Herlitz, J; Nordanstig, J

2017-08-01

Acute lower limb ischaemia (ALLI) is a potentially fatal, limb threatening medical emergency. Early treatment is essential for a good outcome. The aim was to describe the early chain of care in ALLI focusing on lead times and emergency management in order to identify weak links for improvement. This was a retrospective, descriptive case study. This study analysed the medical records of all patients with a main discharge diagnosis of ALLI between January 2009 and December 2014. Predetermined emergency care data on lead times, diagnosis recognition, presenting symptoms, emergency care treatment and outcome were collected for patients who were transported by the Emergency Medical Service (EMS) and those who were not. In total, 552 medical records were audited of which 195 patients fulfilled the inclusion criteria and were analysed. Among them were 117 (60%) transported by the EMS. The median time from symptom onset to revascularisation was 23 (interquartile range [IQR] 10-55; EMS transported) and 93 (IQR 42-152, not EMS transported) hours (p < .01). The time from symptom onset to arrival in hospital was 5 (IQR 2-26; EMS transported) and 48 (IQR 6-108; not EMS transported) hours. After arrival in hospital, the median time to first doctor evaluation was 51 (IQR 28-90; EMS transported) and 80 (IQR 44-169; not EMS transported) minutes, p = .01. Low molecular weight heparin (LMWH) was given to 72% of patients in the emergency department (ED) and a multivariate analysis showed that the use of LMWH was associated with a more favourable outcome. Both the time spent in the ED and the time from the onset of symptoms to revascularisation were considerably longer than optimal. Time delays in the early treatment chain can mainly be attributed to "patient delay" and a considerable time spent in hospital before revascularisation. The use of LMWH as an integral part of ED management was associated with a better outcome. Copyright © 2017 European Society for Vascular Surgery

No effect of an additional early dose of measles vaccine on hospitalization or mortality in children: A randomized controlled trial.

PubMed

Schoeps, Anja; Nebié, Eric; Fisker, Ane Baerent; Sié, Ali; Zakane, Alphonse; Müller, Olaf; Aaby, Peter; Becher, Heiko

2018-04-05

Non-specific effects (NSEs) of vaccines have increasingly gained attention in recent years. Recent studies suggest that live vaccines, such as measles vaccine (MV), have beneficial effects on health, while inactivated vaccines, such as the diphtheria-tetanus-pertussis (DTP) vaccine, may have harmful effects. If this is the case, it should improve child health to move MV closer to the last vaccination with DTP. The objective of this study was to investigate the NSEs of an additional early dose of MV on hospitalization or mortality. Children were randomized to receive either the standard MV at 9 months (control) or an additional early dose of MV 4 weeks after the third dose of DTP-containing Pentavalent vaccine and the standard MV at 9 months (intervention). In this analysis of a secondary outcome in the trial, we investigated the effect of the intervention on a composite endpoint of over-night hospitalization with or without recovery, or death without previous hospitalization, in children between 4.5 and 36 months of age in the Nouna HDSS in Burkina Faso. We used Cox proportional hazards regression with repeated events and time since study enrolment as underlying time-scale. Among 2258 children in the intervention and 2238 children in the control group we observed a total of 464 episodes of hospitalization or mortality. There was no difference between intervention and control group (HR = 1.00, 95% Confidence Interval (CI) 0.83-1.20). Results from the per-protocol and intention-to-treat analysis were similar. Although no significant, results suggest a possible beneficial effect of early MV in children that had not been exposed to an OPV campaign after enrolment (HR = 0.83, 95% CI 0.55-1.29). We did not detect any effect of early MV on subsequent hospitalization or mortality. However, possible effects of early MV could have been obscured by NSEs of the frequent OPV campaigns. Registration: The trial was registered at ClinicalTrials.gov, NCT01644721

Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war.

PubMed

Huerga, Helena; Vasset, Brigitte; Prados, Elisa

2009-05-01

The aim of this study was to describe and analyse hospital mortality patterns after the Liberian war. Data were collected retrospectively from January to July 2005 in a referral hospital in Monrovia, Liberia. The overall fatality rate was 17.2% (438/2543) of medical admissions. One-third of deaths occurred in the first 24h. The adult fatality rate was 23.3% (241/1034). Non-infectious diseases accounted for 56% of the adult deaths. The main causes of death were meningitis (16%), stroke (14%) and heart failure (10%). Associated fatality rates were 48%, 54% and 31% respectively. The paediatric fatality rate was 13.1% (197/1509). Infectious diseases caused 66% of paediatric deaths. In infants <1 month old, the fatality rate was 18% and main causes of death were neonatal sepsis (47%), respiratory distress (24%) and prematurity (18%). The main causes of death in infants > or =1 month old were respiratory infections (27%), malaria (23%) and severe malnutrition (16%). Associated fatality rates were 12%, 10% and 19%. Fatality rates were similar to those found in other sub-Saharan countries without a previous conflict. Early deaths could decrease through recognition and early referral of severe cases from health centres to the hospital and through assessment and priority treatment of these patients at arrival.

Verification of real-time WSA-ENLIL+Cone simulations of CME arrival-time at the CCMC/SWRC from 2010-2016

NASA Astrophysics Data System (ADS)

Wold, A. M.; Mays, M. L.; Taktakishvili, A.; Odstrcil, D.; MacNeice, P. J.; Jian, L. K.

2017-12-01

The Wang-Sheeley-Arge (WSA)-ENLIL+Cone model is used extensively in space weather operations world-wide to model CME propagation. As such, it is important to assess its performance. We present validation results of the WSA-ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC/Space Weather Research Center (SWRC). CCMC/SWRC uses the WSA-ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in-situ ICME leading edge measurements near Earth, STEREO-A and STEREO-B for simulations completed between March 2010-December 2016 (over 1,800 CMEs). We report hit, miss, false alarm, and correct rejection statistics for all three spacecraft. For all predicted CME arrivals, the hit rate is 0.5, and the false alarm rate is 0.1. For the 273 events where the CME was predicted to arrive at Earth, STEREO-A, or STEREO-B and we observed an arrival (hit), the mean absolute arrival-time prediction error was 10.4 ± 0.9 hours, with a tendency to early prediction error of -4.0 hours. We show the dependence of the arrival-time error on CME input parameters. We also explore the impact of the multi-spacecraft observations used to initialize the model CME inputs by comparing model verification results before and after the STEREO-B communication loss (since September 2014) and STEREO-A side-lobe operations (August 2014-December 2015). There is an increase of 1.7 hours in the CME arrival time error during single, or limited two-viewpoint periods, compared to the three-spacecraft viewpoint period. This trend would apply to a future space weather mission at L5 or L4 as another coronagraph viewpoint to reduce CME arrival time errors compared to a single L1 viewpoint.

Early Mobilization in Ischemic Stroke: A Pilot Randomized Trial of Safety and Feasibility in a Public Hospital in Brazil

PubMed Central

Poletto, Simone Rosa; Rebello, Letícia Costa; Valença, Maria Júlia Monteiro; Rossato, Daniele; Almeida, Andrea Garcia; Brondani, Rosane; Chaves, Márcia Lorena Fagundes; Nasi, Luiz Antônio; Martins, Sheila Cristina Ouriques

2015-01-01

Background The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant

TRACON Aircraft Arrival Planning and Optimization Through Spatial Constraint Satisfaction

NASA Technical Reports Server (NTRS)

Bergh, Christopher P.; Krzeczowski, Kenneth J.; Davis, Thomas J.; Denery, Dallas G. (Technical Monitor)

1995-01-01

A new aircraft arrival planning and optimization algorithm has been incorporated into the Final Approach Spacing Tool (FAST) in the Center-TRACON Automation System (CTAS) developed at NASA-Ames Research Center. FAST simulations have been conducted over three years involving full-proficiency, level five air traffic controllers from around the United States. From these simulations an algorithm, called Spatial Constraint Satisfaction, has been designed, coded, undergone testing, and soon will begin field evaluation at the Dallas-Fort Worth and Denver International airport facilities. The purpose of this new design is an attempt to show that the generation of efficient and conflict free aircraft arrival plans at the runway does not guarantee an operationally acceptable arrival plan upstream from the runway -information encompassing the entire arrival airspace must be used in order to create an acceptable aircraft arrival plan. This new design includes functions available previously but additionally includes necessary representations of controller preferences and workload, operationally required amounts of extra separation, and integrates aircraft conflict resolution. As a result, the Spatial Constraint Satisfaction algorithm produces an optimized aircraft arrival plan that is more acceptable in terms of arrival procedures and air traffic controller workload. This paper discusses the current Air Traffic Control arrival planning procedures, previous work in this field, the design of the Spatial Constraint Satisfaction algorithm, and the results of recent evaluations of the algorithm.

Queues with Dropping Functions and General Arrival Processes

PubMed Central

Chydzinski, Andrzej; Mrozowski, Pawel

2016-01-01

In a queueing system with the dropping function the arriving customer can be denied service (dropped) with the probability that is a function of the queue length at the time of arrival of this customer. The potential applicability of such mechanism is very wide due to the fact that by choosing the shape of this function one can easily manipulate several performance characteristics of the queueing system. In this paper we carry out analysis of the queueing system with the dropping function and a very general model of arrival process—the model which includes batch arrivals and the interarrival time autocorrelation, and allows for fitting the actual shape of the interarrival time distribution and its moments. For such a system we obtain formulas for the distribution of the queue length and the overall customer loss ratio. The analytical results are accompanied with numerical examples computed for several dropping functions. PMID:26943171

A Romani mitochondrial haplotype in England 500 years before their recorded arrival in Britain.

PubMed

Töpf, Ana L; Hoelzel, A Rus

2005-09-22

The nomadic Romani (gypsy) people are known for their deep-rooted traditions, but most of their history is recorded from external sources. We find evidence for a Romani genetic lineage in England long before their recorded arrival there. The most likely explanations are that either the historical record is wrong, or that early liaisons between Norse and Romani people during their coincident presence in ninth to tenth century Byzantium led to the spread of the haplotype to England.

The child in hospital*

PubMed Central

1955-01-01

In 1951 the WHO Regional Office for Europe as a part of its long-term activities in child health initiated plans for a meeting between paediatricians and child psychiatrists, at which they could discuss their respective roles and the co-ordination of their work. Early in 1953 an ad hoc committee was called together to discuss the possibility of holding a conference which would delineate the role of the paediatrician in the management of psychosomatic and behaviour disorders in young children. This committee, consisting of leading specialists in paediatrics and child psychiatry, under the chairmanship of Professor R. Debré (France), felt that any wider conference should be devoted to considering more fully the inter-relation of somatic and psychological processes in sick children, the respective roles of paediatricians and child psychiatrists in their treatment, and the working relations between the different disciplines responsible for the care of children. In order to avoid diffusion of effort, and to arrive as far as possible at practical conclusions, the study group that was subsequently convened in Stockholm concentrated on one important aspect of child care—the child in hospital. PMID:14364192

A Descriptive Analysis of Care Provided by Law Enforcement Prior to EMS Arrival in the United States.

PubMed

Klassen, Aaron B; Core, S Brent; Lohse, Christine M; Sztajnkrycer, Matthew D

2018-04-01

Study Objectives Law enforcement is increasingly viewed as a key component in the out-of-hospital chain of survival, with expanded roles in cardiac arrest, narcotic overdose, and traumatic bleeding. Little is known about the nature of care provided by law enforcement prior to the arrival of Emergency Medical Services (EMS) assets. The purpose of the current study was to perform a descriptive analysis of events reported to a national EMS database. This study was a descriptive analysis of the 2014 National Emergency Medical Services Information System (NEMSIS) public release research data set, containing EMS emergency response data from 41 states. Code E09_02 1200 specifically identifies care provided by law enforcement prior to EMS arrival. A total of 25,835,729 unique events were reported. Of events in which pre-arrival care was documented, 2.0% received prior aid by law enforcement. Patients receiving law enforcement care prior to EMS arrival were more likely to be younger (52.8 [SD=23.3] years versus 58.7 [SD=23.3] years), male (54.8% versus 46.7%), and white (80.3% versus 77.5%). Basic Life Support (BLS) EMS response was twice as likely in patients receiving prior aid by law enforcement. Multiple-casualty incidents were five times more likely with prior aid by law enforcement. Compared with prior aid by other services, law enforcement pre-arrival care was more likely with motor vehicle accidents, firearm assaults, knife assaults, blunt assaults, and drug overdoses, and less likely at falls and childbirths. Cardiac arrest was significantly more common in patients receiving prior aid by law enforcement (16.5% versus 2.6%). Tourniquet application and naloxone administration were more common in the law enforcement prior aid group. Where noted, law enforcement pre-arrival care occurs in 2.0% of EMS patient encounters. The majority of cases involve cardiac arrest, motor vehicle accidents, and assaults. Better understanding of the nature of law enforcement care is

Turnaround Time for Early Infant HIV Diagnosis in Rural Zambia: A Chart Review

PubMed Central

Sutcliffe, Catherine G.; van Dijk, Janneke H.; Hamangaba, Francis; Mayani, Felix; Moss, William J.

2014-01-01

Background Early infant HIV diagnosis is challenging in sub-Saharan Africa, particularly in rural areas where laboratory capacity is limited. Specimens must be transported to central laboratories for testing, leading to delays in diagnosis and initiation of antiretroviral therapy. This study was undertaken in rural Zambia to measure the turnaround time for confirmation of HIV infection and identify delays in diagnosis. Methods Chart reviews were conducted from 2010–2012 for children undergoing early infant HIV diagnosis at Macha Hospital in Zambia. Relevant dates, receipt of drugs by mother and child for the prevention of mother-to-child transmission (PMTCT), and test results were abstracted. Results 403 infants provided 476 samples for early infant diagnosis. The median age at the “6-week” and “6-month” assessments was 8.1 weeks and 7.0 months, respectively. The majority of mothers (80%) and infants (67%) received PMTCT. The median time between sample collection and arrival at the central laboratory in Lusaka was 17 days (IQR: 10, 28); arrival at the central laboratory to testing was 6 days (IQR: 5, 11); testing to return of results to the clinic was 29 days (IQR: 17, 36); arrival of results at the clinic to return of results to the caregiver was 45 days (IQR: 24, 79). The total median time from sample collection to return of results to the caregiver was 92 days (IQR: 84, 145). The proportion of HIV PCR positive samples was 12%. The total median turnaround time was shorter for HIV PCR positive as compared to negative or invalid samples (85 vs. 92 days; p = 0.08). Conclusions Delays in processing and communicating test results were identified, particularly in returning results from the central laboratory to the clinic and from the clinic to the caregiver. A more efficient process is needed so that caregivers can be provided test results more rapidly, potentially resulting in earlier treatment initiation and better outcomes for HIV-infected infants

Estimating Controller Intervention Probabilities for Optimized Profile Descent Arrivals

NASA Technical Reports Server (NTRS)

Meyn, Larry A.; Erzberger, Heinz; Huynh, Phu V.

2011-01-01

Simulations of arrival traffic at Dallas/Fort-Worth and Denver airports were conducted to evaluate incorporating scheduling and separation constraints into advisories that define continuous descent approaches. The goal was to reduce the number of controller interventions required to ensure flights maintain minimum separation distances of 5 nmi horizontally and 1000 ft vertically. It was shown that simply incorporating arrival meter fix crossing-time constraints into the advisory generation could eliminate over half of the all predicted separation violations and more than 80% of the predicted violations between two arrival flights. Predicted separation violations between arrivals and non-arrivals were 32% of all predicted separation violations at Denver and 41% at Dallas/Fort-Worth. A probabilistic analysis of meter fix crossing-time errors is included which shows that some controller interventions will still be required even when the predicted crossing-times of the advisories are set to add a 1 or 2 nmi buffer above the minimum in-trail separation of 5 nmi. The 2 nmi buffer was shown to increase average flight delays by up to 30 sec when compared to the 1 nmi buffer, but it only resulted in a maximum decrease in average arrival throughput of one flight per hour.

Population of SOHO/STEREO Kreutz sungrazers and the arrival of comet C/2011 W3 (Lovejoy)

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

Sekanina, Zdenek; Kracht, Rainer, E-mail: Zdenek.Sekanina@jpl.nasa.gov, E-mail: r.kracht@t-online.de

2013-11-20

We examine properties of the population of SOHO/STEREO (dwarf) Kreutz sungrazing comets from 2004 to 2013, including the arrival rates, peculiar gaps, and a potential relationship to the spectacular comet C/2011 W3 (Lovejoy). Selection effects, influencing the observed distribution, are largely absent among bright dwarf sungrazers, whose temporal sequence implies the presence of a swarm, with objects brighter at maximum than an apparent magnitude of 3 arriving at a peak rate of ∼4.6 yr{sup –1} in late 2010, while those brighter than magnitude 2 arrived at a peak rate of ∼4.3 yr{sup –1} in early 2011, both a few timesmore » the pre-swarm rate. The entire population of SOHO/STEREO Kreutz sungrazers also peaked about one year before the appearance of C/2011 W3. Orbital data show, however, that a great majority of bright dwarf sungrazers moved in paths similar to that of comet C/1843 D1, deviating 10° or more from the orbit of C/2011 W3 in the angular elements. The evidence from the swarm and the overall elevated arrival rates suggests the existence of a fragmented sizable sungrazer that shortly preceded C/2011 W3 but was independent of it. On the other hand, these findings represent another warning signal that the expected 21st century cluster of spectacular Kreutz comets is on its way to perihelion, to arrive during the coming decades. It is only in this sense that we find a parallel link between C/2011 W3 and the spikes in the population of SOHO/STEREO Kreutz sungrazers.« less

Scheduling and Separating Departures Crossing Arrival Flows in Shared Airspace

NASA Technical Reports Server (NTRS)

Chevalley, Eric; Parke, Bonny K.; Lee, Paul; Omar, Faisal; Lee, Hwasoo; Beinert, Nancy; Kraut, Joshua M.; Palmer, Everett

2013-01-01

Flight efficiency and reduction of flight delays are among the primary goals of NextGen. In this paper, we propose a concept of shared airspace where departures fly across arrival flows, provided gaps are available in these flows. We have explored solutions to separate departures temporally from arrival traffic and pre-arranged procedures to support controllers' decisions. We conducted a Human-in-the-Loop simulation and assessed the efficiency and safety of 96 departures from the San Jose airport (SJC) climbing across the arrival airspace of the Oakland and San Francisco arrival flows. In our simulation, the SJC tower had a tool to schedule departures to fly across predicted gaps in the arrival flow. When departures were mistimed and separation could not be ensured, a safe but less efficient route was provided to the departures to fly under the arrival flows. A coordination using a point-out procedure allowed the arrival controller to control the SJC departures right after takeoff. We manipulated the accuracy of departure time (accurate vs. inaccurate) as well as which sector took control of the departures after takeoff (departure vs. arrival sector) in a 2x2 full factorial plan. Results show that coordination time decreased and climb efficiency increased when the arrival sector controlled the aircraft right after takeoff. Also, climb efficiency increased when the departure times were more accurate. Coordination was shown to be a critical component of tactical operations in shared airspace. Although workload, coordination, and safety were judged by controllers as acceptable in the simulation, it appears that in the field, controllers would need improved tools and coordination procedures to support this procedure.

Incidence & prognosis of acute kidney injury in individuals of snakebite in a tertiary care hospital in India.

PubMed

Pulimaddi, Ramulu; Parveda, Amruth Rao; Brahmanpally, Balkishan; Kalakanda, Paul Marx; Ramakrishna, K; Chinnapaka, Venkata Ramana Devi

2017-12-01

The snakebites are considered to be an occupational hazard in agriculture workers and the snake handlers, resulting in a considerable morbidity, mortality and economical implications. This study was conducted to determine the incidence, clinical presentation, renal injury and clinical outcome in snakebite victims who developed acute kidney injury (AKI). This hospital-based prospective, observational study was done on 100 cases who were admitted for the management of snakebite and found to develop AKI in a tertiary care hospital at Hyderabad, India. Renal function tests, complete blood picture, urine routine examination, ultrasound examination of abdomen and coagulation profile were done and the prognosis was assessed by noting recovery, mortality, morbidity and/or progress to chronic stage. A total of 100 patients with a mean age of 43.80±12.63 yr (range 18-70); 62 males and 38 females were studied. All had bites on lower limbs. A total of 86 patients arrived in the hospital within 24 h, and 14 arrived after 24 h. Oliguria was found in 60, bleeding tendencies in 64, haemodynamic instability noted - tachycardia in 86. Systolic blood pressure (BP) was <120 mm Hg in 68 and BP was not recordable in four patients. Twelve patients were in stage III kidney disease and needed haemodialysis. Of the 100 cases of snakebite-induced acute kidney failure, 86 recovered and six died. On follow up, after six months eight patients developed chronic kidney failure. A cascade of events tends to occur in severe haemotoxic envenomation such as bleeding disorders, hypotension/circulatory shock, intravascular haemolysis, disseminated intravascular coagulation and acute respiratory disease syndrome (ARDS). The findings of this study showed that early hospitalization, quick antisnake venom administration and adequate supporting care provided promising results.

Early versus late percutaneous revascularization in patients hospitalized with non ST-segment elevation myocardial infarction: The atherosclerosis risk in communities surveillance study.

PubMed

Arora, Sameer; Matsushita, Kunihiro; Qamar, Arman; Stacey, R Brandon; Caughey, Melissa C

2018-02-01

Current guidelines recommend early invasive intervention (<24 hr) for high risk patients with non-ST-segment elevation myocardial infarction (NSTEMI). A delayed invasive strategy (24-72 hr) is considered reasonable for low risk patients. The real-world effectiveness of this strategy is unknown. The ARIC Study has conducted hospital surveillance of acute myocardial infarction (MI) since 1987. NSTEMI was classified using a validated algorithm. We limited our study to patients undergoing early (<24 hr of the event onset), or late (≥24 hr) percutaneous coronary intervention (PCI). Patients were stratified into low (TIMI score 2-4), and high risk (TIMI score 5-7, or presence of cardiogenic shock, ventricular fibrillation, or cardiac arrest). Associations between early versus late PCI and mortality were analyzed using multivariable logistic regression adjusted for demographics, hospitalization year, TIMI score, and comorbidities. From 1987 to 2012, 6,746 patients were hospitalized with NSTEMI and underwent PCI. Most were white (79%), male (68%), with mean age 61 years. The 28-day and 1-year mortality were 2% and 5%, respectively. Most revascularizations (65%) were late. After accounting for potential confounders, early PCI was associated with a 58% reduced 28-day mortality (OR = 0.42; 95% CI: 0.21-0.84) for the entire population, and 57% reduced mortality (OR = 0.43; 95% CI: 0.21-0.88) for high risk patients. By 1-year of follow up, there was no significant difference in mortality with respect to early vs. late PCI. In hospitalized NSTEMI patients with high risk of clinical events, early PCI is associated with improved 28-day survival. © 2017 Wiley Periodicals, Inc.

Concept of Operations for Interval Management Arrivals and Approach

NASA Technical Reports Server (NTRS)

Hicok, Daniel S.; Barmore, Bryan E.

2016-01-01

This paper presents the concept of operations for interval management operations to be deployed in the US National Airspace System (NAS) by the Federal Aviation Administration (FAA) Interval Management Program. The arrivals and approach operations are explored in detail including the primary operation and variations. The use of interval management operations is described that begin in en route airspace and continue to a termination point inside the arrival terminal area in the highly automated terminal environment that includes other arrival management tools such as arrival metering, Ground-based Interval Management - Spacing (GIM-S), and Terminal Sequencing and Spacing (TSAS). The roles of Air Traffic and Pilots and the ground automation tools that are used by Air Traffic Controllers to enable the operations are explored.

Early warning systems and rapid response to the deteriorating patient in hospital: A realist evaluation.

PubMed

McGaughey, Jennifer; O'Halloran, Peter; Porter, Sam; Trinder, John; Blackwood, Bronagh

2017-12-01

To test the Rapid Response Systems programme theory against actual practice components of the Rapid Response Systems implemented to identify those contexts and mechanisms which have an impact on the successful achievement of desired outcomes in practice. Rapid Response Systems allow deteriorating patients to be recognized using Early Warning Systems, referred early via escalation protocols and managed at the bedside by competent staff. Realist evaluation. The research design was an embedded multiple case study approach of four wards in two hospitals in Northern Ireland which followed the principles of Realist Evaluation. We used various mixed methods including individual and focus group interviews, observation of nursing practice between June-November 2010 and document analysis of Early Warning Systems audit data between May-October 2010 and hospital acute care training records over 4.5 years from 2003-2008. Data were analysed using NiVivo8 and SPPS. A cross-case analysis highlighted similar patterns of factors which enabled or constrained successful recognition, referral and response to deteriorating patients in practice. Key enabling factors were the use of clinical judgement by experienced nurses and the empowerment of nurses as a result of organizational change associated with implementation of Early Warning System protocols. Key constraining factors were low staffing and inappropriate skill mix levels, rigid implementation of protocols and culturally embedded suboptimal communication processes. Successful implementation of Rapid Response Systems was dependent on adopting organizational and cultural changes that facilitated staff empowerment, flexible implementation of protocols and ongoing experiential learning. © 2017 John Wiley & Sons Ltd.

[Prognostic factors for in-hospital cardiopulmonary arrests. A review of 760 cases].

PubMed

Fontanals, Jaume; Magaldi, Marta; Caballero, Ángel; Fontanals, Montserrat

2016-07-15

The aim of this study is to analyse in-hospital cardiopulmonary arrests (CA) that took place in conventional wards and evaluate their prognostic factors. Retrospective review of in-hospital CA which occurred in our hospital over a 9-year period. CA that took place in intensive care areas, emergency rooms and operating theatres were excluded from the study. The following data were collected: demographic data, cause and initial rhythm of CA, internal control data, time, place, methods and results after cardiopulmonary resuscitation (CPR) (recovery of spontaneous circulation, [ROSC], and survival at discharge [SAD]) and neurologic performance at discharge. Results were analysed with SPSS(®) v. 20 predictive analytics software. Average age was 66.9±17.5 years; 63.5% male. CA team arrived in 1.75±0.74min on average, and the average length of CPR was 25.8±16.10min. First rhythm: a) shockable rhythms=22.1%; b) asystole=66.2%, and c) pulseless electrical activity=11.7%. ROSC=51% and SAD=24.8%. Factors associated with a better prognostic (P<.05): age, reason for hospital admission, patient's previous physical condition, principal cause of CA, number of defibrillations and average length of CPR. Despite having studied several variables as prognostic factors for CA and some of them being statistically significant, early prediction for survival for an in-hospital CA remains uncertain. Our study suggests that applying rational organisational measures, 25% of in-hospital CA could be discharged from hospital in good condition, and therefore, these organisational and educational measures should be extended to large hospitals. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Use of acute care hospital services by immigrant seniors in Ontario: A linkage study.

PubMed

Ng, Edward; Sanmartin, Claudia; Tu, Jack; Manuel, Doug

2014-10-01

Seniors constitute the largest group of hospital users. The increasing share of immigrants in Canada's senior population can affect the demand for hospital care. This study used the linked 2006 Census-Hospital Discharge Abstract Database to examine hospitalization during the 2004-to-2006 period, by immigrant status, of Ontario seniors living in the community. Hospitalization was assessed with logistic regressions; cumulative length of stay, with zero-truncated negative binomial regressions. All-cause hospitalization and hospitalizations specific to circulatory and digestive diseases were examined. Immigrant seniors had significantly low age-/sex-adjusted odds of hospitalization, compared with Canadian-born seniors (OR = 0.81). The odds varied from 0.4 among East Asians to 0.89 among Europeans, and rose with length of time since arrival from 0.54 for recent (1994 to 2003) to 0.86 for long-term (before 1984) immigrants. Adjustment for demographic and socio-economic characteristics did not change the overall patterns. Immigrants' cumulated length of hospital stay tended to be shorter than or similar to that of Canadian-born seniors. Immigrant seniors, especially recent arrivals, had lower odds of hospitalization and similar time in hospital, compared with Canadian-born seniors. These patterns likely reflect differences in health status. Variations by world region and disease reflect the diverse health care needs of immigrant seniors.

Maternal hepatitis B screening at a private hospital.

PubMed

Murnane, A; Evertson, L; Helmchen, R

1992-10-01

A prospective study was performed to determine whether the Centers for Disease Control risk factors are reliable predictors of the hepatitis B surface antigen (HBsAg) carrier state in the obstetric population at a large private hospital in Cincinnati. During the 12-month study period, 5,877 patients delivered at the hospital. The patients were screened for HBsAg either prenatally or on presentation in labor. Questionnaires were administered after arrival at the hospital to assess for historical risk factors. An overall 0.0925% incidence of HBsAg seropositivity was discovered. All patients who were HBsAg positive had identifiable risk factors.

Combinations of early signs of critical illness predict in-hospital death-the SOCCER study (signs of critical conditions and emergency responses).

PubMed

Harrison, Gordon A; Jacques, Theresa; McLaws, Mary-Louise; Kilborn, Gabrielle

2006-12-01

Medical emergency team (MET) call criteria are late signs of a deteriorating clinical condition. Some early signs predict in-hospital death but have a high prevalence so their use as single sign call criteria could be wasteful of resources. This study searched a large database to explore the association of combinations of recordings of early signs (ES), or early with late signs (LS) with in-hospital death. A cross-sectional survey was undertaken of 3046 non-do not attempt resuscitation adult admissions in 5 hospitals without MET over 14 days. The medical records were reviewed for recordings of 26 ES and 21 LS and in-hospital death. Combinations of ES with or without LS were examined as predictors of death. Global modified early warning scores (GMEWS) were calculated. ES with LS, plus LS only, had higher odd ratios than ES alone. Four combinations of ES were strongly associated with death: cardiovascular plus respiratory with decrease in urinary output, cardiovascular plus respiratory with a decrease in consciousness, respiratory with decrease in urinary output, and cardiovascular plus respiratory. In other combinations, recordings of SpO2 90-95%, systolic blood pressure 80-100 mmHg or decrease in urinary output in turn occurring with one or more disturbed blood gas variable were associated with death. Compared with admissions whose GMEWS were 0-2, admissions with GMEWS 5-15 were 27.1 times more likely to die while those with GMEWS 3-4 were 6.5 times more likely. The results support the inclusion of early signs of a deteriorating clinical condition in sets of call criteria.

Maternal characteristics and birth outcomes resulting from births before arrival at health facilities in Nkangala District, South Africa: a case control study.

PubMed

Khupakonke, Sikhulile; Beke, Andy; Amoko, Donald H A

2017-12-02

Risks of severe, avoidable maternal and neonatal complications at birth are increased if the birth occurs before arrival at the health facility and in the absence of skilled birth attendants. Birth Before Arrival (BBA) is a preventable phenomenon still common in modern-day practice despite extensive improvements made in obstetric care and in accessibility to healthcare in South Africa. This study aimed to determine the risk factors and outcomes in mothers and babies associated with being born before arrival at hospitals. A prospective case control study design was conducted. All BBAs presenting to the hospitals in Nkangala District between November 2015 and February 2016 were included and compared to a consecutive hospital delivery occurring immediately after the arrival of each BBA. T-tests and chi square tests were used to analyse the differences between the groups and a binary logistic regression analysis used to determine predictors of BBAs. All statistical analysis were done using STATA version 14 using a 5% decision level and a 95% confidence interval. During the study period, 4397 in-facility births and 201 BBAs were recorded, 78 BBAs and 75 controls were investigated in this study. The district BBA prevalence was 4.6%. Risk factors identified in mothers of BBAs were: single mothers (83.3% vs 69.3%; p = 0.04); residing in an informal settlement (23.1% vs 5.3%; p = 0.002); and higher gravidity with plurigravida significantly more (60.3% vs 32.5%; p < 0.0001). A prevalent maternal complication in cases was haemorrhage due to retained placenta. Most neonates were born alive with a higher proportion of cases experiencing perinatal complications such as respiratory distress, hypothermia and asphyxia. No significant differences in maternal age, employment status and immediate birth outcomes were found. Residing in informal settlements, higher gravidity, unplanned pregnancy, low birth weight and unbooked were found to predict the occurrence of BBAs

7 CFR 319.8-4 - Notice of arrival.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for the Plant Protection and Quarantine Programs, a notice of such arrival, on a form provided for... 7 Agriculture 5 2010-01-01 2010-01-01 false Notice of arrival. 319.8-4 Section 319.8-4 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE...

Verification of real-time WSA-ENLIL+Cone simulations of CME arrival-time at the CCMC from 2010 to 2016

NASA Astrophysics Data System (ADS)

Wold, Alexandra M.; Mays, M. Leila; Taktakishvili, Aleksandre; Jian, Lan K.; Odstrcil, Dusan; MacNeice, Peter

2018-03-01

The Wang-Sheeley-Arge (WSA)-ENLIL+Cone model is used extensively in space weather operations world-wide to model coronal mass ejection (CME) propagation. As such, it is important to assess its performance. We present validation results of the WSA-ENLIL+Cone model installed at the Community Coordinated Modeling Center (CCMC) and executed in real-time by the CCMC space weather team. CCMC uses the WSA-ENLIL+Cone model to predict CME arrivals at NASA missions throughout the inner heliosphere. In this work we compare model predicted CME arrival-times to in situ interplanetary coronal mass ejection leading edge measurements at Solar TErrestrial RElations Observatory-Ahead (STEREO-A), Solar TErrestrial RElations Observatory-Behind (STEREO-B), and Earth (Wind and ACE) for simulations completed between March 2010 and December 2016 (over 1,800 CMEs). We report hit, miss, false alarm, and correct rejection statistics for all three locations. For all predicted CME arrivals, the hit rate is 0.5, and the false alarm rate is 0.1. For the 273 events where the CME was predicted to arrive at Earth, STEREO-A, or STEREO-B, and was actually observed (hit event), the mean absolute arrival-time prediction error was 10.4 ± 0.9 h, with a tendency to early prediction error of -4.0 h. We show the dependence of the arrival-time error on CME input parameters. We also explore the impact of the multi-spacecraft observations used to initialize the model CME inputs by comparing model verification results before and after the STEREO-B communication loss (since September 2014) and STEREO-A sidelobe operations (August 2014-December 2015). There is an increase of 1.7 h in the CME arrival time error during single, or limited two-viewpoint periods, compared to the three-spacecraft viewpoint period. This trend would apply to a future space weather mission at L5 or L4 as another coronagraph viewpoint to reduce CME arrival time errors compared to a single L1 viewpoint.

A Fast-Time Simulation Tool for Analysis of Airport Arrival Traffic

NASA Technical Reports Server (NTRS)

Erzberger, Heinz; Meyn, Larry A.; Neuman, Frank

2004-01-01

The basic objective of arrival sequencing in air traffic control automation is to match traffic demand and airport capacity while minimizing delays. The performance of an automated arrival scheduling system, such as the Traffic Management Advisor developed by NASA for the FAA, can be studied by a fast-time simulation that does not involve running expensive and time-consuming real-time simulations. The fast-time simulation models runway configurations, the characteristics of arrival traffic, deviations from predicted arrival times, as well as the arrival sequencing and scheduling algorithm. This report reviews the development of the fast-time simulation method used originally by NASA in the design of the sequencing and scheduling algorithm for the Traffic Management Advisor. The utility of this method of simulation is demonstrated by examining the effect on delays of altering arrival schedules at a hub airport.

Ensemble-based methods for forecasting census in hospital units.

PubMed

Koestler, Devin C; Ombao, Hernando; Bender, Jesse

2013-05-30

The ability to accurately forecast census counts in hospital departments has considerable implications for hospital resource allocation. In recent years several different methods have been proposed forecasting census counts, however many of these approaches do not use available patient-specific information. In this paper we present an ensemble-based methodology for forecasting the census under a framework that simultaneously incorporates both (i) arrival trends over time and (ii) patient-specific baseline and time-varying information. The proposed model for predicting census has three components, namely: current census count, number of daily arrivals and number of daily departures. To model the number of daily arrivals, we use a seasonality adjusted Poisson Autoregressive (PAR) model where the parameter estimates are obtained via conditional maximum likelihood. The number of daily departures is predicted by modeling the probability of departure from the census using logistic regression models that are adjusted for the amount of time spent in the census and incorporate both patient-specific baseline and time varying patient-specific covariate information. We illustrate our approach using neonatal intensive care unit (NICU) data collected at Women & Infants Hospital, Providence RI, which consists of 1001 consecutive NICU admissions between April 1st 2008 and March 31st 2009. Our results demonstrate statistically significant improved prediction accuracy for 3, 5, and 7 day census forecasts and increased precision of our forecasting model compared to a forecasting approach that ignores patient-specific information. Forecasting models that utilize patient-specific baseline and time-varying information make the most of data typically available and have the capacity to substantially improve census forecasts.

Estimating epidemic arrival times using linear spreading theory

NASA Astrophysics Data System (ADS)

Chen, Lawrence M.; Holzer, Matt; Shapiro, Anne

2018-01-01

We study the dynamics of a spatially structured model of worldwide epidemics and formulate predictions for arrival times of the disease at any city in the network. The model is composed of a system of ordinary differential equations describing a meta-population susceptible-infected-recovered compartmental model defined on a network where each node represents a city and the edges represent the flight paths connecting cities. Making use of the linear determinacy of the system, we consider spreading speeds and arrival times in the system linearized about the unstable disease free state and compare these to arrival times in the nonlinear system. Two predictions are presented. The first is based upon expansion of the heat kernel for the linearized system. The second assumes that the dominant transmission pathway between any two cities can be approximated by a one dimensional lattice or a homogeneous tree and gives a uniform prediction for arrival times independent of the specific network features. We test these predictions on a real network describing worldwide airline traffic.

Analyzing patient's waiting time in emergency & trauma department in public hospital - A case study

NASA Astrophysics Data System (ADS)

Roslan, Shazwa; Tahir, Herniza Md; Nordin, Noraimi Azlin Mohd; Zaharudin, Zati Aqmar

2014-09-01

Emergency and Trauma Department (ETD) is an important element for a hospital. It provides medical service, which operates 24 hours a day in most hospitals. However overcrowding is not exclusion for ETD. Overflowing occurs due to affordable services provided by public hospitals, since it is funded by the government. It is reported that a patient attending ETD must be treated within 90 minutes, in accordance to achieve the Key Performance Indicator (KPI). However, due to overcrowd situations, most patients have to wait longer than the KPI standard. In this paper, patient's average waiting time is analyzed. Using Chi-Square Test of Goodness, patient's inter arrival per hour is also investigated. As conclusion, Monday until Wednesday was identified as the days that exceed the KPI standard while Chi-Square Test of Goodness showed that the patient's inter arrival is independent and random.

Shear wave arrival time estimates correlate with local speckle pattern.

PubMed

Mcaleavey, Stephen A; Osapoetra, Laurentius O; Langdon, Jonathan

2015-12-01

We present simulation and phantom studies demonstrating a strong correlation between errors in shear wave arrival time estimates and the lateral position of the local speckle pattern in targets with fully developed speckle. We hypothesize that the observed arrival time variations are largely due to the underlying speckle pattern, and call the effect speckle bias. Arrival time estimation is a key step in quantitative shear wave elastography, performed by tracking tissue motion via cross-correlation of RF ultrasound echoes or similar methods. Variations in scatterer strength and interference of echoes from scatterers within the tracking beam result in an echo that does not necessarily describe the average motion within the beam, but one favoring areas of constructive interference and strong scattering. A swept-receive image, formed by fixing the transmit beam and sweeping the receive aperture over the region of interest, is used to estimate the local speckle pattern. Metrics for the lateral position of the speckle are found to correlate strongly (r > 0.7) with the estimated shear wave arrival times both in simulations and in phantoms. Lateral weighting of the swept-receive pattern improved the correlation between arrival time estimates and speckle position. The simulations indicate that high RF echo correlation does not equate to an accurate shear wave arrival time estimate-a high correlation coefficient indicates that motion is being tracked with high precision, but the location tracked is uncertain within the tracking beam width. The presence of a strong on-axis speckle is seen to imply high RF correlation and low bias. The converse does not appear to be true-highly correlated RF echoes can still produce biased arrival time estimates. The shear wave arrival time bias is relatively stable with variations in shear wave amplitude and sign (-20 μm to 20 μm simulated) compared with the variation with different speckle realizations obtained along a given tracking

The Great "Non-Event" of 7 January 2014: Challenges in CME Arrival Time and Geomagnetic Storm Strength Prediction

NASA Astrophysics Data System (ADS)

Mays, M. L.; Thompson, B. J.; Jian, L.; Evans, R. M.; Savani, N.; Odstrcil, D.; Nieves-Chinchilla, T.; Richardson, I. G.

2014-12-01

We present a case study of the 7 January 2014 event in order to highlight current challenges in space weather forecasting of CME arrival time and geomagnetic storm strength. On 7 January 2014 an X1.2 flare and CME with a radial speed ~2400 km/s was observed from active region 11943. The flaring region was only ten degrees southwest of disk center with extensive dimming south of the active region and preliminary analysis indicated a fairly rapid arrival at Earth (~36 hours). Of the eleven forecasting groups world-wide who participated in CCMC's Space Weather Scoreboard (http://kauai.ccmc.gsfc.nasa.gov/SWScoreBoard), nine predicted early arrivals and six predicted dramatic geomagnetic storm impacts (Kp predictions ranged from 6 to 9). However, the CME only had a glancing blow arrival at Earth - Kp did not rise above 3 and there was no geomagnetic storm. What happened? One idea is that the large coronal hole to the northeast of the active region could have deflected the CME. This coronal hole produced a high speed stream near Earth reaching an uncommon speed of 900 km/s four days after the observed CME arrival. However, no clear CME deflection was observed in the outer coronagraph fields of view (~5-20Rs) where CME measurements are derived to initiate models, therefore deflection seems unlikely. Another idea is the effect of the CME flux rope orientation with respect to Earth orbit. We show that using elliptical major and minor axis widths obtained by GCS fitting for the initial CME parameters in ENLIL would have improved the forecast to better reflect the observed glancing blow in-situ signature. We also explore the WSA-ENLIL+Cone simulations, the background solar wind solution, and compare with the observed CME arrival at Venus (from Venus Express) and Earth.

Effect of length of residence on overweight by region of birth and age at arrival among US immigrants.

PubMed

Oza-Frank, Reena; Narayan, K M Venkat

2010-06-01

To estimate associations between the length of residence and overweight among US immigrants by region of birth and age at arrival. Cross-sectional data from the National Health Interview Survey 1997-2005 were pooled. Multivariate-adjusted prevalence and OR were computed to test associations of length of residence and overweight. United States. Immigrant adults aged 18-74 years. The odds of being overweight were three times higher in migrants from Mexico, South America, Europe, Russia, Africa and the Middle East residing in the US for >15 years than their counterparts residing in the United States for <5 years. On the other hand, migrants from the Indian subcontinent and Southeast (SE) Asia had no association between the length of residence and overweight prevalence. Among both men and women, weight differences emerged as early as 5 years after arrival among those arriving at 18-24 years of age (OR 1.5-1.8). The odds of being overweight was higher among Hispanic men arriving before the age of 18 years than the European migrants (Mexico OR 1.7, 95 % CI 1.3, 2.2; South America OR 1.5, 95 % CI 1.0, 2.3), whereas the odds of being overweight among those from Africa and SE Asia was lower (OR 0.5, 95 % CI 0.3, 0.9 and OR 0.5, 95 % CI 0.4, 0.8, respectively). Among women who arrived at 25-44 years of age, the odds of being overweight among those from Africa and the Indian subcontinent was higher than the European migrants (OR 2.9, 95 % CI 1.7, 5.0 and OR 1.8, 95 % CI 1.8, 2.8, respectively). We found associations between the length of residence and overweight to vary by region of birth and age at arrival, highlighting the importance of these characteristics in assessing overweight risk among the US immigrants.

Early examples of art in Scottish hospitals, 2: Crichton Royal Hospital, Dumfries.

PubMed

Park, Maureen

2003-12-01

Fine art has been used in hospitals for centuries. However, Crichton Royal Hospital in Dumfries pioneered the use of art activity in the treatment of its patients. This article is the second of two which look at examples of art created for, and in, Scottish hospitals in the 19th century. It is suggested that the importance of Scotland's contribution to this movement is unrecognized by many of its modern-day practitioners.

Order of arrival affects competition in two reef fishes.

PubMed

Geange, Shane W; Stier, Adrian C

2009-10-01

Many communities experience repeated periods of colonization due to seasonally regenerating habitats or pulsed arrival of young-of-year. When an individual's persistence in a community depends upon the strength of competitive interactions, changes in the timing of arrival relative to the arrival of a competitor can modify competitive strength and, ultimately, establishment in the community. We investigated whether the strength of intracohort competitive interactions between recent settlers of the reef fishes Thalassoma hardwicke and T. quinquevittatum are dependent on the sequence and temporal separation of their arrival into communities. To achieve this, we manipulated the sequence and timing of arrival of each species onto experimental patch reefs by simulating settlement pulses and monitoring survival and aggressive interactions. Both species survived best in the absence of competitors, but when competitors were present, they did best when they arrived at the same time. Survival declined as each species entered the community progressively later than its competitor and as aggression by its competitor increased. Intraspecific effects of resident T. hardwicke were similar to interspecific effects. This study shows that the strength of competition depends not only on the identity of competitors, but also on the sequence and timing of their interactions, suggesting that when examining interaction strengths, it is important to identify temporal variability in the direction and magnitude of their effects. Furthermore, our findings provide empirical evidence for the importance of competitive lotteries in the maintenance of species diversity in demographically open marine systems.

Strengthening economy through tourism sector by tourist arrival prediction

NASA Astrophysics Data System (ADS)

Supriatna, A.; Subartini, B.; Hertini, E.; Sukono; Rumaisha; Istiqamah, N.

2018-03-01

Tourism sector has a tendency to be proposed as a support for national economy to many countries with various of natural resources, such as Indonesia. The number of tourist is very related with the success rate of a tourist attraction, since it is also related with planning and strategy. Hence, it is important to predict the climate of tourism in Indonesia, especially the number of domestic or international tourist in the future. This study uses Seasonal Autoregressive Integrated Moving Average (SARIMA) time series method to predict the number of tourist arrival to tourism strategic areas in Nusa Tenggara Barat. The prediction was done using the international and domestic tourist arrival to Nusa Tenggara Barat data from January 2008 to June 2016. The established SARIMA method was (0,1,1)(0,0,2)12 with MAPE error of 15.76. The prediction for the next six time periods showed that the highest number of tourist arrival is during September 2016 with 330,516 tourist arrivals. Prediction of tourist arrival hopefully might be used as reference for local and national government to make policies to strengthen national economy for a long period of time

Cost analysis of measles in refugees arriving at Los Angeles International Airport from Malaysia

PubMed Central

Coleman, Margaret S.; Burke, Heather M.; Welstead, Bethany L.; Mitchell, Tarissa; Taylor, Eboni M.; Shapovalov, Dmitry; Maskery, Brian A.; Joo, Heesoo; Weinberg, Michelle

2017-01-01

ABSTRACT Background On August 24, 2011, 31 US-bound refugees from Kuala Lumpur, Malaysia (KL) arrived in Los Angeles. One of them was diagnosed with measles post-arrival. He exposed others during a flight, and persons in the community while disembarking and seeking medical care. As a result, 9 cases of measles were identified. Methods We estimated costs of response to this outbreak and conducted a comparative cost analysis examining what might have happened had all US-bound refugees been vaccinated before leaving Malaysia. Results State-by-state costs differed and variously included vaccination, hospitalization, medical visits, and contact tracing with costs ranging from $621 to $35,115. The total of domestic and IOM Malaysia reported costs for US-bound refugees were $137,505 [range: $134,531 - $142,777 from a sensitivity analysis]. Had all US-bound refugees been vaccinated while in Malaysia, it would have cost approximately $19,646 and could have prevented 8 measles cases. Conclusion A vaccination program for US-bound refugees, supporting a complete vaccination for US-bound refugees, could improve refugees' health, reduce importations of vaccine-preventable diseases in the United States, and avert measles response activities and costs. PMID:28068211

Cost analysis of measles in refugees arriving at Los Angeles International Airport from Malaysia.

PubMed

Coleman, Margaret S; Burke, Heather M; Welstead, Bethany L; Mitchell, Tarissa; Taylor, Eboni M; Shapovalov, Dmitry; Maskery, Brian A; Joo, Heesoo; Weinberg, Michelle

2017-05-04

Background On August 24, 2011, 31 US-bound refugees from Kuala Lumpur, Malaysia (KL) arrived in Los Angeles. One of them was diagnosed with measles post-arrival. He exposed others during a flight, and persons in the community while disembarking and seeking medical care. As a result, 9 cases of measles were identified. Methods We estimated costs of response to this outbreak and conducted a comparative cost analysis examining what might have happened had all US-bound refugees been vaccinated before leaving Malaysia. Results State-by-state costs differed and variously included vaccination, hospitalization, medical visits, and contact tracing with costs ranging from $621 to $35,115. The total of domestic and IOM Malaysia reported costs for US-bound refugees were $137,505 [range: $134,531 - $142,777 from a sensitivity analysis]. Had all US-bound refugees been vaccinated while in Malaysia, it would have cost approximately $19,646 and could have prevented 8 measles cases. Conclusion A vaccination program for US-bound refugees, supporting a complete vaccination for US-bound refugees, could improve refugees' health, reduce importations of vaccine-preventable diseases in the United States, and avert measles response activities and costs.

Early hospital discharge of infants born to group B streptococci-positive mothers: a decision analysis.

PubMed

Berger, M B; Xu, X; Williams, J A; Van de Ven, C J M; Mozurkewich, E L

2012-03-01

To compare the cost-effectiveness of an additional 24-hour inpatient observation for asymptomatic term neonates born to group B streptococcus (GBS)-colonised mothers with adequate intrapartum antibiotic prophylaxis (IAP) after an initial 24-hour in-hospital observation. Cost-effectiveness analysis from a societal perspective. United States. Asymptomatic term neonates born to GBS-colonised mothers with IAP after an initial 24-hour in-hospital observation. Monte Carlo simulation for a decision tree model incorporating the following chance events: development of GBS sepsis during the second 24 hours of life, development of GBS sepsis between 48 hours and 7 days of life, prompt versus delayed treatment for sepsis, neonatal mortality and long-term health sequelae. Expected cost and quality-adjusted life years (QALYs), Incremental cost-effectiveness ratio (ICER). Delayed, versus early, hospital discharge results in similar mean expected QALYs, but substantially higher expected cost. The mean difference in QALY is 0.00016 (95% CI 0.00005-0.00040), whereas the mean difference in cost is $1170.96 (95% CI $750.13-1584.32). The ICER is estimated to be $9,771,520.87 per QALY (95% CI $2,573,139.89-24,407,017.82). The proportion of early-onset GBS that develops during the second 24 hours of life, the cost of 24 hours of inpatient observation, and the probability of long-term sequelae following prompt versus delayed treatment play important roles in determining the cost-effectiveness of delayed hospital discharge. Cost-effectiveness analysis suggests that with adequate IAP, discharging asymptomatic term neonates to home after 24 hours is the preferred approach compared with 48 hours inpatient observation. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Breast-feeding and hospitalization for asthma in early childhood: a nationwide longitudinal survey in Japan.

PubMed

Yamakawa, Michiyo; Yorifuji, Takashi; Kato, Tsuguhiko; Yamauchi, Yoshitada; Doi, Hiroyuki

2015-07-01

Whether or not breast-feeding is protective against asthma among children is still controversial. Therefore, we examined the effects of breast-feeding on hospitalization for asthma in early childhood. Secondary data analyses of a nationwide longitudinal survey of children in Japan ongoing since 2001, with results collected from 2001 to 2004. We used logistic regression models to evaluate the associations of breast-feeding with hospitalization for asthma in children between the ages of 6 and 42 months, adjusting for children's factors (sex, day-care attendance and presence of older siblings) and maternal factors (educational attainment and smoking habit). Setting All over Japan. Term singleton children with information on feeding practices during infancy (n 43367). After adjusting for maternal factors and children's factors, exclusive breast-feeding at 6-7 months of age was associated with decreased risk of hospitalization for asthma in children. The adjusted odds ratio was 0.77 (95% CI 0.56, 1.06). One-month longer duration of breast-feeding was associated with a 4% decreased risk of hospitalization for asthma (OR = 0.96; 95% CI 0.92, 0.99). The protective effects of breast-feeding on hospitalization for asthma were observed in children between the ages of 6 and 42 months.

Early nutritional support is associated with decreased length of hospitalization in dogs with septic peritonitis: A retrospective study of 45 cases (2000-2009).

PubMed

Liu, Debra T; Brown, Dorothy C; Silverstein, Deborah C

2012-08-01

To determine whether the timing and route of nutritional support strategy affect length of hospitalization in dogs with naturally occurring septic peritonitis. Retrospective study encompassing cases from 2000 to 2009. University teaching hospital. Forty-five dogs that survived septic peritonitis. None. Nutritional strategy for each dog was categorized as either enteral nutrition (EN: free choice voluntary eating or assisted tube feeding) or central parenteral nutrition (CPN). Early nutritional support was defined as consistent caloric intake initiated within 24 hours postoperatively. Consistent caloric intake occurring after 24 hours was defined as delayed nutritional support. Data reflective of nutritional status included body condition score, serum albumin concentration, and duration of inappetence before and during hospitalization. Body weight change from the beginning to the end of hospitalization was calculated. A modified Survival Prediction Index 2 score was calculated for each dog at admission. Additional clinical data recorded for comparison of illness severity included indicators of severe inflammation (eg, presence of toxic changes in neutrophils and immature neutrophils), coagulopathy (eg, prolonged prothrombin time and activated partial thromboplastin time), the use of vasopressors and blood transfusions, and presence of concurrent illnesses. Nutrition-related complications were classified as mechanical, metabolic, or septic complications. Multivariate linear regression analyses were used to determine the relationship of nutritional strategy with hospitalization length, while considering the presence of nutrition-related complications, the nutritional status- and illness severity-related variables. While controlling for other variables, dogs that received early nutrition had significantly shorter hospitalization length (by 1.6 days). No statistically significant association was found between route of nutrition and hospitalization length. The presence

Identifying barriers from home to the appropriate hospital through near-miss audits in developing countries.

PubMed

Filippi, Véronique; Richard, Fabienne; Lange, Isabelle; Ouattara, Fatoumata

2009-06-01

Near-miss cases often arrive in critical condition in referral hospitals in developing countries. Understanding the reasons why women arrive at these hospitals in a moribund state is crucial to the reduction of the incidence and case fatality of severe obstetric complications. This paper discusses how near-miss audits can empower the hospital teams to document and help reduce barriers to obstetric care in the most useful way and makes practical suggestions on interviews, analytical framework, ethical issues and staff motivation. Review of the evidence shows that case reviews and confidential enquiries appear particularly suitable to the understanding of delays. Criterion-based audits can also achieve this by establishing criteria for referral. However, hospital staff have limited intervention tools at their disposal to address barriers to emergency care at the community level. It is therefore important to involve the district management team and representatives of the community in auditing the health care seeking and treatment of women with near-miss complications.

Early diagnosis of hantavirus infection by family doctors can reduce inappropriate antibiotic use and hospitalization.

PubMed

Brorstad, Alette; Oscarsson, Kristina Bergstedt; Ahlm, Clas

2010-09-01

Hantavirus infections are emerging infections that cause either Hantavirus pulmonary syndrome or haemorrhagic fever with renal syndrome (HFRS). A recent Swedish outbreak of nephropathia epidemica, a European HFRS, was analysed to study the patient flow and clinical picture and to investigate the value of an early diagnosis in general practice. Design. In a retrospective design, medical records of verified cases of Hantavirus infection were studied. The study was conducted in the county of Norrbotten, Sweden. Data from Hantavirus patients diagnosed between 2006 and 2008 were analysed. Demographic data, level of care, treatment, clinical symptoms, and laboratory findings were obtained. In total, 456 cases were included (58% males and 42% females). The majority of patients first saw their general practitioner and were exclusively treated in general practice (83% and 56%, respectively). When diagnosed correctly at the first visit, antibiotics and hospitalization were significantly lowered compared with delayed diagnosis (14% vs. 53% and 30% vs. 54%, respectively; p < 0.0001). The clinical picture was diverse. Early thrombocytopenia was found in 65% of the patients, and haemorrhagic manifestations were documented in a few cases. Signs of renal involvement--haematuria, proteinuria, and raised levels of serum creatinine--were found in a majority of patients. Raised awareness in general practice regarding emerging infections and better diagnostic tools are desirable. This study of a Hantavirus outbreak shows that general practitioners are frontline doctors during outbreaks and through early and correct diagnosis they can reduce antibiotic treatment and hospitalization.

Locating Microseism Sources Using Spurious Arrivals in Intercontinental Noise Correlations

NASA Astrophysics Data System (ADS)

Retailleau, Lise; Boué, Pierre; Stehly, Laurent; Campillo, Michel

2017-10-01

The accuracy of Green's functions retrieved from seismic noise correlations in the microseism frequency band is limited by the uneven distribution of microseism sources at the surface of the Earth. As a result, correlation functions are often biased as compared to the expected Green's functions, and they can include spurious arrivals. These spurious arrivals are seismic arrivals that are visible on the correlation and do not belong to the theoretical impulse response. In this article, we propose to use Rayleigh wave spurious arrivals detected on correlation functions computed between European and United States seismic stations to locate microseism sources in the Atlantic Ocean. We perform a slant stack on a time distance gather of correlations obtained from an array of stations that comprises a regional deployment and a distant station. The arrival times and the apparent slowness of the spurious arrivals lead to the location of their source, which is obtained through a grid search procedure. We discuss improvements in the location through this methodology as compared to classical back projection of microseism energy. This method is interesting because it only requires an array and a distant station on each side of an ocean, conditions that can be met relatively easily.

Inhaled corticosteroids do not influence the early inflammatory response and clinical presentation of hospitalized subjects with COPD exacerbation.

PubMed

Crisafulli, Ernesto; Guerrero, Mónica; Menéndez, Rosario; Huerta, Arturo; Martinez, Raquel; Gimeno, Alexandra; Soler, Néstor; Torres, Antoni

2014-10-01

Inhaled corticosteroids are anti-inflammatory medications that can down-regulate the immunologic response in patients with COPD; however, their role at onset of COPD exacerbation is still not understood. The aim of this study was to assess the early inflammatory response and clinical presentation of patients with COPD exacerbation mediated by inhaled corticosteroids. Prospective data were collected on 123 hospitalized subjects with COPD exacerbation over a 30-month period at 2 Spanish university hospitals. Based on domiciliary use, comparative analyses were performed between subjects who did not use inhaled corticosteroids (n = 58) and subjects who did (n = 65). Measurements of serum biomarkers were recorded on admission to the hospital (day 1) and on day 3; clinical, physiological, microbiological, and severity data and mortality/readmission rates were also recorded. At days 1 and 3, both groups showed a similar inflammatory response; fluticasone produced lower levels of interleukin-8 compared with budesonide (P < .01). All clinical features considered were similar in the 2 groups; multivariate analysis predicting clinical complications on hospitalization showed air-flow obstruction severity as the only predictive factor (odds ratio 3.13, 95% CI 1.13-8.63, P = .02). Our study demonstrates a lack of inhaled corticosteroid influence in the early systemic inflammatory response to and clinical presentation of COPD exacerbation. Copyright © 2014 by Daedalus Enterprises.

Early detection of hospitalized patients with previously diagnosed obstructive sleep apnea using computer decision support alerts.

PubMed

Evans, R Scott; Flint, Vrena B; Cloward, Tom V; Beninati, William; Lloyd, James F; Megwalu, Kimberly; Simpson, Kathy J; Alsharit, Ahmed M; Balls, Shayna B; Farney, Robert J

2013-01-01

Obstructive sleep apnea (OSA) is a worldwide problem affecting 2-14% of the general population and most patients remain undiagnosed. OSA patients are at elevated risk for hypoxemia, cardiac arrhythmias, cardiorespiratory arrest, hypoxic encephalopathy, stroke and death during hospitalization. Clinical screening questionnaires are used to identify hospitalized patients with OSA; especially before surgery. However, current screening questionnaires miss a significant number of patients and require more definitive testing before specific therapy can be started. Moreover, many patients are admitted to the hospital with a previous diagnosis of OSA that is not reported. Thus, many patients with OSA do not receive appropriate therapy during hospitalization due to the lack of information from previous inpatient and outpatient encounters. Large enterprise data warehouses provide the ability to monitor patient encounters over wide geographical areas. This study found that previously diagnosed OSA is highly prevalent and undertreated in hospitalized patients and the use of early computer alerts by respiratory therapists resulted in significantly more OSA patients receiving appropriate medical care (P < 0.002) which resulted in significantly fewer experiencing hypoxemia (P < 0.006). The impact was greater for non-surgery patients compared to surgery patients.

Shear Wave Arrival Time Estimates Correlate with Local Speckle Pattern

PubMed Central

McAleavey, Stephen A.; Osapoetra, Laurentius O.; Langdon, Jonathan

2016-01-01

We present simulation and phantom studies demonstrating a strong correlation between errors in shear wave arrival time estimates and the lateral position of the local speckle pattern in targets with fully developed speckle. We hypothesize that the observed arrival time variations are largely due to the underlying speckle pattern, and call the effect speckle bias. Arrival time estimation is a key step in quantitative shear wave elastography, performed by tracking tissue motion via cross correlation of RF ultrasound echoes or similar methods. Variations in scatterer strength and interference of echoes from scatterers within the tracking beam result in an echo that does not necessarily describe the average motion within the beam, but one favoring areas of constructive interference and strong scattering. A swept-receive image, formed by fixing the transmit beam and sweeping the receive aperture over the region of interest, is used to estimate the local speckle pattern. Metrics for the lateral position of the speckle are found to correlate strongly (r>0.7) with the estimated shear wave arrival times both in simulations and in phantoms. Lateral weighting of the swept-receive pattern improved the correlation between arrival time estimates and speckle position. The simulations indicate that high RF echo correlation does not equate to an accurate shear wave arrival time estimate – a high correlation coefficient indicates that motion is being tracked with high precision, but the location tracked is uncertain within the tracking beam width. The presence of a strong on-axis speckle is seen to imply high RF correlation and low bias. The converse does not appear to be true – highly correlated RF echoes can still produce biased arrival time estimates. The shear wave arrival time bias is relatively stable with variations in shear wave amplitude and sign (−20 μm to 20 μm simulated) compared to the variation with different speckle realizations obtained along a given tracking

Fast first arrival picking algorithm for noisy microseismic data

NASA Astrophysics Data System (ADS)

Kim, Dowan; Byun, Joongmoo; Lee, Minho; Choi, Jihoon; Kim, Myungsun

2017-01-01

Most microseismic events occur during hydraulic fracturing. Thus microseismic monitoring, by recording seismic waves from microseismic events, is one of the best methods for locating the positions of hydraulic fractures. However, since microseismic events have very low energy, the data often have a low signal-to-noise ratio (S/N ratio) and it is not easy to pick the first arrival time. In this study, we suggest a new fast picking method optimised for noisy data using cross-correlation and stacking. In this method, a reference trace is selected and the time differences between the first arrivals of the reference trace and those of the other traces are computed by cross-correlation. Then, all traces are aligned with the reference trace by time shifting, and the aligned traces are summed together to produce a stacked reference trace that has a considerably improved S/N ratio. After the first arrival time of the stacked reference trace is picked, the first arrival time of each trace is calculated automatically using the time differences obtained in the cross-correlation process. In experiments with noisy synthetic data and field data, this method produces more reliable results than the traditional method, which picks the first arrival time of each noisy trace separately. In addition, the computation time is dramatically reduced.

EVA Suits Arrival

NASA Image and Video Library

2002-01-01

Extravehicular Activity (EVA) suits packed inside containers arrive at the Space Station Processing Facility from Johnson Space Center in Texas. The suits will be used by STS-117 crew members to perform several spacewalks during the mission. The mission payload aboard Space Shuttle Atlantis is the S3/S4 integrated truss structure, along with a third set of solar arrays and batteries. The crew of six astronauts will install the truss to continue assembly of the International Space Station.

Early outcome of patients undergoing transcatheter aortic valve implantation (TAVI): The Auckland City Hospital experience 2011-2015.

PubMed

Wu, Sylvia S Y; Wang, Tom Kai Ming; Nand, Parma; Ramanathan, Tharumenthiran; Webster, Mark; Stewart, Jim

2016-01-08

Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR) in high-risk patients. We report the initial TAVI experience at Auckland City Hospital. The records of patients undergoing TAVI between 2011 and 2015 at Auckland City Hospital were reviewed. We report the procedural success and outcome, including major adverse events (death, stroke, myocardial infarction, bleeding, vascular complications and rehospitalisations), degree of aortic regurgitation and symptom status up to 1-year follow-up. Mean age was 80.7 years and mean Euroscore II and Society of Thoracic Surgeons' scores were 8.2% and 6.3% respectively; 50% had undergone previous cardiac surgery. Successful deployment of the valve was achieved in all patients. The cumulative mortality rates at 30 days, 6 months and 1 year were 2.4%, 6.1% and 12.2% and cumulative stroke rates 1.2%, 3% and 8.2% respectively. Severe aortic regurgitation occurred in 2.3% TAVI is available in the New Zealand public hospital system for patients who are high-risk candidates for AVR. Early results are excellent and indicate that the technology is being used appropriately, according to current access criteria. If the early cost effectiveness data are confirmed, the indications for TAVI may widen.

Pediatric Early Warning Systems aid in triage to intermediate versus intensive care for pediatric oncology patients in resource-limited hospitals.

PubMed

Agulnik, Asya; Nadkarni, Anisha; Mora Robles, Lupe Nataly; Soberanis Vasquez, Dora Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Rodriguez-Galindo, Carlos

2018-04-10

Pediatric oncology patients hospitalized in resource-limited settings are at high risk for clinical deterioration resulting in mortality. Intermediate care units (IMCUs) provide a cost-effective alternative to pediatric intensive care units (PICUs). Inappropriate IMCU triage, however, can lead to poor outcomes and suboptimal resource utilization. In this study, we sought to characterize patients with clinical deterioration requiring unplanned transfer to the IMCU in a resource-limited pediatric oncology hospital. Patients requiring subsequent early PICU transfer had longer PICU length of stay. PEWS results prior to IMCU transfer were higher in patients requiring early PICU transfer, suggesting PEWS can aid in triage between IMCU and PICU care. © 2018 Wiley Periodicals, Inc.

Anchorage Arrival Scheduling Under Off-Nominal Weather Conditions

NASA Technical Reports Server (NTRS)

Grabbe, Shon; Chan, William N.; Mukherjee, Avijit

2012-01-01

Weather can cause flight diversions, passenger delays, additional fuel consumption and schedule disruptions at any high volume airport. The impacts are particularly acute at the Ted Stevens Anchorage International Airport in Anchorage, Alaska due to its importance as a major international portal. To minimize the impacts due to weather, a multi-stage scheduling process is employed that is iteratively executed, as updated aircraft demand and/or airport capacity data become available. The strategic scheduling algorithm assigns speed adjustments for flights that originate outside of Anchorage Center to achieve the proper demand and capacity balance. Similarly, an internal departure-scheduling algorithm assigns ground holds for pre-departure flights that originate from within Anchorage Center. Tactical flight controls in the form of airborne holding are employed to reactively account for system uncertainties. Real-world scenarios that were derived from the January 16, 2012 Anchorage visibility observations and the January 12, 2012 Anchorage arrival schedule were used to test the initial implementation of the scheduling algorithm in fast-time simulation experiments. Although over 90% of the flights in the scenarios arrived at Anchorage without requiring any delay, pre-departure scheduling was the dominant form of control for Anchorage arrivals. Additionally, tactical scheduling was used extensively in conjunction with the pre-departure scheduling to reactively compensate for uncertainties in the arrival demand. For long-haul flights, the strategic scheduling algorithm performed best when the scheduling horizon was greater than 1,000 nmi. With these long scheduling horizons, it was possible to absorb between ten and 12 minutes of delay through speed control alone. Unfortunately, the use of tactical scheduling, which resulted in airborne holding, was found to increase as the strategic scheduling horizon increased because of the additional uncertainty in the arrival times

[Frequency of cancer in a specialty hospital in Mexico City. Implications for the development of early detection methods].

PubMed

Herrera-Torre, Analy; García-Rodríguez, Francisco Mario; García, Rebeca Gil; Jiménez-Villanueva, Xicoténcatl; Hernández-Rubio, Angela; Aboharp-Hasan, Ziad

2014-01-01

Cancer is the second cause of death in Mexico. The Juarez Hospital of Mexico is a highly specialized general hospital in which the frequency of cancer treated at the Oncology Unit is a representative sample of the frequency of cancer in the country. To learn about the frequency of presentation of tumors diagnosed in a third level hospital. We reviewed all the biopsies and surgical specimens diagnosed as cancer or malignant tumors registered in the pathology unit during the years 2006 to 2010. We grouped the cases by age, sex, and anatomic site. We identified the 10 most common cancers for both sexes, age groups and sex affected, raising the chances of early detection campaigns reinforce for the most common cancers and try to increase control and cure rates and improve coverage of the economically weak, for their integration into health systems. Information obtained reflects the reality of the country to the general population without entitlements. That in our country women suffer more than men of cancer that breast neoplasms and genital tract are the most frequent, and timely detection systems exist and should be strengthened to achieve greater eligible for early identification of cases in our population.

Budget impact analysis of trastuzumab in early breast cancer: a hospital district perspective.

PubMed

Purmonen, Timo T; Auvinen, Päivi K; Martikainen, Janne A

2010-04-01

Adjuvant trastuzumab is widely used in HER2-positive (HER2+) early breast cancer, and despite its cost-effectiveness, it causes substantial costs for health care. The purpose of the study was to develop a tool for estimating the budget impact of new cancer treatments. With this tool, we were able to estimate the budget impact of adjuvant trastuzumab, as well as the probability of staying within a given budget constraint. The created model-based evaluation tool was used to explore the budget impact of trastuzumab in early breast cancer in a single Finnish hospital district with 250,000 inhabitants. The used model took into account the number of patients, HER2+ prevalence, length and cost of treatment, and the effectiveness of the therapy. Probabilistic sensitivity analysis and alternative case scenarios were performed to ensure the robustness of the results. Introduction of adjuvant trastuzumab caused substantial costs for a relatively small hospital district. In base-case analysis the 4-year net budget impact was 1.3 million euro. The trastuzumab acquisition costs were partially offset by the reduction in costs associated with the treatment of cancer recurrence and metastatic disease. Budget impact analyses provide important information about the overall economic impact of new treatments, and thus offer complementary information to cost-effectiveness analyses. Inclusion of treatment outcomes and probabilistic sensitivity analysis provides more realistic estimates of the net budget impact. The length of trastuzumab treatment has a strong effect on the budget impact.

An early, novel illness severity score to predict outcome after cardiac arrest.

PubMed

Rittenberger, Jon C; Tisherman, Samuel A; Holm, Margo B; Guyette, Francis X; Callaway, Clifton W

2011-11-01

Illness severity scores are commonly employed in critically ill patients to predict outcome. To date, prior scores for post-cardiac arrest patients rely on some event-related data. We developed an early, novel post-arrest illness severity score to predict survival, good outcome and development of multiple organ failure (MOF) after cardiac arrest. Retrospective review of data from adults treated after in-hospital or out-of-hospital cardiac arrest in a single tertiary care facility between 1/1/2005 and 12/31/2009. In addition to clinical data, initial illness severity was measured using serial organ function assessment (SOFA) scores and full outline of unresponsiveness (FOUR) scores at hospital or intensive care unit arrival. Outcomes were hospital mortality, good outcome (discharge to home or rehabilitation) and development of multiple organ failure (MOF). Single-variable logistic regression followed by Chi-squared automatic interaction detector (CHAID) was used to determine predictors of outcome. Stepwise multivariate logistic regression was used to determine the independent association between predictors and each outcome. The Hosmer-Lemeshow test was used to evaluate goodness of fit. The n-fold method was used to cross-validate each CHAID analysis and the difference between the misclassification risk estimates was used to determine model fit. Complete data from 457/495 (92%) subjects identified distinct categories of illness severity using combined FOUR motor and brainstem subscales, and combined SOFA cardiovascular and respiratory subscales: I. Awake; II. Moderate coma without cardiorespiratory failure; III. Moderate coma with cardiorespiratory failure; and IV. Severe coma. Survival was independently associated with category (I: OR 58.65; 95% CI 27.78, 123.82; II: OR 14.60; 95% CI 7.34, 29.02; III: OR 10.58; 95% CI 4.86, 23.00). Category was also similarly associated with good outcome and development of MOF. The proportion of subjects in each category changed

[In-hospital resuscitation. Concept of first-responder resuscitation using semi-automated external defibrillators (AED)].

PubMed

Hanefeld, C; Lichte, C; Laubenthal, H; Hanke, E; Mügge, A

2006-09-29

The prognosis after in-hospital resuscitation has not significantly improved in the last 40 years. This account presents the results over a three-year period of a hospital-wide emergency plan which implements the use of an automated external defibrillator (AED) by the first responder to the emergency call. 15 "defibrillator points" were installed, which could be reached within 30 s from all wards, out-patient departments and other areas, thus making them accessible for immediate defibrillator application. The hospital personnel is trained periodically in the alarm sequence, cardiopulmonary resuscitation and use of the defibrillator. Data on 57 patients who had sustained a cardiac arrest were prospectively recorded and analysed. In 46 patients (81%) the "on-the-spot" personnel (first-responder) was able to apply AED before arrival of the hospital's resuscitation team. Mean period between arrest alarm and activation of the AED was 2.2 (0.7-4.7) min. Ventricular fibrillation or ventricular tachyarrhythmia was recorded in 40 patients, making immediate shock delivery by AED possible. Restoration of the circulation was achieved in 23 (80%) of the patients and 20 (50%) were discharged home, 17 (43%) without neurological deficit. The high proportion of first-responder AED applications and evaluation of the personnel training indicate a wide acceptance of the emergency plan among the personnel. An immediate resuscitation plan consisting of an integrated programme of early defibrillation is feasible and seems to achieve an improved prognosis for patients who have sustained an in-hospital cardiac arrest.

CAT-PUMA: CME Arrival Time Prediction Using Machine learning Algorithms

NASA Astrophysics Data System (ADS)

Liu, Jiajia; Ye, Yudong; Shen, Chenglong; Wang, Yuming; Erdélyi, Robert

2018-04-01

CAT-PUMA (CME Arrival Time Prediction Using Machine learning Algorithms) quickly and accurately predicts the arrival of Coronal Mass Ejections (CMEs) of CME arrival time. The software was trained via detailed analysis of CME features and solar wind parameters using 182 previously observed geo-effective partial-/full-halo CMEs and uses algorithms of the Support Vector Machine (SVM) to make its predictions, which can be made within minutes of providing the necessary input parameters of a CME.

Short Text Messages (SMS) as an Additional Tool for Notifying Medical Staff in Case of a Hospital Mass Casualty Incident.

PubMed

Timler, Dariusz; Bogusiak, Katarzyna; Kasielska-Trojan, Anna; Neskoromna-Jędrzejczak, Aneta; Gałązkowski, Robert; Szarpak, Łukasz

2016-02-01

The aim of the study was to verify the effectiveness of short text messages (short message service, or SMS) as an additional notification tool in case of fire or a mass casualty incident in a hospital. A total of 2242 SMS text messages were sent to 59 hospital workers divided into 3 groups (n=21, n=19, n=19). Messages were sent from a Samsung GT-S8500 Wave cell phone and Orange Poland was chosen as the telecommunication provider. During a 3-month trial period, messages were sent between 3:35 PM and midnight with no regular pattern. Employees were asked to respond by telling how much time it would take them to reach the hospital in case of a mass casualty incident. The mean reaction time (SMS reply) was 36.41 minutes. The mean declared time of arrival to the hospital was 100.5 minutes. After excluding 10% of extreme values for declared arrival time, the mean arrival time was estimated as 38.35 minutes. Short text messages (SMS) can be considered an additional tool for notifying medical staff in case of a mass casualty incident.

Ensemble-based methods for forecasting census in hospital units

PubMed Central

2013-01-01

Background The ability to accurately forecast census counts in hospital departments has considerable implications for hospital resource allocation. In recent years several different methods have been proposed forecasting census counts, however many of these approaches do not use available patient-specific information. Methods In this paper we present an ensemble-based methodology for forecasting the census under a framework that simultaneously incorporates both (i) arrival trends over time and (ii) patient-specific baseline and time-varying information. The proposed model for predicting census has three components, namely: current census count, number of daily arrivals and number of daily departures. To model the number of daily arrivals, we use a seasonality adjusted Poisson Autoregressive (PAR) model where the parameter estimates are obtained via conditional maximum likelihood. The number of daily departures is predicted by modeling the probability of departure from the census using logistic regression models that are adjusted for the amount of time spent in the census and incorporate both patient-specific baseline and time varying patient-specific covariate information. We illustrate our approach using neonatal intensive care unit (NICU) data collected at Women & Infants Hospital, Providence RI, which consists of 1001 consecutive NICU admissions between April 1st 2008 and March 31st 2009. Results Our results demonstrate statistically significant improved prediction accuracy for 3, 5, and 7 day census forecasts and increased precision of our forecasting model compared to a forecasting approach that ignores patient-specific information. Conclusions Forecasting models that utilize patient-specific baseline and time-varying information make the most of data typically available and have the capacity to substantially improve census forecasts. PMID:23721123

SIRTF Arrival

NASA Image and Video Library

2003-03-06

The Space Infrared Telescope Facility (SIRTF) arrives at Building AE from the Lockheed Martin plant in Sunnyvale, Calif., to begin final preparations for its launch aboard a Delta II rocket. SIRTF will obtain images and spectra by detecting the infrared energy, or heat, radiated by objects in space. Most of this infrared radiation is blocked by the Earth's atmosphere and cannot be observed from the ground. Consisting of an 0.85-meter telescope and three cryogenically cooled science instruments, SIRTF is one of NASA's largest infrared telescopes to be launched. SIRTF is scheduled for launch April 15 at 4:34:07 a.m. EDT from Launch Complex 17-B, Cape Canaveral Air Force Station.

Mobile Quarantine Facility (MQF) - Arrival - Ellington AFB (EAFB), TX

NASA Image and Video Library

1969-11-29

S69-60644 (29 Nov. 1969) --- A Mobile Quarantine Facility (MQF), with the crew men of the Apollo 12 lunar landing mission aboard, arrived at the Manned Spacecraft Center (MSC) Saturday morning, Nov. 29, 1969. Astronauts Charles Conrad Jr., Richard F. Gordon Jr., and Alan L. Bean were on their way to the Lunar Receiving Laboratory (LRL) where they will remain in quarantines until Dec. 10, 1969. Minutes earlier the three astronauts had arrived at Ellington Air Force Base from Hawaii aboard a U.S. Air Force C-141 transport. The crewmen were confined to the MQF from splashdown until they arrived at the LRL.

Concept of Operations for Interval Management Arrivals and Approach

NASA Technical Reports Server (NTRS)

Hicok, Daniel S.; Barmore, Bryan E.

2016-01-01

This paper presents the concept of operations for interval management operations to be deployed in the US National Airspace System (NAS) by the Federal Aviation Administration (FAA) after 2020. The use of interval management operations is described that begin in en route airspace and continue to a termination point inside the arrival terminal area, in a terminal environment that includes other arrival management tools such as arrival metering, Ground-based Interval Management - Spacing (GIM-S), and Terminal Sequencing and Spacing (TSAS). The roles of Air Traffic Controllers and Flight Crews and the ground automation tools that are used by Air Traffic Controllers to enable the primary operation and variations are described.

Arrival Metering Precision Study

NASA Technical Reports Server (NTRS)

Prevot, Thomas; Mercer, Joey; Homola, Jeffrey; Hunt, Sarah; Gomez, Ashley; Bienert, Nancy; Omar, Faisal; Kraut, Joshua; Brasil, Connie; Wu, Minghong, G.

2015-01-01

This paper describes the background, method and results of the Arrival Metering Precision Study (AMPS) conducted in the Airspace Operations Laboratory at NASA Ames Research Center in May 2014. The simulation study measured delivery accuracy, flight efficiency, controller workload, and acceptability of time-based metering operations to a meter fix at the terminal area boundary for different resolution levels of metering delay times displayed to the air traffic controllers and different levels of airspeed information made available to the Time-Based Flow Management (TBFM) system computing the delay. The results show that the resolution of the delay countdown timer (DCT) on the controllers display has a significant impact on the delivery accuracy at the meter fix. Using the 10 seconds rounded and 1 minute rounded DCT resolutions resulted in more accurate delivery than 1 minute truncated and were preferred by the controllers. Using the speeds the controllers entered into the fourth line of the data tag to update the delay computation in TBFM in high and low altitude sectors increased air traffic control efficiency and reduced fuel burn for arriving aircraft during time based metering.

Contributed Review: Source-localization algorithms and applications using time of arrival and time difference of arrival measurements

NASA Astrophysics Data System (ADS)

Li, Xinya; Deng, Zhiqun Daniel; Rauchenstein, Lynn T.; Carlson, Thomas J.

2016-04-01

Locating the position of fixed or mobile sources (i.e., transmitters) based on measurements obtained from sensors (i.e., receivers) is an important research area that is attracting much interest. In this paper, we review several representative localization algorithms that use time of arrivals (TOAs) and time difference of arrivals (TDOAs) to achieve high signal source position estimation accuracy when a transmitter is in the line-of-sight of a receiver. Circular (TOA) and hyperbolic (TDOA) position estimation approaches both use nonlinear equations that relate the known locations of receivers and unknown locations of transmitters. Estimation of the location of transmitters using the standard nonlinear equations may not be very accurate because of receiver location errors, receiver measurement errors, and computational efficiency challenges that result in high computational burdens. Least squares and maximum likelihood based algorithms have become the most popular computational approaches to transmitter location estimation. In this paper, we summarize the computational characteristics and position estimation accuracies of various positioning algorithms. By improving methods for estimating the time-of-arrival of transmissions at receivers and transmitter location estimation algorithms, transmitter location estimation may be applied across a range of applications and technologies such as radar, sonar, the Global Positioning System, wireless sensor networks, underwater animal tracking, mobile communications, and multimedia.

Inferring the background traffic arrival process in the Internet.

PubMed

Hága, Péter; Csabai, István; Vattay, Gábor

2009-12-01

Phase transition has been found in many complex interactivity systems. Complex networks are not exception either but there are quite few real systems where we can directly understand the emergence of this nontrivial behavior from the microscopic view. In this paper, we present the emergence of the phase transition between the congested and uncongested phases of a network link. We demonstrate a method to infer the background traffic arrival process, which is one of the key state parameters of the Internet traffic. The traffic arrival process in the Internet has been investigated in several studies, since the recognition of its self-similar nature. The statistical properties of the traffic arrival process are very important since they are fundamental in modeling the dynamical behavior. Here, we demonstrate how the widely used packet train technique can be used to determine the main properties of the traffic arrival process. We show that the packet train dispersion is sensitive to the congestion on the network path. We introduce the packet train stretch as an order parameter to describe the phase transition between the congested and uncongested phases of the bottleneck link in the path. We find that the distribution of the background traffic arrival process can be determined from the average packet train dispersion at the critical point of the system.

Hospital differences in motor activity early after stroke: a comparison of 11 Norwegian stroke units.

PubMed

Hokstad, Anne; Indredavik, Bent; Bernhardt, Julie; Ihle-Hansen, Hege; Salvesen, Øyvind; Seljeseth, Yngve Müller; Schüler, Stephan; Engstad, Torgeir; Askim, Torunn

2015-06-01

Activity levels in patients early after stroke vary across the world. The primary aim of this study was to assess the variation in motor activity in patients admitted to multiple Norwegian stroke units and to identify factors which explained the variation between hospitals. Eligible patients were those less than 14 days after stroke, more than 18 years, not receiving palliative care. Activity levels, people present, and location were recorded by the use of a standard method of observation between 8 am and 5 pm. Hospital policy on serving meals in communal areas was also registered. Mixed general binomial model was used to analyze, which factors explained variation in activity levels between hospitals, after adjusting for age and stroke severity. A total of 393 patients from 11 stroke units were included. The patients spent 44.1% of the day in bed, 43.2% sitting out of bed, and 8.3% in higher motor activities (4.4% were not observed). Increased physical activity was associated with spending more time with a physical therapist, odds ratio (OR), 1.05 (95% confidence interval [CI], 1.03-1.08, P < .001) and admitted to a hospital serving the meals in communal areas, OR, 1.46 (95% CI, 1.09-1.95, P = .011). Despite variation between the hospitals, patients admitted to Norwegian stroke units spend most of the day out of bed. Time spent with a physical therapist and hospitals having a policy of serving meals in communal areas explained most of the variation in activity between hospitals. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Tracheal intubation in the emergency department: the Scottish district hospital perspective.

PubMed

Stevenson, A G M; Graham, C A; Hall, R; Korsah, P; McGuffie, A C

2007-06-01

Tracheal intubation is the accepted gold standard for emergency department (ED) airway management. It may be performed by both anaesthetists and emergency physicians (EPs), with or without drugs. To characterise intubation practice in a busy district general hospital ED in Scotland over 40 months between 2003 and 2006. Crosshouse Hospital, a 450-bed district general hospital serving a mixed urban and rural population; annual ED census 58,000 patients. Prospective observational study using data collection sheets prepared by the Scottish Trauma Audit Group. Proformas were completed at the time of intubation and checked by investigators. Rapid-sequence induction (RSI) was defined as the co-administration of an induction agent and suxamethonium. 234 intubations over 40 months, with a mean of 6 per month. EPs attempted 108 intubations (46%). Six patients in cardiac arrest on arrival were intubated without drugs. 29 patients were intubated after a gas induction or non-RSI drug administration. RSI was performed on 199 patients. Patients with trauma constituted 75 (38%) of the RSI group. 29 RSIs (15%) were immediate (required on arrival at the ED) and 154 (77%) were urgent (required within 30 min of arrival at the ED). EPs attempted RSI in 88 (44%) patients and successfully intubated 85 (97%). Anaesthetists attempted RSI in 111 (56%) patients and successfully intubated 108 (97%). Anaesthetists had a higher proportion of good views at first laryngoscopy and there was a trend to a higher rate of successful intubation at the first attempt for anaesthetists. Complication rates were comparable for the two specialties. Tracheal intubations using RSI in the ED are performed by EPs almost as often as by anaesthetists in this district hospital. Overall success and complication rates are comparable for the two specialties. Laryngoscopy training and the need to achieve intubation at the first (optimum) attempt needs to be emphasised in EP airway training.

Emergency department clinical redesign, team-based care and improvements in hospital performance: A time series analysis.

PubMed

Dinh, Michael M; Green, Timothy C; Bein, Kendall J; Lo, Serigne; Jones, Aaron; Johnson, Terence

2015-08-01

The objective was to evaluate the impact of an ED clinical redesign project that involved team-based care and early senior assessment on hospital performance. This was an interrupted time series analysis performed using daily hospital performance data 6 months before and 8 months after the implementation of the clinical redesign intervention that involved Emergency Consultant-led team-based care, redistribution of ED beds and implementation of a senior nursing coordination roles in the ED. The primary outcome was the daily National Emergency Access Target (NEAT) performance (proportion of total daily ED presentations that were admitted to an inpatient ward or discharged from ED within 4 h of arrival). Secondary outcomes were daily ALOS in ED, inpatient Clinical Emergency Response System (CERS) calls and hospital mortality. Autoregressive Integrated Moving Average analysis was used to model NEAT performance. Hospital mortality was modelled using negative binomial regression. After adjusting for patient volume, inpatient admissions, ambulance, hospital occupancy, weekends ED Consultant numbers, weekends and underlying trends, there was a 17% improvement in NEAT associated with the post-intervention period (95% CI 12, 19% P < 0.001). There was no change in the number of CERS calls and the median daily hospital mortality rate reduced from 1.04% to 0.96% (P = 0.025). An ED-focused clinical redesign project was associated with a 17% improvement in NEAT performance with no evidence of an increase in clinical deterioration on inpatient wards and evidence for an improvement in hospital mortality. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients: The EPOCH Randomized Clinical Trial.

PubMed

Parshuram, Christopher S; Dryden-Palmer, Karen; Farrell, Catherine; Gottesman, Ronald; Gray, Martin; Hutchison, James S; Helfaer, Mark; Hunt, Elizabeth A; Joffe, Ari R; Lacroix, Jacques; Moga, Michael Alice; Nadkarni, Vinay; Ninis, Nelly; Parkin, Patricia C; Wensley, David; Willan, Andrew R; Tomlinson, George A

2018-03-13

There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes. To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use. A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years). Participating hospitals had continuous physician staffing and subspecialized pediatric services. Patient enrollment began on February 28, 2011, and ended on June 21, 2015. Follow-up ended on July 19, 2015. The BedsidePEWS intervention (10 hospitals) was compared with usual care (no severity of illness score; 11 hospitals). The primary outcome was all-cause hospital mortality. The secondary outcome was a significant clinical deterioration event, which was defined as a composite outcome reflecting late ICU admission. Regression analyses accounted for hospital-level clustering and baseline rates. Among 144 539 patient discharges at 21 randomized hospitals, there were 559 443 patient-days and 144 539 patients (100%) completed the trial. All-cause hospital mortality was 1.93 per 1000 patient discharges at hospitals with BedsidePEWS and 1.56 per 1000 patient discharges at hospitals with usual care (adjusted between-group rate difference, 0.01 [95% CI, -0.80 to 0.81 per 1000 patient discharges]; adjusted odds ratio, 1.01 [95% CI, 0.61 to 1.69]; P = .96). Significant clinical deterioration events occurred during 0.50 per 1000 patient-days at hospitals with BedsidePEWS vs 0.84 per 1000 patient-days at hospitals with usual care (adjusted between-group rate difference, -0.34 [95% CI, -0.73 to 0.05 per 1000 patient

Diagnosis and prognosis of early-onset intrahepatic cholestasis of pregnancy: a prospective study.

PubMed

Lin, Jing; Gu, Wei; Hou, Yanyan

2017-11-07

To explore the gestational age of early-onset intrahepatic cholestasis (ICP) of pregnancy, and to analyze the relationship between the clinical biochemical indices and pregnancy outcomes in order to arrive at a reasonable diagnosis and administer appropriate treatment. This is a retrospective clinical study. We selected 47,260 pregnant women who received prenatal care and underwent childbirth at the International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University from January 2014 to December 2016 for participating in this study. Of these 47,260 women, 407 developed ICP. To calculate the gestational week cutoff between early- and late-onset ICP by the receiver-operating characteristic (ROC) curve and Youden's index. Two independent samples t tests and chi square test were used to compare the differences in biochemical indices and pregnancy outcomes between the two groups. We found that 34 weeks is the most appropriate cutoff gestational age for the diagnosis of early-onset ICP. Early-onset ICP is characterized by early onset, long disease duration and a higher incidence of preterm labor, fetal distress, and fetal low birth weight compared to late-onset ICP. Thirty-four weeks is the most appropriate cutoff gestational age for the diagnosis of early-onset ICP. And to reduce the adverse pregnancy outcomes in cases of early-onset ICP, we suggest prolonging gestation up to 37 weeks as far as possible before selecting iatrogenic birth.

Calculating shock arrival in expansion tubes and shock tunnels using Bayesian changepoint analysis

NASA Astrophysics Data System (ADS)

James, Christopher M.; Bourke, Emily J.; Gildfind, David E.

2018-06-01

To understand the flow conditions generated in expansion tubes and shock tunnels, shock speeds are generally calculated based on shock arrival times at high-frequency wall-mounted pressure transducers. These calculations require that the shock arrival times are obtained accurately. This can be non-trivial for expansion tubes especially because pressure rises may be small and shock speeds high. Inaccurate shock arrival times can be a significant source of uncertainty. To help address this problem, this paper investigates two separate but complimentary techniques. Principally, it proposes using a Bayesian changepoint detection method to automatically calculate shock arrival, potentially reducing error and simplifying the shock arrival finding process. To compliment this, a technique for filtering the raw data without losing the shock arrival time is also presented and investigated. To test the validity of the proposed techniques, tests are performed using both a theoretical step change with different levels of noise and real experimental data. It was found that with conditions added to ensure that a real shock arrival time was found, the Bayesian changepoint analysis method was able to automatically find the shock arrival time, even for noisy signals.

Sentinel lymph node biopsy for early oral cancers: Westmead Hospital experience.

PubMed

Abdul-Razak, Muzib; Chung, Hsiang; Wong, Eva; Palme, Carsten; Veness, Michael; Farlow, David; Coleman, Hedley; Morgan, Gary

2017-01-01

Sentinel lymph node biopsy (SLNB) has become an alternative option to elective neck dissection (END) for early oral cavity squamous cell carcinoma (OCSCC) outside of Australia. We sought to assess the technical feasibility of SLNB and validate its accuracy against that of END in an Australian setting. We performed a prospective cohort study consisting of 30 consecutive patients with cT 1 - 2 N 0 OCSCC referred to the Head and Neck Cancer Service, Westmead Hospital, Sydney, between 2011 and 2014. All patients underwent SLNB followed by immediate selective neck dissection (levels I-III). A total of 30 patients were diagnosed with an early clinically node-negative OCSCC (seven cT1 and 23 cT2), with the majority located on the oral tongue. A median of three (range: 1-14) sentinel nodes were identified on lymphoscintigraphy, and all sentinel nodes were successfully retrieved, with 50% having a pathologically positive sentinel node. No false-negative sentinel nodes were identified using selective neck dissection as the gold standard. The negative predictive value (NPV) of SLNB was 100%, with 40% having a sentinel node identified outside the field of planned neck dissection on lymphoscintigraphy. Of these, one patient had a positive sentinel node outside of the ipsilateral supraomohyoid neck dissection template. SLNB for early OCSCC is technically feasible in an Australian setting. It has a high NPV and can potentially identify at-risk lymphatic basins outside the traditional selective neck dissection levels even in well-lateralized lesions. © 2016 Royal Australasian College of Surgeons.

Improved outcomes after successful implementation of a pediatric early warning system (PEWS) in a resource-limited pediatric oncology hospital.

PubMed

Agulnik, Asya; Mora Robles, Lupe Nataly; Forbes, Peter W; Soberanis Vasquez, Doris Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Kleinman, Monica; Rodriguez-Galindo, Carlos

2017-08-01

Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in resource-limited settings. Pediatric early warning systems (PEWS) aid in the early identification of clinical deterioration; however, there are limited data regarding their feasibility or impact in low-resource settings. This study describes the successful implementation of PEWS at the Unidad Nacional de Oncología Pediátrica (UNOP), a pediatric oncology hospital in Guatemala, resulting in improved inpatient outcomes. A modified PEWS was implemented at UNOP with systems to track errors, transfers to a higher level of care, and high scores. A retrospective cohort study was used to evaluate clinical deterioration events in the year before and after PEWS implementation. After PEWS implementation at UNOP, there was 100% compliance with PEWS documentation and an error rate of <10%. Implementation resulted in 5 high PEWS per week, with 30% of patients transferring to a higher level of care. Among patients requiring transfer to the pediatric intensive care unit (PICU), 93% had an abnormal PEWS before transfer. The rate of clinical deterioration events decreased after PEWS implementation (9.3 vs 6.5 per 1000-hospitalpatient-days, p = .003). Despite an 18% increase in total hospital patient-days, PICU utilization for inpatient transfers decreased from 1376 to 1088 PICU patient-days per year (21% decrease; P<.001). This study describes the successful implementation of PEWS in a pediatric oncology hospital in Guatemala, resulting in decreased inpatient clinical deterioration events and PICU utilization. This work demonstrates that PEWS is a feasible and effective quality improvement measure to improve hospital care for children with cancer in hospitals with limited resources. Cancer 2017;123:2965-74. © 2017 American Cancer Society. © 2017 American Cancer Society.

19 CFR 123.61 - Baggage arriving in baggage car.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Baggage arriving in baggage car. 123.61 Section... OF THE TREASURY CBP RELATIONS WITH CANADA AND MEXICO Baggage § 123.61 Baggage arriving in baggage car... cars. [T.D. 70-121, 35 FR 8215, May 26, 1970, as amended by T.D. 82-145, 47 FR 35478, Aug. 16, 1982] ...

19 CFR 123.61 - Baggage arriving in baggage car.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Baggage arriving in baggage car. 123.61 Section... OF THE TREASURY CBP RELATIONS WITH CANADA AND MEXICO Baggage § 123.61 Baggage arriving in baggage car... cars. [T.D. 70-121, 35 FR 8215, May 26, 1970, as amended by T.D. 82-145, 47 FR 35478, Aug. 16, 1982] ...

19 CFR 123.61 - Baggage arriving in baggage car.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Baggage arriving in baggage car. 123.61 Section... car. An inward foreign manifest on Customs Form 7533 shall be used for all baggage arriving in baggage cars. [T.D. 70-121, 35 FR 8215, May 26, 1970, as amended by T.D. 82-145, 47 FR 35478, Aug. 16, 1982] ...

19 CFR 123.61 - Baggage arriving in baggage car.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Baggage arriving in baggage car. 123.61 Section... OF THE TREASURY CBP RELATIONS WITH CANADA AND MEXICO Baggage § 123.61 Baggage arriving in baggage car... cars. [T.D. 70-121, 35 FR 8215, May 26, 1970, as amended by T.D. 82-145, 47 FR 35478, Aug. 16, 1982] ...

19 CFR 123.61 - Baggage arriving in baggage car.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Baggage arriving in baggage car. 123.61 Section... OF THE TREASURY CBP RELATIONS WITH CANADA AND MEXICO Baggage § 123.61 Baggage arriving in baggage car... cars. [T.D. 70-121, 35 FR 8215, May 26, 1970, as amended by T.D. 82-145, 47 FR 35478, Aug. 16, 1982] ...

Development of smartphone application that aids stroke screening and identifying nearby acute stroke care hospitals.

PubMed

Nam, Hyo Suk; Heo, JoonNyung; Kim, Jinkwon; Kim, Young Dae; Song, Tae Jin; Park, Eunjeong; Heo, Ji Hoe

2014-01-01

The benefits of thrombolytic treatment are time-dependent. We developed a smartphone application that aids stroke patient self-screening and hospital selection, and may also decrease hospital arrival time. The application was developed for iPhone and Android smartphones. Map data for the application were adopted from the open map. For hospital registration, a web page (http://stroke119.org) was developed using PHP and MySQL. The Stroke 119 application includes a stroke screening tool and real-time information on nearby hospitals that provide thrombolytic treatment. It also provides information on stroke symptoms, thrombolytic treatment, and prescribed actions when stroke is suspected. The stroke screening tool was adopted from the Cincinnati Prehospital Stroke Scale and is displayed in a cartoon format. If the user taps a cartoon image that represents abnormal findings, a pop-up window shows that the user may be having a stroke, informs the user what to do, and directs the user to call emergency services. Information on nearby hospitals is provided in map and list views, incorporating proximity to the user's location using a Global Positioning System (a built-in function of smartphones). Users can search for a hospital according to specialty and treatment levels. We also developed a web page for hospitals to register in the system. Neurology training hospitals and hospitals that provide acute stroke care in Korea were invited to register. Seventy-seven hospitals had completed registration. This application may be useful for reducing hospital arrival times for thrombolytic candidates.

Improved arrival-date estimates of Arctic-breeding Dunlin (Calidris alpina arcticola)

USGS Publications Warehouse

Doll, Andrew C.; Lanctot, Richard B.; Stricker, Craig A.; Yezerinac, Stephen M.; Wunder, Michael B.

2015-01-01

The use of stable isotopes in animal ecology depends on accurate descriptions of isotope dynamics within individuals. The prevailing assumption that laboratory-derived isotopic parameters apply to free-living animals is largely untested. We used stable carbon isotopes (δ13C) in whole blood from migratory Dunlin (Calidris alpina arcticola) to estimate an in situ turnover rate and individual diet-switch dates. Our in situ results indicated that turnover rates were higher in free-living birds, in comparison to the results of an experimental study on captive Dunlin and estimates derived from a theoretical allometric model. Diet-switch dates from all 3 methods were then used to estimate arrival dates to the Arctic; arrival dates calculated with the in situ turnover rate were later than those with the other turnover-rate estimates, substantially so in some cases. These later arrival dates matched dates when local snow conditions would have allowed Dunlin to settle, and agreed with anticipated arrival dates of Dunlin tracked with light-level geolocators. Our study presents a novel method for accurately estimating arrival dates for individuals of migratory species in which return dates are difficult to document. This may be particularly appropriate for species in which extrinsic tracking devices cannot easily be employed because of cost, body size, or behavioral constraints, and in habitats that do not allow individuals to be detected easily upon first arrival. Thus, this isotopic method offers an exciting alternative approach to better understand how species may be altering their arrival dates in response to changing climatic conditions.

STS-76 crew after arrival at SLF

NASA Technical Reports Server (NTRS)

1996-01-01

STS-76 Mission Commander Kevin P. Chilton (left); Mission Specialists Linda M. Godwin and Shannon W. Lucid; Pilot Richard A. Searfoss and Mission Specialist Michael 'Rich' Clifford chat shortly after their arrival at KSC's Shuttle Landing Facility. Not shown is Payload Commander Ronald M. Sega. The astronauts' late-night arrival allows them to maintain the shift in their waking and sleeping hours, altered in preparation for their upcoming spaceflight. The Space Shuttle Atlantis is scheduled to lift off on STS-76 around 3:35 a.m. EST, March 21, with one of the primary mission objectives being the third docking between the U.S. Shuttle and the Russian Space Station Mir.

Late, but not early, arriving younger siblings foster firstborns' understanding of second-order false belief.

PubMed

Paine, Amy L; Pearce, Holly; van Goozen, Stephanie H M; de Sonneville, Leo M J; Hay, Dale F

2018-02-01

This study examined the influence of younger siblings on children's understanding of second-order false belief. In a representative community sample of firstborn children (N=229) with a mean age of 7years (SD=4.58), false belief was assessed during a home visit using an adaptation of a well-established second-order false belief narrative enacted with Playmobil figures. Children's responses were coded to establish performance on second-order false belief questions. When controlling for verbal IQ and age, the existence of a younger sibling predicted a twofold advantage in children's second-order false belief performance, yet this was the case only for firstborns who experienced the arrival of a sibling after their second birthday. These findings provide a foundation for future research on family influences on social cognition. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Thermal-hydraulic behaviors of vapor-liquid interface due to arrival of a pressure wave

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

Inoue, Akira; Fujii, Yoshifumi; Matsuzaki, Mitsuo

In the vapor explosion, a pressure wave (shock wave) plays a fundamental role for triggering, propagation and enhancement of the explosion. Energy of the explosion is related to the magnitude of heat transfer rate from hot liquid to cold volatile one. This is related to an increasing rate of interface area and to an amount of transient heat flux between the liquids. In this study, the characteristics of transient heat transfer and behaviors of vapor film both on the platinum tube and on the hot melt tin drop, under same boundary conditions have been investigated. It is considered that theremore » exists a fundamental mechanism of the explosion in the initial expansion process of the hot liquid drop immediately after arrival of pressure wave. The growth rate of the vapor film is much faster on the hot liquid than that on the solid surface. Two kinds of roughness were observed, one due to the Taylor instability, by rapid growth of the explosion bubble, and another, nucleation sites were observed at the vapor-liquid interface. Based on detailed observation of early stage interface behaviors after arrival of a pressure wave, the thermal fragmentation mechanism is proposed.« less

Improvement to Airport Throughput Using Intelligent Arrival Scheduling and an Expanded Planning Horizon

NASA Technical Reports Server (NTRS)

Glaab, Patricia C.

2012-01-01

The first phase of this study investigated the amount of time a flight can be delayed or expedited within the Terminal Airspace using only speed changes. The Arrival Capacity Calculator analysis tool was used to predict the time adjustment envelope for standard descent arrivals and then for CDA arrivals. Results ranged from 0.77 to 5.38 minutes. STAR routes were configured for the ACES simulation, and a validation of the ACC results was conducted comparing the maximum predicted time adjustments to those seen in ACES. The final phase investigated full runway-to-runway trajectories using ACES. The radial distance used by the arrival scheduler was incrementally increased from 50 to 150 nautical miles (nmi). The increased Planning Horizon radii allowed the arrival scheduler to arrange, path stretch, and speed-adjust flights to more fully load the arrival stream. The average throughput for the high volume portion of the day increased from 30 aircraft per runway for the 50 nmi radius to 40 aircraft per runway for the 150 nmi radius for a traffic set representative of high volume 2018. The recommended radius for the arrival scheduler s Planning Horizon was found to be 130 nmi, which allowed more than 95% loading of the arrival stream.

Comparison of microbial pattern in early and late onset neonatal sepsis in referral center Haji Adam Malik hospital Medan Indonesia

NASA Astrophysics Data System (ADS)

Hasibuan, B. S.

2018-03-01

Neonatal sepsis contributes a significant rate of infants mortality and morbidity. The pathogens are diverse from region to another and change time to time even in the same place. To analyze the microbial pattern in early and late onset neonatal sepsis andthe pattern of antibiotic resistance of the causative microbes at one of referral center hospital in Indonesia, Haji Adam Malik Hospital, a cross-sectional descriptive study was conducted on neonates with sepsis diagnosis proven with positive blood culture within one year period (2015-2016). Among 626 neonates admitted to perinatology unit, the total of 154 neonates was proven to have neonatal sepsis with positive blood culture with the incidence rate 24.6%. Seventy-nine (51.3%) neonates were diagnosed with early onset sepsis while 75 (48,7%) neonates had late-onset sepsis. Klebsiella pneumonia was the most commonly isolated organism in both early and late onset sepsis, encompassing 19.5% of cases. Periodic surveillance of the causative agents of neonatal sepsis is needed to implement the rational, empirical choice of antibiotic prescription while waiting for blood culture result to come out.

7 CFR 319.55-6 - Inspection and disinfection at port of arrival.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 5 2012-01-01 2012-01-01 false Inspection and disinfection at port of arrival. 319.55... Regulations § 319.55-6 Inspection and disinfection at port of arrival. (a) Paddy rice. All importations of... disinfection in accordance with part 305 of this chapter, or both, at the port of arrival, as shall be required...

7 CFR 319.55-6 - Inspection and disinfection at port of arrival.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 5 2014-01-01 2014-01-01 false Inspection and disinfection at port of arrival. 319.55... Regulations § 319.55-6 Inspection and disinfection at port of arrival. (a) Paddy rice. All importations of... disinfection in accordance with part 305 of this chapter, or both, at the port of arrival, as shall be required...

7 CFR 319.55-6 - Inspection and disinfection at port of arrival.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 5 2013-01-01 2013-01-01 false Inspection and disinfection at port of arrival. 319.55... Regulations § 319.55-6 Inspection and disinfection at port of arrival. (a) Paddy rice. All importations of... disinfection in accordance with part 305 of this chapter, or both, at the port of arrival, as shall be required...

Arrival time distributions of electrons in air showers with primary energies above 10 (18)eV observed at 900m above sea level

NASA Technical Reports Server (NTRS)

Kakimoto, F.; Tsuchimoto, I.; Enoki, T.; Suga, K.; Nishi, K.

1985-01-01

Detection of air showers with primary energies above 10 to the 19th power eV with sufficient statistics is extremely important in an astrophysical aspect related to the Greisen cut off and the origin of such high energy cosmic rays. Recently, a method is proposed to observe such giant air showers by measuring the arrival time distributions of air-shower particles at large core distances with a mini array. Experiments to measure the arrival time distributions of muons were started in 1981 and those of electrons in early 1983 in the Akeno air-shower array (930 gcm cm squared atmospheric depth, 900m above sea level). During the time of observation, the detection area of the Akeno array was expanded from 1 sq km to sq km in 1982 and to 20 sq km in 1984. Now the arrival time distribution of electrons and muons can be measured for showers with primary energies above 1019eV at large core distances.

Officials welcome the arrival of the Japanese Experiment Module

NASA Image and Video Library

2007-04-17

In the Space Station Processing Facility, astronaut Takao Doi (left) and Commander Dominic Gorie pose in front of the Experiment Logistics Module Pressurized Section for the Japanese Experiment Module, or JEM, that recently arrived at Kennedy. Doi and Gorie are crew members for mission STS-123 that will deliver the logistics module to the International Space Station. Earlier, NASA and Japanese Aerospace and Exploration Agency (JAXA) officials welcomed the arrival of the module. The new International Space Station component arrived at Kennedy March 12 to begin preparations for its future launch on mission STS-123. It will serve as an on-orbit storage area for materials, tools and supplies. It can hold up to eight experiment racks and will attach to the top of another larger pressurized module.

Leaf unfolding of Tibetan alpine meadows captures the arrival of monsoon rainfall

PubMed Central

Li, Ruicheng; Luo, Tianxiang; Mölg, Thomas; Zhao, Jingxue; Li, Xiang; Cui, Xiaoyong; Du, Mingyuan; Tang, Yanhong

2016-01-01

The alpine meadow on the Tibetan Plateau is the highest and largest pasture in the world, and its formation and distribution are mainly controlled by Indian summer monsoon effects. However, little is known about how monsoon-related cues may trigger spring phenology of the vast alpine vegetation. Based on the 7-year observations with fenced and transplanted experiments across lower to upper limits of Kobresia meadows in the central plateau (4400–5200 m), we found that leaf unfolding dates of dominant sedge and grass species synchronized with monsoon onset, regardless of air temperature. We also found similar patterns in a 22-year data set from the northeast plateau. In the monsoon-related cues for leaf unfolding, the arrival of monsoon rainfall is crucial, while seasonal air temperatures are already continuously above 0 °C. In contrast, the early-emerging cushion species generally leafed out earlier in warmer years regardless of precipitation. Our data provide evidence that leaf unfolding of dominant species in the alpine meadows senses the arrival of monsoon-season rainfall. These findings also provide a basis for interpreting the spatially variable greening responses to warming detected in the world’s highest pasture, and suggest a phenological strategy for avoiding damages of pre-monsoon drought and frost to alpine plants. PMID:26856260

Transplantation of Ex Vivo Expanded Umbilical Cord Blood (NiCord) Decreases Early Infection and Hospitalization.

PubMed

Anand, Sarah; Thomas, Samantha; Hyslop, Terry; Adcock, Janet; Corbet, Kelly; Gasparetto, Cristina; Lopez, Richard; Long, Gwynn D; Morris, Ashley K; Rizzieri, David A; Sullivan, Keith M; Sung, Anthony D; Sarantopoulos, Stefanie; Chao, Nelson J; Horwitz, Mitchell E

2017-07-01

Delayed hematopoietic recovery contributes to increased infection risk following umbilical cord blood (UCB) transplantation. In a Phase 1 study, adult recipients of UCB stem cells cultured ex vivo for 3 weeks with nicotinamide (NiCord) had earlier median neutrophil recovery compared with historical controls. To evaluate the impact of faster neutrophil recovery on clinically relevant early outcomes, we reviewed infection episodes and hospitalization during the first 100 days in an enlarged cohort of 18 NiCord recipients compared with 86 standard UCB recipients at our institution. The median time to neutrophil engraftment was shorter in NiCord recipients compared with standard UCB recipients (12.5 days versus 26 days; P < .001). Compared with standard UCB recipients, NiCord recipients had a significantly reduced risk for total infection (RR, 0.69; P = .01), grade 2-3 (moderate to severe) infection (RR, 0.36; P < .001), bacterial infection (RR, 0.39; P = .003), and grade 2-3 bacterial infection (RR, 0.21; P = .003) by Poisson regression analysis; this effect persisted after adjustment for age, disease stage, and grade II-IV acute GVHD. NiCord recipients also had significantly more time out of the hospital in the first 100 days post-transplantation after adjustment for age and Karnofsky Performance Status (69.9 days versus 49.7 days; P = .005). Overall, transplantation of NiCord was associated with faster neutrophil engraftment, fewer total and bacterial infections, and shorter hospitalization in the first 100 days compared with standard UCB transplantation. In conclusion, rapid hematopoietic recovery from an ex vivo expanded UCB transplantation approach is associated with early clinical benefit. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Greeting, Hospitality, and Naming among the Bororo of Central Brazil. Working Papers in Sociolinguistics Number 37.

ERIC Educational Resources Information Center

Viertler, Renate B.

Hospitality patterns of the Bororo Indians are illustrated in two examples: the etiquette due to a visiting chief from another Bororo village, and the etiquette due any common visitor from another Bororo village. Formal hospitality differs greatly from the usual etiquette. At a visiting chief's arrival, he enters as the last of his group and waits…

Effort and Potential Efficiencies for Aquatic Non-native Species Early Detection

EPA Science Inventory

This manuscript is based on the early aquatic non-native species detection research in the Duluth-Superior harbor. The problem of early detection is essentially that of a "needle in a haystack" - to detect a newly arrived and presumably rare non-native species with a high probabi...

Particle detection and non-detection in a quantum time of arrival measurement

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

Sombillo, Denny Lane B., E-mail: dsombillo@nip.upd.edu.ph; Galapon, Eric A.

2016-01-15

The standard time-of-arrival distribution cannot reproduce both the temporal and the spatial profile of the modulus squared of the time-evolved wave function for an arbitrary initial state. In particular, the time-of-arrival distribution gives a non-vanishing probability even if the wave function is zero at a given point for all values of time. This poses a problem in the standard formulation of quantum mechanics where one quantizes a classical observable and uses its spectral resolution to calculate the corresponding distribution. In this work, we show that the modulus squared of the time-evolved wave function is in fact contained in one ofmore » the degenerate eigenfunctions of the quantized time-of-arrival operator. This generalizes our understanding of quantum arrival phenomenon where particle detection is not a necessary requirement, thereby providing a direct link between time-of-arrival quantization and the outcomes of the two-slit experiment. -- Highlights: •The time-evolved position density is contained in the standard TOA distribution. •Particle may quantum mechanically arrive at a given point without being detected. •The eigenstates of the standard TOA operator are linked to the two-slit experiment.« less

Mars Science Laboratory Launch-Arrival Space Study: A Pork Chop Plot Analysis

NASA Technical Reports Server (NTRS)

Cianciolo, Alicia Dwyer; Powell, Richard; Lockwood, Mary Kae

2006-01-01

Launch-Arrival, or "pork chop", plot analysis can provide mission designers with valuable information and insight into a specific launch and arrival space selected for a mission. The study begins with the array of entry states for each pair of selected Earth launch and Mars arrival dates, and nominal entry, descent and landing trajectories are simulated for each pair. Parameters of interest, such as maximum heat rate, are plotted in launch-arrival space. The plots help to quickly identify launch and arrival regions that are not feasible under current constraints or technology and also provide information as to what technologies may need to be developed to reach a desired region. This paper provides a discussion of the development, application, and results of a pork chop plot analysis to the Mars Science Laboratory mission. This technique is easily applicable to other missions at Mars and other destinations.

Time of arrival in quantum and Bohmian mechanics

NASA Astrophysics Data System (ADS)

Leavens, C. R.

1998-08-01

In a recent paper Grot, Rovelli, and Tate (GRT) [Phys. Rev. A 54, 4676 (1996)] derived an expression for the probability distribution π(TX) of intrinsic arrival times T(X) at position x=X for a quantum particle with initial wave function ψ(x,t=0) freely evolving in one dimension. This was done by quantizing the classical expression for the time of arrival of a free particle at X, assuming a particular choice of operator ordering, and then regulating the resulting time of arrival operator. For the special case of a minimum-uncertainty-product wave packet at t=0 with average wave number and variance Δk they showed that their analytical expression for π(TX) agreed with the probability current density J(x=X,t=T) only to terms of order Δk/. They dismissed the probability current density as a viable candidate for the exact arrival time distribution on the grounds that it can sometimes be negative. This fact is not a problem within Bohmian mechanics where the arrival time distribution for a particle, either free or in the presence of a potential, is rigorously given by \\|J(X,T)\\| (suitably normalized) [W. R. McKinnon and C. R. Leavens, Phys. Rev. A 51, 2748 (1995); C. R. Leavens, Phys. Lett. A 178, 27 (1993); M. Daumer et al., in On Three Levels: The Mathematical Physics of Micro-, Meso-, and Macro-Approaches to Physics, edited by M. Fannes et al. (Plenum, New York, 1994); M. Daumer, in Bohmian Mechanics and Quantum Theory: An Appraisal, edited by J. T. Cushing et al. (Kluwer Academic, Dordrecht, 1996)]. The two theories are compared in this paper and a case presented for which the results could not differ more: According to GRT's theory, every particle in the ensemble reaches a point x=X, where ψ(x,t) and J(x,t) are both zero for all t, while no particle ever reaches X according to the theory based on Bohmian mechanics. Some possible implications are discussed.

Perturbation analysis of queueing systems with a time-varying arrival rate

NASA Technical Reports Server (NTRS)

Cassandras, Christos G.; Pan, Jie

1991-01-01

The authors consider an M/G/1 queuing with a time-varying arrival rate. The objective is to obtain infinitesimal perturbation analysis (IPA) gradient estimates for various performance measures of interest with respect to certain system parameters. In particular, the authors consider the mean system time over n arrivals and an arrival rate alternating between two values. By choosing a convenient sample path representation of this system, they derive an unbiased IPA gradient estimator which, however, is not consistent, and investigate the nature of this problem.

Apollo 12 Crewmembers - Greeting - Family - Arrival - Ellington AFB (EAFB), TX

NASA Image and Video Library

1969-11-29

S69-60759 (29 Nov. 1969) --- Members of the Apollo 12 lunar landing mission's crew are greeted by their wives and children at the front of a large crowd on hand to welcome the three home. The Mobile Quarantine Facility (MQF), with the crew inside, arrived at Ellington Air Force Base aboard a United States Air Force C-141 transport jet in the early morning hours of Nov. 29, 1969. The crew men, looking out the MQF window at the crowd, are from left to right, astronauts Charles Conrad Jr., Richard F. Gordon Jr. and Alan L. Bean. Their wives are, from left to right, Mrs. Barbara Gordon, Mrs. Jane Conrad and Mrs. Sue Bean. The women are wearing lei's, an Hawaiian tradition. The crew members were taken to Hawaii from their Pacific Ocean recovery site aboard the USS Hornet, prime recovery vessel for the mission.

Early intervention of negative pressure wound therapy using Vacuum-Assisted Closure in trauma patients: impact on hospital length of stay and cost.

PubMed

Kaplan, Mark; Daly, Darron; Stemkowski, Stephen

2009-03-01

The cost of treating complex traumatic wounds is substantial because of trauma severity, potential for infection, and delayed closure. Negative pressure wound therapy using reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum-Assisted Closure* (KCI Licensing, Inc, San Antonio, Texas) is an established, viable option for treating traumatic wounds. The authors used retrospective data to study the clinical and cost-effective benefits of using NPWT/ROCF early on day 1 or day 2 of treatment for traumatic wounds as compared with using it late (on day 3 or later). Hospital data records from trauma wound patients treated with NPWT/ROCF were retrospectively analyzed. Data were subdivided into 2 groups based on start of treatment. The group of patients treated on day 1 or 2 of their hospital stay was referred to as the early group, and that composed of patients treated on day 3 or later as the late group. Clinical and cost-effective metrics were compared between the 2 groups. For the early group, 518 patient records were included; 1000 records were reviewed for the late group. Early-group patients had fewer hospital inpatient days (10.6 vs 20.6 days; P < .0001), fewer treatment days (5.1 vs 6.0 days; P = .0498), shorter intensive care unit (ICU) stays (5.3 vs 12.4 days; P < .0001), and higher ICU admission rates (51.5 vs 44.5%; P = .0091) than the late group. Compared with late-group patients, early-group patients had lower total and variable costs per patient discharge ($43,956 vs $32,175; P < .0001 and $22,891 vs $15,805; P < .0001, respectively). Acute-care trauma wound patients receiving early NPWT/ROCF demonstrated significant reductions in length of stay, treatment days, and ICU stay, which resulted in significant reduced patient treatment costs. These results indicate that early intervention with NPWT/ROCF has potential clinical and cost-effective benefits for the treatment of traumatic wounds.

Separation Assurance and Scheduling Coordination in the Arrival Environment

NASA Technical Reports Server (NTRS)

Aweiss, Arwa S.; Cone, Andrew C.; Holladay, Joshua J.; Munoz, Epifanio; Lewis, Timothy A.

2016-01-01

Separation assurance (SA) automation has been proposed as either a ground-based or airborne paradigm. The arrival environment is complex because aircraft are being sequenced and spaced to the arrival fix. This paper examines the effect of the allocation of the SA and scheduling functions on the performance of the system. Two coordination configurations between an SA and an arrival management system are tested using both ground and airborne implementations. All configurations have a conflict detection and resolution (CD&R) system and either an integrated or separated scheduler. Performance metrics are presented for the ground and airborne systems based on arrival traffic headed to Dallas/ Fort Worth International airport. The total delay, time-spacing conformance, and schedule conformance are used to measure efficiency. The goal of the analysis is to use the metrics to identify performance differences between the configurations that are based on different function allocations. A surveillance range limitation of 100 nmi and a time delay for sharing updated trajectory intent of 30 seconds were implemented for the airborne system. Overall, these results indicate that the surveillance range and the sharing of trajectories and aircraft schedules are important factors in determining the efficiency of an airborne arrival management system. These parameters are not relevant to the ground-based system as modeled for this study because it has instantaneous access to all aircraft trajectories and intent. Creating a schedule external to the CD&R and the scheduling conformance system was seen to reduce total delays for the airborne system, and had a minor effect on the ground-based system. The effect of an external scheduler on other metrics was mixed.

The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study

PubMed Central

Jansen, Tim C; van Bommel, Jasper; Mulder, Paul G; Rommes, Johannes H; Schieveld, Selma JM; Bakker, Jan

2008-01-01

Introduction A limitation of pre-hospital monitoring is that vital signs often do not change until a patient is in a critical stage. Blood lactate levels are suggested as a more sensitive parameter to evaluate a patient's condition. The aim of this pilot study was to find presumptive evidence for a relation between pre-hospital lactate levels and in-hospital mortality, corrected for vital sign abnormalities. Methods In this prospective observational study (n = 124), patients who required urgent ambulance dispatching and had a systolic blood pressure below 100 mmHg, a respiratory rate less than 10 or more than 29 breaths/minute, or a Glasgow Coma Scale (GCS) below 14 were enrolled. Nurses from Emergency Medical Services measured capillary or venous lactate levels using a hand-held device on arrival at the scene (T1) and just before or on arrival at the emergency department (T2). The primary outcome measured was in-hospital mortality. Results The average (standard deviation) time from T1 to T2 was 27 (10) minutes. Non-survivors (n = 32, 26%) had significantly higher lactate levels than survivors at T1 (5.3 vs 3.7 mmol/L) and at T2 (5.4 vs 3.2 mmol/L). Mortality was significantly higher in patients with lactate levels of 3.5 mmol/L or higher compared with those with lactate levels below 3.5 mmol/L (T1: 41 vs 12% and T2: 47 vs 15%). Also in the absence of hypotension, mortality was higher in those with higher lactate levels. In a multivariable Cox proportional hazard analysis including systolic blood pressure, heart rate, GCS (all at T1) and delta lactate level (from T1 to T2), only delta lactate level (hazard ratio (HR) = 0.20, 95% confidence interval (CI) = 0.05 to 0.76, p = 0.018) and GCS (HR = 0.93, 95% CI = 0.88 to 0.99, p = 0.022) were significant independent predictors of in-hospital mortality. Conclusions In a cohort of patients that required urgent ambulance dispatching, pre-hospital blood lactate levels were associated with in-hospital mortality and provided

An organizational metamodel for hospital emergency departments.

PubMed

Kaptan, Kubilay

2014-10-01

I introduce an organizational model describing the response of the hospital emergency department. The hybrid simulation/analytical model (called a "metamodel") can estimate a hospital's capacity and dynamic response in real time and incorporate the influence of damage to structural and nonstructural components on the organizational ones. The waiting time is the main parameter of response and is used to evaluate the disaster resilience of health care facilities. Waiting time behavior is described by using a double exponential function and its parameters are calibrated based on simulated data. The metamodel covers a large range of hospital configurations and takes into account hospital resources in terms of staff and infrastructures, operational efficiency, and the possible existence of an emergency plan; maximum capacity; and behavior both in saturated and overcapacitated conditions. The sensitivity of the model to different arrival rates, hospital configurations, and capacities and the technical and organizational policies applied during and before a disaster were investigated. This model becomes an important tool in the decision process either for the engineering profession or for policy makers.

The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine.

PubMed

Kunze-Szikszay, Nils; Krack, Lennart A; Wildenauer, Pauline; Wand, Saskia; Heyne, Tim; Walliser, Karoline; Spering, Christopher; Bauer, Martin; Quintel, Michael; Roessler, Markus

2016-10-10

Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after the first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples, and the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM. The median (min-max) ISS was 17 points (4-50 points). Four patients (15 %) had HF diagnosed via ROTEM at the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before TxA administration was 11 % (3-99 %) vs. 10 % after TxA administration (4-18 %; p > 0.05). TxA was administered 37 min (10-85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly differ. No adverse drug reactions were observed after TxA administration. HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy administered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically low levels. Early administration of TxA cannot reverse or entirely stop this decrease. The pre-hospital use of TxA should be considered for severely injured patients to prevent the worsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption. ClinicalTrials.gov ID NCT01938768 (Registered 5 September 2013).

Carbon isotope turnover as a measure of arrival time in migratory birds

USGS Publications Warehouse

Oppel, Steffen; Powell, Abby N.

2009-01-01

Arrival time on breeding or non-breeding areas is of interest in many ecological studies exploring fitness consequences of migratory schedules. However, in most field studies, it is difficult to precisely assess arrival time of individuals. Here, we use carbon isotope turnover in avian blood as a technique to estimate arrival time for birds switching from one habitat or environment to another. Stable carbon isotope ratios (δ13C) in blood assimilate to a new equilibrium following a diet switch according to an exponential decay function. This relationship can be used to determine the time a diet switch occurred if δ13C of both the old and new diet are known. We used published data of captive birds to validate that this approach provides reliable estimates of the time since a diet switch within 1–3 weeks after the diet switch. We then explored the utility of this technique for King Eiders (Somateria spectabilis) arriving on terrestrial breeding grounds after wintering and migration at sea. We estimated arrival time on breeding grounds in northern Alaska (95% CI) from red blood cell δ13C turnover to be 4–9 June. This estimate overlapped with arrival time of birds from the same study site tracked with satellite transmitters (5–12 June). Therefore, we conclude that this method provides a simple yet reliable way to assess arrival time of birds moving between isotopically distinct environments.

Knowledge-based scheduling of arrival aircraft

NASA Technical Reports Server (NTRS)

Krzeczowski, K.; Davis, T.; Erzberger, H.; Lev-Ram, I.; Bergh, C.

1995-01-01

A knowledge-based method for scheduling arrival aircraft in the terminal area has been implemented and tested in real-time simulation. The scheduling system automatically sequences, assigns landing times, and assigns runways to arrival aircraft by utilizing continuous updates of aircraft radar data and controller inputs. The scheduling algorithms is driven by a knowledge base which was obtained in over two thousand hours of controller-in-the-loop real-time simulation. The knowledge base contains a series of hierarchical 'rules' and decision logic that examines both performance criteria, such as delay reduction, as well as workload reduction criteria, such as conflict avoidance. The objective of the algorithms is to devise an efficient plan to land the aircraft in a manner acceptable to the air traffic controllers. This paper will describe the scheduling algorithms, give examples of their use, and present data regarding their potential benefits to the air traffic system.

InSight Spacecraft Arrival

NASA Image and Video Library

2018-02-28

At Vandenberg Air Force Base in California, NASA's Interior Exploration using Seismic Investigations, Geodesy and Heat Transport, or InSight, spacecraft arrives at the Astrotech processing facility. InSight was developed and built by Lockheed-Martin Space Systems in Denver, Colorado, and is scheduled for liftoff is May 5, 2018. InSight is the first mission to land on Mars and explore the Red Planet's deep interior. It will investigate processes that shaped the rocky planets of the inner solar system including Earth.

The interplanetary shock of September 24, 1998: Arrival at Earth

NASA Astrophysics Data System (ADS)

Russell, C. T.; Wang, Y. L.; Raeder, J.; Tokar, R. L.; Smith, C. W.; Ogilvie, K. W.; Lazarus, A. J.; Lepping, R. P.; Szabo, A.; Kawano, H.; Mukai, T.; Savin, S.; Yermolaev, Y. I.; Zhou, X.-Y.; Tsurutani, B. T.

2000-11-01

At close to 2345 UT on September 24, 1998, the magnetosphere was suddenly compressed by the passage of an interplanetary shock. In order to properly interpret the magnetospheric events triggered by the arrival of this shock, we calculate the orientation of the shock, its velocity, and its estimated time of arrival at the nose of the magnetosphere. Our best fit shock normal has an orientation of (-0.981 -0.157 -0.112) in solar ecliptic coordinates, a speed of 769 km/s, and an arrival time of 2344:19 at the magnetopause at 10 RE. Since measurements of the solar wind and interplanetary magnetic field are available from multiple spacecraft, we can compare several different techniques of shock-normal determination. Of the single spacecraft techniques the magnetic coplanarity solution is most accurate and the mixed mode solution is of lesser accuracy. Uncertainty in the timing and location of the IMP 8 spacecraft limits the accuracy of solutions using the time of arrival at the position of IMP 8.

COST-EFFECTIVENESS OF EARLY NUTRITIONAL THERAPY IN MALNOURISHED ADULT PATIENTS IN A HIGH COMPLEXITY HOSPITAL.

PubMed

Giraldo Giraldo, Nubia Amparo; Vásquez Velásquez, Johanna; Roldán Cano, Paula Andrea; Ospina Astudillo, Carolina; Sosa Cardona, Yuliet Paulina

2015-12-01

hospital malnutrition is a frequent worldwide problem and its potential issues related include increased complications, length of stay, mortality, and healthcare costs. the aim of this study was to establish the cost-effectiveness of early nutritional therapy for malnourished patients in a high complexity hospital. this analytical study with economic assessment included 227 adult hospitalised and malnourished according to the Subjective Global Assessment. The cohort prospective received Early Nutrition Therapy (ENT), whereas the cohort retrospective received Delayed Nutrition Therapy (DNT). The measures of cost-effectiveness included costs by: length of stay, complications and discharge condition. the cohorts were similar in demographic and clinical characteristics, except that the median age, for the ENT was 61 years (interquartile range [IQR]: 48-71) and for the DNT was 55 years (IQR: 44-67) (p = 0.024). The median length of stay was lower in the ENT (11 days, IQR: 7-17) than in the DNT (18 days, IQR: 10-28) (p < 0.001). The cost per patient discharged alive was US $ 10,261.55 in the ENT and US $ 15,553.11 in the DNT (p=0.043); the cost per patient with complications was US $ 13,663.90 in the ENT and US $ 17,860.32 in the DNT (p= 0.058). ENT increased the likelihood of being discharged alive, RR adjusted=0.31; 95% confidence interval (CI): 0.1; 0.6; (p<0.001) and decreased the likelihood of complications RR crude=0.8; 95% CI: 0.6; 0.9; (p=0.006). early nutritional therapy for malnourished adult patients appears to be cost-effective because it can reduce the length of stay, complications, mortality and associated costs. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Foreign field hospitals in the recent sudden-onset disasters in Iran, Haiti, Indonesia, and Pakistan.

PubMed

von Schreeb, Johan; Riddez, Louis; Samnegård, Hans; Rosling, Hans

2008-01-01

Foreign field hospitals (FFHs) may provide care for the injured and substitute for destroyed hospitals in the aftermath of sudden-onset disasters. In the aftermath of sudden-onset disasters, FFHs have been focused on providing emergency trauma care for the initial 48 hours following the sudden-onset disasters, while they tend to be operational much later. In addition, many have remained operational even later. The aim of this study was to assess the timing, activities, and capacities of the FFHs deployed after four recent sudden-onset disasters, and also to assess their adherence to the essential criteria for FFH deployment of the World Health Organization (WHO). Secondary information on the sudden-onset disasters in Bam, Iran in 2003, Haiti in 2004, Aceh, Indonesia in 2004, and Kashmir, Pakistan in 2005, including the number of FFHs deployed, their date of arrival, country of origin, length of stay, activities, and costs was retrieved by searching the Internet. Additional information was collected on-site in Iran, Indonesia, and Pakistan through direct observation and key informant interviews. Basic information was found for 43 FFHs in the four disasters. The first FFH was operational on Day 3 in Bam and Kashmir, and on Day 8 in Aceh. The first FFHs were all from the militaries of neighboring countries. The daily cost of a bed was estimated to be US$2,000. The bed occupancy rate generally was < 50%. None of the 43 FFHs met the first WHO/Pan-American Health Organization (PAHO) essential requirement if the aim is to provide emergency trauma care, while 15% followed the essential requirement if follow-up trauma and medical care is the aim of deployment. A striking finding was the lack of detailed information on FFH activities. None of the 43 FFHs arrived early enough to provide emergency medical trauma care. The deployment of FFHs following sudden-onset disasters should be better adapted to the main needs and the context and more oriented toward substituting for pre

A pilot project using evidence-based clinical pathways and payment reform in China's rural hospitals shows early success.

PubMed

Cheng, Tsung-Mei

2013-05-01

Reforming China's public hospitals to curb widespread overtreatment and improve the quality and affordability of care has been the most challenging aspect of that nation's ambitious health reform, which began in 2009. This article describes a pilot project under way in several of China's provinces that combines payment reform with the implementation of evidence-based clinical pathways at a few hospitals serving rural areas. Results to date include reduced length-of-stay and prescription drug use and higher patient and provider satisfaction. These early results suggest that the pilot may be achieving its goals, which may have far-reaching and positive implications for China's ongoing reform.

Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions.

PubMed

Fleming, Lisa M; Zhao, Xin; DeVore, Adam D; Heidenreich, Paul A; Yancy, Clyde W; Fonarow, Gregg C; Hernandez, Adrian F; Kociol, Robb D

2018-04-01

Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and stroke patients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality. The study population included 369 hospitals and 285 653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry. We used multivariate logistic regression with generalized estimating equations at the hospital level to identify predictors of EA and determine the association between EA and outcomes. Sixty-five percent of patients ambulated by day 2 of the hospital admission. Patient-level predictors of EA included younger age, male sex, and hospitalization outside of the Northeast ( P <0.01 for all). Hospital size and academic status were not predictive. Hospital-level analysis revealed that those hospitals with EA rates in the top 25% were less likely to have a long length of stay (defined as >4 days) compared with those in the bottom 25% (odds ratio, 0.83; confidence interval, 0.73-0.94; P =0.004). Among a subgroup of fee-for-service Medicare beneficiaries, we found that hospitals in the highest quartile of rates of EA demonstrated a statistically significant 24% lower 30-day readmission rates ( P <0.0001). Both end points demonstrated a dose-response association and statistically significant P for trend test. Multivariable-adjusted hospital-level analysis suggests an association between EA and both shorter length of stay and lower 30-day readmissions. Further prospective studies are needed to validate these findings. © 2018 American Heart Association, Inc.

Early-switch/early-discharge opportunities for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections: proof of concept in the United Arab Emirates.

PubMed

El Houfi, Ashraf; Javed, Nadeem; Solem, Caitlyn T; Macahilig, Cynthia; Stephens, Jennifer M; Raghubir, Nirvana; Chambers, Richard; Li, Jim Z; Haider, Seema

2015-01-01

To describe real-world treatment patterns and health care resource use and to estimate opportunities for early-switch (ES) from intravenous (IV) to oral (PO) antibiotics and early-discharge (ED) for patients hospitalized in the United Arab Emirates (UAE) with methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infections. This retrospective observational medical chart review study enrolled physicians from four UAE sites to collect data for 24 patients with documented MRSA complicated skin and soft tissue infections, hospitalized between July 2010 and June 2011, and discharged alive by July 2011. Data include clinical characteristics and outcomes, hospital length of stay (LOS), MRSA-targeted IV and PO antibiotic use, and ES and ED eligibility using literature-based and expert-validated criteria. Five included patients (20.8%) were switched from IV to PO antibiotics while being inpatients. Actual length of MRSA-active treatment was 10.8±7.0 days, with 9.8±6.6 days of IV therapy. Patients were hospitalized for a mean 13.9±9.3 days. The most frequent initial MRSA-active therapies used were vancomycin (37.5%), linezolid (16.7%), and clindamycin (16.7%). Eight patients were discharged with MRSA-active antibiotics, with linezolid prescribed most frequently (n=3; 37.5%). Fifteen patients (62.5%) met ES criteria and potentially could have discontinued IV therapy 8.3±6.0 days sooner, and eight (33.3%) met ED criteria and potentially could have been discharged 10.9±5.8 days earlier. While approximately one-fifth of patients were switched from IV to PO antibiotics in the UAE, there were clear opportunities for further optimization of health care resource use. Over half of UAE patients hospitalized for MRSA complicated skin and soft tissue infections could be eligible for ES, with one-third eligible for ED opportunities, resulting in substantial potential for reductions in IV days and bed days.

Analysis of Deep Seafloor Arrivals Observed on NPAL04

DTIC Science & Technology

2012-12-03

transmission station to the scattering point (black line) to compute the time spent on the PE-predicted path to the scattering point. This time would...arrives at the OBSs at times corresponding to caustics of the PE predicted time fronts, there are large amplitude, late arrivals that occur between... caustics and even after the PE predicted coda. Similar analysis was done for T500 to T2300 with similar results and is discussed in Section 4 of

Challenges newly-arrived migrant women in Montreal face when needing maternity care: Health care professionals' perspectives.

PubMed

Peláez, Sandra; Hendricks, Kristin N; Merry, Lisa A; Gagnon, Anita J

2017-01-25

People who leave their country of origin, or the country of habitual residence, to establish themselves permanently in another country are usually referred to as migrants. Over half of all births in Montreal, Canada are to migrant women. To understand healthcare professionals' attitudes towards migrants that could influence their delivery of care, our objective was to explore their perspectives of challenges newly-arrived migrant women from non-Western countries face when needing maternity care. In this qualitative multiple case study, we conducted face-to-face interviews with 63 health care professionals from four teaching hospitals in Montreal, known for providing maternity care to a high volume of migrant women. Interviews were transcribed and thematically analysed. Physicians, nurses, social workers, and therapists participated; 90% were female; and 17% were themselves migrants from non-Western countries. According to participants, newly-arrived migrant women face challenges at two levels: (a) direct care (e.g., understanding Canadian health care professionals' expectations, communicating effectively with health care professionals), and (b) organizational (e.g., access to appropriate health care). Challenges women face are strongly influenced by the migrant woman's background as well as social position (e.g., general education, health literacy, socio-cultural integration) and by how health care professionals balance women's needs with perceived requirement to adhere to standard procedures and regulations. Health care professionals across institutions agreed that maternity care-related challenges faced by newly-arrived migrant women often are complex in that they are simultaneously driven by conflicting values: those based on migrant women's sociocultural backgrounds versus those related to the implementation of Canadian guidelines for maternity care in which consideration of migrant women's particular needs are not priority.

Arrival Time Tracking of Partially Resolved Acoustic Rays with Application to Ocean Acoustic Tomography

DTIC Science & Technology

1991-03-01

ocean acoustic tomography. A straightforward method of arrival time estimation, based on locating the maximum value of an interpolated arrival, was...used with limited success for analysis of data from the December 1988 Monterey Bay Tomography Experiment. Close examination of the data revealed multiple...estimation of arrival times along an ocean acoustic ray path is an important component of ocean acoustic tomography. A straightforward method of arrival time

Design Considerations for a New Terminal Area Arrival Scheduler

NASA Technical Reports Server (NTRS)

Thipphavong, Jane; Mulfinger, Daniel

2010-01-01

Design of a terminal area arrival scheduler depends on the interrelationship between throughput, delay and controller intervention. The main contribution of this paper is an analysis of the above interdependence for several stochastic behaviors of expected system performance distributions in the aircraft s time of arrival at the meter fix and runway. Results of this analysis serve to guide the scheduler design choices for key control variables. Two types of variables are analyzed, separation buffers and terminal delay margins. The choice for these decision variables was tested using sensitivity analysis. Analysis suggests that it is best to set the separation buffer at the meter fix to its minimum and adjust the runway buffer to attain the desired system performance. Delay margin was found to have the least effect. These results help characterize the variables most influential in the scheduling operations of terminal area arrivals.

Semiautomated external defibrillators for in-hospital early defibrillation: a comparative study.

PubMed

Nocchi, Federico; Derrico, Pietro; Masucci, Gerardina; Capussotto, Carlo; Cecchetti, Corrado; Ritrovato, Matteo

2014-01-01

Semiautomated external defibrillators (AEDs) should be considered as a means to facilitate in-hospital early defibrillation (IHED) in areas where advanced life support rescuers are not readily available. In this study, we aimed to develop a checklist and a measurement protocol to evaluate and compare AEDs by assessing factors that may affect IHED. A clinical and technical comparison of six AEDs was performed. Technical specifications were analyzed, while an emergency team evaluated ergonomics and appropriateness for IHED at Bambino Gesù Children's Hospital. A measurement protocol was implemented, which aimed to assess the ability of defibrillators to recognize shockable and nonshockable rhythms, accuracy of delivered energy, and charging time. Designs of AEDs differed in several features which influence their appropriateness for IHED. Some units showed poor ergonomics and instructions/feedback for cardiopulmonary resuscitation. Differences between defibrillators in recognizing shockable and nonshockable rhythms emerged for polymorphic ventricular tachycardia waveforms and when the frequency and amplitude of input signals varied. Tests for accuracy revealed poor performances at low and high impedance levels for most AEDs. Notably, differences greater than 20 seconds were found in the time from power-on to "ready for discharge." The approach we used to assess AEDs allowed us to evaluate their appropriateness with respect to the organizational context, to measure their parameters, and to compare models. Results showed that ergonomics and/or performances (timing and accuracy) could be improved in each device.

InSight Spacecraft Arrival

NASA Image and Video Library

2018-02-28

After arrival at Vandenberg Air Force Base in California, ground crews prepare NASA's Interior Exploration using Seismic Investigations, Geodesy and Heat Transport, or InSight, spacecraft for transportation to the Astrotech processing facility. InSight was developed and built by Lockheed-Martin Space Systems in Denver, Colorado, and is scheduled for liftoff is May 5, 2018. InSight is the first mission to explore the deep interior of Mars. It will investigate processes that shaped the rocky planets of the inner solar system including Earth.

Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes

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

Chan, Elisa K.; Woods, Ryan; McBride, Mary L.

Purpose: The risk of cardiac injury with hypofractionated whole-breast/chest wall radiation therapy (HF-WBI) compared with conventional whole-breast/chest wall radiation therapy (CF-WBI) in women with left-sided breast cancer remains a concern. The purpose of this study was to determine if there is an increase in hospital-related morbidity from cardiac causes with HF-WBI relative to CF-WBI. Methods and Materials: Between 1990 and 1998, 5334 women ≤80 years of age with early-stage breast cancer were treated with postoperative radiation therapy to the breast or chest wall alone. A population-based database recorded baseline patient, tumor, and treatment factors. Hospital administrative records identified baseline cardiacmore » risk factors and other comorbidities. Factors between radiation therapy groups were balanced using a propensity-score model. The first event of a hospital admission for cardiac causes after radiation therapy was determined from hospitalization records. Ten- and 15-year cumulative hospital-related cardiac morbidity after radiation therapy was estimated for left- and right-sided cases using a competing risk approach. Results: The median follow-up was 13.2 years. For left-sided cases, 485 women were treated with CF-WBI, and 2221 women were treated with HF-WBI. Mastectomy was more common in the HF-WBI group, whereas boost was more common in the CF-WBI group. The CF-WBI group had a higher prevalence of diabetes. The 15-year cumulative hospital-related morbidity from cardiac causes (95% confidence interval) was not different between the 2 radiation therapy regimens after propensity-score adjustment: 21% (19-22) with HF-WBI and 21% (17-25) with CF-WBI (P=.93). For right-sided cases, the 15-year cumulative hospital-related morbidity from cardiac causes was also similar between the radiation therapy groups (P=.76). Conclusions: There is no difference in morbidity leading to hospitalization from cardiac causes among women with left-sided early

Size speed bias or size arrival effect-How judgments of vehicles' approach speed and time to arrival are influenced by the vehicles' size.

PubMed

Petzoldt, Tibor

2016-10-01

Crashes at railway level crossings are a key problem for railway operations. It has been suggested that a potential explanation for such crashes might lie in a so-called size speed bias, which describes the phenomenon that observers underestimate the speed of larger objects, such as aircraft or trains. While there is some evidence that this size speed bias indeed exists, it is somewhat at odds with another well researched phenomenon, the size arrival effect. When asked to judge the time it takes an approaching object to arrive at a predefined position (time to arrival, TTA), observers tend to provide lower estimates for larger objects. In that case, road users' crossing decisions when confronted with larger vehicles should be rather conservative, which has been confirmed in multiple studies on gap acceptance. The aim of the experiment reported in this paper was to clarify the relationship between size speed bias and size arrival effect. Employing a relative judgment task, both speed and TTA estimates were assessed for virtual depictions of a train and a truck, using a car as a reference to compare against. The results confirmed the size speed bias for the speed judgments, with both train and truck being perceived as travelling slower than the car. A comparable bias was also present in the TTA estimates for the truck. In contrast, no size arrival effect could be found for the train or the truck, neither in the speed nor the TTA judgments. This finding is inconsistent with the fact that crossing behaviour when confronted with larger vehicles appears to be consistently more conservative. This discrepancy might be interpreted as an indication that factors other than perceived speed or TTA play an important role for the differences in gap acceptance between different types of vehicles. Copyright © 2016 Elsevier Ltd. All rights reserved.

75 FR 13293 - Agency Information Collection Activities: Arrival and Departure Record

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-19

...), the Form I-94W (Nonimmigrant Visa Waiver Arrival/Departure), and the Electronic System for Travel... Act (Pub. L.104-13). Your comments should address one of the following four points: (1) Evaluate..., Nonimmigrant Visa Waiver Arrival/Departure, Electronic System for Travel Authorization (ESTA) OMB Number: 1651...

Survival and Neurologic Outcome After Out-of-hospital Cardiac Arrest. Results of the Andalusian Out-of-hospital Cardiopulmonary Arrest Registry.

PubMed

Rosell Ortiz, Fernando; Mellado Vergel, Francisco; López Messa, Juan Bautista; Fernández Valle, Patricia; Ruiz Montero, María M; Martínez Lara, Manuela; Vergara Pérez, Santiago; Vivar Díaz, Itziar; Caballero García, Auxiliadora; García Alcántara, Ángel; García Del Águila, Javier

2016-05-01

There is a paucity of data on prehospital cardiac arrest in Spain. Our aim was to describe the incidence, patient characteristics, and outcomes of out-of-hospital emergency care for this event. We conducted a retrospective analysis of a prospective registry of cardiopulmonary arrest handled by an out-of-hospital emergency service between January 2008 and December 2012. The registry included all patients considered to have a cardiac etiology as the cause of arrest, with a descriptive analysis performed of general patient characteristics and factors associated with good neurologic outcome at hospital discharge. A total of 4072 patients were included, with an estimated incidence of 14.6 events per 100000 inhabitants and year; 72.6% were men. The mean age was 62.0 ± 15.8 years, 58.6% of cases occurred in the home, 25% of patients had initial defibrillable rhythm, 28.8% of patients arrived with a pulse at the hospital (58.3% of the group with defibrillable rhythm), and 10.2% were discharged with good neurologic outcome. The variables associated with this recovery were: witnessed arrest (P=.04), arrest witnessed by emergency team (P=.005), previous life support (P=.04), initial defibrillable rhythm (P=.0001), and performance of a coronary interventional procedure (P=.0001). More than half the cases of sudden cardiac arrest occur at home, and the population was found to be relatively young. Although recovery was satisfactory in 1 out of every 10 patients, there is a need for improvement in the phase prior to emergency team arrival. Coronary interventional procedures had an impact on patient prognosis. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Evaluation of sorafenib for advanced hepatocellular carcinoma with low α-fetoprotein in arrival time parametric imaging using contrast-enhanced ultrasonography.

PubMed

Shiozawa, Kazue; Watanabe, Manabu; Ikehara, Takashi; Shimizu, Ryo; Shinohara, Mie; Igarashi, Yoshinori; Sumino, Yasukiyo

2017-01-01

To determine the usefulness of arrival time parametric imaging (AtPI) using contrast-enhanced ultrasonography (CEUS) with Sonazoid in evaluating early response to sorafenib for hepatocellular carcinoma (HCC). Twenty-one advanced HCC patients with low α-fetoprotein (AFP) levels (≤35 ng/ml) who received sorafenib for at least 4 weeks were enrolled in this study. CEUS was performed before and 2 weeks after treatment, and the images of the target lesion in the arterial phase were analyzed by AtPI. In the color mapping images obtained by AtPI, the mean arrival time of the contrast agent in the target lesion from the reference point (mean time: MT) was calculated. In each patient, differences between MT before and MT 2 weeks after treatment were compared. MT (+) and MT (-) groups were defined as difference of 0 s or greater and less than 0 s, respectively. Overall survival was evaluated between the two groups. In the MT (+) (11 patients) and MT (-) (10 patients) groups, the median survival time was 792 and 403 days, respectively, which was statistically significant. The results suggested that AtPI was useful for evaluating early response to sorafenib for advanced HCC with low AFP level.

Empirical estimation of the arrival time of ICME Shocks

NASA Astrophysics Data System (ADS)

Shaltout, Mosalam

Empirical estimation of the arrival time of ICME Shocks Mosalam Shaltout1 ,M.Youssef 1and R.Mawad2 1 National Research Institute of Astronomy and Geophysics (NRIAG) ,Helwan -Cairo-Egypt Email: mosalamshaltout@hotmail.com 2 Faculty of Science-Monifiia University-Physics Department-Shiben Al-Koum -Monifiia-Egypt We are got the Data of the SSC events from Preliminary Reports of the ISGI (Institut de Physique du Globe, France) .Also we are selected the same CME interval 1996-2005 from SOHO/LASCO/C2.We have estimated the arrival time of ICME shocks during solar cycle 23rd (1996-2005), we take the Sudden storm commencement SSC as a indicator of the arrival of CMEs at the Earth's Magnetosphere (ICME).Under our model ,we selected 203 ICME shock-SSC associated events, we got an imperial relation between CME velocity and their travel time, from which we obtained high correlation between them, R=0.75.

ECOSTRESS Arrival and Processing

NASA Image and Video Library

2018-04-09

In the Space Station Processing Facility at NASA's Kennedy Space Center in Florida, the ECOsystem Spaceborne Thermal Radiometer Experiment on Space Station (ECOSTRESS) has arrived in its shipping container. The container is being inspected and thoroughly cleaned prior to opening. ECOSTRESS is designed to monitor one of the most basic processes in living plants: the loss of water through the tiny pores in leaves. ECOSTRESS will launch to the International Space Station aboard a Dragon spacecraft launched by a Falcon 9 rocket on the SpaceX CRS-15 mission in June 2018.

InSight Spacecraft Arrival

NASA Image and Video Library

2018-02-28

After a U.S. Air Force C-17 aircraft arrived at Vandenberg Air Force Base in California, ground crews offload NASA's Interior Exploration using Seismic Investigations, Geodesy and Heat Transport, or InSight, spacecraft designed to land on Mars. InSight was developed and built by Lockheed-Martin Space Systems in Denver, Colorado, and is scheduled for liftoff is May 5, 2018. InSight is the first mission to explore the Red Planet's deep interior. It will investigate processes that shaped the rocky planets of the inner solar system including Earth.

InSight Spacecraft Arrival

NASA Image and Video Library

2018-02-28

A U.S. Air Force C-17 aircraft arrives at Vandenberg Air Force Base in California carrying NASA's Interior Exploration using Seismic Investigations, Geodesy and Heat Transport, or InSight, spacecraft designed to land on Mars. InSight was developed and built by Lockheed-Martin Space Systems in Denver, Colorado, and is scheduled for liftoff is May 5, 2018. InSight is the first mission to explore the Red Planet's deep interior. It will investigate processes that shaped the rocky planets of the inner solar system including Earth.

The awareness of experience innovation and an application in private hospitals.

PubMed

Luleci, Nimet Emel; Gemlik, Hatice Nilay; Bektas, Gulfer; Manioglu, Yagmur

2015-10-01

To evaluate the perspective of private hospitals regarding experience innovation. The qualification-type study was conducted in Istanbul, Turkey, in February 2015, and comprised 17 hospitals where patients and employees were interviewed using a semi-structured consultation guide. The employees were examined regarding the meaning of innovation, awareness of experience innovation and its measurement. The patients were asked about the reason for choosing a hospital, the actual reason for arrival at the hospital and the impressions while leaving the hospital. Based on the obtained answers, experience innovation was examined. Of the 87 subjects interviewed, 51(59%) were patients and 36(41%) were hospital employees. Overall, there were 61(70%) women and 26(30%) men in the age range of 21-75 years. It was observed that the tendencies of hospitals for innovation activities were high, but they confused it with novelty. Investments made without taking experience innovation into account do not convert into targeted results.

Early urinary diversion with ileal conduit and vesicovaginostomy in the treatment of radiation cystitis due to carcinoma cervix: a study from a tertiary care hospital in South India.

PubMed

Banerji, John Samuel; Devasia, Antony; Kekre, Nitin Sudhakar; Chacko, Ninan

2015-10-01

To study the magnitude of radiation cystitis following radiation therapy for carcinoma cervix, and propose an algorithm to decide on early diversion, with or without vesicovaginostomy. Women who developed radiation cystitis following radiotherapy for carcinoma cervix from January 1998 to December 2011 were included in this retrospective study. Electronic hospital records were analysed to document the presence of radiation cystitis. All women who developed evidence of radiation-induced cystitis, according to the common toxicity and Radiation Therapy Oncology Group criteria, were included in the study. We looked at transfusion requirements, number of hospital admissions, quality of life and cost involved. Chi-square tests were done where applicable. SPSS version 16 was used for analysis. Of the 902 patients who received radiation for carcinoma cervix in the 13-year period, 62 (6.87%) developed grade 3/4 cystitis. Twenty-eight of them underwent ileal conduit diversion, with 18 undergoing concomitant vesicovaginostomy. When compared with the patients who did not have diversion, the transfusion requirements, number of hospital admissions and quality of life had a statistically significant difference. Cost analysis of early diversion too showed a marginal benefit with early diversion. The limitation of the study was that it was retrospective in nature. In radiation cystitis, multiple hospital admissions and consequential increase in cost is the norm. In severe disease, early diversion is a prudent, cost-effective approach with good quality of life and early return to normal activity. © 2014 Royal Australasian College of Surgeons.

Frederick National Lab Aids Liberian Hospitals Through Project C.U.R.E. | FNLCR Staging

Cancer.gov

When Project C.U.R.E.'s much-needed medical supplies and equipment arrive in Liberia, the Frederick National Lab’s Kathryn Kynvin is there to receive and distribute the donations to hospitals who continue to treat survivors of the most recent Ebola

77 FR 49451 - Agency Information Collection Activities: Consideration of Deferred Action for Childhood Arrivals...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-16

...-NEW] Agency Information Collection Activities: Consideration of Deferred Action for Childhood Arrivals... Deferred Action for Childhood Arrivals, 1615-NEW'' in the subject box. Regardless of the method used for... collection. (2) Title of the Form/Collection: Consideration of Deferred Action for Childhood Arrivals. (3...

A Hospital Clinic Early Intervention Program.

ERIC Educational Resources Information Center

Simser, Judith I.; Steacie, Pamela

1993-01-01

The Aural Habilitation Program of Children's Hospital of Eastern Ontario (Canada) provides weekly, individualized aural habilitation sessions for parents of young children with hearing impairments and offers guidance in creating a listening, learning environment in the home. Strategies for developing parents' skills and confidence are described.…

District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries.

PubMed

Stewart, Barclay T; Gyedu, Adam; Quansah, Robert; Addo, Wilfred Larbi; Afoko, Akis; Agbenorku, Pius; Amponsah-Manu, Forster; Ankomah, James; Appiah-Denkyira, Ebenezer; Baffoe, Peter; Debrah, Sam; Donkor, Peter; Dorvlo, Theodor; Japiong, Kennedy; Kushner, Adam L; Morna, Martin; Ofosu, Anthony; Oppong-Nketia, Victor; Tabiri, Stephen; Mock, Charles

2016-01-01

Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. Consensus on trauma care audit filters was built between twenty panellists using a Delphi technique with four anonymous, iterative surveys designed to elicit: (i) trauma care processes to be measured; (ii) important features of audit filters for the district-level hospital setting; and (iii) potentially useful filters. Filters were ranked on a scale from 0 to 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. Panellists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1--0.58; Round 2--0.66; Round 3--0.76; and Round 4--0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage--vital signs are recorded within 15 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation--a large bore IV was placed within 15 min of patient arrival; referral--if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs

District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries

PubMed Central

Stewart, Barclay T; Gyedu, Adam; Quansah, Robert; Addo, Wilfred Larbi; Afoko, Akis; Agbenorku, Pius; Amponsah-Manu, Forster; Ankomah, James; Appiah-Denkyira, Ebenezer; Baffoe, Peter; Debrah, Sam; Donkor, Peter; Dorvlo, Theodor; Japiong, Kennedy; Kushner, Adam L; Morna, Martin; Ofosu, Anthony; Oppong-Nketia, Victor; Tabiri, Stephen; Mock, Charles

2015-01-01

Introduction Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. Methods Consensus on trauma care audit filters was built between twenty panelists using a Delphi technique with four anonymous, iterative surveys designed to elicit: i) trauma care processes to be measured; ii) important features of audit filters for the district-level hospital setting; and iii) potentially useful filters. Filters were ranked on a scale from 0 – 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. Results Panelists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1 - 0.58; Round 2 - 0.66; Round 3 - 0.76; and Round 4 - 0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage - vital signs are recorded within 15 minutes of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation - a large bore IV was placed within 15 minutes of patient arrival; referral - if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. Conclusion This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar

CCP Crew Access Arm Arrival

NASA Image and Video Library

2016-08-11

A heavy-lift transport truck, carrying the Crew Access Arm for Space Launch Complex 41, arrives at Complex 41 at Cape Canaveral Air Force Station in Florida. The arm will be installed on the Complex 41 Crew Access Tower. It will be used as a bridge by astronauts to board Boeing's CST-100 Starliner spacecraft as it stands on the launch pad atop a United Launch Alliance Atlas V rocket.

The patients' library movement: an overview of early efforts in the United States to establish organized libraries for hospital patients.

PubMed Central

Panella, N M

1996-01-01

The patients' library movement in the United States, a dynamic, cohesive drive begun and sustained by librarians and physicians, strove to promote placement of organized libraries for patients in hospitals. It took shape in the early years of this century, evolving from its proponents' deeply held conviction that books and reading foster the rehabilitation of sick people. The American Library Association's World War I service to hospitalized military personnel dramatically reinforced the conviction; the post-World War I institution of public library extension services to general hospitals explicitly reflected it. Enormous energy was infused into the patients' library movement. Throughout the first half of this century, there were sustained efforts not only to establish organized libraries for hospitalized people but also to expand and systematically study bibliotherapy and to shape patients' librarianship as a professional specialty. The movement's achievements include the establishment of patients' library committees within national and international associations; impetus for development of academic programs to train patients' librarians; and publication, from 1944 through 1970, of successive sets of standards for hospital patients' libraries. The first of these remain the first standards written and issued by a professional library association for a hospital library. PMID:8938330

[Refugees at Malmö Epidemic Hospital in 1945].

PubMed

Cronberg, S

1993-01-01

In 1945, 423 refugees were admitted because of contagious disease at Malmö Epidemic Hospital. Of these refugees 159 men and 167 women arrived from the German concentration camps in Ravensbrück, Buchenwald, Bergen-Belsen, Neuengamme and others. Others arrived in a boat destined to be sunk when peace came and the crew changed mind, letting the boat board at Malmö harbour. Thus life was saved to more than 95% of its passengers. Of the refugees 31% came from Poland, 24% from Scandinavian countries, 12% from Benelux and 10% from France. Louse-borne typhus was the most frequent diagnosis that occurred in 35%. Other common disorders were diphtheria, scarlet fever, enteric fever and tuberculosis. Almost all prisoners from concentration camps were malnourished and had sustained severe cruelty. Most of them recovered rapidly when given food and vitamins.

Early-Life Trauma in Hospitalized Patients With Mood Disorders and Its Association With Clinical Outcomes.

PubMed

Parsaik, Ajay K; Abdelgawad, Noha; Chotalia, Jigar K; Lane, Scott D; Pigott, Teresa A

2017-01-01

The prevalence of childhood trauma and its impact on clinical outcomes in hospitalized patients with mood disorders is unknown. We studied the frequency of childhood trauma among inpatient adults with mood disorders and its association with clinical outcomes. Patients admitted to our hospital with a primary diagnosis of mood disorders completed the short form of the Early Trauma Inventory-Self-Report (ETISR-SF), the Sheehan Disability Scale, and the Clinician-Rated Dimensions of Psychosis Symptom Severity scale. A regression model adjusted for multiple comparisons was used to examine the association between scores on the ETISR-SF and clinical outcomes. Subjects were 167 patients, all of whom reported ≥1 types of childhood trauma: 90% general trauma, 75% physical abuse, 71% emotional abuse, 50% sexual abuse, and 35% all 4 types of abuse. The subtypes of abuse did not differ by sex or race. Diagnoses in the sample were bipolar disorder 56%, major depressive disorder 24%, schizoaffective disorder 14%, and substance-induced mood disorder 5%. The mean age in the sample was 35±11.5 years, 53% were male, and 64% also had substance abuse disorders. Higher scores on the ETISR-SF were associated with longer hospital stays [odds ratio (OR)=1.13; 95% confidence interval (CI), 1.05-1.22], and greater disruption of work/school life (OR=1.12; 95% CI, 1.04-1.21). There was also a trend for higher ETISR-SF scores to be associated with more severe psychotic symptoms (OR=1.13; 95% CI, 1.01-1.27) and more disruption in social (OR=1.14; 95% CI, 1.06-1.22) and family life (OR=1.09; 95% CI, 1.02-1.17). Childhood trauma was reported by all of the 167 patients, with general trauma the most common and approximately half reporting sexual abuse. Childhood trauma was associated with poor clinical outcomes. Early recognition of trauma and trauma-related therapeutic interventions may improve outcomes.

19 CFR 12.112 - Notice of arrival of pesticides and devices.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Notice of arrival of pesticides and devices. 12...; DEPARTMENT OF THE TREASURY SPECIAL CLASSES OF MERCHANDISE Pesticides and Devices § 12.112 Notice of arrival of pesticides and devices. (a) General. An importer desiring to import pesticides or devices into the...

19 CFR 12.112 - Notice of arrival of pesticides and devices.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Notice of arrival of pesticides and devices. 12...; DEPARTMENT OF THE TREASURY SPECIAL CLASSES OF MERCHANDISE Pesticides and Devices § 12.112 Notice of arrival of pesticides and devices. (a) General. An importer desiring to import pesticides or devices into the...

19 CFR 12.112 - Notice of arrival of pesticides and devices.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Notice of arrival of pesticides and devices. 12...; DEPARTMENT OF THE TREASURY SPECIAL CLASSES OF MERCHANDISE Pesticides and Devices § 12.112 Notice of arrival of pesticides and devices. (a) General. An importer desiring to import pesticides or devices into the...

19 CFR 12.112 - Notice of arrival of pesticides and devices.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Notice of arrival of pesticides and devices. 12...; DEPARTMENT OF THE TREASURY SPECIAL CLASSES OF MERCHANDISE Pesticides and Devices § 12.112 Notice of arrival of pesticides and devices. (a) General. An importer desiring to import pesticides or devices into the...

19 CFR 12.112 - Notice of arrival of pesticides and devices.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Notice of arrival of pesticides and devices. 12...; DEPARTMENT OF THE TREASURY SPECIAL CLASSES OF MERCHANDISE Pesticides and Devices § 12.112 Notice of arrival of pesticides and devices. (a) General. An importer desiring to import pesticides or devices into the...

Early primary care follow-up after ED and hospital discharge - does it affect readmissions?

PubMed

Sinha, Sanjai; Seirup, Joanna; Carmel, Amanda

2017-04-01

After hospitalization, timely discharge follow-up has been linked to reduced readmissions in the heart failure population, but data from general inpatients has been mixed. The objective of this study was to determine if there was an association between completed follow-up appointments within 14 days of hospital discharge and 30-day readmission amongst primary care patients at an urban academic medical center. Index discharges included both inpatient and emergency room settings. A secondary objective was to identify patient factors associated with completed follow-up appointments within 14 days. We conducted a retrospective review of primary care patients at an urban academic medical center who were discharged from either the emergency department (ED) or inpatient services at the Weill Cornell Medical Center/New York Presbyterian Hospital from 1 January 2014-31 December 2014. Cox proportional hazard models were used to identify the relationship between follow-up in primary care within 14 days and readmission within 30 days. Logistic regression was used to evaluate the association of patient factors with 14-day follow-up. Among 9,662 inpatient and ED discharges, multivariable analysis (adjusting for age, gender, race/ethnicity, insurance, number of diagnoses on problem list, length of stay, and discharge service) showed that follow-up with primary care within 14 days was not associated with a lower hazard of readmission within 30 days (HR = 0.78; 95% CI 0.56-1.09). A higher number of diagnoses on the problem list was associated with greater odds of follow-up for both inpatient and emergency department discharges (inpatient: HR = 1.03, 95% CI 1.02-1.04; ED: HR = 1.02, 95% CI 1.00-1.04). For inpatient discharges, each additional day in length of stay was associated with 3% lower odds of follow-up (HR = 0.97, 95% CI 0.96-0.99). Early follow-up within 14 days after discharge from general inpatient services was associated with a trend toward lower hazard of

Impacts of Hospitals' Innovativeness on Information System Outsourcing Decisions

PubMed Central

2014-01-01

Objectives The purpose of this study was to identify the effects of hospitals' innovativeness on outsourcing decision-making regarding four information system (IS) functions, namely, software programs, network maintenance, hardware systems, and PC/printer maintenance. Methods Using the 2011 roster of the Korean Hospital Association, this study selected 311 general hospitals as a study population. After identifying the managers who were in charge of outsourcing, this study administered questionnaires. A total of 103 hospitals responded. Results Of the responding hospitals, 55.34% outsourced at least one IS function, whereas 88.35% outsourced at least one managerial function. IS outsourcing was motivated by the need for outside experts, but other managerial functions were outsourced for cost savings. Innovative and early adopter hospitals were 4.52 and 4.91 times more likely to outsource IS functions related with work processes (i.e., software and network maintenance) than early and late majority hospitals, respectively. IT outsourcing effectiveness significantly influenced the outsourcing decisions regarding four IS functions. Hospitals that had perceived more risks of outsourcing significantly preferred non-outsourcing on their hardware systems, but the risks of outsourcing were not significant for outsourcing decisions regarding the other IS functions. Hospitals' innovativeness also significantly explained the quantity of innovation adoptions. Innovative and early adopter hospitals did more outsourcing than early and late majority hospitals. Conclusions Hospitals' innovativeness influences decision-making regarding outsourcing. Innovative hospitals are more likely to outsource their work-process-related IS functions. Thus, organizational traits, especially hospitals' innovativeness, should be considered as a key success factor for IS management. PMID:24872912

Impacts of hospitals' innovativeness on information system outsourcing decisions.

PubMed

Park, Jae Sung

2014-04-01

The purpose of this study was to identify the effects of hospitals' innovativeness on outsourcing decision-making regarding four information system (IS) functions, namely, software programs, network maintenance, hardware systems, and PC/printer maintenance. Using the 2011 roster of the Korean Hospital Association, this study selected 311 general hospitals as a study population. After identifying the managers who were in charge of outsourcing, this study administered questionnaires. A total of 103 hospitals responded. Of the responding hospitals, 55.34% outsourced at least one IS function, whereas 88.35% outsourced at least one managerial function. IS outsourcing was motivated by the need for outside experts, but other managerial functions were outsourced for cost savings. Innovative and early adopter hospitals were 4.52 and 4.91 times more likely to outsource IS functions related with work processes (i.e., software and network maintenance) than early and late majority hospitals, respectively. IT outsourcing effectiveness significantly influenced the outsourcing decisions regarding four IS functions. Hospitals that had perceived more risks of outsourcing significantly preferred non-outsourcing on their hardware systems, but the risks of outsourcing were not significant for outsourcing decisions regarding the other IS functions. Hospitals' innovativeness also significantly explained the quantity of innovation adoptions. Innovative and early adopter hospitals did more outsourcing than early and late majority hospitals. Hospitals' innovativeness influences decision-making regarding outsourcing. Innovative hospitals are more likely to outsource their work-process-related IS functions. Thus, organizational traits, especially hospitals' innovativeness, should be considered as a key success factor for IS management.

Out-of-hours medical cover in community hospitals: implications for palliative care.

PubMed

Kerr, Chris; Hawker, Sheila; Payne, Sheila; Lloyd-Williams, Mari; Seamark, David

2006-02-01

The new General Medical Services contract in England means many GPs have transferred out-of hours work to their primary care organization, with implications for continuity of palliative care in community hospitals. To examine existing arrangements for out-of-hours medical cover in community hospitals, focusing on palliative care. Telephone survey of community hospital managers/senior nurses across England and Wales. Interviews (n = 62) revealed nursing staff were satisfied with existing out-of-hours care. Concern was expressed about the future of out-of-hours medical care from GPs as new services will cover larger areas, meaning unknown doctors may attend, taking longer to arrive. Arrangements for out-of-hours medical cover in community hospitals are in transition, threatening the continuity of care for dying patients.

78 FR 76636 - Agency Information Collection Activities: Consideration of Deferred Action for Childhood Arrivals...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-18

...-0124] Agency Information Collection Activities: Consideration of Deferred Action for Childhood Arrivals... Deferred Action for Childhood Arrivals. (3) Agency form number, if any, and the applicable component of the... childhood arrivals: 1. Were under the age of 31 as of June 15, 2012; 2. Came to the United States before...

Arrival and Departure Patterns of Public Sector Employees before and after Implementation of Flexitime.

ERIC Educational Resources Information Center

Ronen, Simcha

1981-01-01

Examined the effects of a flexible working hours schedule on the arrival and departure times of 162 public sector employees. Results indicated that workers, when scheduling their own workday, deviate only moderately from their preflexitime arrival/departure times; and they tend to develop relatively stable arrival/departure patterns. (Author/RC)

Automatic pickup of arrival time of channel wave based on multi-channel constraints

NASA Astrophysics Data System (ADS)

Wang, Bao-Li

2018-03-01

Accurately detecting the arrival time of a channel wave in a coal seam is very important for in-seam seismic data processing. The arrival time greatly affects the accuracy of the channel wave inversion and the computed tomography (CT) result. However, because the signal-to-noise ratio of in-seam seismic data is reduced by the long wavelength and strong frequency dispersion, accurately timing the arrival of channel waves is extremely difficult. For this purpose, we propose a method that automatically picks up the arrival time of channel waves based on multi-channel constraints. We first estimate the Jaccard similarity coefficient of two ray paths, then apply it as a weight coefficient for stacking the multichannel dispersion spectra. The reasonableness and effectiveness of the proposed method is verified in an actual data application. Most importantly, the method increases the degree of automation and the pickup precision of the channel-wave arrival time.

Home-based care after a shortened hospital stay versus hospital-based care postpartum: an economic evaluation.

PubMed

Petrou, Stavros; Boulvain, Michel; Simon, Judit; Maricot, Patrice; Borst, François; Perneger, Thomas; Irion, Olivier

2004-08-01

To compare the cost effectiveness of early postnatal discharge and home midwifery support with a traditional postnatal hospital stay. Cost minimisation analysis within a pragmatic randomised controlled trial. The University Hospital of Geneva and its catchment area. Four hundred and fifty-nine deliveries of a single infant at term following an uncomplicated pregnancy. Prospective economic evaluation alongside a randomised controlled trial in which women were allocated to either early postnatal discharge combined with home midwifery support (n= 228) or a traditional postnatal hospital stay (n= 231). Costs (Swiss francs, 2000 prices) to the health service, social services, patients, carers and society accrued between delivery and 28 days postpartum. Clinical and psychosocial outcomes were similar in the two trial arms. Early postnatal discharge combined with home midwifery support resulted in a significant reduction in postnatal hospital care costs (bootstrap mean difference 1524 francs, 95% confidence interval [CI] 675 to 2403) and a significant increase in community care costs (bootstrap mean difference 295 francs, 95% CI 245 to 343). There were no significant differences in average hospital readmission, hospital outpatient care, direct non-medical and indirect costs between the two trial groups. Overall, early postnatal discharge combined with home midwifery support resulted in a significant cost saving of 1221 francs per mother-infant dyad (bootstrap mean difference 1209 francs, 95% CI 202 to 2155). This finding remained relatively robust following variations in the values of key economic parameters performed as part of a comprehensive sensitivity analysis. A policy of early postnatal discharge combined with home midwifery support exhibits weak economic dominance over traditional postnatal care, that is, it significantly reduces costs without compromising the health and wellbeing of the mother and infant.

Patterns of pre-hospital events and management of motorcycle-related injuries in a tropical setting.

PubMed

Aduayi, Olufunso Simisola; Aduayi, Victor Adovi; Komolafe, Edward Oluwole

2017-09-01

This study sought to highlight associated factors and evaluate outcomes of motorcycle-related injuries (MCRI) among adults managed in a university teaching hospital in south-western Nigeria. The study was a cross-sectional descriptive study of 150 adult patients presenting with MCRI at the adult accident and emergency unit of the hospital. Information on the use of helmet, alcohol intake, number of pillion passengers, type of collision and time of arrival at hospital was collected. Patients were followed up and questionnaires were completed after discharge, referral or death. The male to female ratio was 4:1 with patients aged 20-29 years (n = 44, 29.3%) having the highest incidence of MCRI. Only 4 (2.7%) patients used helmet at the time of injury. About one-third of the patients (n = 59, 39.3%) arrived at the hospital within 1-6 hours after injury. The limbs were the most frequently involved site of injury, hence orthopaedic procedures constituted the highest number of interventions. Mortality rate was 10.7% (16 out of 150) with head injury being the leading cause. MCRI requires more emphasis on preventive measures. This will play a crucial role in the reduction of the associated morbidity and mortality.

Parker Solar Probe Spacecraft Arrival, Offload and Transport

NASA Image and Video Library

2018-04-03

NASA's Parker Solar Probe, secured in its shipping container, arrives at the Astrotech processing facility near the agency's Kennedy Space Center in Florida. The spacecraft arrived aboard a U.S. Air Force C-5 transport aircraft at Space Coast Regional Airport in Titusville, Florida. The Parker Solar Probe will launch on a United Launch Alliance Delta IV Heavy rocket from Space Launch Complex 37 at Cape Canaveral Air Force Station in Florida in July 2018. The mission will perform the closest-ever observations of a star when it travels through the Sun's atmosphere, called the corona. The probe will rely on measurements and imaging to revolutionize our understanding of the corona and the Sun-Earth connection.

Hospital variability in use of anticoagulant strategies during acute myocardial infarction treated with an early invasive strategy.

PubMed

Arnold, Suzanne V; Li, Shu-Xia; Alexander, Karen P; Spertus, John A; Nallamothu, Brahmajee K; Curtis, Jeptha P; Kosiborod, Mikhail; Gupta, Aakriti; Wang, Tracy Y; Lin, Haiqun; Dharmarajan, Kumar; Strait, Kelly M; Lowe, Timothy J; Krumholz, Harlan M

2015-06-15

During a myocardial infarction, no single best approach of systemic anticoagulation is recommended, likely due to a lack of comparative effectiveness studies and trade-offs between treatments. We investigated the patterns of use and site-level variability in anticoagulant strategies (unfractionated heparin [UFH] only, low-molecular-weight heparin [LMWH] only, UFH+LMWH, any bivalirudin) of 63 796 patients with a principal diagnosis of myocardial infarction treated with an early invasive strategy with percutaneous coronary intervention at 257 hospitals. About half (47%) of patients received UFH only, 6% UFH+LMWH, 7% LMWH only, and 40% bivalirudin. Compared with UFH, the median odds ratio was 2.90 for LMWH+UFH, 4.70 for LMWH only, and 3.09 for bivalirudin, indicating that 2 "identical" patients would have a 3- to 4-fold greater likelihood of being treated with anticoagulants other than UFH at one hospital compared with another. We then categorized hospitals as low- or high-users of LMWH and bivalirudin. Using hierarchical, multivariate regression models, we found that low bivalirudin-using hospitals had higher unadjusted bleeding rates, but the risk-adjusted and anticoagulant-adjusted bleeding rates did not differ across the hospital anticoagulation phenotypes. Risk-standardized mortality and risk-standardized length of stay also did not differ across hospital phenotypes. We found substantial site-level variability in the choice of anticoagulants for invasively managed acute myocardial infarction patients, even after accounting for patient factors. No single hospital-use pattern was found to be clinically superior. More studies are needed to determine which patients would derive the greatest benefit from various anticoagulants and to support consistent treatment of patients with the optimal anticoagulant strategy. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

The Secular Trends in the Incidence Rate and Outcomes of Out-of-Hospital Cardiac Arrest in Taiwan—A Nationwide Population-Based Study

PubMed Central

Wang, Cheng-Yi; Wang, Jen-Yu; Teng, Nai-Chi; Chao, Ting-Ting; Tsai, Shu-Ling; Chen, Chi-Liang; Hsu, Jeng-Yuan; Wu, Chin-Pyng; Lai, Chih-Cheng; Chen, Likwang

2015-01-01

Objective This study investigated the trends in incidence and mortality of out-of-hospital cardiac arrest (OHCA), as well as factors associated with OHCA outcomes in Taiwan. Methods Our study included OHCA patients requiring cardiopulmonary resuscitation (CPR) upon arrival at the hospital. We used national time-series data on annual OHCA incidence rates and mortality rates from 2000 to 2012, and individual demographic and clinical data for all OHCA patients requiring mechanical ventilation (MV) care from March of 2010 to September of 2011. Analytic techniques included the time-series regression and the logistic regression. Results There were 117,787 OHCAs in total. The overall incidence rate during the 13 years was 51.1 per 100,000 persons, and the secular trend indicates a sharp increase in the early 2000s and a decrease afterwards. The trend in mortality was also curvilinear, revealing a substantial increase in the early 2000s, a subsequent steep decline and finally a modest increase. Both the 30-day and 180-day mortality rates had a long-term decreasing trend over the period (p<0.01). For both incidence and mortality rates, a significant second-order autoregressive effect emerged. Among OHCA patients with MV, 1-day, 30-day and 180-day mortality rates were 31.3%, 75.8%, and 86.0%, respectively. In this cohort, older age, the female gender, and a Charlson comorbidity index score ≥ 2 were associated with higher 180-day mortality; patients delivered to regional hospitals and those residing in non-metropolitan areas had higher death risk. Conclusions Overall, both the 30-day and the 180-day mortality rates after OHCA had a long-term decreasing trend, while the 1-day mortality had no long-term decline. Among OHCA patients requiring MV, those delivered to regional hospitals and those residing in non-metropolitan areas tended to have higher mortality, suggesting a need for effort to further standardize and improve in-hospital care across hospitals and to advance pre-hospital

Risk factors for apnea in pediatric patients transported by paramedics for out-of-hospital seizure.

PubMed

Bosson, Nichole; Santillanes, Genevieve; Kaji, Amy H; Fang, Andrea; Fernando, Tasha; Huang, Margaret; Lee, Jumie; Gausche-Hill, Marianne

2014-03-01

Apnea is a known complication of pediatric seizures, but patient factors that predispose children are unclear. We seek to quantify the risk of apnea attributable to midazolam and identify additional risk factors for apnea in children transported by paramedics for out-of-hospital seizure. This is a 2-year retrospective study of pediatric patients transported by paramedics to 2 tertiary care centers. Patients were younger than 15 years and transported by paramedics to the pediatric emergency department (ED) for seizure. Patients with trauma and those with another pediatric ED diagnosis were excluded. Investigators abstracted charts for patient characteristics and predefined risk factors: developmental delay, treatment with antiepileptic medications, and seizure on pediatric ED arrival. Primary outcome was apnea defined as bag-mask ventilation or intubation for apnea by paramedics or by pediatric ED staff within 30 minutes of arrival. There were 1,584 patients who met inclusion criteria, with a median age of 2.3 years (Interquartile range 1.4 to 5.2 years). Paramedics treated 214 patients (13%) with midazolam. Seventy-one patients had apnea (4.5%): 44 patients were treated with midazolam and 27 patients were not treated with midazolam. After simultaneous evaluation of midazolam administration, age, fever, developmental delay, antiepileptic medication use, and seizure on pediatric ED arrival, 2 independent risk factors for apnea were identified: persistent seizure on arrival (odds ratio [OR]=15; 95% confidence interval [CI] 8 to 27) and administration of field midazolam (OR=4; 95% CI 2 to 7). We identified 2 risk factors for apnea in children transported for seizure: seizure on arrival to the pediatric ED and out-of-hospital administration of midazolam. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Investigating and Learning Lessons from Early Experiences of Implementing ePrescribing Systems into NHS Hospitals: A Questionnaire Study

PubMed Central

Cresswell, Kathrin; Coleman, Jamie; Slee, Ann; Williams, Robin; Sheikh, Aziz

2013-01-01

Background ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned. Methods A descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated. Results We obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity. Conclusions Whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in

Pegasus ICON Wing Arrival

NASA Image and Video Library

2017-02-22

The wing for the Orbital ATK Pegasus XL rocket arrives by truck at Building 1555 at Vandenberg Air Force Base in California. The Pegasus rocket is being prepared for NASA's Ionospheric Connection Explorer, or ICON, mission. ICON will launch from the Kwajalein Atoll aboard the Pegasus XL on Dec. 8, 2017. ICON will study the frontier of space - the dynamic zone high in Earth's atmosphere where terrestrial weather from below meets space weather above. The explorer will help determine the physics of Earth's space environment and pave the way for mitigating its effects on our technology, communications systems and society.

Orion Stage Adapter Arrival

NASA Image and Video Library

2018-04-03

NASA's Super Guppy aircraft touches down at the Shuttle Landing Facility at the agency's Kennedy Space Center in Florida. The Super Guppy is carrying the Orion Stage Adapter (OSA), the second flight-hardware section of NASA's Space Launch System (SLS) rocket that has arrived at Kennedy. The OSA will connect the Orion spacecraft to the upper part of the SLS rocket, the interim cryogenic propulsion stage (ICPS). Both the OSA and ICPS are being stored for processing in the center's Space Station Processing Facility in preparation for Exploration Mission-1, the first uncrewed, integrated launch of the SLS rocket and Orion spacecraft.

9 CFR 93.707 - Inspection at the port of first arrival.

Code of Federal Regulations, 2010 CFR

2010-01-01

... port of first arrival. (a) A hedgehog or tenrec from any part of the world must be inspected by an APHIS inspector at the port of first arrival. Subject to the other provisions in this subpart, a... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Inspection at the port of first...

Integration and Language Learning of Newly Arrived Migrants Using Mobile Technology

ERIC Educational Resources Information Center

Bradley, Linda; Lindström, Nataliya Berbyuk; Hashemi, Sylvana Sofkova

2017-01-01

The purpose of this study is to investigate the mobile activities newly arrived migrants are engaged in when learning the Swedish language and about Swedish culture and society. Further, the study also explores the use of a mobile application (app) provided to the newly arrived migrants to use for pronunciation practice. The study involved 38…

Analysis of sequencing and scheduling methods for arrival traffic

NASA Technical Reports Server (NTRS)

Neuman, Frank; Erzberger, Heinz

1990-01-01

The air traffic control subsystem that performs scheduling is discussed. The function of the scheduling algorithms is to plan automatically the most efficient landing order and to assign optimally spaced landing times to all arrivals. Several important scheduling algorithms are described and the statistical performance of the scheduling algorithms is examined. Scheduling brings order to an arrival sequence for aircraft. First-come-first-served scheduling (FCFS) establishes a fair order, based on estimated times of arrival, and determines proper separations. Because of the randomness of the traffic, gaps will remain in the scheduled sequence of aircraft. These gaps are filled, or partially filled, by time-advancing the leading aircraft after a gap while still preserving the FCFS order. Tightly scheduled groups of aircraft remain with a mix of heavy and large aircraft. Separation requirements differ for different types of aircraft trailing each other. Advantage is taken of this fact through mild reordering of the traffic, thus shortening the groups and reducing average delays. Actual delays for different samples with the same statistical parameters vary widely, especially for heavy traffic.

Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted?

PubMed

Kosashvili, Yona; Aharonson-Daniel, L; Daniel, Limor A; Peleg, Kobi; Horowitz, Ariel; Laor, Danny; Blumenfeld, Amir

2009-07-01

The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams. 15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs. A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as >or=10 casualties or >or=4 suffering from injuries with an ISS>or=16 arriving to a single hospital. The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8+/-13.3 (range 4-56, median 16.5). In 95% of the HMCIs the casualty load was Hospital preparedness can be better defined by a fixed number of casualties rather than a percentile of its bed capacity. Only 20% of the arriving casualties will require immediate medical treatment. Implementation of this concept may improve the utilisation of national emergency health resources both in the preparation phase and on real time.

Contributed Review: Source-localization algorithms and applications using time of arrival and time difference of arrival measurements

DOE PAGES

Li, Xinya; Deng, Zhiqun Daniel; Rauchenstein, Lynn T.; ...

2016-04-01

Locating the position of fixed or mobile sources (i.e., transmitters) based on received measurements from sensors is an important research area that is attracting much research interest. In this paper, we present localization algorithms using time of arrivals (TOA) and time difference of arrivals (TDOA) to achieve high accuracy under line-of-sight conditions. The circular (TOA) and hyperbolic (TDOA) location systems both use nonlinear equations that relate the locations of the sensors and tracked objects. These nonlinear equations can develop accuracy challenges because of the existence of measurement errors and efficiency challenges that lead to high computational burdens. Least squares-based andmore » maximum likelihood-based algorithms have become the most popular categories of location estimators. We also summarize the advantages and disadvantages of various positioning algorithms. By improving measurement techniques and localization algorithms, localization applications can be extended into the signal-processing-related domains of radar, sonar, the Global Positioning System, wireless sensor networks, underwater animal tracking, mobile communications, and multimedia.« less

Contributed Review: Source-localization algorithms and applications using time of arrival and time difference of arrival measurements

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

Li, Xinya; Deng, Zhiqun Daniel; Rauchenstein, Lynn T.

Locating the position of fixed or mobile sources (i.e., transmitters) based on received measurements from sensors is an important research area that is attracting much research interest. In this paper, we present localization algorithms using time of arrivals (TOA) and time difference of arrivals (TDOA) to achieve high accuracy under line-of-sight conditions. The circular (TOA) and hyperbolic (TDOA) location systems both use nonlinear equations that relate the locations of the sensors and tracked objects. These nonlinear equations can develop accuracy challenges because of the existence of measurement errors and efficiency challenges that lead to high computational burdens. Least squares-based andmore » maximum likelihood-based algorithms have become the most popular categories of location estimators. We also summarize the advantages and disadvantages of various positioning algorithms. By improving measurement techniques and localization algorithms, localization applications can be extended into the signal-processing-related domains of radar, sonar, the Global Positioning System, wireless sensor networks, underwater animal tracking, mobile communications, and multimedia.« less

Priority Queuing Models for Hospital Intensive Care Units and Impacts to Severe Case Patients

PubMed Central

Hagen, Matthew S.; Jopling, Jeffrey K; Buchman, Timothy G; Lee, Eva K.

2013-01-01

This paper examines several different queuing models for intensive care units (ICU) and the effects on wait times, utilization, return rates, mortalities, and number of patients served. Five separate intensive care units at an urban hospital are analyzed and distributions are fitted for arrivals and service durations. A system-based simulation model is built to capture all possible cases of patient flow after ICU admission. These include mortalities and returns before and after hospital exits. Patients are grouped into 9 different classes that are categorized by severity and length of stay (LOS). Each queuing model varies by the policies that are permitted and by the order the patients are admitted. The first set of models does not prioritize patients, but examines the advantages of smoothing the operating schedule for elective surgeries. The second set analyzes the differences between prioritizing admissions by expected LOS or patient severity. The last set permits early ICU discharges and conservative and aggressive bumping policies are contrasted. It was found that prioritizing patients by severity considerably reduced delays for critical cases, but also increased the average waiting time for all patients. Aggressive bumping significantly raised the return and mortality rates, but more conservative methods balance quality and efficiency with lowered wait times without serious consequences. PMID:24551379

Soyuz TMA-07M arrival

NASA Image and Video Library

2012-12-21

ISS034-E-010181 (21 Dec. 2012) --- As the International Space Station and Soyuz TMA-07M spacecraft were making their relative approaches on Dec. 21, one of the Expedition 34 crew members on the orbital outpost captured this photo of the Soyuz. The background is in northern Algeria, near the Atlas Mountains. Inside the arriving spacecraft were astronaut Chris Hadfield of the Canadian Space Agency, cosmonaut Roman Romanenko of Russia's Federal Space Agency and NASA astronaut Tom Marshburn.

Soyuz TMA-07M arrival

NASA Image and Video Library

2012-12-21

ISS034-E-010180 (21 Dec. 2012) --- As the International Space Station and Soyuz TMA-07M spacecraft were making their relative approaches on Dec. 21, one of the Expedition 34 crew members on the orbital outpost captured this photo of the Soyuz. The background is in northern Algeria, near the Atlas Mountains. Inside the arriving spacecraft were astronaut Chris Hadfield of the Canadian Space Agency, cosmonaut Roman Romanenko of Russia's Federal Space Agency and NASA astronaut Tom Marshburn.

Modeling Weather Impact on Airport Arrival Miles-in-Trail Restrictions

NASA Technical Reports Server (NTRS)

Wang, Yao; Grabbe, Shon

2013-01-01

When the demand for either a region of airspace or an airport approaches or exceeds the available capacity, miles-in-trail (MIT) restrictions are the most frequently issued traffic management initiatives (TMIs) that are used to mitigate these imbalances. Miles-intrail operations require aircraft in a traffic stream to meet a specific inter-aircraft separation in exchange for maintaining a safe and orderly flow within the stream. This stream of aircraft can be departing an airport, over a common fix, through a sector, on a specific route or arriving at an airport. This study begins by providing a high-level overview of the distribution and causes of arrival MIT restrictions for the top ten airports in the United States. This is followed by an in-depth analysis of the frequency, duration and cause of MIT restrictions impacting the Hartsfield-Jackson Atlanta International Airport (ATL) from 2009 through 2011. Then, machine-learning methods for predicting (1) situations in which MIT restrictions for ATL arrivals are implemented under low demand scenarios, and (2) days in which a large number of MIT restrictions are required to properly manage and control ATL arrivals are presented. More specifically, these predictions were accomplished by using an ensemble of decision trees with Bootstrap aggregation (BDT) and supervised machine learning was used to train the BDT binary classification models. The models were subsequently validated using data cross validation methods. When predicting the occurrence of arrival MIT restrictions under low demand situations, the model was able to achieve over all accuracy rates ranging from 84% to 90%, with false alarm ratios ranging from 10% to 15%. In the second set of studies designed to predict days on which a high number of MIT restrictions were required, overall accuracy rates of 80% were achieved with false alarm ratios of 20%. Overall, the predictions proposed by the model give better MIT usage information than what has been

Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis

PubMed Central

Andersen, Lars W; Kurth, Tobias; Chase, Maureen; Berg, Katherine M; Cocchi, Michael N; Callaway, Clifton

2016-01-01

Objectives To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. Design Prospective observational cohort study. Setting Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. Participants Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. Intervention Epinephrine given within two minutes after the first defibrillation. Main outcome measures Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were “at risk” of receiving epinephrine within the same minute but who did not receive it. Results 2978patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine

Does pet arrival trigger prosocial behaviors in individuals with autism?

PubMed

Grandgeorge, Marine; Tordjman, Sylvie; Lazartigues, Alain; Lemonnier, Eric; Deleau, Michel; Hausberger, Martine

2012-01-01

Alteration of social interactions especially prosocial behaviors--an important aspect of development--is one of the characteristics of autistic disorders. Numerous strategies or therapies are used to improve communication skills or at least to reduce social impairments. Animal-assisted therapies are used widely but their relevant benefits have never been scientifically evaluated. In the present study, we evaluated the association between the presence or the arrival of pets in families with an individual with autism and the changes in his or her prosocial behaviors. Of 260 individuals with autism--on the basis of presence or absence of pets--two groups of 12 individuals and two groups of 8 individuals were assigned to: study 1 (pet arrival after age of 5 versus no pet) and study 2 (pet versus no pet), respectively. Evaluation of social impairment was assessed at two time periods using the 36-items ADI-R algorithm and a parental questionnaire about their child-pet relationships. The results showed that 2 of the 36 items changed positively between the age of 4 to 5 (t(0)) and time of assessment (t(1)) in the pet arrival group (study 1): "offering to share" and "offering comfort". Interestingly, these two items reflect prosocial behaviors. There seemed to be no significant changes in any item for the three other groups. The interactions between individuals with autism and their pets were more--qualitatively and quantitatively--reported in the situation of pet arrival than pet presence since birth. These findings open further lines of research on the impact of pet's presence or arrival in families with an individual with autism. Given the potential ability of individuals with autism to develop prosocial behaviors, related studies are needed to better understand the mechanisms involved in the development of such child-pet relationship.

Urban sprawl and delayed ambulance arrival in the U.S.

PubMed

Trowbridge, Matthew J; Gurka, Matthew J; O'Connor, Robert E

2009-11-01

Minimizing emergency medical service (EMS) response time is a central objective of prehospital care, yet the potential influence of built environment features such as urban sprawl on EMS system performance is often not considered. This study measures the association between urban sprawl and EMS response time to test the hypothesis that features of sprawling development increase the probability of delayed ambulance arrival. In 2008, EMS response times for 43,424 motor-vehicle crashes were obtained from the Fatal Analysis Reporting System, a national census of crashes involving > or =1 fatality. Sprawl at each crash location was measured using a continuous county-level index previously developed by Ewing et al. The association between sprawl and the probability of a delayed ambulance arrival (> or =8 minutes) was then measured using generalized linear mixed modeling to account for correlation among crashes from the same county. Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival (p=0.03). This probability increases quadratically as the severity of sprawl increases while controlling for nighttime crash occurrence, road conditions, and presence of construction. For example, in sprawling counties (e.g., Fayette County GA), the probability of a delayed ambulance arrival for daytime crashes in dry conditions without construction was 69% (95% CI=66%, 72%) compared with 31% (95% CI=28%, 35%) in counties with prominent smart-growth characteristics (e.g., Delaware County PA). Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival following motor-vehicle crashes in the U.S. The results of this study suggest that promotion of community design and development that follows smart-growth principles and regulates urban sprawl may improve EMS performance and reliability.

Arrival of Sulfate Aerosols from Iceland's Laki Eruption (1783-1784 AD) to the Greenland Ice Sheet: A Critical Ice Core Dating Tool

NASA Astrophysics Data System (ADS)

Wei, L.; Mosley-Thompson, E.

2006-12-01

The Laki (Iceland) volcanic event was a basaltic flood lava eruption lasting from June 8, 1783 to February 7, 1784. The timing of the arrival of the sulfate aerosols and volcanic fragments to the Greenland Ice Sheet (GIS) remains uncertain, but is important to confirm as the highly conductive sulfate layer has been consistently used as a time stratigraphic marker (1783 AD) in ice cores collected across Greenland. However, in the GISP2 ice core a few glass shards were found within the annual layer lying just below that containing the sulfate aerosols from Laki suggesting that the ash arrived first, in 1783, while the aerosols arrived the following year [Fiacco et al., 1994]. Additional published ice core results have neither confirmed nor refuted this observation. We have taken advantage of the accurately dated, high temporal resolution ice cores collected by PARCA (Program for Arctic Regional Climate Assessment) to (1) determine more precisely the timing of the arrival of Laki's sulfate aerosols and (2) assess the spatial variability of the excess sulfate contributed by Laki to the GIS. Our results indicate that the sulfate emitted from the Laki eruption most likely arrived on the GIS in the late summer or early fall of 1783 AD. This is also supported by contemporary weather logs and official reports of the appearance of Laki haze [Thordarson and Self, 2003]. The flux of Laki sulfate varies significantly over the GIS, largely as a function of the regional annual accumulation rate. Laki sulfate aerosols also arrived as a single pulse in most of the PARCA cores, suggesting that only a small fraction of the gases emitted from Laki reached the stratosphere. References: Fiacco, R.J.,et al., Atmospheric aerosol loading and transport due to the 1783-84 Laki eruption in Iceland, interpreted from ash particles and acidity in the GISP2 ice core, Quat. Res., 42, 231-240, 1994. Thordarson, T, and S. Self, Atmospheric and environmental effects of the 1783-1784 Laki eruption: A

Accurate identification of microseismic P- and S-phase arrivals using the multi-step AIC algorithm

NASA Astrophysics Data System (ADS)

Zhu, Mengbo; Wang, Liguan; Liu, Xiaoming; Zhao, Jiaxuan; Peng, Ping'an

2018-03-01

Identification of P- and S-phase arrivals is the primary work in microseismic monitoring. In this study, a new multi-step AIC algorithm is proposed. This algorithm consists of P- and S-phase arrival pickers (P-picker and S-picker). The P-picker contains three steps: in step 1, a preliminary P-phase arrival window is determined by the waveform peak. Then a preliminary P-pick is identified using the AIC algorithm. Finally, the P-phase arrival window is narrowed based on the above P-pick. Thus the P-phase arrival can be identified accurately by using the AIC algorithm again. The S-picker contains five steps: in step 1, a narrow S-phase arrival window is determined based on the P-pick and the AIC curve of amplitude biquadratic time-series. In step 2, the S-picker automatically judges whether the S-phase arrival is clear to identify. In step 3 and 4, the AIC extreme points are extracted, and the relationship between the local minimum and the S-phase arrival is researched. In step 5, the S-phase arrival is picked based on the maximum probability criterion. To evaluate of the proposed algorithm, a P- and S-picks classification criterion is also established based on a source location numerical simulation. The field data tests show a considerable improvement of the multi-step AIC algorithm in comparison with the manual picks and the original AIC algorithm. Furthermore, the technique is independent of the kind of SNR. Even in the poor-quality signal group which the SNRs are below 5, the effective picking rates (the corresponding location error is <15 m) of P- and S-phase arrivals are still up to 80.9% and 76.4% respectively.

Early Detection of Chronic Obstructive Pulmonary Disease in Apparently Healthy Attendants of Tertiary Care Hospital and Assessment of its Severity.

PubMed

Zubair, Tahira; Abbassi, Amanullah; Khan, Osama Ahsan

2017-05-01

Early detection of Chronic Obstructive Pulmonary Disease in apparently healthy attendants of tertiary care hospital and assessment of its severity. Cross-sectional, observational study. Study was conducted from January 2015 to July 2015 at Dow University Hospital, Ojha campus. Ascreening method was designed for apparently healthy individuals including attendants of patients, hospital staff, faculty and students, belonging to age group 18-60 years after excluding severe obesity and already diagnosed respiratory and cardiovascular diseases by means of history. Each participant performed pulmonary function tests via spirometer after filling a questionnaire based on various risk factors and symptoms of chronic obstructive pulmonary disease (COPD). Data was entered and analysed by SPSS-20. Out of the 517 participants, 122 (23.6%) were found to have COPD diagnosed by means of spirometry. Out of these, 23 (4.4%) had COPD stage I, 42 (8.1%) had COPD II, 34 (6.6%) had COPD III, and 23 (4.4%) had COPD IV. Exposure to smoking, wooden stoves, pesticides, biomass fuel, aerosol sprays, gas grill and vehicle exhaust were found to be statistically significant factors in relation to development of COPD. Apparently healthy individuals may have underlying COPD and active screening by means of spirometry plays vital role in early detection of COPD. Smoking and exposure to certain hazardous environmental pollutants are responsible for the development and progression of COPD.

Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re-Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012).

PubMed

Golovics, Petra A; Lakatos, Laszlo; Mandel, Michael D; Lovasz, Barbara D; Vegh, Zsuzsanna; Kurti, Zsuzsanna; Szita, Istvan; Kiss, Lajos S; Balogh, Mihaly; Pandur, Tunde; Lakatos, Peter L

2015-09-01

Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.

The third stage of Lunar Prospector's Athena arrives at LC 46 at CCAS

NASA Technical Reports Server (NTRS)

1997-01-01

The third stage of the Lockheed Martin Athena launch vehicle arrives at Launch Complex 46 at Cape Canaveral Air Station before it is mated to the second stage. The protective covering for safe transportation is removed before the third stage is lifted on the launch pad. Athena is scheduled to carry the Lunar Prospector spacecraft for an 18-month mission that will orbit the Earth's moon to collect data from the lunar surface. Scientific experiments to be conducted by the Prospector include locating water ice that may exist near the lunar poles, gathering data to understand the evolution of the lunar highland crust and the lunar magnetic field, finding radon outgassing events, and describing the lunar gravity field by means of Doppler tracking. The launch is now scheduled for early-January 1998.

Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital.

PubMed

Ahmad, Arif; Carleton, Jared D; Ahmad, Zoha F; Agarwala, Ashish

2016-09-01

The purpose of this study was to compare the operative and early perioperative outcomes of laparoscopic versus robotic-assisted Roux-en-Y gastric bypass procedures performed in a community hospital setting. The study was a chart review and analysis of the early perioperative outcomes of a total of 345 Roux-en-Y gastric bypass procedures performed by a single surgeon in a community hospital setting from January 2011 to October 2014. Of these, 173 procedures were performed laparoscopically and 172 were performed with robotic assistance utilizing the daVinci(®) surgical platform. Factors such as baseline patient characteristics, operative time, estimated blood loss (EBL), conversions to open procedure, complication rates, adverse events, length of stay (LOS), and return to the operating room for the two groups were retrospectively analyzed from a prospectively maintained database. Student's t test with unequal variances was used for statistical analysis, and a p value <0.05 was used for significance. There were no statistically significant differences in complication rates, EBL, or LOS between the two groups. There was a significant difference between the total operative times (135.30 ± 37.60 min for the laparoscopic procedure versus 154.84 ± 38.44 min for the robotic procedure, p < 0.05). There were no adverse intraoperative events, conversions to open procedures, leaks, strictures, returns to the operating room within 30 days, or mortalities in either group. Our study, which is the first of its kind to analyze the operative and early perioperative outcomes between laparoscopic and robotic-assisted Roux-en-Y gastric bypass procedures in the US community hospital setting, indicates that both are comparable in terms of safety, efficacy, and operative and early perioperative outcomes.

Cassini orbiter arrives at SLF

NASA Technical Reports Server (NTRS)

1997-01-01

Workers prepare to tow away the large container with the Cassini orbiter from KSC's Shuttle Landing Facility. The orbiter just arrived on the U.S. Air Force C-17 air cargo plane, shown here, from Edwards Air Force Base, California. The orbiter and the Huygens probe already being processed at KSC are the two primary components of the Cassini spacecraft, which will be launched on a Titan IVB/Centaur expendable launch vehicle from Cape Canaveral Air Station. Cassini will explore Saturn, its rings and moons for four years. The Huygens probe, designed and developed for the European Space Agency (ESA), will be deployed from the orbiter to study the clouds, atmosphere and surface of Saturn's largest moon, Titan. The orbiter was designed and assembled at NASA's Jet Propulsion Laboratory in California. Following postflight inspections, integration of the 12 science instruments not already installed on the orbiter will be completed. Then, the parabolic high-gain antenna and the propulsion module will be mated to the orbiter, followed by the Huygens probe, which will complete spacecraft integration. The Cassini mission is targeted for an Oct. 6 launch to begin its 6.7-year journey to the Saturnian system. Arrival at the planet is expected to occur around July 1, 2004.

Fire history on the California Channel Islands spanning human arrival in the Americas.

PubMed

Hardiman, Mark; Scott, Andrew C; Pinter, Nicholas; Anderson, R Scott; Ejarque, Ana; Carter-Champion, Alice; Staff, Richard A

2016-06-05

Recent studies have suggested that the first arrival of humans in the Americas during the end of the last Ice Age is associated with marked anthropogenic influences on landscape; in particular, with the use of fire which, would have given even small populations the ability to have broad impacts on the landscape. Understanding the impact of these early people is complicated by the dramatic changes in climate occurring with the shift from glacial to interglacial conditions. Despite these difficulties, we here attempt to test the extent of anthropogenic influence using the California Channel Islands as a smaller, landscape-scale test bed. These islands are famous for the discovery of the 'Arlington Springs Man', which are some of the earliest human remains in the Americas. A unifying sedimentary charcoal record is presented from Arlington Canyon, Santa Rosa Island, based on over 20 detailed sedimentary sections from eight key localities. Radiocarbon dating was based on thin, fragile, long fragments of charcoal in order to avoid the 'inbuilt' age problem. Radiocarbon dating of 49 such fragments has allowed inferences regarding the fire and landscape history of the Canyon ca 19-11 ka BP. A significant period of charcoal deposition is identified approximately 14-12.5 ka BP and bears remarkable closeness to an estimated age range of the first human arrival on the islands.This article is part of the themed issue 'The interaction of fire and mankind'. © 2016 The Author(s).

Fire history on the California Channel Islands spanning human arrival in the Americas

PubMed Central

Hardiman, Mark; Scott, Andrew C.; Pinter, Nicholas; Anderson, R. Scott; Ejarque, Ana; Carter-Champion, Alice; Staff, Richard A.

2016-01-01

Recent studies have suggested that the first arrival of humans in the Americas during the end of the last Ice Age is associated with marked anthropogenic influences on landscape; in particular, with the use of fire which, would have given even small populations the ability to have broad impacts on the landscape. Understanding the impact of these early people is complicated by the dramatic changes in climate occurring with the shift from glacial to interglacial conditions. Despite these difficulties, we here attempt to test the extent of anthropogenic influence using the California Channel Islands as a smaller, landscape-scale test bed. These islands are famous for the discovery of the ‘Arlington Springs Man’, which are some of the earliest human remains in the Americas. A unifying sedimentary charcoal record is presented from Arlington Canyon, Santa Rosa Island, based on over 20 detailed sedimentary sections from eight key localities. Radiocarbon dating was based on thin, fragile, long fragments of charcoal in order to avoid the ‘inbuilt’ age problem. Radiocarbon dating of 49 such fragments has allowed inferences regarding the fire and landscape history of the Canyon ca 19–11 ka BP. A significant period of charcoal deposition is identified approximately 14–12.5 ka BP and bears remarkable closeness to an estimated age range of the first human arrival on the islands. This article is part of the themed issue ‘The interaction of fire and mankind’. PMID:27216524

Simulation Results for Airborne Precision Spacing along Continuous Descent Arrivals

NASA Technical Reports Server (NTRS)

Barmore, Bryan E.; Abbott, Terence S.; Capron, William R.; Baxley, Brian T.

2008-01-01

This paper describes the results of a fast-time simulation experiment and a high-fidelity simulator validation with merging streams of aircraft flying Continuous Descent Arrivals through generic airspace to a runway at Dallas-Ft Worth. Aircraft made small speed adjustments based on an airborne-based spacing algorithm, so as to arrive at the threshold exactly at the assigned time interval behind their Traffic-To-Follow. The 40 aircraft were initialized at different altitudes and speeds on one of four different routes, and then merged at different points and altitudes while flying Continuous Descent Arrivals. This merging and spacing using flight deck equipment and procedures to augment or implement Air Traffic Management directives is called Flight Deck-based Merging and Spacing, an important subset of a larger Airborne Precision Spacing functionality. This research indicates that Flight Deck-based Merging and Spacing initiated while at cruise altitude and well prior to the Terminal Radar Approach Control entry can significantly contribute to the delivery of aircraft at a specified interval to the runway threshold with a high degree of accuracy and at a reduced pilot workload. Furthermore, previously documented work has shown that using a Continuous Descent Arrival instead of a traditional step-down descent can save fuel, reduce noise, and reduce emissions. Research into Flight Deck-based Merging and Spacing is a cooperative effort between government and industry partners.

Babies born before arrival to hospital and maternity unit closures in Queensland and Australia.

PubMed

Kildea, Sue; McGhie, Alexandra C; Gao, Yu; Rumbold, Alice; Rolfe, Margaret

2015-09-01

Evidence suggests the closure of maternity units is associated with an increase in babies born before arrival (BBA). To explore the association between the number of maternity units in Australia and Queensland by birthing numbers, BBA rate and geographic remoteness of the health district where the mother lives. A retrospective study utilised routinely collected perinatal data (1992-2011). Pearson correlation tested the relationship between BBA rate and number of maternity units. Linear regression examined this association over time. During 1992-2011, the absolute numbers (N=22,814) of women having a BBA each year in Australia increased by 47% (N=836-1233); and 206% (n=140-429) in Queensland. This coincided with a 41% reduction in maternity units in Australia (N=623-368=18 per year) and a 28% reduction in Queensland (n=129-93). BBA rates increased significantly across Australia, r=0.837, n=20 years, p<0.001 and Queensland, r=0.917, n=20 years, p<0.001 and this was negatively correlated with the number of maternity units in Australia, r=-0.804, n=19 years, p<0.001 and Queensland, r=-0.906, n=19 years, p<0.001. The closure of maternity units over a 20-year period across Australia and Queensland is significantly associated with increased BBA rates. The distribution is not limited to rural and remote areas. Given the high risk of adverse maternal and neonatal outcomes associated with BBA, it is time to revisit the closure of units. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

The association between hospital outcomes and diagnostic imaging: early findings.

PubMed

Lee, David W; Foster, David A

2009-11-01

Resource use variation across the United States prompts the important question of whether "more is better" when it comes to health care services. The aim of this study was to examine correlations between the use of 4 common imaging modalities (CT, MR, ultrasound, and radiography) and in-hospital mortality and costs. Using clinical and utilization data for 1.1 million inpatient admissions at 102 US hospitals during 2007, two hospital-specific, risk-adjusted imaging utilization measures for each modality were constructed that controlled for patients' demographic and clinical characteristics and for hospital characteristics were constructed for each modality. First, logistic regression was used to estimate the odds that each type of imaging service would be provided during an admission. Second, the mean number of services per admission was estimated using output from a two-part ordinary least squares model. Hospital-specific, risk-adjusted inpatient mortality and total hospital costs were also computed, and correlations between the imaging utilization measures and the mortality and cost outcome measures were then assessed using Pearson's correlation coefficients (P < .05). The correlation analyses were weighted by hospital admission volume. Hospitals in which patients were more likely to receive imaging services during admissions had lower mortality, even after controlling for potential confounders. Correlation coefficients were -0.2 for all modalities (P = .02-.05). Weaker correlations existed between mean services per admission and mortality, while costs trended insignificantly higher with greater utilization. This study lays the foundation for further exploration of the relationship between resource use and the clinical and economic outcomes associated with imaging utilization.

Hospital at home versus in-patient hospital care.

PubMed

Shepperd, S; Iliffe, S

2005-07-20

Hospital at home is defined as a service that provides active treatment by health care professionals, in the patient's home, of a condition that otherwise would require acute hospital in-patient care, always for a limited period. To assess the effects of hospital at home compared with in-patient hospital care. We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) specialised register (November 2004), MEDLINE (1966 to 1996), EMBASE (1980 to 1995), Social Science Citation Index (1992 to 1995), Cinahl (1982 to 1996), EconLit (1969 to 1996), PsycLit (1987 to 1996), Sigle (1980 to 1995) and the Medical Care supplement on economic literature (1970 to 1990). Randomised trials of hospital at home care compared with acute hospital in-patient care. The participants were patients aged 18 years and over. Two reviewers independently extracted data and assessed study quality. Twenty two trials are included in this update of the review. Among trials evaluating early discharge hospital at home schemes we found an odds ratio (OR) for mortality of 1.79 95% CI 0.85 to 3.76 for elderly medical patients (age 65 years and over) (n = 3 trials); OR 0.58; 95% CI 0.29 to 1.17 for patients with chronic obstructive pulmonary disease (COPD) (n = 5 trials); and OR 0.78; 95%CI 0.52 to 1.19 for patients recovering from a stroke (n = 4 trials). Two trials evaluating the early discharge of patients recovering from surgery reported an OR 0.43 (95% CI 0.02 to 10.89) for patients recovering from a hip replacement and an OR 1.01 (95% CI 0.37 to 2.81) for patients with a mix of conditions at three months follow-up. For readmission to hospital we found an OR 1.76; 95% CI 0.78 to 3.99 at 3 months follow-up for elderly medical patients (n = 2 trials); OR 0.81; 95% CI 0.55 to 1.19 for patients with COPD (n = 5 trials); and OR 0.96; 95% CI 0.63 to 1.45 for patients recovering from a stroke (n = 3 trials). No significant heterogeneity was observed. One trial recruiting patients

Latecomers: The Sources and Impacts of Late Arrival among Adolescent Immigrant Students

ERIC Educational Resources Information Center

Allard, Elaine C.

2016-01-01

In this ethnographic study, the author describes and analyzes the experiences of latecomers, adolescent immigrant students who arrive late in the school year. She shines a light on the multifaceted challenges posed by these students' transnationalism, undocumented status, and labor migration, which contribute to their late arrival and threaten…

Platform C North Arrival

NASA Image and Video Library

2016-08-30

A section of the second half of the C-level platforms, C North, for NASA’s Space Launch System (SLS) rocket, arrives at the agency’s Kennedy Space Center in Florida. The platform was offloaded from a heavy lift transport truck and secured in a staging area in the west parking lot of the Vehicle Assembly Building (VAB). The Ground Systems Development and Operations Program is overseeing upgrades and modifications to VAB High Bay 3 to support processing of the SLS and Orion spacecraft. A total of 10 levels of new platforms, 20 platform halves altogether, will surround the SLS rocket and Orion spacecraft and provide access for testing and processing.

Orion Stage Adapter Arrival

NASA Image and Video Library

2018-04-03

NASA's Super Guppy aircraft taxies onto the tarmac after touching down at the Shuttle Landing Facility at the agency's Kennedy Space Center in Florida. The Super Guppy is carrying the Orion Stage Adapter (OSA), the second flight-hardware section of NASA's Space Launch System (SLS) rocket that has arrived at Kennedy. The OSA will connect the Orion spacecraft to the upper part of the SLS rocket, the interim cryogenic propulsion stage (ICPS). Both the OSA and ICPS are being stored for processing in the center's Space Station Processing Facility in preparation for Exploration Mission-1, the first uncrewed, integrated launch of the SLS rocket and Orion spacecraft.

Orion Stage Adapter Arrival

NASA Image and Video Library

2018-04-03

NASA's Super Guppy aircraft glides to a stop at the Shuttle Landing Facility at the agency's Kennedy Space Center in Florida. The Super Guppy is carrying the Orion Stage Adapter (OSA), the second flight-hardware section of NASA's Space Launch System (SLS) rocket that has arrived at Kennedy. The OSA will connect the Orion spacecraft to the upper part of the SLS rocket, the interim cryogenic propulsion stage (ICPS). Both the OSA and ICPS are being stored for processing in the center's Space Station Processing Facility in preparation for Exploration Mission-1, the first uncrewed, integrated launch of the SLS rocket and Orion spacecraft.

Orion Stage Adapter Arrival

NASA Image and Video Library

2018-04-03

NASA's Super Guppy aircraft prepares to touch down at the Shuttle Landing Facility at the agency's Kennedy Space Center in Florida. The Super Guppy is carrying the Orion Stage Adapter (OSA), the second flight-hardware section of NASA's Space Launch System (SLS) rocket that has arrived at Kennedy. The OSA will connect the Orion spacecraft to the upper part of the SLS rocket, the interim cryogenic propulsion stage (ICPS). Both the OSA and ICPS are being stored for processing in the center's Space Station Processing Facility in preparation for Exploration Mission-1, the first uncrewed, integrated launch of the SLS rocket and Orion spacecraft.

The fruit and vegetable import pathway for potential invasive pest arrivals.

PubMed

Lichtenberg, Erik; Olson, Lars J

2018-01-01

The expansion of international trade in commodities increases the risk of alien species invasions. Invaders are difficult to detect on introduction, so prevention remains the preferred strategy for managing the threat of invasions. Propagule pressure has been shown to be a good predictor of invasion risk. Most studies to date, however, link potential invasive species arrivals with indirect measures of propagule pressure such as aggregate trade volumes. This paper estimates propagule pressure using data that measure actual arrivals. Specifically, it uses inspection data that covers almost all U.S. fruit and vegetable imports from 2005-2014 to estimate a logit model of the probability of potential invasive species arrival and expected propagule frequencies for 2,240 commodity/country of origin combinations. Clear patterns in the geographic origin and commodity pathways for potential pests are identified. The average probability of arrival is low, approximately 0.03, but is two to ten times higher for some commodities, most notably herbs. We identify commodities with a high number of expected arrivals due to either a large volume of trade, high interception rates, or a combination of both. Seven of the top ten countries of origin for propagule frequency are from the Western Hemisphere and further trade liberalization within the Western Hemisphere is likely to heighten challenges to enforcement of US phytosanitary standards. Patterns in the data can help identify the commodities and countries of origin in greatest need of technical assistance and guide targeting of surveillance for the pathways of greatest phytosanitary concern.

The fruit and vegetable import pathway for potential invasive pest arrivals

PubMed Central

2018-01-01

The expansion of international trade in commodities increases the risk of alien species invasions. Invaders are difficult to detect on introduction, so prevention remains the preferred strategy for managing the threat of invasions. Propagule pressure has been shown to be a good predictor of invasion risk. Most studies to date, however, link potential invasive species arrivals with indirect measures of propagule pressure such as aggregate trade volumes. This paper estimates propagule pressure using data that measure actual arrivals. Specifically, it uses inspection data that covers almost all U.S. fruit and vegetable imports from 2005–2014 to estimate a logit model of the probability of potential invasive species arrival and expected propagule frequencies for 2,240 commodity/country of origin combinations. Clear patterns in the geographic origin and commodity pathways for potential pests are identified. The average probability of arrival is low, approximately 0.03, but is two to ten times higher for some commodities, most notably herbs. We identify commodities with a high number of expected arrivals due to either a large volume of trade, high interception rates, or a combination of both. Seven of the top ten countries of origin for propagule frequency are from the Western Hemisphere and further trade liberalization within the Western Hemisphere is likely to heighten challenges to enforcement of US phytosanitary standards. Patterns in the data can help identify the commodities and countries of origin in greatest need of technical assistance and guide targeting of surveillance for the pathways of greatest phytosanitary concern. PMID:29451910

Individual quality explains association between plumage colouration, arrival dates and mate acquisition in yellow warblers (Setophaga petechia).

PubMed

Jones, Teri B; Drake, Anna; Green, David J

2014-05-07

In many bird species colour traits influence social dominance and breeding success. In our study we first evaluated whether the colour of the basic plumage (tail feathers grown at the end of the breeding season), that provides an index of individual quality, influenced winter habitat use by yellow warblers. We then evaluated whether winter habitat use (inferred using δ13C and δ15N signatures of winter grown greater-coverts) influenced alternate plumage colouration, after controlling for individual quality using basic plumage colouration. Finally, we investigated whether basic and alternate plumage colouration influenced arrival dates, mate acquisition, breeding phenology and reproductive success of yellow warblers breeding in southern (Revelstoke, B.C.) and arctic (Inuvik, N.W.T.) Canada. The colour (chroma and hue) of tail feathers, grown on the breeding grounds, was not related to subsequent winter habitat use. Greater covert and tail feather colour (chroma and hue) were correlated, suggesting genetics and/or individual quality played a role in pigment deposition. After controlling for individual difference in tail colour, δ13C values did not explain any variation in greater covert colour, but birds with high δ15N signatures had greater coverts with higher chroma. Male arrival dates varied with tail chroma in Revelstoke and tail hue in Inuvik. Males that arrived early paired with older and/or more colourful mates that initiated clutches earlier, and at one site (Revelstoke) were more likely to fledge young. In addition, in Revelstoke (but not Inuvik) males with high tail hue also acquired more colourful mates. In contrast, after controlling for individual differences in tail colour, greater covert colour did not affect male arrival date, the quality of the mate obtained or reproductive success in either population. Our results suggest that plumage colour effects on breeding phenology and mate acquisition result from differences in the intrinsic quality of

Individual quality explains association between plumage colouration, arrival dates and mate acquisition in yellow warblers (Setophaga petechia)

PubMed Central

2014-01-01

Background In many bird species colour traits influence social dominance and breeding success. In our study we first evaluated whether the colour of the basic plumage (tail feathers grown at the end of the breeding season), that provides an index of individual quality, influenced winter habitat use by yellow warblers. We then evaluated whether winter habitat use (inferred using δ13C and δ15N signatures of winter grown greater-coverts) influenced alternate plumage colouration, after controlling for individual quality using basic plumage colouration. Finally, we investigated whether basic and alternate plumage colouration influenced arrival dates, mate acquisition, breeding phenology and reproductive success of yellow warblers breeding in southern (Revelstoke, B.C.) and arctic (Inuvik, N.W.T.) Canada. Results The colour (chroma and hue) of tail feathers, grown on the breeding grounds, was not related to subsequent winter habitat use. Greater covert and tail feather colour (chroma and hue) were correlated, suggesting genetics and/or individual quality played a role in pigment deposition. After controlling for individual difference in tail colour, δ13C values did not explain any variation in greater covert colour, but birds with high δ15N signatures had greater coverts with higher chroma. Male arrival dates varied with tail chroma in Revelstoke and tail hue in Inuvik. Males that arrived early paired with older and/or more colourful mates that initiated clutches earlier, and at one site (Revelstoke) were more likely to fledge young. In addition, in Revelstoke (but not Inuvik) males with high tail hue also acquired more colourful mates. In contrast, after controlling for individual differences in tail colour, greater covert colour did not affect male arrival date, the quality of the mate obtained or reproductive success in either population. Conclusions Our results suggest that plumage colour effects on breeding phenology and mate acquisition result from differences

[In-patient (early) rehabilitation].

PubMed

Wallesch, Claus-W; Lautenschläger, Sindy

2017-04-01

It is difficult to develop the financing and hospital provision of interventions for early rehabilitation within the diagnosis-related group (DRG) system. In addition to a range of partially rehabilitative complex interventions, the system recognizes three main forms of early rehabilitative interventions: geriatric, neurological/neurosurgical, and interdisciplinary and others. In this article, the appropriate definitions and cost-effectiveness of these procedures are analyzed and compared. The early rehabilitative interventions are characterized by constant cooperation in the therapeutic team, especially neurological early rehabilitation through the incorporation of nursing as a therapeutic profession. Whereas geriatric and neurological early rehabilitation are reflected in the DRG system, the former provided in many general hospitals and the latter mainly in specialized institutions, interdisciplinary early rehabilitation has only occasionally been represented in the DRG system so far. If all acute in-patients who require early rehabilitation should receive such an intervention, an additional fee must be implemented for this this interdisciplinary service.

Early identification of trauma patients in need for emergent transfusion: results of a single-center retrospective study evaluating three scoring systems.

PubMed

Swerts, Frederic; Mathonet, Pierre Yves; Ghuysen, Alexandre; D Orio, Vincenzo; Minon, Jean Marc; Tonglet, Martin

2018-05-31

The Trauma-Induced Coagulopathy Clinical Score (TICCS) was developed to be calculable on the site of injury to discriminate between trauma patients with or without the need for damage control resuscitation and thus transfusion. This early alert could then be translated to in-hospital parameters at patient arrival. Base excess (BE) and ultrasound (FAST) are known to be predictive parameters for emergent transfusion. We emphasize that adding these two parameters to the TICCS could improve the scoring system predictability. A retrospective study was conducted in the University Hospital of Liège. TICCS was calculated for every patient. BE and FAST results were recorded and points were added to the TICCS according to the TICCS.BE definition (+ 3 points if BE < - 5 and + 3 points in case of a positive FAST). Emergent transfusion was defined as the use of at least one blood product in the resuscitation room. The capacity of the TICCS, the TICCS.BE and the Trauma-Associated Severe Hemorrhage (TASH) to predict emergent transfusion was assessed. A total of 328 patients were included. Among them, 14% needed emergent transfusion. The probability for emergent transfusion grows with the TICCS and the TICCS.BE values. We did not find a significant difference between the TICCS (AUC 0.73) and the TICCS.BE (AUC 0.76). The TASH proved to be more predictive (AUC 0.89). 66.6% of the patients with a TICCS ≥ 10 and 81.5% with a TICCS.BE ≥ 14 required emergent transfusion. Adding BE and FAST to the original TICCS does not significantly improve the scoring system predictability. A prehospital TICCS > 10 could be used as a trigger for emergent transfusion activation. TASH could then be used at hospital arrival. Prehospital TASH calculation may be possible but should be further investigated. Diagnostic test, level III.

Aorta Balloon Occlusion in Trauma: Three Cases Demonstrating Multidisciplinary Approach Already on Patient’s Arrival to the Emergency Room

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

Hörer, Tal M., E-mail: tal.horer@orebroll.se; Hebron, Dan; Swaid, Forat

PurposeTo describe the usage of aortic balloon occlusion (ABO), based on a multidisciplinary approach in severe trauma patients, emphasizing the role of the interventional radiologist in primary trauma care.MethodsWe briefly discuss the relevant literature, the technical aspects of ABO in trauma, and a multidisciplinary approach to the bleeding trauma patient. We describe three severely injured trauma patients for whom ABO was part of initial trauma management.ResultsThree severely injured multi-trauma patients were treated by ABO as a bridge to surgery and embolization. The procedures were performed by an interventional radiologist in the early stages of trauma management.ConclusionsThe interventional radiologist and themore » multidisciplinary team approach can be activated already on severe trauma patient arrival. ABO usage and other endovascular methods are becoming more widely spread, and can be used early in trauma management, without delay, thus justifying the early activation of this multidisciplinary approach.« less

[Crisis unit at the general hospital: Determinants of further hospitalization].

PubMed

Norotte, C; Omnès, C; Crozier, C; Verlyck, C; Romanos, M

2017-10-01

The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of

Toward Shorter Hospitalization After Endoscopic Transsphenoidal Pituitary Surgery: Day-by-Day Analysis of Early Postoperative Complications and Interventions.

PubMed

Shimanskaya, Viktoria E; Wagenmakers, Margreet A E M; Bartels, Ronald H M A; Boogaarts, Hieronymus D; Grotenhuis, J André; Hermus, Ad R M M; van de Ven, Annenienke C; van Lindert, Erik J

2018-03-01

It is unclear which patients have the greatest risk of developing complications in the first days after endoscopic transsphenoidal pituitary surgery (ETS) and how long patients should stay hospitalized after surgery. The objective of this study is to identify which patients are at risk for early postoperative medical and surgical reinterventions to optimize the length of hospitalization. The medical records of 146 patients who underwent ETS for a pituitary adenoma between January 2013 and July 2016 were reviewed retrospectively. Data were collected on baseline patient-related characteristics, characteristics of the pituitary adenoma, perioperative complications and interventions, and postoperative outcomes. Patients who underwent additional interventions on days 2, 3, and 4 after ETS were identified as cases, and patients who did not have any interventions after day 1 postoperatively were identified as controls. Diabetes mellitus (odds ratio [OR], 4.279; 95% confidence interval [CI], 1.149-15.933; P = 0.03), incomplete adenoma resection (OR, 2.840; 95% CI, 1.228-6.568; P = 0.02) and increased morning sodium concentration on day 2 after surgery (OR, 5.211; 95% CI, 2.158-12.579; P <0.001) were associated with reinterventions. Patients without interventions on day 1 or 2 had only an 18.6% chance of a reintervention (OR, 0.201; 95% CI, 0.095-0.424). Patients with diabetes mellitus, incomplete adenoma resection, and increased morning sodium concentration on day 2 after surgery have an increased chance on reinterventions. In addition, patients without any interventions on day 1 and 2 are at low risk for later reinterventions. These patients could be suitable candidates for early hospital discharge. Copyright © 2018 Elsevier Inc. All rights reserved.

Evaluating hospital discharge planning: a randomized clinical trial.

PubMed

Evans, R L; Hendricks, R D

1993-04-01

To select patients for early discharge planning, a randomized clinical trial evaluated a protocol that used risk factors identified upon hospital admission. The goal of the study was to determine if intervention with high-risk patients could reduce the need for hospital admission or skilled care. Of 13,255 patients screened, 835 study participants were identified as "at risk" for frequent health care resource use. Half of the high-risk patients were randomly assigned to the experimental group (n = 417) and received discharge planning from day 3 of their hospital stay, while the control group (n = 418) received discharge planning only if there was a written physician request. Those patients receiving early, systematic discharge planning experienced an increased likelihood of successful return to home after hospital admission and a decreased chance of unscheduled readmission for the 9-month study period. Length of the index hospital stay was not affected by early planning, however. The major clinical implication is the potential for discharge planners to decrease the need for, and use of, health care resources after hospital admission.

Delta II JPSS-1 Spacecraft Arrival

NASA Image and Video Library

2017-09-01

The Joint Polar Satellite System-1, or JPSS-1, arrives at the Astrotech Processing Facility at Vandenberg Air Force Base in California. JPSS is the first in a series four next-generation environmental satellites in a collaborative program between the National Oceanic and Atmospheric Administration (NOAA) and NASA. The satellite is scheduled to liftoff Nov. 10, 2017 atop a United Launch Alliance Delta II rocket.

14 CFR 93.23 - Arrival Authorizations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... International Airport § 93.23 Arrival Authorizations. (a) Except as otherwise established by the FAA under... limited to: (1) 88 per hour between the hours of 7 a.m. and 7:59 p.m. Monday through Friday and 12 p.m. and 7:59 p.m. Sunday, (i) Not to exceed 50 during each half-hour beginning at 7 a.m. and ending at 7...

14 CFR 93.23 - Arrival Authorizations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... International Airport § 93.23 Arrival Authorizations. (a) Except as otherwise established by the FAA under... limited to: (1) 88 per hour between the hours of 7 a.m. and 7:59 p.m. Monday through Friday and 12 p.m. and 7:59 p.m. Sunday, (i) Not to exceed 50 during each half-hour beginning at 7 a.m. and ending at 7...

8 CFR 258.3 - Action upon arrival.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS LIMITATIONS ON PERFORMANCE OF LONGSHORE WORK BY ALIEN CREWMEN § 258.3 Action upon arrival. (a) The master or agent of the vessel... the vessel will perform longshore work at any port before departing the United States; and (2) If...

19 CFR 122.31 - Notice of arrival.

Code of Federal Regulations, 2011 CFR

2011-04-01

... following information: (1) Type of aircraft and registration number; (2) Name (last, first, middle, if... provided in paragraph (b) of this section, all aircraft entering the United States from a foreign area must give advance notice of arrival. (b) Exceptions for scheduled aircraft of a scheduled airline. Advance...

19 CFR 122.31 - Notice of arrival.

Code of Federal Regulations, 2013 CFR

2013-04-01

... following information: (1) Type of aircraft and registration number; (2) Name (last, first, middle, if... provided in paragraph (b) of this section, all aircraft entering the United States from a foreign area must give advance notice of arrival. (b) Exceptions for scheduled aircraft of a scheduled airline. Advance...

19 CFR 122.31 - Notice of arrival.

Code of Federal Regulations, 2014 CFR

2014-04-01

... following information: (1) Type of aircraft and registration number; (2) Name (last, first, middle, if... provided in paragraph (b) of this section, all aircraft entering the United States from a foreign area must give advance notice of arrival. (b) Exceptions for scheduled aircraft of a scheduled airline. Advance...

Cancellation of spurious arrivals in Green's function extraction and the generalized optical theorem

USGS Publications Warehouse

Snieder, R.; Van Wijk, K.; Haney, M.; Calvert, R.

2008-01-01

The extraction of the Green's function by cross correlation of waves recorded at two receivers nowadays finds much application. We show that for an arbitrary small scatterer, the cross terms of scattered waves give an unphysical wave with an arrival time that is independent of the source position. This constitutes an apparent inconsistency because theory predicts that such spurious arrivals do not arise, after integration over a complete source aperture. This puzzling inconsistency can be resolved for an arbitrary scatterer by integrating the contribution of all sources in the stationary phase approximation to show that the stationary phase contributions to the source integral cancel the spurious arrival by virtue of the generalized optical theorem. This work constitutes an alternative derivation of this theorem. When the source aperture is incomplete, the spurious arrival is not canceled and could be misinterpreted to be part of the Green's function. We give an example of how spurious arrivals provide information about the medium complementary to that given by the direct and scattered waves; the spurious waves can thus potentially be used to better constrain the medium. ?? 2008 The American Physical Society.

Can lay responder defibrillation programmes improve survival to hospital discharge following an out-of-hospital cardiac arrest?

PubMed

Smith, Leigh M; Davidson, Patricia M; Halcomb, Elizabeth J; Andrew, Sharon

2007-11-01

The importance of early defibrillation in improving outcomes and reducing morbidity following out-of-hospital cardiac arrest underscores the importance of examining novel approaches to treatment access. The increasing evidence to support the importance of early defibrillation has increased attention on the potential for lay responders to deliver this therapy. This paper seeks to critically review the literature that evaluates the impact of lay responder defibrillator programs on survival to hospital discharge following an out-of-hospital cardiac arrest in the adult population. The electronic databases, Medline and CINAHL, were searched using keywords including; "first responder", "lay responder", "defibrillation" and "cardiac arrest". The reference lists of retrieved articles and the Internet were also searched. Articles were included in the review if they reported primary data, in the English language, which described the effect of a lay responder defibrillation program on survival to hospital discharge from out-of-hospital cardiac arrest in adults. Eleven studies met the inclusion criteria. The small number of published studies, heterogeneity of study populations and study outcome methods prohibited formal meta-analysis. Therefore, narrative analysis was undertaken. Studies included in this report provided inconsistent findings in relation to survival to hospital discharge following out-of-hospital cardiac arrest. Although there are limited data, the role of the lay responder appears promising in improving the outcome from out-of-hospital cardiac arrest following early defibrillation. Despite the inherent methodological difficulties in studying this population, future research should address outcomes related to morbidity, mortality and cost-effectiveness.

7 CFR 319.24-4 - Notice of arrival of corn by permittee.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 5 2011-01-01 2011-01-01 false Notice of arrival of corn by permittee. 319.24-4... HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FOREIGN QUARANTINE NOTICES Corn Diseases Regulations Governing Entry of Indian Corn Or Maize § 319.24-4 Notice of arrival of corn by permittee. Immediately upon...

7 CFR 319.24-4 - Notice of arrival of corn by permittee.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 5 2010-01-01 2010-01-01 false Notice of arrival of corn by permittee. 319.24-4... HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FOREIGN QUARANTINE NOTICES Corn Diseases Regulations Governing Entry of Indian Corn Or Maize § 319.24-4 Notice of arrival of corn by permittee. Immediately upon...

Hardware-software complex of informing passengers of forecasted route transport arrival at stop

NASA Astrophysics Data System (ADS)

Pogrebnoy, V. Yu; Pushkarev, M. I.; Fadeev, A. S.

2017-02-01

The paper presents the hardware-software complex of informing the passengers of the forecasted route transport arrival. A client-server architecture of the forecasting information system is represented and an electronic information board prototype is described. The scheme of information transfer and processing, starting with receiving navigating telemetric data from a transport vehicle and up to the time of passenger public transport arrival at the stop, as well as representation of the information on the electronic board is illustrated and described. Methods and algorithms of determination of the transport vehicle current location in the city route network are considered in detail. The description of the proposed forecasting model of transport vehicle arrival time at the stop is given. The obtained result is applied in Tomsk for forecasting and displaying the arrival time information at the stops.

Satisfaction among early and mid-career dentists in a metropolitan dental hospital in China.

PubMed

Cui, Xiaoxi; Dunning, David G; An, Na

2017-01-01

A growing body of research has examined career satisfaction among dentists using a standardized instrument, dentist satisfaction survey (DSS). This project examined career satisfaction of early to mid-career dentists in China, a population whose career satisfaction, heretofore, has not been studied. This is an especially critical time to examine career satisfaction because of health care reform measures being implemented in China. A culturally sensitive Chinese-language version of the DSS (CDSS) was developed and electronically administered to 367 early and mid-career dentists in a tertiary dental hospital in Beijing, China. One hundred and seventy respondents completed the survey. The average total career score was 123, with a range of 82-157. Data analysis showed some significant differences in total career score and several subscales based on gender, working hours per week, and years in practice. A stepwise regression model revealed that two variables predicted total career score: working hours per week and gender. Stepwise regression also demonstrated that four subscales significantly predicted the overall professional satisfaction subscale score: respect, delivery of care, income and patient relations. Implications of these results are discussed in light of the health care delivery system and dentist career paths in China.

Implementing Obstetric Early Warning Systems.

PubMed

Friedman, Alexander M; Campbell, Mary L; Kline, Carolyn R; Wiesner, Suzanne; D'Alton, Mary E; Shields, Laurence E

2018-04-01

Severe maternal morbidity and mortality are often preventable and obstetric early warning systems that alert care providers of potential impending critical illness may improve maternal safety. While literature on outcomes and test characteristics of maternal early warning systems is evolving, there is limited guidance on implementation. Given current interest in early warning systems and their potential role in care, the 2017 Society for Maternal-Fetal Medicine (SMFM) Annual Meeting dedicated a session to exploring early warning implementation across a wide range of hospital settings. This manuscript reports on key points from this session. While implementation experiences varied based on factors specific to individual sites, common themes relevant to all hospitals presenting were identified. Successful implementation of early warnings systems requires administrative and leadership support, dedication of resources, improved coordination between nurses, providers, and ancillary staff, optimization of information technology, effective education, evaluation of and change in hospital culture and practices, and support in provider decision-making. Evolving data on outcomes on early warning systems suggest that maternal risk may be reduced. To effectively reduce maternal, risk early warning systems that capture deterioration from a broad range of conditions may be required in addition to bundles tailored to specific conditions such as hemorrhage, thromboembolism, and hypertension.

Self-Regulation in Newly Arrived International Adoptees

ERIC Educational Resources Information Center

Tirella, Linda Grey; Miller, Laurie C.

2011-01-01

Many newly arrived international adoptees (IA) have difficulties with eating, sleeping, and self-soothing/self-stimulating (SS) behaviors. However, to date the prevalence of these problems and associated risk factors have not been clearly identified. Therefore, we proposed to evaluate 387 IA for the presence of these self-regulation and behavioral…

Accurate seismic phase identification and arrival time picking of glacial icequakes

NASA Astrophysics Data System (ADS)

Jones, G. A.; Doyle, S. H.; Dow, C.; Kulessa, B.; Hubbard, A.

2010-12-01

A catastrophic lake drainage event was monitored continuously using an array of 6, 4.5 Hz 3 component geophones in the Russell Glacier catchment, Western Greenland. Many thousands of events and arrival time phases (e.g., P- or S-wave) were recorded, often with events occurring simultaneously but at different locations. In addition, different styles of seismic events were identified from 'classical' tectonic earthquakes to tremors usually observed in volcanic regions. The presence of such a diverse and large dataset provides insight into the complex system of lake drainage. One of the most fundamental steps in seismology is the accurate identification of a seismic event and its associated arrival times. However, the collection of such a large and complex dataset makes the manual identification of a seismic event and picking of the arrival time phases time consuming with variable results. To overcome the issues of consistency and manpower, a number of different methods have been developed including short-term and long-term averages, spectrograms, wavelets, polarisation analyses, higher order statistics and auto-regressive techniques. Here we propose an automated procedure which establishes the phase type and accurately determines the arrival times. The procedure combines a number of different automated methods to achieve this, and is applied to the recently acquired lake drainage data. Accurate identification of events and their arrival time phases are the first steps in gaining a greater understanding of the extent of the deformation and the mechanism of such drainage events. A good knowledge of the propagation pathway of lake drainage meltwater through a glacier will have significant consequences for interpretation of glacial and ice sheet dynamics.

First arrival time picking for microseismic data based on DWSW algorithm

NASA Astrophysics Data System (ADS)

Li, Yue; Wang, Yue; Lin, Hongbo; Zhong, Tie

2018-03-01

The first arrival time picking is a crucial step in microseismic data processing. When the signal-to-noise ratio (SNR) is low, however, it is difficult to get the first arrival time accurately with traditional methods. In this paper, we propose the double-sliding-window SW (DWSW) method based on the Shapiro-Wilk (SW) test. The DWSW method is used to detect the first arrival time by making full use of the differences between background noise and effective signals in the statistical properties. Specifically speaking, we obtain the moment corresponding to the maximum as the first arrival time of microseismic data when the statistic of our method reaches its maximum. Hence, in our method, there is no need to select the threshold, which makes the algorithm more facile when the SNR of microseismic data is low. To verify the reliability of the proposed method, a series of experiments is performed on both synthetic and field microseismic data. Our method is compared with the traditional short-time and long-time average (STA/LTA) method, the Akaike information criterion, and the kurtosis method. Analysis results indicate that the accuracy rate of the proposed method is superior to that of the other three methods when the SNR is as low as - 10 dB.

Screening for Infectious Diseases among Newly Arrived Migrants: Experiences and Practices in Non-EU Countries of the Mediterranean Basin and Black Sea.

PubMed

Napoli, Christian; Dente, Maria Grazia; Kärki, Tommi; Riccardo, Flavia; Rossi, Pasqualino; Declich, Silvia

2015-12-08

Changing migration dynamics in the Mediterranean Sea and differences in infectious diseases (ID) burden between the countries of origin have raised questions whether public health actions are needed to avoid the transmission of ID. Screening newly arrived migrants for ID is one health monitoring option, offering opportunities for prevention, early detection and treatment. The authors conducted a survey among country experts in non-European Union countries of the Mediterranean and Black Sea, in order to explore current ID screening practices and policies for newly arrived migrants. The association between the existence of guidelines and the proportion of refugees in the population was also estimated. Eighteen country experts responded (90%) out of the 20 invited. Eleven countries (61%) implemented screening programmes and six (38%) had national guidelines. Screening was performed most often for tuberculosis at the holding level. A higher proportion of refugees in the population was associated with the existence of guidelines for screening (p = 0.05). Fourteen experts (88%) considered screening among migrants useful. The results show that screening for ID in newly arrived migrants is relevant for non-EU countries of the Mediterranean and Black Sea. Common guidelines could be promoted focusing on both individual and public health benefits of screening programmes.

The early effects of Medicare's mandatory hospital pay-for-performance program.

PubMed

Ryan, Andrew M; Burgess, James F; Pesko, Michael F; Borden, William B; Dimick, Justin B

2015-02-01

To evaluate the impact of hospital value-based purchasing (HVBP) on clinical quality and patient experience during its initial implementation period (July 2011-March 2012). Hospital-level clinical quality and patient experience data from Hospital Compare from up to 5 years before and three quarters after HVBP was initiated. Acute care hospitals were exposed to HVBP by mandate while critical access hospitals and hospitals located in Maryland were not exposed. We performed a difference-in-differences analysis, comparing performance on 12 incentivized clinical process and 8 incentivized patient experience measures between hospitals exposed to the program and a matched comparison group of nonexposed hospitals. We also evaluated whether hospitals that were ultimately exposed to HVBP may have anticipated the program by improving quality in advance of its introduction. Difference-in-differences estimates indicated that hospitals that were exposed to HVBP did not show greater improvement for either the clinical process or patient experience measures during the program's first implementation period. Estimates from our preferred specification showed that HVBP was associated with a 0.51 percentage point reduction in composite quality for the clinical process measures (p > .10, 95 percent CI: -1.37, 0.34) and a 0.30 percentage point reduction in composite quality for the patient experience measures (p > .10, 95 percent CI: -0.79, 0.19). We found some evidence that hospitals improved performance on clinical process measures prior to the start of HVBP, but no evidence of this phenomenon for the patient experience measures. The timing of the financial incentives in HVBP was not associated with improved quality of care. It is unclear whether improvement for the clinical process measures prior to the start of HVBP was driven by the expectation of the program or was the result of other factors. © Health Research and Educational Trust.

Research Of Airborne Precision Spacing to Improve Airport Arrival Operations

NASA Technical Reports Server (NTRS)

Barmore, Bryan E.; Baxley, Brian T.; Murdoch, Jennifer L.

2011-01-01

In September 2004, the European Organization for the Safety of Air Navigation (EUROCONTROL) and the United States Federal Aviation Administration (FAA) signed a Memorandum of Cooperation to mutually develop, modify, test, and evaluate systems, procedures, facilities, and devices to meet the need for safe and efficient air navigation and air traffic control in the future. In the United States and Europe, these efforts are defined within the architectures of the Next Generation Air Transportation System (NextGen) Program and Single European Sky Air Traffic Management Research (SESAR) Program respectively. Both programs have identified Airborne Spacing as a critical component, with Automatic Dependent Surveillance Broadcast (ADS-B) as a key enabler. Increased interest in reducing airport community noise and the escalating cost of aviation fuel has led to the use of Continuous Descent Arrival (CDA) procedures to reduce noise, emissions, and fuel usage compared to current procedures. To provide these operational enhancements, arrival flight paths into terminal areas are planned around continuous vertical descents that are closer to an optimum trajectory than those in use today. The profiles are designed to be near-idle descents from cruise altitude to the Final Approach Fix (FAF) and are typically without any level segments. By staying higher and faster than conventional arrivals, CDAs also save flight time for the aircraft operator. The drawback is that the variation of optimized trajectories for different types and weights of aircraft requires the Air Traffic Controller to provide more airspace around an aircraft on a CDA than on a conventional arrival procedure. This additional space decreases the throughput rate of the destination airport. Airborne self-spacing concepts have been developed to increase the throughput at high-demand airports by managing the inter-arrival spacing to be more precise and consistent using on-board guidance. It has been proposed that the

Tidal Analysis and Arrival Process Mining Using Automatic Identification System (AIS) Data

DTIC Science & Technology

2017-01-01

elevation at the time of vessel movement and calculating the tidal dependence (TD) parameter to 23 U.S. port areas for the years 2012– 2014. Tidal prediction...predictions, obtained from the National Oceanographic and Atmospheric Administration, are used to rank relative tidal dependence for arriving cargo and...sector traffic percentages and tidal dependence metric ............................. 11 Arrival process mining

Association Between Onset-to-Door Time and Clinical Outcomes After Ischemic Stroke.

PubMed

Matsuo, Ryu; Yamaguchi, Yuko; Matsushita, Tomonaga; Hata, Jun; Kiyuna, Fumi; Fukuda, Kenji; Wakisaka, Yoshinobu; Kuroda, Junya; Ago, Tetsuro; Kitazono, Takanari; Kamouchi, Masahiro

2017-11-01

The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T 0-1 , ≤1 hour; T 1-2 , >1 and ≤2 hours; T 2-3 , >2 and ≤3 hours; T 3-6 , >3 and ≤6 hours; T 6-12 , >6 and ≤12 hours; T 12-24 , >12 and ≤24 hours; and T 24- , >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement ( T 0- 1 , 2.79 [2.28-3.42]; T 1-2 , 2.49 [2.02-3.07]; T 2-3 , 1.52 [1.21-1.92]; T 3-6 , 1.72 [1.44-2.05], with reference to T 24- ) and good functional outcome ( T 0-1 , 2.68 [2.05-3.49], T 1-2 2.10 [1.60-2.77], T 2-3 1.53 [1.15-2.03], T 3-6 1.31 [1.05-1.64], with reference to T 24- ), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after

TDRS-M Spacecraft Arrival

NASA Image and Video Library

2017-06-23

NASA's TDRS-M satellite arrives inside its shipping container at Space Coast Regional Airport in Titusville, Florida, aboard a U.S. Air Force transport aircraft. The spacecraft is transported to the nearby Astrotech facility, also in Titusville, for preflight processing. The TDRS-M is the latest spacecraft destined for the agency's constellation of communications satellites that allows nearly continuous contact with orbiting spacecraft ranging from the International Space Station and Hubble Space Telescope to the array of scientific observatories. Liftoff atop a United Launch Alliance Atlas V rocket is scheduled to take place from Space Launch Complex 41 at Cape Canaveral Air Force Station at 9:02 a.m. EDT Aug. 3, 2017.

Platform C South Arrival

NASA Image and Video Library

2016-08-04

A heavy load transport truck from Tillett Heavy Hauling in Titusville, Florida, arrives at the Vehicle Assembly Building (VAB) at NASA’s Kennedy Space Center in Florida, carrying a section of the first half of the C-level work platforms, C south, for the agency’s Space Launch System (SLS) rocket. The platform will be delivered to the VAB staging area in the west parking lot. The Ground Systems Development and Operations Program is overseeing upgrades and modifications to VAB High Bay 3 to support processing of the SLS and Orion spacecraft. A total of 10 levels of new platforms, 20 platform halves altogether, will surround the SLS rocket and Orion spacecraft and provide access for testing and processing.

Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis.

PubMed

Andersen, Lars W; Kurth, Tobias; Chase, Maureen; Berg, Katherine M; Cocchi, Michael N; Callaway, Clifton; Donnino, Michael W

2016-04-06

To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. Prospective observational cohort study. Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. Epinephrine given within two minutes after the first defibrillation. Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were "at risk" of receiving epinephrine within the same minute but who did not receive it. 2978 patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine administration was also associated with a decreased odds of return of spontaneous circulation

US hospital care for patients with HIV infection and pneumonia: the role of public, private, and Veterans Affairs hospitals in the early highly active antiretroviral therapy era.

PubMed

Uphold, Constance R; Deloria-Knoll, Maria; Palella, Frank J; Parada, Jorge P; Chmiel, Joan S; Phan, Laura; Bennett, Charles L

2004-02-01

We evaluated differences in processes and outcomes of HIV-related pneumonia care among patients in Veterans Affairs (VA), public, and for-profit and not-for-profit private hospitals in the United States. We compared the results of our current study (1995 to 1997) with those of our previous study that included a sample of patients receiving care during the years 1987 to 1990 to determine how HIV-related pneumonia care had evolved over the last decade. The sample consisted of 1,231 patients with HIV infection who received care for Pneumocystis carinii pneumonia (PCP) and 750 patients with HIV infection who received care for community-acquired pneumonia (CAP) during the years 1995 to 1997. We conducted a retrospective medical record review and evaluated patient and hospital characteristics, HIV-related processes of care (timely use of anti-PCP medications, adjunctive corticosteroids), non-HIV-related processes of care (timely use of CAP treatment medications, diagnostic testing, ICU utilization, rates of endotracheal ventilation, placement on respiratory isolation), length of inpatient hospital stay, and inpatient mortality. Rates of timely use of antibiotics and adjunctive corticosteroids for treating PCP were high and improved dramatically from the prior decade. However, compliance with consensus guidelines that recommend < 8 h as the optimal time window for initiation of antibiotics to treat CAP was lower. For both PCP and CAP, variations in processes of care and lengths of in-hospital stays, but not mortality rates, were noted at VA, public, private not-for-profit hospitals, and for-profit hospitals. This study provides the first overview of HIV-related pneumonia care in the early highly active antiretroviral therapy era, and contrasts current findings with those of a similarly conducted study from a decade earlier. Quality of care for patients with PCP improved, but further efforts are needed to facilitate the appropriate management of CAP. In the third decade of

STS-85 Crew Arrival for TCDT

NASA Technical Reports Server (NTRS)

1997-01-01

The Space Shuttle Mission STS-85 crew arrives at the Shuttle Landing Facility for their mission's Terminal Countdown Demonstration Test (TCDT), a dress rehearsal for launch. They are (from left): Mission Specialist Stephen K. Robinson; Payload Commander N. Jan Davis; Mission Specialist Robert L. Curbeam; Commander Curtis L. Brown, Jr.; Pilot Kent V. Rominger; and Payload Specialist Bjarni V. Tryggvason. The liftoff for STS-85 is targeted for August 7, 1997.

Markovian Queues with Arrival Dependence

DTIC Science & Technology

1976-03-01

adding together the three balance equations for P 2o’ ^21’ "^22 as ^°ll°ws ’ 1 20 2 21 <W P21= XP10 + *2P22 H- ( ^ l^ 2 )p22 = Xp11 "lP20 +UlP21 +V22...REPORT DOCUMENTATION PAGE READ INSTRUCTIONSBEFORE COMPLETING FORM 1 REPORT NUMBER 2 . GOVT ACCESSION NO. 3. RECIPIENT’S CATALOG NUMBER 4. TITLE (and...ADDITIONAL FACTS CONCERNING THE TRANSIENT DISTRIBUTION OF WAITING TIMES FOR ARRIVING CUSTOMERS 2 ? IV. THE TWO CHANNEL SERVER QUEUE WITH SINGLE

Robotic Refueling Mission-3 Arrival and Processing

NASA Image and Video Library

2018-05-08

NASA’s Robotic Refueling Mission 3 (RRM3) arrived at Kennedy Space Center’s Space Station Processing Facility on May 8. The fluid transfer module will demonstrate innovative methods to store, transfer and freeze standard cryogenic fluid in space. RRM3 is scheduled to launch to the International Space Station later this year.

Feasibility Criteria for Interval Management Operations as Part of Arrival Management Operations

NASA Technical Reports Server (NTRS)

Levitt, Ian M.; Weitz, Lesley A.; Barmore, Bryan E.; Castle, Michael W.

2014-01-01

Interval Management (IM) is a future airborne spacing concept that aims to provide more precise inter-aircraft spacing to yield throughput improvements and greater use of fuel efficient trajectories for arrival and approach operations. To participate in an IM operation, an aircraft must be equipped with avionics that provide speeds to achieve and maintain an assigned spacing interval relative to another aircraft. It is not expected that all aircraft will be equipped with the necessary avionics, but rather that IM fits into a larger arrival management concept developed to support the broader mixed-equipage environment. Arrival management concepts are comprised of three parts: a ground-based sequencing and scheduling function to develop an overall arrival strategy, ground-based tools to support the management of aircraft to that schedule, and the IM tools necessary for the IM operation (i.e., ground-based set-up, initiation, and monitoring, and the flight-deck tools to conduct the IM operation). The Federal Aviation Administration is deploying a near-term ground-automation system to support metering operations in the National Airspace System, which falls within the first two components of the arrival management concept. This paper develops a methodology for determining the required delivery precision at controlled meter points for aircraft that are being managed to a schedule and aircraft being managed to a relative spacing interval in order to achieve desired flow rates and adequate separation at the meter points.

Improved hospital mortality with a low MET dose: the importance of a modified early warning score and communication tool.

PubMed

Mullany, D V; Ziegenfuss, M; Goleby, M A; Ward, H E

2016-11-01

Rapid response systems have been mandated for the recognition and management of the deteriorating patient. Increasing medical emergency team (MET) dose may be associated with improved outcomes. Large numbers of MET calls may divert resources from the program providing the service unless additional personnel are provided. To describe the implementation and outcomes of a multifaceted rapid response system (RRS) in a teaching hospital, we conducted an observational study. The RRS consisted of the introduction of a MET together with 1) redesign of the ward observation chart with the vital sign variables colour-coded to identify variation from normal; 2) mandated minimum frequency of vital sign measurement; 3) three formal levels of escalation based on the degree of physiological instability as measured by a modified early warning score (MEWS); 4) COMPASS© education and e-learning package with a two-hour face-to-face small group tutorial; 5) practise in escalation and communication using the ISBAR (Identify, Situation, Background, Assessment, Response/Recommendation) communication tool. The primary outcome measures were all-cause hospital mortality rate and hospital standardised mortality ratio (HSMR) compared to peer hospitals calculated by the Health Round Table. There were 161,153 separations and 1,994 hospital deaths from July 2008 to December 2012. The MET call rate was 11.3 per 1000 separations in 2012. There was a decline in all-cause hospital mortality from 13.8 to 11 deaths/1000 separations. The HSMR decreased from 95.7 in 2008 to 66 in the second half of 2012 (below the three standard deviation control limit). A low MET dose may be associated with improved hospital mortality when combined with a MEWS and an intervention to improve communication.

Officials welcome the arrival of the Japanese Experiment Module

NASA Image and Video Library

2007-04-17

In the Space Station Processing Facility, Scott Higginbotham, payload manager for the International Space Station, discusses the Experiment Logistics Module Pressurized Section for the Japanese Experiment Module (JEM), with Dr. Hidetaka Tanaka, the JEM Project Team resident manager at KSC for the Japanese Aerospace and Exploration Agency (JAXA). Earlier, NASA and JAXA officials welcomed the arrival of the module. The new International Space Station component arrived at Kennedy March 12 to begin preparations for its future launch on mission STS-123. It will serve as an on-orbit storage area for materials, tools and supplies. It can hold up to eight experiment racks and will attach to the top of another larger pressurized module.

Application of Queueing Theory to the Analysis of Changes in Outpatients' Waiting Times in Hospitals Introducing EMR

PubMed Central

Cho, Kyoung Won; Kim, Seong Min; Chae, Young Moon

2017-01-01

Objectives This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. Methods We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. Results Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. Conclusions It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process. PMID:28261529

Application of Queueing Theory to the Analysis of Changes in Outpatients' Waiting Times in Hospitals Introducing EMR.

PubMed

Cho, Kyoung Won; Kim, Seong Min; Chae, Young Moon; Song, Yong Uk

2017-01-01

This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process.

Diagnosis according to time of arrival at "The Great New York State Fair".

PubMed

Nacca, Katherine; Scott, Jay; Grant, William

2014-02-01

To study the diagnoses of patients presenting to a medical facility within a mass-gathering public event, "The Great New York State Fair" (NYSF) based on chief complaints, diagnoses, and time of arrival. The goal of the study was to assess the need for increased staffing, services, or supplies during certain times of day for an event that gathers approximately 1 million patrons over a 12-day span. Patrons occupy the grounds between the hours of 10 am and 11 pm, while workers and staff are on the grounds around the clock. Triage data gathered by trained medical students was collected from all of the patients seen during the 2009 NYSF from 12 am to 11:59 pm. Triage information was categorized based on the nature of complaint, physician impression, and time of arrival to assess for trends in the distribution of common chief complaints and diagnoses at a mass-gathering medical care facility. The early hours of the NYSF were occupied mostly with treatment of minor first aid complaints, while later hours were occupied more commonly by orthopedic complaints. Insect stings were the most frequent complaint throughout the day. Daytime and evening hours at the fair have a significant number of orthopedic diagnoses and may benefit from specific staff and equipment sufficient to handle these complaints. Stings and minor first aid injuries are also significant and may benefit from adequate stocking of the infirmary for such events. Major medical complaints, including cardiac and neurological complaints, did occur but were a minor part of the total patient population.

Malaria in rural Mozambique. Part II: children admitted to hospital.

PubMed

Bassat, Quique; Guinovart, Caterina; Sigaúque, Betuel; Aide, Pedro; Sacarlal, Jahit; Nhampossa, Tacilta; Bardají, Azucena; Nhacolo, Ariel; Macete, Eusébio; Mandomando, Inácio; Aponte, John J; Menéndez, Clara; Alonso, Pedro L

2008-02-26

Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Minimum community based-incidence rates (MCBIRs) complement hospital data, describing the malaria burden in the community. A retrospective analysis of all admitted malaria cases to a Mozambican rural hospital between June 2003 and May 2005 was conducted. Prevalence and case fatality rates (CFR) for each sign and symptom were calculated. Logistic regression was used to identify variables which were independent risk factors for death. MCBIRs for malaria and severe malaria were calculated using data from the Demographic Surveillance System. Almost half of the 8,311 patients admitted during the study period had malaria and 13,2% had severe malaria. Children under two years accounted for almost 60% of all malaria cases. CFR for malaria was 1.6% and for severe malaria 4.4%. Almost 19% of all paediatric hospital deaths were due to malaria. Prostration (55.0%), respiratory distress (41.1%) and severe anaemia (17.3%) were the most prevalent signs among severe malaria cases. Severe anaemia and inability to look for mother's breast were independent risk factors for death in infants younger than eight months. For children aged eight months to four years, the risk factors were malnutrition, hypoglycaemia, chest indrawing, inability to sit and a history of vomiting.MCBIRs for severe malaria cases were highest in children aged six months to two years of age. MCBIRs for severe malaria per 1,000 child years at risk for the whole study period were 27 in infants, 23 in children aged 1 to <5 years and two in children aged > or =5 years. Malaria remains the number one cause of admission in this area of rural Mozambique, predominantly affecting young children, which are also at higher risk of dying. Measures envisaged to protect children during their first two years of life are likely to have a greater impact than at any other age.

Malaria in rural Mozambique. Part II: children admitted to hospital

PubMed Central

Bassat, Quique; Guinovart, Caterina; Sigaúque, Betuel; Aide, Pedro; Sacarlal, Jahit; Nhampossa, Tacilta; Bardají, Azucena; Nhacolo, Ariel; Macete, Eusébio; Mandomando, Inácio; Aponte, John J; Menéndez, Clara; Alonso, Pedro L

2008-01-01

Background Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Minimum community based-incidence rates (MCBIRs) complement hospital data, describing the malaria burden in the community. Methods A retrospective analysis of all admitted malaria cases to a Mozambican rural hospital between June 2003 and May 2005 was conducted. Prevalence and case fatality rates (CFR) for each sign and symptom were calculated. Logistic regression was used to identify variables which were independent risk factors for death. MCBIRs for malaria and severe malaria were calculated using data from the Demographic Surveillance System. Results Almost half of the 8,311 patients admitted during the study period had malaria and 13,2% had severe malaria. Children under two years accounted for almost 60% of all malaria cases. CFR for malaria was 1.6% and for severe malaria 4.4%. Almost 19% of all paediatric hospital deaths were due to malaria. Prostration (55.0%), respiratory distress (41.1%) and severe anaemia (17.3%) were the most prevalent signs among severe malaria cases. Severe anaemia and inability to look for mother's breast were independent risk factors for death in infants younger than eight months. For children aged eight months to four years, the risk factors were malnutrition, hypoglycaemia, chest indrawing, inability to sit and a history of vomiting. MCBIRs for severe malaria cases were highest in children aged six months to two years of age. MCBIRs for severe malaria per 1,000 child years at risk for the whole study period were 27 in infants, 23 in children aged 1 to <5 years and two in children aged ≥5 years. Conclusion Malaria remains the number one cause of admission in this area of rural Mozambique, predominantly affecting young children, which are also at higher risk of dying. Measures envisaged to protect children during their first two years of life are likely to have a greater impact than at any other age

7 CFR 319.37-11 - Arrival notification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 5 2010-01-01 2010-01-01 false Arrival notification. 319.37-11 Section 319.37-11 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FOREIGN QUARANTINE NOTICES Nursery Stock, Plants, Roots, Bulbs, Seeds, and Other Plant Products 1,2 § 319.37-11...

7 CFR 319.37-11 - Arrival notification.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 5 2011-01-01 2011-01-01 false Arrival notification. 319.37-11 Section 319.37-11 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FOREIGN QUARANTINE NOTICES Nursery Stock, Plants, Roots, Bulbs, Seeds, and Other Plant Products 1,2 § 319.37-11...

Is it necessary to assume an apartheid-like social structure in Early Anglo-Saxon England?

PubMed

Pattison, John E

2008-11-07

It has recently been argued that there was an apartheid-like social structure operating in Early Anglo-Saxon England. This was proposed in order to explain the relatively high degree of similarity between Germanic-speaking areas of northwest Europe and England. Opinions vary as to whether there was a substantial Germanic invasion or only a relatively small number arrived in Britain during this period. Contrary to the assumption of limited intermarriage made in the apartheid simulation, there is evidence that significant mixing of the British and Germanic peoples occurred, and that the early law codes, such as that of King Ine of Wessex, could have deliberately encouraged such mixing. More importantly, the simulation did not take into account any northwest European immigration that arrived both before and after the Early Anglo-Saxon period. In view of the uncertainty of the places of origin of the various Germanic peoples, and their numbers and dates of arrival, the present study adopts an alternative approach to estimate the percentage of indigenous Britons in the current British population. It was found unnecessary to introduce any special social structure among the diverse Anglo-Saxon people in order to account for the estimates of northwest European intrusion into the British population.

Is it necessary to assume an apartheid-like social structure in Early Anglo-Saxon England?

PubMed Central

Pattison, John E

2008-01-01

It has recently been argued that there was an apartheid-like social structure operating in Early Anglo-Saxon England. This was proposed in order to explain the relatively high degree of similarity between Germanic-speaking areas of northwest Europe and England. Opinions vary as to whether there was a substantial Germanic invasion or only a relatively small number arrived in Britain during this period. Contrary to the assumption of limited intermarriage made in the apartheid simulation, there is evidence that significant mixing of the British and Germanic peoples occurred, and that the early law codes, such as that of King Ine of Wessex, could have deliberately encouraged such mixing. More importantly, the simulation did not take into account any northwest European immigration that arrived both before and after the Early Anglo-Saxon period. In view of the uncertainty of the places of origin of the various Germanic peoples, and their numbers and dates of arrival, the present study adopts an alternative approach to estimate the percentage of indigenous Britons in the current British population. It was found unnecessary to introduce any special social structure among the diverse Anglo-Saxon people in order to account for the estimates of northwest European intrusion into the British population. PMID:18430641

Patient, hospital, and neighborhood factors associated with treatment of early-stage breast cancer among Asian American women in California

PubMed Central

Gomez, Scarlett Lin; Press, David J.; Lichtensztajn, Daphne; Keegan, Theresa H. M.; Shema, Sarah J.; Le, Gem M.; Kurian, Allison W.

2012-01-01

Background Clinical guidelines recommend breast conserving surgery (BCS) with radiation as a viable alternative to mastectomy for treatment of early-stage breast cancer. Yet, Asian Americans (AA) are more likely than other groups to have mastectomy or omit radiation after BCS. Methods We applied polytomous logistic regression and recursive partitioning (RP) to analyze factors associated with mastectomy, or BCS without radiation, among 20,987 California AAs diagnosed with stage 0–II breast cancer from 1990–2007. Results The percentage receiving mastectomy ranged from 40% among US-born Chinese to 58% among foreign-born Vietnamese. Factors associated with mastectomy included tumor characteristics such as larger tumor size, patient characteristics such as older age and foreign birthplace among some AA ethnicities, and additional factors including hospital (smaller hospital size, not NCI cancer center, low socioeconomic status (SES) patient composition, and high hospital AA patient composition) and neighborhood characteristics (ethnic enclaves of low SES). These hospital and neighborhood characteristics were also associated with BCS without radiation. Through RP, the highest mastectomy subgroups were defined by tumor characteristics such as size and anatomic location, in combination with diagnosis year and nativity. Conclusions Tumor characteristics and, secondarily, patient, hospital and neighborhood factors, are predictors of mastectomy and omission of radiation following BCS among AAs. Impact By focusing on interactions among patient, hospital, and neighborhood factors in the differential receipt of breast cancer treatment, our study identifies subgroups of interest for further study, and translation into public health and patient-focused initiatives to ensure that all women are fully informed about treatment options. PMID:22402290

Health problems of newly arrived migrants and refugees in Europe.

PubMed

Pavli, Androula; Maltezou, Helena

2017-07-01

The number of migrants and refugees in Europe in the past few years has increased dramatically due to war, violence or prosecutions in their homeland. Migration may affect physical, mental and social health. The objective of this article is to assess migrants and refugees' health problems, and to recommend appropriate interventions. A PubMed search of published articles on health problems of newly arrived migrants and refugees was conducted from 2003 through 2016, focusing on the current refugee crisis in Europe. In addition to communicable diseases, such as respiratory, gastrointestinal and dermatologic infections, non-communicable diseases, including chronic conditions, mental and social problems, account for a significant morbidity burden in newly arrived migrants and refugees. Vaccine-preventable diseases are also of outmost importance. The appropriate management of newly arrived refugees and migrants' health problems is affected by barriers to access to health care including legal, communication, cultural and bureaucratic difficulties. There is diversity and lack of integration regarding health care provision across Europe due to policy differences between health care systems and social services. There is a notable burden of communicable and non-communicable diseases among newly arrived migrants and refugees. Provision of health care at reception and temporary centres should be integrated and provided by a multidisciplinary team Appropriate health care of migrants and refugees could greatly enhance their health and social status which will benefit also the host countries at large. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

AIMBAT: A Python/Matplotlib Tool for Measuring Teleseismic Arrival Times

NASA Astrophysics Data System (ADS)

Lou, X.; van der Lee, S.; Lloyd, S.

2013-12-01

Python is an open-source, platform-independent, and object-oriented scripting language. It became more popular in the seismologist community since the appearance of ObsPy (Beyreuther et al. 2010, Megies et al. 2011), which provides a powerful framework for seismic data access and processing. This study introduces a new Python-based tool named AIMBAT (Automated and Interactive Measurement of Body-wave Arrival Times) for measuring teleseismic body-wave arrival times on large-scale seismic event data (Lou et al. 2013). Compared to ObsPy, AIMBAT is a lighter tool that is more focused on a particular aspect of seismic data processing. It originates from the widely used MCCC (Multi-Channel Cross-Correlation) method developed by VanDecar and Crosson (1990). On top of the original MCCC procedure, AIMBAT is automated in initial phase picking and is interactive in quality control. The core cross-correlation function is implemented in Fortran to boost up performance in addition to Python. The GUI (graphical user interface) of AIMBAT depends on Matplotlib's GUI-neutral widgets and event-handling API. A number of sorting and (de)selecting options are designed to facilitate the quality control of seismograms. By using AIMBAT, both relative and absolute teleseismic body-wave arrival times are measured. AIMBAT significantly improves efficiency and quality of the measurements. User interaction is needed only to pick the target phase arrival and to set a time window on the array stack. The package is easy to install and use, open-source, and is publicly available. Graphical user interface of AIMBAT.

Modelling tourists arrival using time varying parameter

NASA Astrophysics Data System (ADS)

Suciptawati, P.; Sukarsa, K. G.; Kencana, Eka N.

2017-06-01

The importance of tourism and its related sectors to support economic development and poverty reduction in many countries increase researchers’ attentions to study and model tourists’ arrival. This work is aimed to demonstrate time varying parameter (TVP) technique to model the arrival of Korean’s tourists to Bali. The number of Korean tourists whom visiting Bali for period January 2010 to December 2015 were used to model the number of Korean’s tourists to Bali (KOR) as dependent variable. The predictors are the exchange rate of Won to IDR (WON), the inflation rate in Korea (INFKR), and the inflation rate in Indonesia (INFID). Observing tourists visit to Bali tend to fluctuate by their nationality, then the model was built by applying TVP and its parameters were approximated using Kalman Filter algorithm. The results showed all of predictor variables (WON, INFKR, INFID) significantly affect KOR. For in-sample and out-of-sample forecast with ARIMA’s forecasted values for the predictors, TVP model gave mean absolute percentage error (MAPE) as much as 11.24 percent and 12.86 percent, respectively.

Epidemiological and clinical aspects of ear nose and throat sensorineural emergencies in the Yaoundé reference hospital.

PubMed

Djomou, François; Nkouo, Yves Christian Andjock; Mindja, Eko David; Nchinda, Choffor; Meka, Luc; Mbamyah-Lyonga, Emilia; Ndjolo, Alexis

2016-01-01

Sensorineural emergencies (SNE) are rare clinical situations. Few patients consult early explaining subsequent difficulty in having accurate data and management. Three clinical conditions are considered SNE in otolaryngology; they include sudden sensorineural hearing loss (SSHL), Bell's palsy and acute vertigo. There is very little data available on sensorineural emergencies in our setting. The aim of this study was to provide preliminary data on the management of Ear Nose and Throat (ENT) sensorineural emergency cases in Yaoundé Reference Hospital. A descriptive retrospective study was carried out based on data collected over a period of 5 years, January 2010 to July 2014 at the Yaoundé Reference Hospital. Information was obtained from patients' files collected from the archives of the institution. Patients presenting with SSHL, Bell's palsy, acute vertigo who consulted during the study period were included in the study. A total of 22 patients were included in the study out of 6406 patients who consulted at the ENT Unit. The prevalence of SNE in ENT consultations was 0.003, distributed as follows; 13 patients (59.1%) of SNE had Bell's palsy, seven (31.8%) had vestibular neuritis and two (9.1%) had SSHL. The prevalence of SNE was low with idiopathic Bell's palsy being the most frequent. There was a general delay in arrival of patients hence delay in diagnosis. This delay could equally be a factor for treatment failure and poor prognosis. More effort should be made in terms of population sensitization about the necessity of getting early medical attention.

Health Profiles of Newly Arrived Refugee Children in the United States, 2006-2012.

PubMed

Yun, Katherine; Matheson, Jasmine; Payton, Colleen; Scott, Kevin C; Stone, Barbara L; Song, Lihai; Stauffer, William M; Urban, Kailey; Young, Janine; Mamo, Blain

2016-01-01

We conducted a large-scale study of newly arrived refugee children in the United States with data from 2006 to 2012 domestic medical examinations in 4 sites: Colorado; Minnesota; Philadelphia, Pennsylvania; and Washington State. Blood lead level, anemia, hepatitis B virus (HBV) infection, tuberculosis infection or disease, and Strongyloides seropositivity data were available for 8148 refugee children (aged < 19 years) from Bhutan, Burma, Democratic Republic of Congo, Ethiopia, Iraq, and Somalia. We identified distinct health profiles for each country of origin, as well as for Burmese children who arrived in the United States from Thailand compared with Burmese children who arrived from Malaysia. Hepatitis B was more prevalent among male children than female children and among children aged 5 years and older. The odds of HBV, tuberculosis, and Strongyloides decreased over the study period. Medical screening remains an important part of health care for newly arrived refugee children in the United States, and disease risk varies by population.

[Historical exploration of Acapulco hospitals, Guerrero, Mexico].

PubMed

Fajardo-Ortiz, Guillermo; Salcedo-Alvarez, Rey Arturo

2006-01-01

This study attempts to recount the history of the main hospitals of the port of Acapulco from colonial times until the end of the 20th century. The Augustine friars began hospital care at the end of the first part of the 16th century. Later, Bernardino Alvarez (1514?-1584), with the support of the Spanish crown, founded the first formal hospital in Acapulco called Hospital de Nuestra Señora de la Consolación (Our Lady of Consolation Hospital). During the 16th and 17th centuries, the sick were attended by friars, and by the end of the 19th century there were physicians and surgeons. From the end of the Independence War until the end of the 19th century, the port did not have any true hospital. The first degreed physicians and surgeons arrived and resided in Acapulco in 1920. In 1938, the Hospital Civil Morelos (Morelos Civil Hospital) began providing services. It was replaced by the Hospital General de Acapulco (General Hospital of Acapulco). At the fourth decade of the past century the Cruz Roja (Red Cross) was created. In 1957 the hospital services of the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute of Social Security), which was founded in 1963, was inaugurated with the Unidad Medico/Social (Medical and Social Unit) of the IMSS in Acapulco. This began the journey of modernity in Acapulco. In 1992, Hospital Regional Vicente Guerrero (Regional Hospital Vicente Guerrero) of the IMSS, initiated its services. In 1960, medical services for civil workers and their families were housed in the Hospital Civil Morelos (Morelos Civil Hospital). Shortly afterwards, the Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE, Security and Social Services Institute for State Employees) had their own hospital. During the 20th century, Acapulco has added other hospital services to care for members of the navy and armed forces, as well as for those persons with financial resources for private care.

Judging arrival times of incoming traffic vehicles is not a prerequisite for safely crossing an intersection: Differential effects of vehicle size and type in passive judgment and active driving tasks.

PubMed

Mathieu, Julie; Bootsma, Reinoud J; Berthelon, Catherine; Montagne, Gilles

2017-02-01

Using a fixed-base driving simulator we compared the effects of the size and type of traffic vehicles (i.e., normal-sized or double-sized cars or motorcycles) approaching an intersection in two different tasks. In the perceptual judgment task, passively moving participants estimated when a traffic vehicle would reach the intersection for actual arrival times (ATs) of 1, 2, or 3s. In line with earlier findings, ATs were generally underestimated, the more so the longer the actual AT. Results revealed that vehicle size affected judgments in particular for the larger actual ATs (2 and 3s), with double-sized vehicles then being judged as arriving earlier than normal-sized vehicles. Vehicle type, on the other hand, affected judgments at the smaller actual ATs (1 and 2s), with cars then being judged as arriving earlier than motorcycles. In the behavioral task participants actively drove the simulator to cross the intersection by passing through a gap in a train of traffic. Analyses of the speed variations observed during the active intersection-crossing task revealed that the size and type of vehicles in the traffic train did not affect driving behavior in the same way as in the AT judgment task. First, effects were considerably smaller, affecting driving behavior only marginally. Second, effects were opposite to expectations based on AT judgments: driver approach speeds were smaller (rather than larger) when confronted with double-sized vehicles as compared to their normal-sized counterparts and when confronted with cars as compared to motorcycles. Finally, the temporality of the effects was different on the two tasks: vehicle size affected driver approach speed in the final stages of approach rather than early on, while vehicle type affected driver approach speed early on rather than later. Overall, we conclude that the active control of approach to the intersection is not based on successive judgments of traffic vehicle arrival times. These results thereby question the

Scottish Women's Hospitals--the 90th anniversary of their work in Serbia.

PubMed

Mikić, Zelimir

2005-01-01

The Scottish Women's Hospitals (SWH), a unique health institution in the history of medicine, staffed entirely by women, was founded soon after the outbreak of the First World War, August 12, 1914 in Edinburgh, by the National Union of Women's Suffrage Societies. The founder and the main driving force behind this organisation was Dr. Elsie Inglis (1864-1917). Although her proposition to the British War Office had been rejected, she offered her services to the Allies (France, Belgium, Russia and Serbia). The first 200 bed SWH unit was sent to France in November 1914, and soon after followed other units, so at the end there were 13 very well equipped SWH units working in the various theatres of war in Belgium, Serbia, Russia, Rumania and Greece. The first unit of SWH came to Serbia in early January 1915, and was located at Kragujevac. Soon after, three other SWH units arrived to Serbia and were stationed at Mladenovac, Valjevo and Lazarevac. It was an enormous help to Serbia, full of wounded and sick people, due to the dreadful typhus epidemic which was devastating the country. A large SWH unit, attached to the Southern Slav Volunteer Division, had worked on the Dobrudja front, and there were three hospitals and a special transport unit on the Salonika Front, which were all engaged in the treatment of Serbian wounded soldiers until the end of the First World War. Two other SWH units, located in France, were treating the Serbian refugees. Serving bravely and honorably on the various theatres of war, the legendary Scottish Women's Hospitals made enormous contributions to the allied war efforts, and helped Serbian people a great deal.

Review of early assessment models of innovative medical technologies.

PubMed

Fasterholdt, Iben; Krahn, Murray; Kidholm, Kristian; Yderstræde, Knud Bonnet; Pedersen, Kjeld Møller

2017-08-01

Hospitals increasingly make decisions regarding the early development of and investment in technologies, but a formal evaluation model for assisting hospitals early on in assessing the potential of innovative medical technologies is lacking. This article provides an overview of models for early assessment in different health organisations and discusses which models hold most promise for hospital decision makers. A scoping review of published studies between 1996 and 2015 was performed using nine databases. The following information was collected: decision context, decision problem, and a description of the early assessment model. 2362 articles were identified and 12 studies fulfilled the inclusion criteria. An additional 12 studies were identified and included in the review by searching reference lists. The majority of the 24 early assessment studies were variants of traditional cost-effectiveness analysis. Around one fourth of the studies presented an evaluation model with a broader focus than cost-effectiveness. Uncertainty was mostly handled by simple sensitivity or scenario analysis. This review shows that evaluation models using known methods assessing cost-effectiveness are most prevalent in early assessment, but seems ill-suited for early assessment in hospitals. Four models provided some usable elements for the development of a hospital-based model. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Early Ambulation Decreases Length of Hospital Stay, Perioperative Complications and Improves Functional Outcomes in Elderly Patients Undergoing Surgery for Correction of Adult Degenerative Scoliosis.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Fialkoff, Jared; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos

2017-09-15

Ambispective cohort review. To examine the effects of early mobilization on patient outcomes, complications profile, and 30-day readmission rates. Prolonged immobilization after surgery can result in functional decline and an increased risk of hospital-associated complications. We conducted an ambispective study of 125 elderly patients (>65 years) undergoing elective spinal surgery for correction of adult degenerative scoliosis. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. "Days of immobility" was defined as the number of days until a patient moved out of bed beyond a chair. Patients in the top and bottom quartiles were dichotomized into "early ambulators" and "late ambulators", respectively. Early ambulators were ambulatory within 24 hours of surgery, whereas late ambulators were ambulatory at a minimum of 48 hours after surgery. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between early ambulators and late ambulators. Baseline characteristics were similar between both cohorts. Compared with patients with a longer duration of immobility (i.e., late ambulators), the prevalence of at least one perioperative complication was significantly lower in the early ambulators cohort (30% vs. 54%, P = 0.06). The length of inhospital stay was 34% shorter in the early ambulators cohort (5.33 days vs. 8.11 days, P = 0.01). Functional independence was superior in the early ambulators cohort, with the majority of patients discharged directly home after surgery compared with late ambulators (71.2% vs. 22.0%, P = 0.01). Early ambulation after surgery significantly reduces the incidence of perioperative complications, shortens duration of inhospital stay, and contributes to improved perioperative functional status in elderly patients. Even a delay of 24 hours to ambulation is

Delta II JPSS-1 Spacecraft Arrival

NASA Image and Video Library

2017-09-01

A technician at Vandenberg Air Force Base in California inspects the shipping container for the Joint Polar Satellite System-1, or JPSS-1, as it arrives at the Astrotech Processing Facility. JPSS is the first in a series four next-generation environmental satellites in a collaborative program between the National Oceanic and Atmospheric Administration (NOAA) and NASA. The satellite is scheduled to liftoff Nov. 10, 2017 atop a United Launch Alliance Delta II rocket.

Delta II JPSS-1 Spacecraft Arrival

NASA Image and Video Library

2017-09-01

Technicians at Vandenberg Air Force Base in California inspect the shipping container for the Joint Polar Satellite System-1, or JPSS-1, as it arrives at the Astrotech Processing Facility. JPSS is the first in a series four next-generation environmental satellites in a collaborative program between the National Oceanic and Atmospheric Administration (NOAA) and NASA. The satellite is scheduled to liftoff Nov. 10, 2017 atop a United Launch Alliance Delta II rocket.

STS-86 Mission Specialist Wolf arrives at SLF before launch